Hi, Doc. I’m from the government

Officials in California just announced that they were working with Harvard University doctors Jerry Avorn and Michael Fischer to overhaul how painkillers are prescribed to disabled workers in the state.

The federal health reform law aims to take this so-called “academic detailing” crusade nationwide. Proponents say it’s an effective way to provide doctors with unbiased information on various prescription-drug options.

But the government has an ulterior motive – cost control.

Government-chartered detailers can pressure doctors to consider not just the best course of treatment when writing a prescription – but also its cost.

That’s a serious mistake. Government officials have no business invading the examination room and sacrificing the medical interests of patients on the altar of cost-savings.

Academic detailing involves sending independent experts – typically physicians, nurses or pharmacists – to visit doctors and share the latest research on prescription drugs and therapies. These experts are supposedly neutral and objective in the information they convey.

Supporters of the practice believe that such noncommercial outreach is crucial to counterbalance the influence of pharmaceutical company representatives, who obviously have an incentive to encourage doctors to prescribe their products.

Other states, including Pennsylvania, Vermont, and South Carolina have instituted programs to influence doctors’ prescription habits.

The Obama administration has plans of its own. The 2009 stimulus bill provided the Agency for Healthcare Quality and Research, a division within the Department of Health and Human Services, with $300 million to lay the groundwork for a national academic-detailing program.

Obamacare built upon this framework by creating the Patient Centered Outcomes and Research Institute, which is expected to have a $500 million budget by 2015. Its mission? To perform “comparative effectiveness research” that weighs the relative merits of various drugs and medical treatments.

The AHRQ will then dispatch an army of federally trained “experts” to visit doctors across the country to publicize the government’s findings. The agency has already spent $11.7 million contracting out to a firm called Total Therapeutic Management to train medical professionals to do academic detailing.

Officials hope that their research initiatives will reveal that older, cheaper therapies work just as well as newer, more-expensive choices. If they do, then federal health care programs would have some measure of justification for slashing spending on cutting-edge prescription drugs.

Of course, the government is hardly the unbiased actor it claims to be. With annual Medicare and Medicaid spending near $900 billion and growing at a substantial clip, policymakers have a strong incentive to identify potential areas for cuts. Researchers may face strong pressure to “discover” that expensive treatments aren’t worth the money.

Further, as currently envisioned, academic detailers are completely unaccountable. Their drug-industry counterparts are subject to strict federal and state regulations on advertising and incentives. And they can face criminal sanctions if they provide misleading or false information.

By contrast, there’s almost no oversight for the AHRQ’s efforts – aside from a broad directive that they “must be consistent with Food and Drug Administration policies.”

When a pharmaceutical industry representative pointed out this regulatory imbalance, Harvard’s Dr. Avorn, the godfather of academic detailing, scoffed, saying that the notion that government-funded efforts would provide bad medical advice is “ridiculous, offensive, self-serving and ill-informed.”

Others beg to differ. “One should not, however, assume that educational activities and materials are inherently impartial, accurate and balanced simply because they are being presented and funded by academics and government, rather than industry,” notes Dr. Joshua D. Lenchus, Associate Director of University of Miami-Jackson Memorial Hospital’s Center for Patient Safety.

Lenchus also points out that Avorn owns and operates a for-profit academic-detailing company.

There’s nothing wrong with helping doctors get the best and most up-to-date information about available treatment options. But there’s a very fine line between helping doctors make informed decisions and explicitly telling them what to do. And if the federal government gets involved, that won’t be an academic distinction.

Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.

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