Healthy Skepticism Library item: 17384

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Stein C
A colorful strategy
The Boston Globe 2002 Apr 9

Full text:

Dr. Tom Lee is fighting rising prescription drug costs with red, yellow, and green.

Lee is chief medical officer of a group of 5,000 doctors affiliated with Partners HealthCare. For the past few years he and some colleagues have been sending out a three-colored chart to doctors in the network. The poster-sized mailing is pretty basic. Down the left side are categories of drugs: antibiotics, antihistamines, antidepressants. Across the right are the three colors: green for the cheapest drugs, yellow for the next most expensive, red for the highest-priced medicines.

Lee wants doctors to work from left to right. In the category of cholesterol-lowering drugs, for example, he wants doctors to prescribe Lipitor, in the green zone, rather than Pravachol or Mevacor in the red. All are effective in treating the problem. The chart supplies some price information on the drugs. More is available online.

Doctors traditionally haven’t paid much attention to drug prices. It is not a subject that has been taught in medical schools. But times have changed. ‘‘If we don’t pay attention,’‘ said Lee, ‘‘we will waste money and there will be less available to take care of sick people.’‘ Since doctors write the prescriptions, the idea is to get them engaged in the process in a simple and time-efficient way. Hence the chart.

In the discussion over rising drug costs, a number of more dramatic solutions have been advocated. Some people favor price controls. Others have suggested the answer is a ban on the direct-to-consumer drug ads that have become so common on television. Get rid of Joan Lunden, the thinking goes, and the problem will be solved.

In the old Soviet Union these might pass for good ideas. In America they don’t work. Price controls cause more problems than they solve. And the notion of banning drug ads, besides possibly violating the First Amendment, is based on the paternalistic view that consumers are easily brainwashed and will demand brand-name drugs, which their doctors must give them.

Jerry Avorn doesn’t buy that. ‘‘The constant complaining about the drug companies wears thin,’‘ said Avorn, a professor at the Harvard Medical School who specializes in pharmacy issues. Avorn concedes the drug companies are a loud and well-financed voice in the drug debate. But doctors need to have a voice too, said Avorn, an alternative voice that speaks out in favor of using the right drug, not necessarily the most heavily advertised drug.

Avorn invented something called ‘‘academic detailing.’‘ If you think of drug firm advertising as propaganda, academic detailing is the Voice of America, a counterforce supplying unbiased information. Partners, which subscribes to the practice, sends out its own pharmacists to talk to doctors about drug use. CareGroup, parent company of Beth Israel Deaconess Medical Center, does the same thing. Those involved say the effort pays dividends. CareGroup says its drug costs rose about 8 percent in 2000 and 14 percent in 2001, well below the national average of 15 to 17 percent for the period. Partners’ numbers are slightly higher, but still below the national norm.

Tom Lee admits this strategy is not a miracle cure for combating growing drug costs. In some cases – patients with heart disease are a good example – proper medical care requires putting more, not fewer people, on prescription drugs. In many categories of drugs there are no substitutes, cheap or otherwise. Some of the newest drugs on the market are terribly expensive. Enbrel, a new arthritis drug, costs more than $10,000 a year. Ironically the drug was invented by a researcher at Massachusetts General Hospital, a Partners affiliate. ‘‘It’s the price of medical progress,’‘ said Lee.

Still you have to think Lee and his colleagues are on the right track. Doctors, consumers, and those who pay the bills all need to push back against rising drug costs. Red, green, and yellow is not a bad place to start.