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There was a time when pharmaceutical sales reps made their way into every physician office, outpatient clinic, and hospital -- and wherever else physicians were likely to be prescribe the drugs manufactured by their companies. There were even occasional sightings in the operating room!

In the largely unregulated world of pharmaceutical marketing, sales reps provided face-to-face education regarding their products; gift-giving and "favors" were an integral part of this approach. Then the rules governing physician ethics began to change, and even the sales reps' practice of offering "free samples" was met with suspicion that clinicians were being pressured to prescribe more expensive drugs for their patients.

As the healthcare industry underwent its technological transformation, pharmaceutical companies took their marketing campaigns online. Now that detailed information about a drug is available any time at the click of a mouse, many busy clinicians prefer not to meet with sales reps. that up to 79% of doctors prefer to visit pharmaceutical websites for answers to their questions, the chief reason being that sales reps generally don't provide new information.

With so many drugs now in use, and so many new ones being introduced to the market every year, where might healthcare facilities and clinicians turn for timely, evidence-based, unbiased information? My advice would be to consider an academic detailing (AD) program.

AD refers to university- or other non-commercial-based education of prescribers by trained health care professionals (e.g., pharmacists, physicians, nurses) that is focused on better aligning the prescribing of specific drugs with the medical evidence (i.e., from randomized controlled trials). The goal is one I've been touting for decades -- improving the quality of patient care while reducing costs. Perhaps the most important characteristic of these programs is that they are not linked financially to the pharmaceutical industry.

For more than 25 years, a variety of AD programs have been effective in increasing appropriate prescribing of certain medications as well as educating clinicians about screening guidelines and other non-pharmaceutical interventions. In the U.S., there are several university-based state-wide AD programs (Vermont, Oregon, South Carolina), and a non-profit organization operates AD programs in Pennsylvania, Massachusetts and Washington, DC. Many in the industry may be unfamiliar with AD, but that is about to change.

The (NaRCAD) was funded by Agency for Healthcare Research and Quality to establish a technical assistance and a capacity-building resource center for clinical outreach education. Its chief role is to help organizations with limited resources to create and improve their own programs, and to facilitate the formation of a network of AD programs.

NaRCAD works to increase access to evidence-based, interactive education for front-line clinicians on topics that matter most to their patients. To accomplish this, NaRCAD trains and supports educators for state and local public health departments, develops resources and tools, and connects educators with its extensive partner network. In theory, the long-term relationships forged between health educators and clinicians will foster evidence-based decisions that improve the health of diverse populations, including underserved patients (e.g., reduced overmedication in the elderly, greater access to sexual health education resources, fewer overdoses from opioid addiction).

Today, NaRCAD is in the process of conducting a nationwide survey of academic detailers and organizational representatives to evaluate the scope, effectiveness and sustainability of existing AD programs across a broad range of clinical settings. Analyses of the survey results, along with literature reviews and group discussions, will be used to advance research in the field of AD, and overall reports on results will be shared via NaRCAD's websites.

Clinicians -- and the entire healthcare system -- stand to benefit from a non-commercial, evidence-based approach to pharmaceutical education. To my mind, AD is far superior to the traditional format of commingling information with marketing.

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