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.