Counter-Detailing

Physicians overwhelmed by the “firehose” of new medical information pouring from medical journals need docents to guide them through the recommendations, writes Dr. Jerry Avorn, a professor of medicine at Harvard Medical School in today's New York Times. One potential source of guidance—the clinical practice guidelines written by professional societies—may be tainted by conflicts of interest, he warns.

"Take, for example, the recommendations issued recently by the American Association of Clinical Endocrinologists on caring for patients with diabetes. The AACE's latest guidelines elevate many second- or third-line drugs to more prominent positions in the prescribing hierarchy, rivaling once uncontested go-to medications like metformin, an inexpensive generic. They also emphasize the riskiness of established treatments like insulin and glipizide, which now carry yellow warning labels in the AACE summary.

Several of the now promoted drugs are expensive newcomers that lack the track records of clinical effectiveness and safety held by the older, potentially displaced treatments. The changes were made, ostensibly, to give physicians more treatment choices for their patients. But there is also concern that they could have been influenced by another factor: the manufacturers of some of these new drugs financially supported the development of the guidelines, and many of the authors are paid consultants to some of those companies.

Avorn touts the “academic detailing” that his Independent Drug Information Services provides in Pennsylvania and the District of Columbia. The group sends independent analysts into physician offices with “non-product driven” assessments of the medical literature.

Follow Merrill Goozner on Twitter: @MHgoozner