Wednesday, May 30, 2007

Drug Makers Finance Nurses as On-Site, Chart-Reviewing Drug Reps

You read the title correctly.

Drug Makers Finance Nurses as On-Site, Chart-Reviewing Drug Reps

The Wall Street Journal in its free article here used the title "Drug Makers Finance Nurses for U.K. Doctors", however I believe my title captures the essence of this article more accurately.


Drug companies are paying for nurses to study patient charts to identify people with chronic illnesses. The nurses, who come from nursing contractors, then recommend which patients should be called in for a check-up and perhaps prescribed new treatment -- sometimes a medicine made by the company funding the nurses. The work is part of what the industry calls "disease-management programs," which the companies say improve care for people with illnesses like diabetes, asthma or heart disease.

The risk, however, is that companies use the programs as a back door for marketing their pills. The programs also raise concerns about patient privacy.

I would agree with that assessment. It's incredible that drug companies sponsor nursing contractors to send nurses into clinician offices for chart reviews and involvement in the clinical decisionmaking process. If that is not the poster definition for "appearance of conflict of interest" if not conflict outright, I don't know what is. Clinicians are also to blame for allowing this.

Are some clinicians themselves accepting pharma money for permitting this "service" on their premises? Want to place bets?

Of course, another paragraph brings a familiar name to the forefront (I am increasingly losing pride in having that company's name on my CV):

Last fall, the Association of the British Pharmaceutical Industry, a trade group, temporarily suspended the United Kingdom subsidiary of Merck & Co. from the trade group after finding that the company had used a program for patients with high blood pressure to promote its drug Cozaar ... In the program that resulted in Merck's recent temporary suspension, the company had been paying for nurses to review patients with high blood pressure in doctors' offices across Britain since 2004. In March 2006, a Merck sales representative filed a complaint with the Prescription Medicines Code of Practice Authority, a U.K. watchdog, alleging that the company was trying to use the program to promote its drug Cozaar. The watchdog body found that Merck had instructed its sales reps to offer the program to doctors who were big prescribers of Cozaar, making the program a reward for high prescribers of the drug. The group suspended Merck for three months and forced it to write a letter to doctors in the program alerting them to the violation and apologizing. The company said in a statement at the time that it took the breach "very seriously," and that it "is working hard on corrective actions."

"Corrective actions" include what, exactly, I ask?

Some clinicians resist:

Jim Kennedy, a physician from Middlesex, England, says he's turned down offers from drug sales representatives to send special nurse teams to his practice. There is a "perceived or real risk of the pharmaceutical companies' interests taking precedence over the patients' interests," says Dr. Kennedy, who is also the spokesman for the Royal College of General Practitioners, a professional group. He says many doctors in his group share his concern.

This "service" is spreading:

While company-sponsored nurse teams are most common in Britain, the practice is growing in other countries that also pay for medical care including Belgium, Germany and Ireland, says Hywell Evans, head of the European unit of Quintiles Transnational Corp., a company based in Research Triangle Park, N.C., that provides nurses and other services to drug companies.

The article goes on to describe how patient record privacy is supposedly protected in these programs, which gives me little confidence that there are no abuses in this regard.

Read the whole article. However, I believe what we are seeing is an increasingly complete takeover of clinical medicine by industry. This also helps me understand the huge resources diverted to drug marketing strategy. It must take a lot of MBA's to come up with these schemes, and bureacracy and support staff to maintain them.

-- SS


Anonymous said...


Thank you for keeping abreast of the medical and pharmaceutical businesses--a service corporate-run media fails to do (for fear of lost revenue?) I continue to think that by educating myself (a non-medical person), and sharing your info, I can "make a difference." But when articles such as this one just keep coming . . . and coming . . . and coming, I despair. It appears pharma/medicine, like Mother Nature, have staying power and boundless resources. I see the only hope remaining for patients/consumers is for an implosion created not by our outrage or need, but by their own greed and corruption.


Anonymous said...

At some point one is left unable to respond. Allowing physical access to patient records for the purpose of data mining, and make no mistake this is data mining, is indefensible.

Per the Toronto Sun we learn:

May 28, 2007

Drug costs eroding medicare

Federal NDP Leader Jack Layton makes a valid point about the skyrocketing costs of prescription drugs.

They are undermining the founding principle of medicare -- universality.

Prescription drugs are the fastest-growing component of health spending, second only in total cost to hospitals. At $20 billion annually (2005 figures), we spend more on drugs than we do doctors.

Costs have doubled since 1985 and have raced far ahead of inflation.

The NHS is bleeding money and here in the US we are looking for ways to reduce drug cost. These schemes are only a means to promote drug use through another marketing channel.

The doctors, nurses, and drug companies involved in this campaign should be suspended until a review, and reeducation, can take place to reinforce the concept of the patient doctor relationship.

Steve Lucas