A bitter bill to swallow

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It's game seven of the National League Championship Series and the New York Mets, down two runs in the bottom of the 9th, have runners on first and second with no outs. "Willie, we have to bunt!" I scream. But the manager Mr. Randolph disagrees, sending injured power-hitter Cliff Floyd to the plate on a doomed bat-swinging assignment.

Baseball is a complex game. But while managing a team requires immense knowledge, talent and experience, being an armchair fan is easy: celebrate, brag, curse, moan, pray, hide. But while I have a strong affinity for the Mets, I'd never pretend I could do anything other than a terrible job for them.

But not everyone shies away from causing havoc when they seem out of their depth.

Healthcare is a complex industry. The trouble is, everybody has a personal stake, not least lawmakers. But many legislators lack the industry experience to foresee the unintended consequences of their actions.

Take New Hampshire's recent legislation outlawing the sale of prescription data for commercial use. "NH folks don't like people invading their privacy," declared sponsor Rep. Cindy Rosenwald, who insists the law will also help control spiraling Medicaid costs. A key provision permits the non-commercial use of data, and it sounds so good, no wonder the Senate passed the bill with little opposition, and even less debate.

Just one problem: the Rx database is so expensive to create that if commercial uses are eliminated, costs become prohibitive. The result? Researchers and law-enforcement investigators are deprived of essential data and, thus, the law's non-commercial provision becomes academic. "It takes away the incentive for collecting these data," summized IMS Health and Verispan, having jointly filed suit to have the law overturned.

How did these know-on effects get overlooked? Industry reputation might be a factor. "Anything [pharma companies] want is viewed skeptically, and anything they don't want is viewed favorably," notes Charles Arlinghaus, president of the Josiah Bartlett Center for Public Policy in Concord. "Those who see it as negative can't point to any horrific resulting danger like taxes going up..." He also feels the issues were not aired. "The bill sort of went through without people paying attention." It certainly appears that way.

Part of the problem, says Arlinghaus, is that NH doctors either approve of the law or don't care. Some are undoubtedly annoyed by dealing with reps, while the "average doctor has 40 other things to worry about."

Dr. Tom Stossel, professor of medicine at Harvard Medical School, blames a "rampant anti-business movement in medicine," fostering "sanctimonious, holier-than-thou emanations" from those who are intelligent, but who lack experience working with industry.

The ramifications--aside from depriving researchers and government agencies of essential data--could mean that communications to healthcare providers become less relevant or, worse still, cease to exist at all.

The fear is for this data-decimating disease to become a legislative epidemic. Other states, including New York and California, have already considered similar bills, while in Congress, Rep. Pete Stark and Rep. Frank Pallone have drafted legislation to prevent reps from "hawking snake oil to doctors."

And so, while IMS Health and Verispan may have the most to lose, the entire healthcare industry has a stake in the outcome. Doctors and patients need to be educated on the value of collecting prescription data--and on the consequences of not collected it--while lawmakers have a responsibility to at least discuss the issues and listen to those who truly know how this business works.

Now, if Willie had only consulted me before he sent Cliff hobbling to the plate...
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