Who watches the watchdogs of ‘detailing’ of pharmaceuticals?

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 being 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.

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 — the work isn’t being done by academics. The government hired a firm, Total Therapeutic Management, and is paying them $11,680,060 to recruit and train physicians, pharmacists, nurses and physician assistants.

Will physicians be required to be visited by this new battalion of government agents? Will physicians be given incentives to spend time with detailers 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 their top priority is “high-volume” practices.

Rather than focusing on offices with disproportionately high negative patient outcomes, Uncle Sam is directing its efforts against doctors who are high prescribers. That’s 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.  

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 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 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?

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

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

Peter J. Pitts, a former FDA Associate Commissioner, is president of the Center for Medicine in the Public Interest.

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