Chicago
"We need to be holding their hand and whispering in their ear Neurontin for pain, Neurontin for monotherapy, Neurontin for bipolar, Neurontin for everything," sales reps at Park-Davis, now Pfizer, were told in 1996 by senior executive John Ford. "I don't want to hear that safety crap either."
Eight years later, after thousands were harmed or killed from such off-label marketing -- Neurontin could only be legally promoted for seizures and post-shingles nerve pain -- a judgment against Pfizer awarded $430 million to the nation's Attorneys General who earmarked $21 million for training products for prescribers to help prevent future Neurontins.
Last week representatives from 23 medical centers, medical boards, accrediting agencies, the AMA, FDA, VA, the American Medical Student Association, nurse and pharmacist organizations and Attorney General offices pooled their educational initiatives, some already institutionalized into medical schools, at a Critical Prescribing Skills conference in Chicago, hosted by the University of Illinois-Chicago (UIC).
No snappy Crestor or Vytorin tote bags were seen among the 150 participants and conflict of interest sheets revealed 40 of 42 speakers had none. But conference attendees were less interested in bashing drug reps' high flying sales tactics than learning from them and even incorporating them into their own drug teaching and learning as "academic detailing."
A pharmaceutical marketing elective, for example, developed from the settlement at the UIC College of Pharmacy by conference chairs, Bruce L. Lambert, Ph.D., Professor, Department of Pharmacy Administration and Gordon D. Schiff, M.D., Associate Professor, Harvard Brigham and Women's Hospital uses former sales reps to demonstrate how one-on-one encounters can become psychologically coercive.
A project based at UIC and Cook County Stroger Hospital, Chicago's only public hospital, leveraged the institutions' formulary committees to help serve as firewalls to offset such excessive pressure says Dr. Schiff, former Director of Clinical Quality Research and Improvement at Stroger. "We invited sales reps to go on the record and videotape their drug pitch which we told them we would show unedited to the formulary committee--but there were no takers."
Prescribers were taught how to deal with patients who come in waving ads since direct-to-consumer advertising was legalized in 1997. "Doctors have a hard time saying no if a drug is effective, even if it is expensive," said Audiey Kao, M.D., Vice President of Ethics at the American Medical Association which created two educational products, shown at the conference. Doctors are "nervous" that rebuffed patients will go elsewhere, agreed Richard Pinckney, M.D., Professor at the University of Vermont College of Medicine whose project teaches prescribers refusal skills and sends "secret shoppers" to ask for a brand name insomnia drug to see how training worked.
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