Medical group opts for objective Rx plan

Posted Sept. 16, 2008, at 7:14 p.m.

ROCKPORT, Maine — Citing concerns over patient safety and escalating costs, the Maine Medical Association recently endorsed a plan to establish a new medication information program that will provide objective prescribing guidance to thousands of doctors and other health care providers through-out the state.

At the annual meeting of the MMA, held Sept. 5-7 at the Samoset Resort in Rockport, members passed a resolution to join Vermont and New Hampshire physicians in endorsing the evidence-based prescribing information program known in medical circles as “academic detailing.”

Academic detailing is the term for providing science-based, impartial information about prescription drugs, from a nonindustry source, to physicians and other prescribers.

By contrast, “pharmaceutical detailing” describes sales visits in which drug company representatives tout the benefits of their companies’ products. Critics of pharmaceutical detailing say that new, expensive drugs often are introduced in these visits to replace older medications that have a lower price tag and may be just as effective as their replacements.

“Doctors are smart people,” Gordon Smith, executive vice president of the MMA, said in an interview at the conference. “They know the pitch from the industry is not necessarily objective information. The companies are trying to sell a product. It’s marketing and sales.

“Our information [in the academic detailing program] will come from people like those at Harvard Medical School, people who are not paid by the pharmaceutical industry, to actually look at the comparative effectiveness and the cost of drugs,” he said.

An academic detailing initiative in Pennsylvania has resulted in doctors ordering lower-cost medications and improving patients’ health, Smith added. New Hampshire and Vermont also have academic detailing programs in place.

Ken Johnson, senior vice president of the drug industry’s lobbying organization, Pharmaceutical Research and Manufacturers of America, said Tuesday that PhRMA welcomes the participation of the medical association in Maine’s academic detailing program.

“We are now encouraged that the state will work with the Maine Medical [Association] to implement the program,” Johnson said in an e-mailed statement. “It is very reassuring that the medical professionals devoted to the most effective care possible for the state’s patients will be involved in the process.”

State legislation enacted two years ago requires that every drug company participating in MaineCare, Maine’s health care program for low-income residents, contribute $1,000 a year to an educational fund. That money, administered through the state Department of Health and Human Services, will be used to contract with the Harvard academic detailing program as well as to recruit and train teams of Maine-based health professionals to disseminate the information to interested medical practices.

Recruitment and training will be provided by the MMA. Smith said he hopes teams will be on the road by January. The anticipated startup cost of the program is $150,000 — a small fraction of what private companies spend to market their products in Maine, Smith said.

Practices that want to be visited by pharmaceutical company representatives still may do so, Smith said, although many practices already have eliminated such contacts.

Smith noted that ethics programs for doctors and the pharmaceutical industry have virtually eliminated gift-giving and other enticements to physicians.

“We have cleaned up the relationships between the doctors and the companies a lot, and there was a lot to clean up, including the dinners, the golf, the conferences,” said Smith, who has been doing his job for 28 years.

Even freebies like company-branded coffee mugs and notepads no longer are allowed, he said.

Drugs reps can pay for a “modest lunch in conjunction with a bona fide educational presentation,” Smith said, and that’s about it.

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