Another Sign of the End-Times for the Doctor-Patient Relationship

January 16th, 2008 by DrRich

A feel-good story in the Philadelphia Inquirer does not make DrRich feel good.

The story extols a local (to Philadelphia) start-up company called Verilogue. Verilogue places digital audio recorders in the offices of physicians, and “captures every word” of the doctor-patient encounter. Verilogue then processes these conversations, appropriately scrubbing them of identifiers, and places them into a searchable digitized database. Verilogue’s clients - consisting, so far, of nine large but publicly unidentified drug companies - then pay to get access to that data for the express purpose of doing market research. According to the Inquirer, “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.” So, thanks to Verilogue, drug companies for the first time will be able to design marketing materials according to what actually takes place between doctors and patients behind those closed doors.

Drug companies will certainly find this kind of information useful, and (what with docs today having to cram all that P4P and other mandatory whatnot into their 7.5 minutes per patient encounter) eye-opening. The pharmaceutical marketing experts undoubtedly will learn that what they’ve got to do in order to encourage doctors to sell their drugs in this environment is to distill their marketing messages down to less than 10 seconds of utterly compelling prose. All that excessive verbiage they’re able to include in their luxuriously sedate and drawn-out TV commercials (warning about priapism with Cialis, for instance), will need to be cut out. Perhaps details like this can be packaged into an attractive pamphlet, which docs can toss at their patients as they process them through the efficient office experience (shoving them back out into the hall, bundle of clothing in hand).

Specific doctors are targeted for the Verilogue opportunity according to the needs of the company’s pharmaceutical clients. That is, which drugs are their clients interested in moving, and which doctors are most likely to see patients eligible for those drugs? Doctors who agree to record their patient encounters are, according to the company, paid an amount “similar to stipends paid to medical investigators in other clinical research.”

To witness the process in action, the Inquirer reporter helpfully visited the office of one Nathan Zankman, pediatrician. When a 4-year-old boy with asthma (one of the targeted diseases) came in, Dr. Zankman asked the boy’s mother for permission “to have their conversation recorded for use in medical research.” She agreed, later telling the reporter, “I look at it as helping medical research. . . .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.”

So what’s not to like here? Allow DrRich:

1) Coersion. When their doctors ask to record the office visit, patients - already reduced to mere supplicants, seeking to have their medical needs fulfilled by doctors whose life work depends on keeping third party payers satisfied - are immediately placed into an untenable position. It would be very difficult for patients to refuse this request. In the Inquirer article for instance, Dr. Zankman allows that he has never had a patient turn down a request to record an office visit.

2) Wasting precious time. To whatever extent the doctor takes the necessary care to fully inform the patient as to the real purpose for the recordings, the time taken to do so is likely subtracted from the strictly limited office visit. Of course, the wasting of time can be minimized by not informing patients of what’s actually going on (see item 3).

3) Misinformation. DrRich suspects the Inquirer reporter was witnessing a pretty typical example of the Verilogue process. (Generally what happens when a reporter wants to showcase a new medical technology is that he/she contacts the company, which suggests a “model” physician for the interview.) At least in this case, it appears the patient’s mother was sadly misinformed as to what was actually going on. She was apparently led to believe the recording would be used explicitly for medical research, that is, would presumably advance the state of the medical art, and would potentially help future patients. But that wasn’t the case at all. The recording was being made only for market research. 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.

4) Mal-compensation. 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.

There’s nothing about the Verilogue business model that’s inherently bad or unethical. There’s nothing here that couldn’t be fixed with sufficient disclosure, full transparency and appropriate compensation. In DrRich’s view, the two founders of this company - who come from a pharmaceutical market research background, and whose sense of propriety thus may have been professionally altered - should have established fairer processes. The reporter for the Inquirer should have discerned the problems with what she witnessed and subsequently wrote about. But at the very least, the doctors working with Verilogue ought to be taking pains to protect the rights and welfare of their own patients.

That they apparently do not may simply reflect thoughtlessness and greed. On the other hand, it may reflect the extent to which the doctor-patient relationship has been systematically destroyed. Once you have succeeded in destroying that relationship, all sorts of new business opportunities will open themselves up. Apparently these will be blithely accepted (if not celebrated) by all parties involved, and will even be subjects of ain’t-it-wonderful feature stories.

Posted in General Rationing Issues, Primary Care in America | 5 Comments »