Thursday, January 17, 2008

Hey, Big Pharma!! My Doctor's Visit is Private, Stay Out!!

Yesterday, Dr.Rich pointed to an article in the Philadelphia Inquirer which induced copious amounts of moaning and ranting within my living room.

Here's a brief excerpt [emphasis mine]:

When Zaccary Newsham-Quinn, 4, visits his pediatrician in Levittown, the doctor, Nathan Zankman, asks if he would be willing to have their conversation recorded for use in medical research.

Zaccary's mother, Danielle, agrees, and signs a consent form, and the doctor turns on a small digital recorder that captures every word between the physician and patient behind the examining-room door.

Later, Zankman sends the recording via computer, along with others he made that day, to a Fort Washington start-up technology company, Verilogue Inc.

Verilogue has software that analyzes the real-time patient-physician interactions, compiles a verbatim transcript, and puts the recording and transcript in a database that Verilogue clients in the health-care industry will use to learn what doctors and patients actually say to each other about diseases and medicines.

So what kind of medical research is being done here?

Capturing real physician-patient interactions is new to pharmaceutical market research. The idea came from Verilogue's two young founders, Jeff Kozloff and Jamison Barnett, both 31, who had worked in pharmaceutical market research, and who saw a need to go beyond traditional recall methods, such as focus groups and interviews based on memory after the fact.

"The idea is, by increasing access to information where it's truly happening, at the point of practice, you are increasing knowledge, and will be able to come up with better support and communication materials for physicians and patients because they shared their experience," said Kozloff, Verilogue's president and chief executive officer.

The research will lead to improved marketing materials...aaah. So far Verilogue has nine large (unidentified) pharmaceutical clients and "a network of participating physicians nationwide."
Doctors record their interactions with patients during two days each month, and are paid what Verilogue said is a nominal fee for their time.
The Inquirer reports that Dr. Zankman has been recording patient visits a couple days a month in the three months since he signed up with Verilogue. Zankman says that he has concentrated on four medical conditions chosen by Verilogue which are fairly common in pediatrics: allergic rhinitis, asthma, persisitent asthma in a child less than 4 years, and ADHD.

When Zankman asked Danielle Newsham, 29, if she would be willing for Zaccary's office appointment to be audio-recorded and used for research by companies, she quickly said yes.

"We're here quite frequently. I look at it as helping medical research," said Newsham. [...]

"I'm a firm believer in science and technology. If companies could learn something from conversations about my son's condition, maybe it could help someone else."

But it doesn't sound like Verilogue's service is aimed to boost science and technology. It is aimed at the marketing efforts of pharmaceutical and biotech companies who desire to "get a glimpse of the patient's state of mind, progression of disease, and what is said about the company's medications - or a competitor's drug."

Regarding the nominal fee paid to participating physicians, the company said "the fee is similar to stipends paid to medical investigators in other clinical research."

"We are not the next Google, but we are revolutionizing our own segment in the industry," Kozloff said. "The physician-patient conversation behind closed doors is the epicenter. The long-term value of what we are doing has tremendous upside potential for everyone in the health-care continuum."

I agree that the physician-patient relationship is the epicenter of healthcare, or at least it should be. But it is a confidential, privileged relationship and should not be infringed upon by those seeking to tweak a marketing message. I find it disappointing that physicians would agree to this "research" in exchange for a stipend. And what about the extra time it takes to obtain the agreement from the patient or even explaining what the "research" is about. Time is money and time is limited in a doctor's visit.

Beyond the issues of coersion, the waste of precious doctor-patient face time, and the misinformation regarding the true nature of the research, Dr.Rich made a wonderful point regarding compensation for the study.

This is a purely commercial endeavor; it has nothing whatever to do with scientific or medical advancement, and everything to do with marketing advancement (specifically, to tailor marketing messages in order to optimize drug sales). So at the end of the day the patient and her little son were unwittingly drafted into a particularly sophisticated focus group.

Traditionally, participants in market research focus groups are paid for their efforts. Since in this case the patient is at least as much a participant in the generation of marketable data as is the doctor, the patient undeniably deserves his/her fair share of the proceeds. The cut should be at least a 50%, or preferably more since it is the patient whose personal medical information is being risked in a private, for-sale-to-whomever, corporate-controlled database. There’s no indication that the patients are being informed that this is a money-generating endeavor, let alone being offered their fair share in compensation for their participation and their personal risk.

I've participated in a focus group here in DC and was compensated generously for my time. But my experience was much different than if I had arrived at my doctor's office and was asked on the spot to allow my visit to be recorded for "research."

If I choose to respond to an invitation aimed at market research, then that is my perogative. If my doctor is paid to ask me to participate in market research, then a conflict of interest has arisen. This goes byond the drug rep trinkets and gifts which are increasingly becoming unwelcome in the physician's office and in various healthcare settings.

My message to Big Pharma and their marketing teams...stay out of my doctor's office!!! You are not welcome there, at least while I'm talking.


  1. Finally, I was able to see your blog after seeing you post around the community.

    Your blog looks interesting and looks I will learn alot here.

    Have a wonderful weekend.


  2. oh my. yes that is scary and wrong. it is the wrong direction. is nothing sacred or private nowadays? good post.

  3. Last year BC/BS began their "invitation" to their new service: Accordant Care. I declined. They kept calling. They were guising it as doing me, the patient a favor, dealing with a chronic illness, they had nurses on call 24-7 and could streamline my care and help me with my specialists and meds. Really? Just another way to get their noses into controlling their costs and my care.

  4. just stopping by to say howdy invitation to stop over at my place...i am having a love-in.

  5. This is an example of patient pandering at its highest, all to covertly benefit everyone BUT the patient.

    Sick, just sick.

