In patients' hunt for care, doctor database 'a place to start'

Unless you've had heart trouble in Schenectady, N.Y., you've probably never heard of cardiologist Steven Weitz. But he has made a difference in this leafy town of 60,000 on the Mohawk River.

Weitz has helped usher in major changes in how local paramedics, emergency room staff and heart specialists treat heart attacks so doctors can clear patients' clogged arteries as quickly as possible.

His colleagues say that when Weitz talks, people listen. It's their high regard for him, their tendency to follow his lead, that distinguishes Weitz as one of the nation's Most Influential Doctors, a database USA TODAY is launching online today.

Created for USA TODAY by the Santa Fe medical information firm Qforma, the database lists about 6,000 specialists in the treatment of high cholesterol, high blood pressure, diabetes and asthma from more than 300 communities across the USA. More doctors in other specialties will be added in coming months.

Unlike standard best-doctor lists compiled by opinion-based surveys, the Qforma analysis represents a national effort to track subtle differences in doctors' practice patterns that reveal, on a local level, which doctors most influence their peers. The project's goal is to offer consumers an innovative resource during the complex decision of how to choose a doctor.

"I do feel strongly that this is a good tool to give people a place to start," says Qforma's CEO Kelly Myers.

The company's approach exploits a wealth of commercially available information. Unbeknownst to most patients and many physicians, countless details of a doctor's professional activities — from procedures to referrals to prescribing records — are readily available, at a price, to marketers, medical information firms and drug companies.

Qforma carries out its medical analyses primarily for drug firms, which prize such information. Among other things, drug company executives pick influential doctors to sit on advisory boards, identify gaps in treatment that might be filled by new drugs and sway their colleagues to use a company's products, rather than generics or those sold by rivals, says Marcia Harms of the Prescription Project, a Boston-based advocacy group pushing to limit pharma's influence over doctors.

An analysis by Tulikaa Bhatia of Rutgers Business School and her colleagues found that marketing drugs to "opinion leaders" boosts prescription revenue.

"Even though a guy only writes $25 worth of prescriptions himself, he may influence other people who write $100 worth," Bhatia says.

That's a situation that has raised some concerns.

New HampshireRep. Cindy Rosenwald, chairwoman of the state's health committee, worried so much about the commercial use of prescribing data that in 2006 she persuaded her fellow legislators to restrict the practice, prompting the medical information firm IMS health to file a writ of appeal before the U.S. Supreme Court. Because of the ban, no New Hampshire doctors appear in the Qforma database.

Rosenwald, argues that drug reps armed with doctors' prescribing histories can sway them to prescribe drugs that may not be in patients' best interest. There's also evidence, she says, that such marketing tactics drive up costs by pushing brand-name drugs over generics.

For patients, however, the database represents a new resource for assessing doctors.

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