On a recent afternoon in Charleston, S.C., a food fight began again. Not a fight, really, but a disagreement among the leaders of the state's SCORxE program — designed to educate physicians with unbiased and accurate information about prescription drugs. The basic issue: Should representatives of the program bring the doctors pizza for lunch? Sarah Ball, the indefatigable pharmacist who leads SCORxE, says no. The whole point of SCORxE, after all, is to counteract Big Pharma's hard-sell drug marketing. But sometimes you have to fight fire with fire, says Dr. Robert Malcolm, a psychiatrist and adviser to SCORxE. "We are competing with people who bring food," he says.
Patients rarely question the drugs their doctors prescribe. But the truth is that doctors don't always prescribe the best or cheapest treatment. Actually, they don't always know what that is, given that they lack the time to keep up with the latest drug journal articles, pore over research on the Web or attend medical conferences. One of doctors' most convenient sources of new-drug information is, therefore, also the most biased: the chipper, gift-laden pharmaceutical salespeople who come to doctors' offices bearing free samples, prescribing tips and copies of the latest study that shows how great their new drug is. They also bring food — pizza, doughnuts, chalupas, cookies — to help their sales pitches go down easier.
Drug companies say the visits keep doctors educated about important new trends. But harried doctors are often persuaded to prescribe expensive new drugs, even though older drugs or generics would be just as effective. A Harvard model projects that every dollar spent on better information would yield $2 in drug savings. That's a big deal to cash-strapped states that pay a large chunk of Medicaid patients' drug costs. Thus SCORxE — South Carolina Offering Prescribing Excellence — a joint program between the state's Medicaid program and the South Carolina College of Pharmacy, which trains its pharmacist-reps to visit doctors' offices armed with unbiased studies.
Programs like SCORxE (pronounced score), which launched last October with a budget of about $1 million for the first year, are not without controversy. They represent an unusual and, at least initially, somewhat expensive new role for government. A few other states have similar programs, and the idea has taken hold in Australia and Canada. But in deeply conservative South Carolina, it is surprising to find enthusiasm for using state money to counteract private-industry marketing.
Dr. Kris Crawford, a bedrock Republican and the only physician in the state's house of representatives, is unexpectedly open to the idea. "We're never thrilled with government programs here in South Carolina, but the government does have a responsibility to do things that the private sector won't do for themselves," he says. "I think it's a great idea."
There are no data yet from South Carolina, but the measure seems to be working in other places. In Pennsylvania, the state calculated that among just one subgroup of patients — seniors in a prescription-relief program — the state saves $572,000 a year on acid-reflux drug costs alone, simply by reminding doctors that pricey Nexium, the "purple pill," often has cheaper, equally effective generic alternatives. It's a model that may soon go nationwide. On July 31, the Independent Drug Education and Outreach Act of 2008 was introduced in both houses of Congress. If it passes, it could fund programs like SCORxE around the country.
Sophie Robert, a pharmacist (like all other SCORxE reps), was visiting a family-medicine clinic in southern Charleston recently. The topic of the day: antidepressants. A family doctor at the clinic, Dr. Annette Anderson, spent about 15 minutes with Robert — far longer than she ever devotes to the six or so drug reps who show up unbidden every day. Anderson says she likes the idea of unbiased information delivered right to her office. She does, though, have one small suggestion for the program in the future. "Pizza," she says. "The staff would really like that."