Even good evidence needs promotion

NEW YORK (Reuters Health) - What medicine you get from your doctor may depend on more than just scientific evidence -- for instance, on drug makers’ sales reps. Now, almost 150 academic researchers have taken up the gauntlet, touring the country to promote their findings on the best and cheapest blood pressure medicine.

After more than two years on the road, they have analyzed the results: a 23 percent increase in the number of patients who get the recommended drugs, called diuretics, in the counties they targeted most heavily. This is more than twice the increase in the US over the same period.

“We thought it would make a bigger difference, but it did make some difference,” said Dr. Barry Davis, of the University of Texas School of Public Health in Houston, who worked on the study, published in the Archives of Internal Medicine.

“We are fighting an uphill battle against a very common diagnosis where billions of dollars are involved,” he added.

In 2002, Davis was one of the researchers behind a large study comparing different blood pressure medicines. He found that the older, cheaper drugs -- so-called thiazide-type diuretics -- did better than newer medications, and at a fraction of the price.

But although the results soon made it into national guidelines, Davis was disappointed to see that this didn’t seem to have a dramatic effect on doctors’ prescriptions.

So with $4-million in funding from the National Institutes of Health, he and his colleagues convinced other investigators from the initial trial to start touting the use of diuretics at small meetings with local doctors.

Earlier, smaller studies had shown that this practice -- which basically mimics what drug reps do and is called “academic detailing” -- can be an effective way to sway doctors’ prescribing patterns. But there is a major problem: Who will fund it?

While big drug makers may funnel billions into marketing knowing that the money will come back manifold, health-care systems often don’t invest in such efforts, said Jeremy Grimshaw, an expert in health-knowledge transfer at the University of Ottawa in Canada.

“I would argue that they need to start doing that,” Grimshaw, who was not involved in the new study, told Reuters Health.

He said the new study showed academic detailing is a viable way to fight back commercial interests. While the effect might not be huge, he added, an improvement in evidence-based prescribing of even a few percent is enough to “have important public health effects.”

In a commentary on the new study, Dr. Jerry Avorn said the drug industry’s financial motivation may not always serve patients’ best interest. As an example, he mentioned the painkiller Vioxx, which Merck withdrew in 2004 after it became clear that it caused heart attacks and wasn’t better than older drugs.

“Patients are left to bear the burden of the mediocre efficacy or increased risk of these products, while all of us get to pay for their high cost,” Avorn, of the Harvard Medical School, writes in the Archives of Internal Medicine.

But making sure the best scientific evidence finds its way into clinical practice takes effort.

“Alas,” Avorn writes, “trial results do not transform practitioners’ decisions any more than pills leap out of their containers and into patients’ gastrointestinal tracts.”

SOURCE: here

Archives of Internal Medicine, May 24, 2010.