Details, Details

About four years ago, government-funded researchers completed a comprehensive eight-year study comparing various blood pressure control medications. The results were trumpeted across the front page of nearly every American newspaper. Cheap generic diuretics, which have been around since the 1950s, turned out to be just as effective as expensive brand name drugs for treating high blood pressure.

This news held great promise for millions of senior citizens, since high blood pressure is associated with aging and is a major contributor to heart disease, which remains the number one killer of Americans. The authors of the study pledged to engage in a massive education campaign to bring the good news to physicians and their older patients: You don’t have to go broke medicating your high blood pressure.

Did they do it? And did it work? I was motivated to look for answers to these questions this morning by a front page story in the Wall Street Journal, which documented a small project run by Dr. Jerry Avorn of Harvard University that engages in just such “counter detailing.” The name comes from the pharmaceutical industry’s term for its sales representatives, who go from physician's office to physician's office providing details about the latest drugs pouring out their companies' labs. To counter-detail is to substitute science for this marketing, which, the story revealed, now employs 90,000 detailers and cost drug consumers about $12 billion annually.

This $80 million government study – which could have saved taxpayers billions of dollars now that they are helping to pay for seniors' drugs – has not had a major impact on physician prescribing practices. According to IMS Health, which tracks prescription data in the U.S., the number of diuretic prescriptions rose to 103.6 million in 2005, about a 3.5 percent increase over the previous year. Prescriptions for other blood pressure control medications looked like this: ACE inhibitors, 149 million prescriptions, up 4 percent over 2004; beta blockers, 127 million prescriptions, up 6 percent; calcium channel blockers, 89 million prescriptions, up 1 percent.

It is difficult to draw precise conclusions from this broad data because many people take more than one blood pressure control medication. But it is probably fair to say that the massive shift to diuretics as first-line therapy, which had been the hope of the National Heart Lung and Blood Institute researchers, has not taken place.

This is not just a dollars and cents question. People who take generic or low co-pay medications stick to their regimens at higher rates than people who must pay higher prices. A February study in the Archives of Internal Medicine looked at compliance data from patients in three-tier pharmacy benefit plans (these plans usually have low or no co-payments for generics; higher co-pays for “preferred” brand name drugs; and the highest co-pays for the most expensive, non-preferred drugs in the plan formulary).

The results? About 58.8 percent of patients took every pill in their prescription and returned for a refill if the drug was a generic with a low or no-copay. However, only 52.2 percent of patients with high co-pays completed their prescriptions. There was also a smaller but statistically significant improvement in compliance among patients in the middle co-pay tier compared to the highest priced drugs.

The bottom line is that counter-detailing that encourages consumers to take generics isn’t just about saving money. It can save lives when the generic is just as good as the pricier product. Why? People who can afford their medicine tend to take it all. And they tend to stick to the schedule, which, after all, is what the doctor ordered.

Alas, Dr. Avorn’s little counter-detailing shop at Harvard is moving forward at a snail's pace. It has a million-dollar-a-year grant from the state of Pennsylvania. That's about the same amount of money it takes the pharmaceutical industry to put about seven detailers in the field.

Seven down, 89,993 to go.

Posted by gooznews at March 13, 2006 03:59 PM