  6. I see your point on this but there is another angle to consider. Asthma, specifically, is a poorly treated disease. Patients use the medication until they get "better", then quit. Most patients and caregivers don't realize, or forget, that taking the meds consisistently result in better control, fewer recurrences and (most importantly) fewer trips to the emergency room (which is MOST costly). Big Pharma is trying to find a way to get that message through to patients and caregivers, so that in the end, health care costs are reduced for all. Big Pharma isn't always the enemy here. Have you ever considered where you'd be without your medications???

  7. Plumloco78: As an AstraZeneca person, I'm certain that asthma control is a primary concern. AZ has several products aimed at that very goal, including Accolate, Bambec, Bricanyl, Oxis, Pulmicort, Rhinocort, and Symbicort.

    I agree that the message of treating beyond the "getting better" point is a fine goal to prevent more severe attacks. However, recording private doctor-patient conversations is not necessary in forming that message, as you've already stated all that's needed to say.

    I'd like to ask in return, does AZ have a substantial strategy in ensuring that patients have the medication they need to remain compliant. Or is that not worthy of the marketing research department?

    Regarding your final comments - "Big Pharma isn't always the enemy here. Have you ever considered where you'd be without your medications???" I am very specific in the complaints I choose to address in discussing Big Pharma, as I also give positive credit when it's due. But I doubt that you truly wanted a answer and your question was an attempt at launching a 'red herring.'

    But I do appreciate your willingness to leave a comment after your visit. Come back often.

  8. I was invited a week or so ago to the new grand opening of a physican's office. The office was very high-tec, and had made full implementation of the latest technology. Their eventual idea was to provide a medical record which would be made available to their clients via the web. I asked if they had ever thought of also recording the visit via audio and making this part of the chart also. Natrually I thought of this while reading this post. Imagine, therefore that this was available, but without any ties to the big pharma--just part of your record. Would this be a good or bad thing in your view?

  9. Dan, I do think that fully integrated and compatible electronic medical records are inevitable with the advances in health IT. However security is still an issue which needs to be worked out before patient records can be universally accessible to those who truly need access.

    Personally, I do not believe that audio recordings are a necessary part of a patient's permanent record. If the patient desires an audio recording, he is welcome to ask if the doctor objects to his making a tape for his personal review. This could be helpful if the patient has some cognitive issues or is about to receive some very heavy news of a definitive diagnosis (such as MS.) This is one reason why many folks bring a second set of ears to hear what they might miss during the doctor's appointment. If the patient desired, he could even create his own MP3-like records at home. But I don't think that I would trust these recordings to be available online.

    And I especially object to the use of private visits for market research and that opinion will not change, no matter if it is big pharma, medical devices, or insurance consultants. Just my opinion.

  10. Hi, I also work for a big pharma company and thought I would add to the conversation. This opinion is purely my own personal take.

    Having your interaction with a medical professional be private is a right that everyone should have. But that does not mean the individuals can't to waive that right, in specific circumstances, if they choose.

    I think the larger issue here is if this was portrayed to patients as "advancing science" as opposed to "advancing understanding of patient care and support".

    There are real issues in how patients get the information and support they need. Most Doctors I talk to have a lot to say about patients not being complinat with their MEDs and treatment programs.

    This is an issue where patients, proffesionals, and Pharma companies all have the same interest. Helping patients understand their condition, there medication, and, as a result, staying on their treatment plans...

    Not sure this is the approach I would support to adress the issue...but the issue is very important and is about more than jsut coming up with slicker marketing materials.

    Thanks for allowing me to participate.

  11. Thank you lytrob for contributing to the discussion.

    You said, "I think the larger issue here is if this was portrayed to patients as "advancing science" as opposed to "advancing understanding of patient care and support"."

    I agree with your statement. The purpose of the medical research as described in the Philadelphia Inquirer appears to be focused solely at pharmaceutical marketing.

    From Verilogue's website [emphasis mine]: "Verilogue brings patients, physicians and the healthcare industry together to share information, enhance disease understanding and participate in medical marketing research. In order to develop more effective medicines and communication materials for patients..."

    From the article, "Verilogue's technology allows pharmaceutical and biotech firms to hear first-hand from customers, get a glimpse of the patient's state of mind, progression of disease, and what is said about the company's medications - or a competitor's drug."

    From Verilogue's website: "This important medical marketing research adheres to strict information privacy and security standards..."

    From article: "It's marketing 101," said Kozloff, a graduate of the Wharton School. "Listen to your customers, in their natural environment, without any outside influences."

    In Marketing, the goal is to form a compelling marketing message which will entice the consumer to act upon the message and 'buy into' an idea, whether that's to purchase something or to act on a specific behavior.

    Compliance is an important issue, one which I have discussed with my MS nurse. She has stated that I am one of the most compliant patients, but I have had huge hurdles to negotiate in order to receive necessary medication. She does think it ironic that some patients for whom insurance covers their needs will choose to be noncompliant or to allow $5 co-pays to stand in their way of taking their medications.

    These issues are greater than one consulting firm (who may be obtaining information under false pretenses), or the big pharmaceutical companies (who want us to believe that money is not a motive in obtaining our trust), or the insurance industry (who tries to find ways to make each patient's care less costly to cover), or even the investors and CEOs who are rewarded for increased marketshare and profit margins.

    There is so much static and discourse in the world of media marketing, consumer education, and healthcare politics that the solution to addressing patient compliance is a complicated one indeed.

    You said, "This is an issue where patients, proffesionals, and Pharma companies all have the same interest. Helping patients understand their condition, there medication, and, as a result, staying on their treatment plans..."

    I can think of many other ways to harvest the information necessary to begin to address this problem without asking doctors and patients to give-up their privacy priviledges under false pretenses.

    How would you suggest a solution should be approached in this very real problem you bring up?