Thread by @hmkyale

Was watching #Dopesick, and I started reflecting on when I first learned IMS (now IQVIA) tracked every prescription by every doc &sold it to pharma so the doctors could be targeted for drug sales… and how inappropriate that seemed to me. And yet I didn’t do anything.

I was on a plane and a drug representative was sitting beside me going through the prescriptions written by doctors he covered - and there was so much detail. Data-drive marketing…& we docs had no idea the companies were tracking us in this way… & IMS was making billions on it.

It felt like an invasion of privacy… & I was puzzled that it could be legal…we were saying at the time that pharma should not be giving gifts…but we didn’t talk about tracking of individual MD's prescribing patterns by the sales teams - and how they acted on that information.

Watching the show about what Purdue did brought me back to that… how an industry spied on doctors to determine how they used products and sold the information to industry so that sophisticated targeting could be implemented. And I guess pharmacies were complicit by selling data.

And I think, what is going on today that I am not doing enough to expose and address. And the tracking of doctors… yes, even more than before.

And my daughter just reminded me about Sorrell v IMS Health: n 2007, the Vermont legislature passed a law that banned the sale, transmission or use of prescriber-identifiable data (''PI data'') for marketing or promoting a prescription drug without the consent of the prescriber.

But...'Three companies -- IMS Health, Verispan and Source Healthcare Analytics, a unit of Dutch publisher Wolters Kluwer -- that collect and sell such data and by a trade group for pharmaceutical manufacturers challenged the law.’ oyez.org/cases/2010/10-…

And...'The U.S. Court of Appeals for the 2nd Circuit struck down the measure, holding that it violated the First Amendment because it restricts the speech rights of data miners without directly advancing legitimate state interests.’ So companies could spy on doctors...

And @Scotus 'affirmed the lower court order in an opinion by Justice Anthony Kennedy.' "Vermont's statute, which imposes content-and speaker-based burdens on protected expression, is subject to heightened judicial scrutiny," Kennedy wrote. A 6-3 decision.

@Scotus Meanwhile, Justice Stephen Breyer dissented, joined by Justices Ruth Bader Ginsburg and Elena Kagan. "The First Amendment does not require courts to apply a special 'heightened' standard of review when reviewing such an effort," Breyer wrote. [Sigh] HT @becca_krum

@Scotus @becca_krum This from @JournalGIM … 'This is the story of a 2003 workshop designed to increase medical residents’ willingness to prescribe opioids for chronic pain.’ link.springer.com/article/10.100…

@Scotus @becca_krum @JournalGIM 'Resident attitudes toward prescribing opioids for chronic pain were changed by the workshop. They indicated increased willingness to prescribe opioids and less concern about addiction or side effects.’ -Diana Burgess,

@Scotus @becca_krum @JournalGIM 'I now see that concepts I included in my workshop, such as “pseudo-addiction,” were part of a marketing scheme to sell OxyContin ...now-defunct American Pain Society, whose guidelines formed basis for my workshop, received most of its support from Purdue Pharma…’ - Craig Roth

@Scotus @becca_krum @JournalGIM 'I regret not being able to discern appropriate information for providing best patient care & teaching..also felt remorse, guilt, embarrassment, & shame. Writing this piece provided 1st opportunity to give voice to these feelings & contemplate ways of dealing w/them.’ -Craig Roth

@Scotus @becca_krum @JournalGIM And this… by @RendonJim… How Nonprofits Helped Fuel the Opioid Crisis… need more disclosure among non-profits about where the money is coming from… why so much education they provide is sponsored by for profits… philanthropy.com/article/how-no… HT @thackerpd

@Scotus @becca_krum @JournalGIM @RendonJim @thackerpd 'A Chronicle investigation has found that patient-advocacy groups, physicians’ organizations, and other nonprofits became an integral part of the pharmaceutical industry’s efforts to sway doctors, patients, and policy makers to create broad new markets for opioids.’ @Philanthropy

@Scotus @becca_krum @JournalGIM @RendonJim @thackerpd @Philanthropy “What they were really doing was sponsoring this campaign to change culture of prescribing, to make doctors feel more comfortable w/ opioids as class of drug,” Kolodny says. Pouring money into nonprofits was one of key ways companies sought to boost opioid prescriptions & sales.

@Scotus @becca_krum @JournalGIM @RendonJim @thackerpd @Philanthropy 'Over the course of 2 decades, opioid manufacturers awarded >$60m to nonprofits, according to 2020 Senate Finance Committee, gaining influence with and access to patient advocates and physicians’ groups that could be credible messengers for the manufacturers’ business strategy'

@Scotus @becca_krum @JournalGIM @RendonJim @thackerpd @Philanthropy ‘...opioid manufacturers ...saw nonprofits as instrumental to achieving the business goal of boosting prescriptions and sales of opioids. Internal documents disclosed in lawsuits describe nonprofits as “partners” and refer to them in company business-strategy plans.'

@Scotus @becca_krum @JournalGIM @RendonJim @thackerpd @Philanthropy ' in 2018, McCaskill introduced legislation to expand a 2010 sunshine law to require pharmaceutical companies to disclose funding to patient-advocacy and education groups, physicians’ organizations, and others...legislation went nowhere.’ [Still seems like a good idea]

@Scotus @becca_krum @JournalGIM @RendonJim @thackerpd @Philanthropy Why wouldn’t credible non-profits, starting today, publicly report all their donations/revenue from industry… and make clear how the money is used… and what percent of its budget it constitutes. Wouldn’t that show be a start for transparency and trust?