The November 2007 issue of Consumer Reports features an article entitled “Treatment traps to avoid.” The article focuses on unnecessary and overused health care treatments (in the United States). One major emphasis of the report is the emphasis on the approval of new drugs and the marketing process for drugs in the U.S. in general, which includes both substantial direct-to-consumer marketing (illegal everywhere else in the world except for New Zealand), and extensive marketing to physicians — for both on-label and off-label uses — by means of gifts, samples, meals, and reprints of research sponsored by the manufacturers. Research frequently establishes a drug’s efficacy vs. placebo, but more rarely compares new drugs with the established standard of care and demonstrates incremental effectiveness, much less incremental cost-effectiveness.
As a result of a $430 million settlement between drug manufacturer Warner-Lambert and the U.S. government, several projects have been funded to study and address issues in the marketing of pharmaceuticals. One such project, Formulary Leveraged Improved Prescribing (FLIP) is centered across the street from my office, and is a joint effort between the University of Illinois at Chicago and the John H. Stroger, Jr., Hospital of Cook County.
As its name suggests, FLIP is directed at members of formulary committees of hospitals and health plans and is intended to encourage them to take a critical look at their drugs choices for the formulary and to become an important source of provider education. Both patients and physicians may be particularly interested in FLIP’s 24 Principles for Rational Prescribing, a set of guidelines for increasing the overall safety of prescribing while lowering costs. Many of these, not surprising, involve using non-drug therapies and favoring older, well-established drugs over newer.
Part of the major difficulty in improving the decisions made by practitioners in prescribing drugs is that the decisions are made under time/resource constraints. General recommendations for improving prescribing behaviour (like FLIP’s principles for rational prescribing) may go a little way toward avoiding ‘treatment traps’ but more improvement must also come from effective education/ targeted intervention based on what we know about resistance to persuasion and cognitive biases.
Carolyn, as a cognitive psychologist and a medical educator, I couldn’t agree with you more! I have the impression that FLIP is also doing considerable work on those areas, but it’s new project and that work hasn’t come to fruition yet.
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