Detailer visits long on numbers, short on good information

LETTER — Posted April 12, 2004

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Daily an unceasing train of detail men and women rumbles through our offices. In their wake is left an abundance of sample pharmaceutical products and a quantity of gibberish styled as a scientific justification for the preference of one glittering product over another.

Lightening-fast interactions conducted across a "windowed barrier reef" or Formica countertop, leave a blur of claims and unchallenged assertions hanging in the air for the physician to contemplate (but not for too long). All the graphs strung together would undoubtedly reach to the moon, but to no higher intellect.

Absent from the quotidian detail visit is any rational discourse of data presenting an adequate expression of dependent measures, (e.g., the "Seven Criteria For Benign Prostatic Hypertrophy," or the clinical criteria by which one could reasonably sample symptoms of depression or insomnia).

Absent from the puffing concerning the value of a given product is a rational offering of data (e.g., the number of patients needed to be treated to achieve one benefit, and reporting experimental data in natural [absolute] rather than relative frequencies).

Absent from the detail is comparison data of a reliable nature presented in a comprehensive and clear manner that would permit a clinician to make rational assessments and choices of the value of the pharmaceutical product.

To the extent that medical education is a potential benefit to be achieved from drug representative visits, it is imperative that the profession forcefully express itself concerning what it demands from the industry's presentation of data.

Medical societies owe it to their members and to the members' patients to shape the manner in which pharmaceutical information is imparted to its constituents.

Medical care can only benefit by a rethinking and remounting of the traditional drug detail.

The detail has changed very little since I was awarded my first premium pen. Also, everything else in medicine has changed, and so the drug pitch must change along with the shifting tide of medical necessity, education, economics and rational drug use. Let us act within our societies to effect reasonable changes and bring useful detail to the detail.

Scott A. Kale, MD, Chicago

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/04/12/edlt0412.htm.

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