[Congressional Record Volume 154, Number 129 (Thursday, July 31, 2008)]
[Senate]
[Pages S7952-S7953]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. KOHL (for himself, Mr. Durbin, Mr. Kennedy, and Mr. 
        Casey):
  S. 3396. A bill to amend the Public Health Service Act to provide 
grants or contracts for prescription drug education and outreach for 
healthcare providers and their parents; to the Committee on Health, 
Education, Labor, and Pensions.
  Mr. KOHL. Mr. President, I rise today to introduce the Independent 
Drug Education and Outreach Act. Over the past year, the Committee on 
Aging has been taking a close look at the relationship between the 
pharmaceutical industry and our Nation's physicians. Not only does the 
interaction between these two parties seem to be fraught with conflicts 
of interest, but it is likely that the marketing methods employed by 
drug companies--and the manner in which they educate doctors about 
their products--have an impact on the rising costs of prescription 
drugs in America.
  When it comes to knowing what treatment options are available to 
doctors, pharmaceutical sales reps are currently one of the most common 
ways physicians learn about the latest drugs on the market. However, 
these sales reps often seem to confuse educating with selling, and 
evidence shows that doctors' prescribing patterns can be heavily 
influenced by the sometimes biased information handed out by these 
sales representatives.
  The Independent Drug Education and Outreach Act offers an alternative 
method of providing information to doctors. It's called academic 
detailing, and we believe it can have a positive impact on both quality 
and cost of healthcare nationwide. Academic detailing provides 
physicians and other prescribers with an objective source of unbiased 
information on all prescription drugs, based on scientific research 
certified by HHS. The information is presented to doctors in their own 
offices by trained clinicians and pharmacists. Academic detailing 
ensures that physicians have access to the most comprehensive data 
available on drug safety of the full array of pharmaceutical treatment 
options, including low-cost generic alternatives.
  The proposed legislation would provide two sets of grants. The first 
grant program would create educational materials for doctors on the 
safety, efficacy, and cost of prescription drugs, including generic 
drugs and over-the-counter alternatives. A second set of up to ten 
grants would be used to dispatch trained medical staff--such as 
pharmacists, nurses, and other health care professionals--into 
physicians' offices to distribute and discuss the independent 
information. To ensure their neutrality, all grant recipients would be 
prohibited from receiving financial support from drug manufacturers.
  When doctors are better informed about the full range of drugs 
available on the market, they are more likely to prescribe the most 
effective treatment, as opposed to the latest brand-name blockbuster 
drug. The result is also lower health care costs. A study in the New 
England Journal of Medicine projected that for every dollar spent on 
academic detailing, two dollars can be saved in drug costs, due in part 
to the increased use of generic drugs. In this way, a Federal academic 
detailing program will likely pay for itself, while saving the 
government, consumers, and employers a considerable amount of money.
  I would like to thank my cosponsors in the Senate, Majority Whip Dick 
Durbin, HELP Committee Chairman Ted Kennedy, and Senator Bob Casey. I 
would also like to thank Representatives Henry Waxman and Frank 
Pallone, who are introducing a companion bill today in the House. We 
stand together with the goal of providing doctors with unbiased 
information on prescription drugs, and ensuring Americans receive the 
quality health care they deserve.
  Mr. DURBIN. Prescription drugs can restore health, prevent illness, 
and extend lives. But deciding whether to prescribe a drug, and which 
one, requires a careful balancing of potential benefits, risks, and 
costs.
  Prescribing should not be determined by how heavily a drug is 
promoted by a pharmaceutical company. Sadly, this is largely what 
happens today.
  Our health care system does not generate objective, easy-to-access 
information for doctors to guide them when it comes to prescribing 
options.

