Every Clinician Deserves an Un-Sales Rep

Jerry Avorn, MD


January 19, 2007


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When I was practicing primary care, each year it got tougher to stay on top of the medical literature. But I had unlimited access to dozens of attractive, articulate people who came right to my office, at my convenience, to "update" me on topics like "modern concepts in hypertension" or "how to lower your patients' cholesterol." Some brought me lunch while they taught me; others offered to provide the education at a Red Sox game. The material they provided was user-friendly, accessible, engaging, and clinically relevant. But the only reason these "detail men or detail women" did this was to increase the sales of products of the drug companies each of them worked for, and the data they presented were carefully selected to accomplish just that goal. I wished that someone would come to my office and give me user-friendly drug information that was more neutral, not designed primarily to push products.

To address that unmet need, my colleagues and I created the concept of "academic detailing." We trained pharmacists to visit doctors in their offices to offer concise, clinically relevant overviews of various therapeutic categories. The only goal was to provide unbiased, commercial-free data about optimal care.[1] Sometimes they even brought lunch.

The original program was funded by a federal grant, but today similar programs are in operation in several countries.[2] In Australia, the government pays for a nationwide program that covers 60% of the country's primary care doctors. We've recently begun a program in Pennsylvania funded by that state; our reviews and teaching materials are freely available to all at[3] We all benefit if doctors have access to even-handed, non-product-driven drug information. Such programs can improve appropriate prescribing, and over time should even be able to save more than they cost, while helping us make smarter prescribing choices for our patients.

That's my opinion. I'm Dr. Jerry Avorn, Professor of Medicine at Harvard Medical School.


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