Collaboration in Civic Spheres

UW doc: here’s how a small clinic can divorce Big Pharma

by Matt Rosenberg May 28th, 2013

In a new report published in the May-June 2013 edition of the Journal of the American Board of Family Medicine, University of Washington-Seattle doctor David Evans and several co-authors from Oregon describe how an independent community medical practice can consciously adopt new policies to diminish the influence of big pharmaceutical firms on their drug prescribing policies and thus give patients and insurers opportunities to cut related costs. They say theirs appears to be the first report on how small private practices, in particular, can develop a clear process on how to do this.

Evans and co-authors from the Oregon State College of Pharmacy and the Portland-based Oregon Rural Practice-based Research Network in “Breaking Up is Hard to Do: Lessons Learned from a Pharma-Free Practice Transformation,” tell the story of Madras Medical Group in rural eastern Oregon. Two of the practice’s five family physicians took a “champion” role to educate themselves, other doctors and the 18 additional staff members about the influence on prescribing practices of free lunches, promotional items and free drug samples provided by pharmaceutical company salespeople who visited the clinic regularly.

Pharmaceutical sales personnel are also known as “detailers.” According to Evans and the report’s co-authors, the industry spends in the tens of billions each year to support detailers’ direct marketing outreach to medical facilities in order to get doctors to prescribe what they are selling, even though lower-cost, equally effective alternatives may exist.

First, Madras Medical staff collected data on the extent of detailers’ presence. They found that over a six-month period detailers visited the clinic 199 times, or an average of just more than 33 times monthly, and sponsored 23 in-clinic lunches over a nine-month stretch.

Staff also found that for 46 drugs identified in the sample cabinet, “reasonable less expensive alternatives could be found for 38″ saving “the ultimate payer $70 per therapy per month.”

In interviews with the clinic’s staff, researchers found they enjoyed getting coffee mugs, pens and pads from the pharma detailers and brought the items home: that they also used the contents of the drug sample cabinet themselves; and enjoyed the pharma-sponsored lunches with work colleagues.

The two provider “champions” of reform within the practice presented during staff meetings peer-reviewed articles on the effects of pharmaceutical marketing on prescribing practices, patient safety and drug costs, and also initiated talks on the “the ethics of gifting.” As a result the doctors and staff agreed to initiate a “pharma-free policy.”

The practice covered the cost of monthly staff lunches instead of relying on pharma sales personnel to do so, and also found objective educational materials to shape discussion of new and old drugs, at monthly educational meetings. All branded office supplies from pharma firms was disposed of and replaced, at a cost of less than $200.

Evans and co-authors write that less than one quarter of the 800,000 U.S. doctors work in academic medical settings, where policies restricting the influence of Big Pharma marketing are more likely to have been adopted. So it’s especially important, they maintain, that smaller and independent medical practices be able and willing to consider taking the kinds of steps demonstrated by Madras Medical.

According to the report, starting this August under the Affordable Care Act of 2010, the Physician Payment Sunshine Act will require that makers of “drugs, devices and biologics paid for by Medicare or Medicaid” report to a public database all the payments they’ve made to doctors and teaching hospitals.

ProPublica’s landmark “Dollars for Docs” project provides a database searchable by state, and name of facility and provider. It focuses on direct payments to doctors or facilities by pharma firms for research work, consulting, lectures and other services; and is current through 2012. Search Washington state here.

Concerns about the influence of pharmaceutical marketing were also the subject of a paper by UW dental school professor Philip Hujoel, reported on at Public Data Ferret as part of our growing Open Science archive.


Public Data Ferret is a news knowledge base program of the 501c3 public charity, Public Eye Northwest. Ferret In The News. Donate; subscribe (free)/volunteer.

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