The recent news of Pfizer’s $2.3 billion fine for inappropriate and illegal promotion of Bextra and other drugs for “off label” uses understandably raises the public’s concerns about the influence that the pharmaceutical industry has on their doctors’ prescribing choices. The stories of gifts, golf outings and resort junkets expose a side of the relationship between doctors and pharmaceutical representatives about which many of us have expressed concern for a long time.
On the other hand, most health care providers — doctors, physician assistants and nurse practitioners — are simply looking for a legitimate way, in the course of their very busy days, to make well-informed and scientifically based prescribing choices with and for their patients. Traditionally a major source of information has been the visit of pharmaceutical representatives to doctors’ offices during which they provide information about the drugs they are marketing using sales aides, a process called “detailing.” However, the proprietary interests that underlie the information provided by pharmaceutical representatives during these visits raises serious questions about whose interests are being served, and many studies have shown an adverse effect on prescribing practices.
During the past month, Maine has launched a new service aimed at providing physicians, physician assistants and nurse practitioners with current and unbiased information on the treatment of common and important illnesses. The Maine Independent Clinical Information Service (MICIS) was developed as the result of a 2007 legislative mandate intended to improve health care quality and clinical outcomes. It is administered by the Maine Medical Association in partnership with the Department of Health and Human Services.
The Maine Independent Clinical Information Service is voluntary, guided by a physician-led advisory committee that uses trained clinicians known as “academic detailers” to visit practices throughout the state. At these visits the academic detailers provide literature and a review of up-to-date research based on analysis conducted by the Independent Drug Information Service of Harvard Medical School. They also engage doctors and other providers in clinical discussions to share their accumulated experience and wisdom with each other.
In its first month of activity, academic detailers for the Maine Independent Clinical Information Service have visited eight sites, interacting with health care professionals, and 18 additional practice visits are scheduled. The first module, on the management of people with diabetes, has been well received with positive feedback from providers. Many have requested — and have been provided with — additional information and literature.
The intent of the Maine Independent Clinical Information Service is straightforward: to provide health care professionals with the information they need to prescribe the best — not necessarily the newest or most expensive — drugs for their patients. Combined with the additional information provided about disease management, this has the potential to improve outcomes. And while the primary goal of this program is quality, the experience in other states, including Pennsylvania, Vermont, South Carolina, Massachusetts, New York and the District of Columbia, has demonstrated that academic detailing also helps to control costs, a critical consideration as our nation undertakes health care reform and considers the values of universal access, cost management and quality.
Noah Nesin, a family physician, is medical director of Health Access Network in Lincoln and chairs the Maine Independent Clinical Information Service physician oversight committee. Benjamin Schaefer is a cardiologist with Northeast Cardiology Associates in Bangor and chief of cardiology at St. Joseph Hospital. He is a member of the Maine Independent Clinical Information Service physician oversight committee.