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Save Money? Improve Care? What's Not To Like? Support Academic Detailing in Budget.

Save Money? Improve Care? What's Not To Like? Support Academic Detailing in Budget.

June 19, 2013

In a recent New York Times Op-Ed, “Healing the Overwhelmed Physician,” Harvard Medical School professor Dr. Jerry Avorn highlights how "academic detailing" can both save money and improve patient care.  The House-Senate conference now meeting to finalize the state budget should support the Senate's move to fund this program, which could save some $3 million for MassHealth. Avorn explains how busy physicians struggle to keep up with the steady influx of medical information that is published each week. Modern medicine offers many choices—but this puts a burden on doctors to sort through the available options and identify the best course of treatment.

For years, the pharmaceutical industry has taken advantage of this “information overload” by sending out sales representatives to promote their products. These sales representatives, called detailers, travel to physician practices to deliver sales pitches lauding the benefits of their drugs. Often, detailers provide a free meal and drug samples as an enticement for providers to listen to their spiel. Various medical groups create clinical practice guidelines to aid physicians in their treatment decisions.

Unfortunately, these guidelines may also be tainted by financial conflicts of interest. For instance, some guidelines are developed by practitioners simultaneously serving as industry consultants to a particular pharmaceutical company. Thus, the recommendations can be biased—much like the promotional pitches that pharmaceutical detailers give.

Independent guidance, such as that produced by the Cochrane Collaboration, does exist.  While this is valuable, further steps are necessary to disseminate this evidence-based information. That is where academic detailing comes in. Academic detailing helps doctors stay abreast of current information while avoiding the biases of pharmaceutical-sponsored education. How does it work? Doctors, nurses, or pharmacists are trained to understand comprehensive and unbiased clinical data. They then visit physicians’ practices to pass this information on to practitioners. Academic detailers do not have a financial stake in the drugs that they are recommending, and thus serve as a counterweight to industry-sponsored information. Academic detailing has the potential to achieve two goals, both of which are good for Massachusetts:

  1. Promoting better patient outcomes. Academic detailers will present a more complete view of the available clinical data. This stands in sharp contrast to the selective marketing techniques used by pharmaceutical representatives, who focus on highlighting a drug’s strengths while glossing over its weaknesses.
  2. Reducing healthcare costs. Academic detailers recommend off-patent drugs when evidence shows that they are a safer and more effective treatment option. Pharma has no incentive to market off-patent drugs because, for them, that’s not where the money is. One study from Harvard Medical School and Brigham and Women’s Hospital found that each dollar spent on academic detailing saved two dollars in prescription drug costs. This means substantial savings on prescription drug expenditures statewide— potentially big enough for Massachusetts to recover most or all of what it spends to fund an academic detailing program.

Improved outcomes and lower costs? Sounds like a no-brainer, and we hope our legislators will agree. The Senate budget included $500,000 for academic detailing. No funds were allocated in the House proposal. The Senate Ways and Means Committee calculated a $3 million savings payoff from the measure, making it a smart investment.

Although Massachusetts initially emerged as a leader in academic detailing, in recent years, it has failed to maintain funding for this program. We are now presented with an opportunity for Massachusetts to once again foster a robust academic detailing program and, in turn, encourage a patient care environment that is based on science, not sales pitches.  -Claudia Kraft