[[Page S7953]]

  New drugs are constantly entering the marketplace, but there's very 
little objective information about what drug might be marginally safer 
or more effective than existing drugs.
  Even the most vigilant doctors would be challenged to monitor the 
dozens of medical journals that could contain a helpful study comparing 
the safety and effectiveness of drugs.
  The pharmaceutical industry has taken advantage of this information 
void.
  It spends about $7 billion a year marketing to physicians and sends 
over 90,000 sales representatives, called detailers, to pitch their 
company's latest and most expensive drugs.
  What the drug industry is doing is not education. It is promotion. 
And there's a big difference between the two.
  The drug company sales representatives are hired more for their 
charisma than their scientific knowledge, and they provide doctors with 
information skewed to portray their company's product in the most 
favorable light.
  The sales representatives arrive with free lunches and free drug 
samples. Lucrative speaking and consulting fees are possible for 
doctors who change their prescribing to the liking of a drug company.
  The consequence of such a system is clear: an over-reliance on 
prescribing the latest, most expensive drugs even when existing drugs 
are as effective, as safe, or cost less.
  The pain-reliever Vioxx provides a cautionary tale of what can happen 
when marketing prowess trumps evidence-based medicine.
  Heavy marketing quickly made Vioxx a blockbuster drug with $3 billion 
a year in sales, despite a lack of evidence that it could provide any 
greater pain relief for most patients than Advil and despite early 
indications that it increased the risk of heart attacks. Many Americans 
needlessly paid more and placed themselves at risk because the benefits 
of Vioxx were oversold and the risks minimized.

  Another example is the marketing of calcium-channel blockers in 
1990s. Heavy marketing increased the sales of the new patent-protected 
calcium-channel blockers but decreased sales of other blood-pressure 
drugs, such as thiazide diuretics and betablockers, that were cheaper 
and often more effective.
  A more recent example is the cholesterol drug Vytorin. The new drug 
has been heavily marketed since it was introduced in 2004. But a study 
released earlier this year did not find that Vytorin was any better at 
limiting plaque buildup in the arteries than Zocor, an older 
cholesterol drug that recently came out in a lower-priced generic form.
  We have to find a better way to educate physicians about prescription 
drug options and fill the void of medical information that the drug 
industry is now taking advantage of.
  Part of the solution is academic detailing, an idea first developed 
by Jerry Avorn, a physician at Harvard Medical School and Brigham and 
Women's Hospital in Boston.
  Academic detailing programs use some of the marketing tools that the 
drug industry has used so effectively, such as office visits to 
physicians and easy-to-read materials, but employs them to promote 
appropriate prescribing, based on an objective analysis of the medical 
literature.
  These programs--which send trained nurses and pharmacists, armed with 
unbiased information, to doctors' office--have been shown to generate 
$2 in savings for every $1 that it costs to implement them.
  Pennsylvania's PACE program is the State's pharmacy assistance 
program for low- and moderate-income seniors, and it runs the most 
notable publicly funded academic detailing program.
  The PACE academic detailing program has reduced costs associated with 
the overuse of Nexium, an acid-reflux drug for which there are similar 
lower-cost alternatives, and reduced the use of Cox-2 inhibitors such 
as Vioxx.
  Today, I am joining Senator Kohl and Senators Kennedy and Casey in 
introducing legislation that would promote additional academic 
detailing programs.
  The Independent Drug Education and Outreach Act would provide funds 
to medical schools, schools of pharmacies, and others for the 
development of educational materials based on what unbiased, peer-
reviewed medical literature says about appropriate prescribing for a 
particular condition.
  The bill also would provide funds to ten governmental or non-profit 
groups to train nurses and pharmacists and to send them to physician 
offices to present and discuss this information directly with 
physicians.
  The bill includes protections against financial conflicts of interest 
and calls on the Agency for Health Care Research and Quality to review 
the accuracy of the information provided to doctors.
  The Independent Drug Education and Outreach Act would begin to fix 
one of the glaring shortcomings of our current health care system: the 
lack of a systematic way of disseminating information on the relative 
benefits, risks, and costs of various treatment options directly to 
doctors.
  When it comes to prescription drugs, newer isn't necessarily better. 
In many cases, they are not.
  We can no longer afford to rely on drug company salespersons to be 
doctors' primary source of information about new drugs.
  I urge my colleagues to support this bill.
                                 ______