Saturday, October 13, 2007

Has Pharma Marketing Finally Gone Over the Top? Invading the Medical Record

First, let me explain the drill. Your doc has just seen you in the office and needs now to write note for your chart. She phones a special number that connects to a commercial transcription service. She dictates into the phone. At the other end, voice recognition software is used to generate a neatly typed note--electronic if you're with the modern wave and the doc uses an electronic record; on paper if this is a Model T doc still using the old system. The doc gets to see the final note to proofread and correct. Then it's signed and becomes a part of your permanent record.

You notice that there is nothing in what I have just described about any advertising for prescription drugs. A lost opportunity for pharma maketing, huh? But that may be about to change, if a firm in Stanford, CA has anything to say about it.

This outfit that calls itself datumRx claims to have access to a whole bunch of these transcription firms. They are trolling the drug companies to pay them to insert drug ads into these chart notes. Supposing you have asthma and your doc says the word "asthma" in your note. That keyword might then trigger the system to stick the logo for the drug company's newest and most expensive asthma drug in full color at the bottom of the chart note.

As datumRx gushes to the drug companies (see their complete sales pitch at, “Your logo…becomes a permanent part of the patient’s medical record. [Your] ad is viewed by every doctor that visits with the patient thereafter.”

But that's not all. datumRx also offers an audio drug-ad service so that when the physician calls the transcription number to dictate, she first hears a brief drug company ad before she can start.

Now, why would docs put up with this? You guessed it--follow the money. datumRx recommends that the transcription service offer each doc's office a discounted rate if they permit the ads. (Individual doctors can choose to opt out of the "service," leaving it all on the up and up, they claim--and yes, every part of this sleaze package is perfectly legal.)

The sales-pitch info from datumRx contains four "endorsements" from physicians. Admittedly none of them is a ringing endorsement; they mostly say that would tolerate this. Nevertheless my personal vote would be to confirm that those physicians actually said this and knew what they were saying, and if so, they should be shot.

Now before I get on my high horse (as if I am not already), some truth in advertising. The datumRx information came to me from a website on innovative pharmaceutical marketing that some colleagues at the National Physicians Alliance kindly shared ( I have no information that as yet, any of these ads have appeared anywhere, or that any drug firm has signed up with datumRx.

Despite that qualification, I think datumRx might very well serve as the poster child for the over-the-top commercialization of medicine. Stop and think for a minute about the medical record. This is the document that malpractice defense lawyers tell us, at every opportunity, should never, ever be altered once a note is entered, because any attempt to alter the record is a sure loss of any potential future malpractice suit. The ethicists, who do not care about lawsuits, say the same thing about the sanctity of the record--it is elevated to the same status of importance as the scientist's lab notebook. Think of the countless hours we spend teaching medical students and residents what to write, or not write, in their chart notes, to assure the highest quality patient care.

And now these bozos want to buy and sell space in the medical record just like you trade pork belly futures. I assume that the docs that would save a few bucks on their transcription costs in this way would also sell space on their white coats for drug display ads, so that they go around looking like Nascar drivers. (And yes, I am fully aware that angry Nascar fans will write in to complain about this derogatory comparison.) I assume those docs would also, for the right fee, put up TV monitors in their exam roooms, playing endless loops of "ask your doctor" DTC ads while the captive patients wait their requisite one hour for the doctor to enter the room.

This will all end when we physicians regrow a critical portion of our anatomy that has been sadly missing for far too long and say "no."

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