Government Detailing

From today’s edition of The Washington Examiner:

Who watches the watchdogs of government prescription detailing?

Misguided political philosophy and tens of millions of taxpayer dollars are behind one of the least transparent aspects of Obamacare, government-funded pharmaceutical "detailing."

Known by those who support it as "academic detailing," it is an effort by Uncle Sam to change the prescribing habits of America's physicians. So what's the problem?

Well, that change is driven by the largest health care insurance company in the country to lower costs rather than improve patient care. And that insurance behemoth is the government of the United States.

Specifically, the verbatim goal is to change prescribing habits that are "not in accord with the recommendations" of studies commissioned by the Agency for Healthcare Research and Quality.

The long and the short of it is that our government is spending tens of millions of tax dollars to tell our doctors how to practice medicine based on studies that are commissioned without any public input or transparency.

And the term "academic detailing" isn't accurate -- because the work isn't being done by academics. The AHRQ hired a firm, Total Therapeutic Management, and is paying it $11,680,060 to recruit and train physicians, pharmacists, nurses and physician assistants.

That's not academic detailing. That's government detailing. And the devil is in the details.

Will physicians be required to be visited by this new battalion of government agents? Will physicians be given incentives to spend time with AHRQ's angels and punished if they do not (via Medicare and Medicaid restrictions)?

And how will Uncle Sam decide which doctors are to be visited? Will "high prescribers" of on-patent medicines be on a priority list? Barry Patel, the CEO of Total Therapeutic Management, said its top priority is "high volume" practices.

Rather than focusing on offices with disproportionately high negative patient outcomes, Uncle Sam is directing its efforts against those doctors who are high prescribers -- which is a pretty good indicator about what government detailing is all about -- decreasing cost rather than improving care.

And what safeguards are in place to certify that physicians are being presented information that is unbiased? Previous government detailing efforts have often focused on demonstrating their own value by highlighting the cost-effectiveness of initiatives through savings generated from the increased utilization of generics and other low-cost therapies.

The repercussions of choosing short-term savings over long-term results, of cost-based choices over patient-centric care, of "fail first" policies over the right treatment for the right patient at the right time -- are pernicious to both the public purse and the public health. Skimping on a more expensive medicine today but paying for an avoidable hospital stay later is a fool's errand.

And how can an "academic detailing" program funded by our nation's largest payer (Uncle Sam) be considered neutral? Just like detailing programs run by pharmaceutical companies, there is an inherent "interest."

And that's OK -- as long as that "interest" is transparent. Who will be the arbiters of transparency? Who will decide what these detailers can say or not say? Will these government "reps" have to play by the same rules as their pharmaceutical counterparts?

And, importantly, what is the oversight mechanism? If academic detailers stray into off-label conversations, to whom does the FDA complain? Whom does the Department of Justice investigate? Who pays the fine? Quis custodiet ipsos custodes?

As currently designed, government detailing is a tool to increase government control over the practice of medicine and is a slippery slope towards the introduction of health care rationing and price controls.

Congressional oversight must be required for the $42.3 million that AHRQ has already awarded for public and physician outreach.

As Rudyard Kipling said to the Royal College of Surgeons in London in 1923, "Words are, of course, the most powerful drug used by mankind. ... They enter into and colour the minutest cells of the brain."

We allow them to be usurped and corrupted at our own peril.

Peter J. Pitts, a former Food and Drug Administration associate commissioner, is president of the Center for Medicine in the Public Interest.