Forbes | Cory L. Andrews
In a variation on the old
saying “if you can’t beat ‘em, join ‘em,” a number of states have initiated
programs where purportedly independent clinicians, pharmacists and other
medical personnel pay visits to physicians as a way of countering the
information delivered to health care providers by drug company sales people
(who are known as “detailers”). States such as Pennsylvania and South
Carolina are funding this “academic detailing” as a tool to reduce those
governments’ prescription drug-related health care expenses.
Counter-detailers reportedly inform doctors that older drugs or less
expensive generics can be as or more effective in treating some conditions than
newer, patented products. Thanks to the 2009 federal stimulus bill and
the ObamaCare law, the federal government is now looking to get into the
academic detailing business.
We’re all for more information
in the marketplace, and especially more health care information. But we
don’t particularly appreciate it when government puts its massive thumb on the
information scales in the way we are seeing with academic detailing. For
instance, through the state law being challenged in the Supreme Court Sorrell
v. IMS Health case (argued before the Justices tomorrow, more on
that here), Vermont is encumbering drug detailing by prohiting drug
companies from using “prescriber identifiable” prescription data for
detailing purposes. The Vermont law says nothing, however, about the
state’s own counter-detailing program. So Vermont’s academic detailers
are free to use such data, while drug companies cannot. That is one,
among many reasons, why the Supreme Court should strike down Vermont’s law as
unconstitutional.
Another way government places
its thumb on the scales regarding drug company detailing vs. counter-detailing
is described in a just-released WLF Legal
Backgrounder by Dr.
Joshua D. Lenchus, Assistant Professor of Clinical Medicine at the University
of Miami Miller School of Medicine. As Dr. Lenchus relates, federal and
state governments impose a growing network of rules and regulations on the
promotional activities of pharmaceutical companies in the interests of ensuring
that the information doctors receive is correct and credible, and that company
reps don’t unduly or unethically influence doctors’ decisions. Drug
company and medical trade associations also demand that their members conform
to voluntary codes of conduct.
Government-sponsored academic
detailers, on the other hand, do not currently have to conform to any such
regulatory oversight standards. Their information providing process is
entirely opaque, Dr. Lenchus notes, and no clear rules exist to govern
state counter-detailers’ practice of providing lunches or continuing medical
education credits for their doctor targets. The paper lists a number of
unanswered questions along these lines, arguing that, “Policy-makers must
address these issues to ensure that medical professionals, and in turn their
patients, are confident in the accuracy and reliability of the academic
detailing initiative and the information it disseminates. ”
WLF is also filing
comments today with the Department of Health and Human
Services which requested public input on Dissemination of Comparative
Effectiveness Research to Patients and Providers to Increase Adoption advancing
its position that if a regulatory regime is to exist for company
dissemination of information, government-sponsored detailers should face
similar oversight.
In sum, if government is
taking the stance of “if you can’t beat ‘em, join ‘em,” then we must urge that
(pardon our reliance on another worn-out saying) “what’s good for the goose is
good for the gander.”