New reps, new rap: The counter-detailers

States worried about the rising toll of drug spending are sending nurses and pharmacists to talk with doctors about their prescribing habits.

By Kevin B. O'Reilly, AMNews staff. Sept. 24, 2007.

Midway through a visit with a physician, drug rep Leigh Bradshaw, RN, noticed the doctor's posture change. He sat up straight and listened intently as she discussed evidence on the relative merits of proton pump inhibitors and other acid-suppressing therapies.

"I was at Grand Rounds last week, and they were saying exactly the same thing," Bradshaw recalls the doctor saying with amazement. "This is really good stuff!"

Accustomed to a seamless mixture of relevant drug information and sales pitch from pharmaceutical sales representatives, it is little wonder that doctors are sometimes taken aback by Bradshaw's approach to detailing. She is one of a new breed of drug reps whose job is not to sell a drug, but to sell the evidence.

Bradshaw, a registered nurse, is one of 11 pharmacists and nurses who work as detailers for a 2-year-old program called the Independent Drug Information Service. IDIS gets $1 million a year from the Pennsylvania Dept. of Aging's Pharmaceutical Assistance Contract for the Elderly program, known as PACE, to pay these so-called counter-detailers.

That money also funds the work of a team of Harvard Medical School pharmacoepidemiologists and physician experts who prepare comprehensive, user-friendly evidence reviews for the detailers to discuss with doctors. The IDIS reps also are trained on how to build relationships with physicians, all aimed at influencing prescribing behavior.

Counter-detailing, or academic detailing, has existed since the 1980s, but only lately has it started gaining traction as a way for states to take a kinder, gentler approach to getting the most out of their drug spending budgets. The idea is to use the pharmaceutical industry's detailing methods to steer physicians toward the older, less-expensive, but still appropriate medication choices.