Elissa Ladd, RN
on NP Prescribing Practices
Elissa Ladd, RN, PhD, FNP, a clinical assistant professor at the MGH Institute of Health Professions in Boston, is taking her nearly $400,000 grant from State Attorney General Thomas Reilly to make a documentary for nurse practitioners that links pharmaceutical perks to prescribing practices and offers strategies to counter pharmaceutical companies’ marketing influence.
Funded by a 2004 settlement with Warner-Lambert for allegedly promoting an epilepsy drug for uses not approved by the FDA, the U.S. Attorneys General Consumer and Prescriber Grant Program expects to grant about $20 million nationwide to educate consumers and prescribers about pharmaceutical industry marketing practices.
Ladd, who wrote her dissertation on antibiotic prescribing patterns among nurse practitioners and physicians, was the only nurse among the four Massachusetts grant recipients. She will conduct a follow-up study to assess the influence of her work through the “There’s No Such Thing as a Free Lunch or Dinner: A Web-Based Pharmaceutical Practice Program for Advanced Practice Nurses” grant.
Q Why target nurse practitioners?
Extensive data have been reported regarding how pharmaceutical marketing affects physician prescribing behavior. There’s not a lot of data about nurse practitioner prescribing practices in relation to pharmaceutical marketing.
Q Are nurse practitioners more likely to prescribe certain medications?
What we prescribe is similar to what physicians prescribe: analgesics, antibiotics, and hypertensive medications. It has been shown there’s an inappropriate rate of prescribing broad-spectrum antibiotics that are highly marketed.
Q Does the pharmaceutical industry court nurse practitioners?
We’re being increasingly courted. When you go to national meetings, the pharmaceutical company presence is huge. The reps make visits to describe their products, called “detailing,” and they give samples, pads, and pens. Many times, they bring free lunch. That’s a very big part of the pharmaceutical marketing budget.
Pharmaceutical companies also sponsor continuing education programs for physicians and nurse practitioners at national conferences across the country. You get a lot of good information from these classes in terms of the evaluation and diagnosis of a particular problem. But many times, continuing education encourages the use of one product over others.
Many times pharmaceutical companies have continuing-education-sponsored dinners. The drug company pays a physician or a nurse practitioner to give a talk at a lovely restaurant, and everyone orders drinks and good food. I was talking to a nurse practitioner recently about this grant. She said, “But it’s such a great opportunity to network at these dinners.” I think she was surprised that the dinners may have an effect on the drugs she prescribes. According to research, it [the dinner] does affect prescribing practices.
Q What information will the documentary include?
First, there is an overview of the drug research and development process. Pharmaceutical companies say pharmaceutical products in this country are expensive because of the research and development process, but marketing certainly contributes to the price of medications in this country.
The second part will be an overview of pharmaceutical marketing practices and the known evidence about how pharmaceutical marketing affects prescribing behavior.
The third part is about the ethical dimensions of pharmaceutical marketing: You’d never find a sample for penicillin or amoxicillin in a doctor’s office. They only sample the medications that have been released recently and are quite costly.
Fourth, we look at strategies to improve prescribing practices, such as improving interactions with pharmaceutical sales reps, to be able to critically evaluate what the rep is saying and to bring the discussion back to science.
Q What do you hope to achieve?
There are a lot of social issues involved in (prescribing) decisions that we may not be aware of. Many times after drugs are approved, follow-up studies are sponsored by drug companies. The studies get published in the literature, but some of us may not be aware of where the funding is coming from. If a source of info comes via marketing procedures, it behooves us to be more analytic in terms of what is appropriate and what isn’t.
Heather World is a freelance health care writer. To comment, e-mail firstname.lastname@example.org.