Here's an interesting idea: Pennsylvania, which is getting whacked with billions in drugs for state employees, Medicaid, and the elderly, has launched an "unsales" program where detailers visit docs to tout the benefits of generics and lifestyle changes over brand-name drugs. From an article in the Wall Street Journal:
Thomas Snedden, who runs the Pennsylvania Department of Aging's drug-assistance program, called on Dr. Avorn when he wanted to counterbalance brand-name marketing. The department, via a contractor, agreed to pay a foundation led by Dr. Avorn $3 million over three years to put an "unsales" force in the field.
Pennsylvania has long tried to influence prescribing by doctors in the state. In the early 1990s, Mr. Snedden's department took advantage of computerized ordering systems at pharmacies to block state payments for Halcion, a sleeping pill then linked to violent agitation especially in the elderly. Worried that doctors were ignoring heightened warnings, the state started rejecting prescription claims for Halcion. Prescriptions dropped 95 percent in a month, Mr. Snedden says.
Mr. Snedden acknowledges that overriding prescriptions at the pharmacy isn't popular with doctors or patients. "We're trying to go directly to the physicians, instead of the pharmacists, and have a dialogue with them about prescribing practices that we think should be corrected," he says.
To get their feet in the door, these academic detailers don't hand out coffee mugs or pens. Instead, they have a letter of introduction from Avorn, and offer to give them a free copy of a book he wrote about the drug industry (or a choice of a couple other Harvard professor-written medical books) in return for a few minutes of their time. Harvard also has certified the meetings, so docs who do a post-test can get CME credit.
I know Kaiser has a program that looks at prescribing habits and sends out docs or pharmacists to educate over- and under-prescribers. If this program in Pennsylvania succeeds, we might see a lot more of this type of education in the future.