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Attending the Critical Prescribing Skills Conference

Posted by Jack Rusley

“Maybe it’s time for us to think: WWID,” Dr. Jerry Avorn said. “What would industry do?” After many years of arguing with classmates and others that the pharmaceutical and device industries should do more to provide access to essential medicines and less to influence physicians to use their products with flashy marketing and shotty research, I was taken aback by this question at first. As I settled into my seat, I realized that Dr. Avorn – a well known internist, geriatrician, and drug epidemiologist at Harvard – was pushing us to consider the most cost-efficient and effective methods for educating prescribers and changing their prescribing behavior…toward safer, more cost-effective drugs.

In recognition of AMSA’s extensive work on industry interaction and conflict of interest issues, the organization was invited to select 15 students to join more than 100 physicians, lawyers, policy makers, and allied health professionals at the University of Illinois at Chicago for a two day conference titled “Critical Prescribing Skills: Advances from the Attorney General Consumer and Prescriber Education Grant Program.” The grants and the conference were made possible by a $2.3 billion settlement between Pfizer and the state Attorneys General over the marketing of Neurontin (gabapentin) for off-label uses.

We heard from more than 20 grantees—a nurse practitioner who contributes to the Consumers Union Best Buy Drugs program, a PhD from UCSF who sits on World Health Organization committees on drug research and development, the AMA’s Vice President for Ethics, and many more—but the common goal was helping prescribers make better decisions and use the most efficacious, evidence-based, and cost-effective treatments available. Ah, if only this was as easy as it sounds! Most groups developed online modules that physicians, pharmacists, nurse practitioners, and other targeted prescribers can complete, ideally raising their awareness of marketing influence and conflicts of interest and leading them to make better prescribing choices. Almost all the groups struggled to get a large number of prescribers to participate, and when they did, had trouble quantifying any changes in behavior—both common issues in medical education research.

Thomas Abrams, head of the Food and Drug Administration department that regulates industry marketing was the other keynote speaker, and gave us a fascinating overview of how the agency works, what they can do (i.e. require black box warnings, which they do occasionally; call for a drug recall, which they do rarely), and what they can’t do (i.e. pull TV ads). He made it clear that the FDA does its best to work with drug companies instead of trying to impose it’s will, and that for the most part, industry cooperates and pushes the envelope at the same time.

AMSA and student activists received many acknowledgements throughout the conference, especially around their force for policy changes at their academic medical centers (AMCs). Outgoing Chair of AMSA’s PharmFree Campaign, Nitin Roper, spoke on a panel about AMSA’s work on the Physician Payment Sunshine Act (now law), the PharmFree Scorecard (now in its 4th year), and numerous AMC policy changes spurred by student activism.

As I flew home to Providence after two days of conference fun (minus the Disneyland rides), I was heartened by three things:

  • the amazing students I met and reconnected with are not only extremely well-informed, passionate, and articulate, but are also clearly the future leaders on industry interaction issues,
  • there is a small but growing group of physicians, nurses, pharmacists, policy makers, and lawyers who have committed a large part of their careers and lives to these issues (translation: we are not alone, and you will have somewhere to go after graduation), and
  • government is on our side, from the FDA to Attorneys General to Senator Grassley, there is a strong sentiment that access to safe, affordable medicines is a public good and a human right.

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