In the past few days, I have met with several pharma companies with new drugs intended for use on a broad scale. In the old days (not too long ago), the only way to really reach practitioners was through the “blanket” approach of armies of sales reps and docs hired to give speakers’ bureau talks. Many practices are actively blocking sales reps for very good reasons (concerns about bias) and speakers’ bureaus are going away, also for good reason. We have recently banned Duke faculty from Speakers Bureaus because the speaker signs a contract to give the company message, not the message of the speaker.
In the ideal world the web of professional societies and academic health and science systems would help providers do the best possible job with therapeutic decision making and implementation of treatments. Unfortunately, there is ample evidence that the CME system does an inadequate job of informing practitioners about the nuts and bolts of clinical decision-making and use of drugs and devices. Academic medical centers have not seen this as a priority. In a Circulation article, Bob Harrington and I noted that our own medical school spends less on CME for its physicians than the costs of several transgenic mouse cages for a year, yet we have good evidence of suboptimal prescribing and intervention patterns (although certainly not worse than most US systems!).
A major change in American medicine is the massive consolidation occurring into integrated health systems as independent medical practices can no longer survive financially. These systems give us an opening to provide education at the point of care using electronic health records and disease registries.
I hope the Center for Educational Excellence within the DCRI will show the way. Dr. Grichnik and team have the right ideas at the right time, but putting together educational programs that link electronic health records, disease registries, continuous improvement, population management and personalized medicine will be the challenge.
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