Research, Educational, and professional institutions throughout the United States got a windfall this spring when Oregon Attorney General Hardy Myers announced 24 grants totaling more than $9 million to be used over the next two years to develop programs to educate physicians and other healthcare providers about pharmaceutical marketing. The aim is to teach healthcare professionals how to resist pressure to prescribe in ways that may benefit a pharma company's bottom line more than their patients, and how to find unbiased sources of information about drugs so they can make better prescribing choices.
The well from which these educational dollars spring is the Attorney General Consumer and Prescriber Education Grant Program, created as part of the Neurontin settlement. In that case, Warner-Lambert, now owned by Pfizer, was charged with illegally marketing the epilepsy drug for unapproved uses. In addition to a $240 million criminal fine and an $83.6 million settlement in civil damages for losses incurred against the federal portion of the Medicaid program, the company reached a $38 million settlement in civil liabilities with the 50 states and the District of Columbia. This $38 million settlement, reached in 2004, included $28 million for advertising and programs that would provide prescribing education. The program is administered by a special committee comprised of the offices of the attorneys general of Florida, New York, Ohio, Oregon, Texas, and Vermont; other attorneys general offices also serve on a rotating basis. The Center for Evidence-based Policy at Oregon Health and Science University currently is the program's grant administrator. In addition to the $9 million in grants already in motion, another $11 million will become available for prescriber education as the program rolls out. There also will be grants to educate consumers on prescription drug issues. Information about future grants will be posted on the Web site of the National Association for Attorneys General, www.naag.org.
CME providers are putting the grant dollars to good use. For example, the University of Kentucky College of Medicine, Department of Family and Community Medicine, Lexington, which received a $362,000 grant, is developing five modules that will be taught both online and in live meetings for medical students, physician assistant students, and practicing docs. The program will include outcomes measurement, and will be certified to offer credits to doctors and pharmacists. “At times, more cost-effective drugs may be overlooked. We're optimistic that this curriculum will improve prescribers' ability to evaluate and prescribe medicine in the most cost-effective manner,” said Paul Dassow, MD, assistant dean for continuing medical education with the University of Kentucky College of Medicine and principal investigator on the grant, in a statement from the Kentucky AG.
The University of Vermont College of Medicine Area Health Education Centers; Dartmouth College, Hanover, N.H.; and the Vermont Veterans Hospital in White River Junction were collectively awarded almost $800,000 under this round of grants. The University of Vermont AHEC's program will use actors to portray drug company reps in simulations, an addition to its current academic detailing program that is designed to counteract the influence of pharma sales people. The grant also will allow the program to reach physicians and students beyond Vermont, in Maine, New Hampshire, and New York. Dartmouth will use researchers at the Vermont Veterans Administration to create “Prescription Drug Fact Boxes,” similar to the Food and Drug Administration's “Nutrition Facts” boxes on food products, to provide docs with a fast-and-easy way to see the evidence-based prescription drug information before prescribing a drug for a patient.
In Massachusetts, Boston-based Brigham and Women's Hospital, Harvard Pilgrim Healthcare, and Massachusetts General Hospital's Institute of Health Professionals, as well as Meyers Primary Care, Worcester, collectively received $1.6 million in the new grants. The MGM Institute of Health Professionals is developing a program that will teach nurse practitioners — who are also courted by pharma companies — to prescribe drugs based on evidence. In a statement, Massachusetts Attorney General Tom Reilly said, “They will use these grants to conduct studies and develop programs that may be adopted across the country.”
The American Medical Association, Chicago, landed a $397,980 grant to develop a program to provide education about pharma marketing strategies and techniques and the industry's influence on physicians' work throughout their careers. The AMA will develop the curriculum in conjunction with Stanford University, New York University, and the University of Texas, Houston. The Hektoen Institute, also in Chicago, was awarded a $400,000 grant to develop and disseminate a curriculum aimed at better formulary development for prescription drugs in the hospital environment, according to a statement by the Illinois Attorney General.
Kaiser Permanente Colorado, Denver, will use its grant to develop an educational needs assessment for prescribing physicians, and try to identify how commonly marketed pharmaceuticals affect a physician's practice. Once that's accomplished, Kaiser will develop a Web-based curriculum and assess the outcomes, according to principal investigator David Price, MD, Kaiser Permanente's education director.
The National Center for Farmworker Health, Buda, Texas, is taking a different approach: It will use its $400,000 grant to analyze the curricula developed by some of the other grantees to determine if the prescribing habits of healthcare practitioners serving farmworkers could be improved by countering marketing practices of drug companies. The Federation of State Medical Boards Education and Research Foundation, Dallas, will use its $382,334 grant to develop a nationwide online education program to counter pharma marketing.
In a statement, Linda Pinsky, MD, an attending physician at the University of Washington Medical Center and Women's Health Clinic, Seattle, who was awarded a grant for her “Drug Reps in the Attic” project, said, “Providers may recognize bias in the information they receive from industry representatives but consider themselves immune to its influence. But the CEOs of these businesses are neither philanthropists nor stupid. The pharmaceutical industry conducted outcome studies on their advertising campaigns long before they did on their medications.” The UW project will focus on bias in industry-sponsored and — supported education, promotion of free samples, and the relationship between consumer advertising and patient medication requests.
The Attorney General Consumer and Prescriber Education Program initial grant recipients are:
University of Kentucky
American Medical Association
Harvard Pilgrim Health Care
University of Arizona
Hektoen Institute
Brigham & Women's Hospital
University of Washington
University of California — San Francisco
University of North Carolina — Chapel Hill
University of Vermont
Meyers Primary Care Institute
Wake Forest University
Northeastern Ohio Universities College of Medicine
Dartmouth College
University of Alabama — Birmingham
Portland VA Research Foundation
Oregon Health Policy and Research
Kaiser Health Plan of Colorado
Lovelace Clinic Foundation
Massachusetts General Hospital Institute of Health Professionals
Georgetown University
University of Georgia School of Pharmacy
National Center for Farmworker Health
Federation of State Medical Boards Education and Research Foundation