Academic detailing and the odds at Agincourt
Today we share a post from Community Catalyst’s prescription drug blog, PostScript.
We read with interest Merrill Goozner’s blog, “Putting Academic Detailing in Perspective.” See, the Agency for Healthcare Research and Quality recently distributed $30 million of stimulus funds to 9000 locations around the country to get doctors unbiased patient-centered outcome research through academic detailing, also sometimes called prescriber education. (Community Catalyst and the Pew Prescription Project have supported federal and state academic detailing efforts–more here and here.) Goozner seems to suggest that, while nice, such grants cannot hope to match “the combined might of the marketing arms of Big Pharma, Big Bio and Big Device.” With a little guess-timation, he says the number of academic detailers that such grants could deploy is a drop in the bucket compared to pharma sales reps: “Do the math,” Goozner writes. “50,000 for the drug industry; 300 for the truth squad. Henry V had better odds at Agincourt.”
Well, sort of. Yes, in numbers, the (shrinking) army of company detailers far outstrips the number of academic detailers currently in the field, or that would be deployed as part of AHRQ grants. But there are other questions of public policy and public health at work here, and it’s worth looking at what those are.
Academic detailing, to refresh, sends trained clinicians such as pharmacists and nurses into the field to talk to doctors. Versed in the body of research on a condition or drug class, the academic detailers talk with doctors about what the science shows to be the safest, most effective treatment out there. They are employed by a nonprofit or a public agency—and therefore not working on a sales commission or motivated by profit to promote one product over another.
Though some doctors may be looking for perks or samples, many say they talk to drug reps because they can’t always find the information they need elsewhere. But it’s more useful for a busy doctor to meet with one academic detailer who knows about all therapies for a given condition and how they’ve faired in trials, than to meet with several commercial detailers, who rarely have clinical backgrounds and are interested, in every case, in talking up one product: theirs.
And there’s the big difference: sales reps are there to sell drugs. Academic detailers are there to talk about what drugs and therapies are out there, and what the science shows works best.
Goozner’s shrug of a post also ignores the bigger picture: Academic detailing isn’t happening in a vacuum. The deployment of prescriber education at local, state and regional levels in the last five years—and now at the federal level—is part of a growing awareness that pharmaceutical marketing has the potential to interfere with safe prescribing and patient care—and a broader effort to make sure it doesn’t. Medical schools, trade organizations, and a range of medical specialty societies have adopted policies to clarify the relationship between pharmaceutical companies and their members and faculty. Companies have begun to disclose their payments to doctors, and the Physician Payment Sunshine Act passed, establishing a new national transparency standard.
Goozner (and PhRMA President Ken Johnson, in recent comments), seem to suggest that academic detailing is a purely counter-industry tactic, designed to take on—or take down—Big Pharma. But it isn’t, and to suggest so obscures academic detailing’s real, and very common, mission: to improve clinical care.
There are thousands of investments made daily at local and system-wide levels to improve patient care, and this is one of them. Academic detailing is, at bottom, an effort to improve patient outcomes through rational, evidence-based prescribing. Just as one hospital’s efforts to reduce its infection rates should not be dismissed for not reversing the national trend of hospital-acquired infections, so attempts to get the best science into the hands of doctors who want it should not be dismissed as insignificant or trifling. Good medicine matters, at every level.
–Kate Petersen, PostScript blogger
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