August 13, 2008

Drug Reps From Congress To Detail Doctors



Oh, my God, I hope you're lying down for this.


I get raped by an email that is not caught by my spam filter, it says that Congress is considering a bill that would create an academic detailing program-- sending in a team of doctors to visit other doctors and give them "unbiased" (scare quotes mine) information about prescription drugs.

I have some questions, of course:

1.  This is going to be federally funded: how much will these doctors get paid?

2.  Will they be allowed to take docs out to lunch and dinner?  If not, is it because it's a waste of time (in which case why does it matter that Pharma does it) or because you don't want to unduly influence the doctors (in which case...?)

3. Where will you get these "academic detailers?"  Are they academics?  No possibility of bias there, right?  Do you really think it was drug reps that made Depakote ubiquitous?

4. Where will this unbiased information come from?  You're going to be using published data-- isn't that already free of bias?

5. Seriously, is anyone even a little bit horrified that doctors have so checked out of their own education that Congress has to send in tutors?

5b.  Oh, you mean there's so much pressure from marketing that doctors are confused or even manipulated?  Then we should probably set up some academic detailers to go teach nutrition to McDonalds customers.  I mean, if doctors aren't smart enough to withstand marketing, what chance does anyone else have against a Britney Spears Pepsi ad?

5c.  While we're at it, how about academic detailers to Congress?  You know, unbiased information on the ethanol mandate and other special interest Kool-Aid they're drinking?


I'll add that for four years, I was hired by the state Medicaid (DHS) as just such an academic detailer.  I went around to all the hospitals, especially the state hospitals, giving talks and meeting with docs, trying to reduce the polypharmacy and dosing problem (e.g. three antipsychotics at lower doses, or Haldol 20 + Seroquel 25, etc.) 

You want the ironic part?  They hired me because the assistant commissioner of DHS was at a Pharma sponsored dinner program I gave, and thought I my talk about the perils of polypharmacy was compelling-- and not Pharma biased. 

Oh, and in answer to #1: they paid me more than Pharma did.  Tax dollars at work.  I'm happy to take the money, of course, but I've previously given my solution for fixing drug costs while simultaneously improving clinical practice.  All of this other stuff is useless politics.






Comments

Nice comments. I saw this n... (Below threshold)

August 14, 2008 9:43 AM | Posted by MedsVsTherapy: | Reply

Nice comments. I saw this news story, too, yesterday. And did what was probably a similar choke-on-my-morning-coffee gasp. Sure, there are problems with the marketing of pharmaceuticals. But this is the most ridiculous solution I have heard. because of the Alaska/Zyprexa suit, the details of the Zyprexa campaign are out there on the web. I don't think the govt could assemble a team to rival the marketing blitz that Lilly put on for Zyprexa.

Plus, the "empirical studies" themselves are suspect. DeAngelis, JAMAs editor, just had to publish a big apology editorial about how clueless ( - or complicit?) JAMA has been about funny numbers in the reporting of trials (2008, 299(15), p1833).

This morning, I opened up my MedScape email - they had a poll about this armada of government docs out there giving away pens and sticky notes with the "EBM" logo. 20% of responders felt that this would reduce bias. At the same time, however, 30% felt that their practice was not influenced at all by drug reps (an oft-repeated but unsupported opinion), so that there was no problem to be corrected.

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The information is never un... (Below threshold)

August 19, 2008 4:24 AM | Posted by Linda Margaret: | Reply

The information is never unbiased, unfortunately. But choosing the bias to which you should listen--that's the beauty of transparency of source (and source funding). Patients are some of the best recommenders of health care products, services, and treatments. They have usually experimented enough to know what works for them, and they want others like them to benefit from their knowledge and experience.

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You want the ironic part? T... (Below threshold)

May 15, 2009 12:55 AM | Posted by steaven: | Reply

You want the ironic part? They hired me because the assistant commissioner of DHS was at a Pharma sponsored dinner program I gave, and thought I my talk about the perils of polypharmacy was compelling– and not Pharma biased.

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your post is good... (Below threshold)

May 15, 2009 2:42 AM | Posted by Rocky: | Reply

your post is good

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