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.