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Reporter looks at why, how clinic banned drug reps and their samples Date: 10/15/13

Markian Hawryluk, a health reporter with The Bend (Ore.) Bulletin, describes how he reported and wrote an article about a local clinic that decided to kick out the drug reps – and how it changed their practice of medicine.

Markian Hawryluk

By Markian Hawryluk

With no major medical research facilities in our immediate area, I take note anytime a medical study mentions one of our local hospitals or clinics. A press release from Oregon State University in May citing the actions of a physician clinic in nearby Madras, Ore., (about 45 miles north of Bend) caught my attention.

It had been six years since another reporter reported on the clinic’s unusual decision to ban pharmaceutical sales reps. Two years ago I had mentioned in a story the real but hidden cost of free drug samples. It wasn’t really news anymore.

The development was that a researcher from Oregon State University and one of the physicians from the clinic had published a new article that described the process the clinic had taken to ban drug reps. When I got a copy of the article, I realized there was probably a great backstory in how the doctors and staff came to their decision – if I could get the doctors and staff to share it with me.

The article in the Journal of the American Board of Family Medicine described the process in the standard sterile language of academic and clinical publishing. I figured if I could get the doctors talking, I’d have fodder for a narrative version.

I contacted the lead author of the study, David Evans, M.D., who recently left the clinic and is teaching family practice medicine at the University of Washington. I asked him to walk me through the entire story, how their concerns had grown and what prompted them to take action.

The doctors had become increasingly uncomfortable with sales pitch they were getting from the drug reps, and tolerated it only because they felt many of the low-income patients relied on the free drug samples they brought. The doctors analyzed what sort of drugs were in the sample closet and realized those were primarily expensive brand name drugs that patients couldn’t afford once the samples ran out. They were always skeptical of the biased information they received about the drugs’ effects. Instead they instituted a regular meeting to go over the medical literature regarding the medications they prescribed.

Meanwhile they asked the staff about their concerns about banning drug representatives. The staff liked the lunches the reps brought because it gave them an opportunity to socialize. The doctors decided to fund their own monthly lunch instead.

The staff then collected all the promotional products left behind by the reps and threw them away. The office manager actually had to buy replacement pens, notepads, even a new break room clock.

I drove up to Madras and spent hours talking to the doctors and nurses about the impact of drug reps. They were somewhat confused about why I was interested in the story after all this time, and started to describe the broader issues of pharmaceutical influence of physician prescribing. The longer they talked, the more they opened up and gave me the details – like the rosettes of butter or the sought-after Viagra pens – that I needed to make this story a compelling read.

I wanted to put their experience and concerns into a broader context, knowing that drug rep detailing wasn’t affecting only our local area. I searched PubMed and Google for mentions of drug reps in the medical literature and found several researchers that had been studying the issue, as well as national experts who had commented on the problem.

I wanted to get a drug reps’ perspective into the story and asked local physicians I talk to regularly to pass on the names of some of the reps that visit their offices. Not surprisingly, none of the drug reps I tracked down were willing to talk on the record, and the drug companies referred me to their trade group, the Pharmaceutical Research and Manufacturers of America, better known as PhRMA. But I did find some former drug reps, including Shahram Ahari, who collaborated on a PLOS article about drug detailing in 2007. They confirmed what the doctors were telling me about how they tried to manipulate physicians into prescribing more of their drugs.

Many of the experts talked about the new Physician Payments Sunshine Act – a part of the Affordable Care Act that will require pharmaceutical companies to disclose the money and gifts given to physicians. I spent of lot of time reporting on the potential impact of that law, but had to cut most of that because of space concerns.

Space was a major factor in how the story played out. With no hard news hook, the story really only worked as a narrative. Initially, I had planned to run in it in our weekly health section. But I soon realized it wouldn’t fit in the limited space we had there.

We struggled with where to run the story. Our paper publishes a quarterly health magazine, which would provide ample space, but that would delay publication for a couple of months. The other option was a Sunday A1 story, which had less space but better visibility. Eventually, I decided to just write the article the way I thought it should read, and then determine where to place it.

Once it was written, it just felt like Sunday morning story, something a reader would spent some time with over their morning coffee. That turned out to be true. By 9 a.m. on the day of publication, my email was full with reader comments.

Markian Hawryluk is a health reporter with the Bend Bulletin, a daily newspaper in Bend, Ore. He spent 15 years as a health policy reporter in Washington, D.C., writing for trade publications, including American Medical News. The awards for his health reporting include the Bruce Baer Award, Oregon’s top prize for investigative journalism. Last year, he was a Knight-Wallace Fellow at the University of Michigan and this year is a member of AHCJ’s 2013-14 class of Regional Health Journalism Fellows