Taking Action for Good Prescribing Ethics

Ethical analysis is only worthwhile if it ultimately leads to action. This is a fan letter about two terrific projects that translate ethical scrutiny of pharmaceutical industry practices into change-promoting efforts.

The peRx (“Prescribing Evidence-Based Therapies”) project , led by Elissa Ladd, PhD, a family nurse practitioner at the Massachusetts General Hospital Institute of Health Professions, developed four video modules (available free on the website) targeted to nurse practitioners, but potentially useful for any and all health professionals and students. The modules, each about 20 minutes long, discuss the drug approval process, Pharma marketing techniques, and prudent prescribing practices. They are informative, engaging, and entertaining.

The project is funded by a grant from the fund created by the settlement between Warner-Lambert and the Attorneys General of all 50 states, to settle allegations about unlawful marketing of Neurontin. This is how money from settlements of this kind should be used – to fund counter-detailing efforts. The peRx project is conducting an evaluation study, but no results are available yet.

No Free Lunch is an information-packed website whose aim is to “[inform] health care providers as well as the general public about pharmaceutical industry efforts to promote their products and influence prescribing; provide, evidence that promotion does in fact influence health care provider behavior, often in ways that run counter to good patient care; and provide products that can replace pharmaceutical company paraphernalia and spread our message.”

Like peRx, the No Free Lunch project is acting, not preaching. I especially like this pledge that health professionals are encouraged to make:

"I, __________________, am committed to practicing medicine in the best interest of my patients and on the basis of the best available evidence, rather than on the basis of advertising or promotion.

I therefore pledge to accept no money, gifts, or hospitality from the pharmaceutical industry; to seek unbiased sources of information and not rely on information disseminated by drug companies; and to avoid conflicts of interest in my practice, teaching, and/or research."

To my eye, peRx and No Free Lunch are exemplary grassroots efforts to promote clinically and ethically informed prescribing practices. They represent a crucial form of ethical activism – advocacy and education directed to clinicians. We need political activists and political leaders to promote “top down” ethical activism, in the form of regulation, legislation, and, where needed, litigation. But we also need “ground up” ethical activism like peRx and No Free Lunch to strengthen the constituency that will demand that our leaders do the right thing.