IMS Canada makes much hay of their aggregation of physician prescribing data that is sold to pharmaceutical companies. However, as outlined in our article, aggregation with physician identification does not preclude the generation of individual physician prescribing profiles. Each physicians’ unique identification number is part of such reports and can be readily linked to contact information and other reports on their prescribing using IMS Canada's FINDr database which is likewise sold to drug companies. The value of prescription data sold by IMS Canada to pharmaceutical companies would be greatly decreased if individual physicians could not be linked to their prescribing practices. The pharmaceutical companies pay the freight and it is principally their interests that are being served by the sale of physician-linked prescription data. Any accruing benefits to researchers, medical educators, physicians, politicians, policy analysts and the public are secondary and offered in exchange for present prescription data mining practices. While prescriber data has value for research, professional development and policy making, this value does not negate the obligation to collect and sell the data with the informed consent of physicians. In his letter, Dr. Korman said, "Our practices have been approved in Quebec by our Health Information Advisory Board, which has strong physician representation." The mandate of the board as stated in its charter reads: "IMS Canada's present operations concerning the collection, compiling and handling [of prescription data] are in accordance with statutory requirements in Canada and in Quebec. Consequently, the nature of these operations are not to be included in the Advisory Committee's mandate."

Dr. Korman makes much of certification under the CSA's Model Code for the Protection of Personal Information. The CSA code requires informed consent: "The knowledge and consent of the individual are required for the collection, use, or disclosure of personal information, except where inappropriate." A note regarding when it may be deemed "inappropriate" to inform an individual and seek consent cites legal, medical and security reasons. IMS Health’s own privacy code states: "Where IMS Health collects prescriber information, we consider it inappropriate and impractical to obtain consent." We contend that the machination of aggregation with identification yields sensitive personal information about the professional activities and practices of the physician and the collection and sale of this data should be subject to that physician’s positive informed consent. In our view IMS' privacy code with regard to consent is not consistent with the CSA code.

Dr. Korman stressed that IMS Health does not collect identifiable patient information and this is exactly what we reported although obviously without sufficient emphasis to his liking.

Dr. Korman feels we did not give IMS Canada its due for what efforts have been made to inform physicians about its business activities and the services available to physicians. Single mailings to physicians in Ontario in 1996 and in Quebec in 1999, and having web sites (unpublicized in either mailing), are insufficient actions. There was no consent response form incorporated into either mailing. There should be regular affirmation of informed consent by all physicians from across Canada for this data collection.

We did not mention physician response rates to the mail outs IMS Canada conducted because neither was intended or designed to be a survey. Additionally, the physician response rates were so low, 1.8% and 0.87% in Quebec and Ontario respectively (IMS Canada communication April 18, 2000) it was hardly representative.

We contend our conclusions are very relevant given the recent passage of Federal Bill C-6 and growing concerns about personal information compiled in many databases throughout Canada. The current reality of prescription data mining practices is that they are at variance with all 5 of the CMA's principles for the sale and use of physician prescription data. IMS Canada has not made a reasonable effort to procure informed consent from Canadian physicians. The conduct of IMS Canada bespeaks to the current reality of the need for independent regulation of the prescription data mining industry.