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    • Why We Matter
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    • Contact Us
  • Tools & Resources
    • AD Core Toolkits >
      • Opioid Safety Toolkit
      • HIV Prevention Toolkit
      • E-Detailing Toolkit
      • Materials Toolkit
    • AD Literature Archives
  • Webinars
    • Webinar Series
    • E-Detailing Webinars
    • E-Detailing Roundtables
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    • Best Practices Blog
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The DETAILS BLOG

Capturing Stories from the Field: Reflections, Challenges, & Best Practices

Who Do You Trust?

10/13/2017

 
Navigating a Disorienting Healthcare Landscape | Jerry Avorn, MD, NaRCAD Co-Director
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Tags: Evidence-Based Medicine, Health Policy, Jerry Avorn, Medications

​First, about the grammar. Readers under 65 will be forgiven if they never heard of the daytime television quiz show “Who Do You Trust?” that aired from 1957 to 1963. In it, male contestants were asked if they wanted to answer a question or whether they ‘trusted’ their wife to do so. Concerns by snarky little kids like me that it really should have been “Whom Do You Trust?” did not diminish the show’s popular appeal. Gender issues went totally undiscussed.

​All grown up now and confronting a changing health care landscape, that still-sometimes-snarky little boy often wonders, as do many of my clinician colleagues, who can be trusted in the world of medical information, especially in relation to prescription drugs. Gone are the simpler times when one had to worry only about whether the drug ads and sales reps were really presenting a balanced picture of all the evidence, which was a hard enough challenge. 
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We now know that we also have to be concerned about off-label marketing campaigns offering impermissible (and often downright deceptive) statements about efficacy –  excesses for which over $16 billion has now been paid to state attorneys general in legal penalties and settlements.

​As I’ve noted previously, the courts and the FDA are also moving toward much more permissiveness with company claims about efficacy and safety. And in last year’s 21st Century Cures Act, Congress instructed the FDA to be more open to accepting lower standards for drug approval.

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Then there are newer sources of information whose trustworthiness is not always clear. More and more, this includes the prescription benefit management (PBM) companies, which seem to be holding on to an ever-larger fraction of the funds flowing through their rich payment pipelines, yet provide little transparency about who gets to keep what rebate dollars, and for what reason. Once billed as cost-savings protectors and comparative effectiveness gurus, the PBMs are under increasing scrutiny, and asked to make their financial data transparent and to clarify just who’s saving what for whom (or is it ‘for who?’).

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Nor can we always be sure what angle the payors are playing. Why is Drug A on the formulary, but not its sibling Drug B? It may be an astute purchasing decision, or just the result of a rebate hack. And how much are prior authorization rules and growing co-payments designed to promote evidence-based care, or other less worthy goals? Even clinical guidelines put out by third parties vary from the most rigorous to pretty sketchy. 

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This leads to one good answer to the ungrammatical question in our title. With these galloping changes in an ever-more marketplace-oriented health care system, every prescriber needs and deserves a smart, superbly informed colleague to rely on to get the best possible syntheses of the clinical evidence – someone who has no other agenda or motivation other than getting the facts right and transmitting them faithfully.

​Each year, we can take less comfort in counting only on FDA-approved indications, or payor policies, or PBM choices, or advertised claims. The more compromised each of these sources becomes, the more we’ll need ‘honest brokers’ like well-trained and un-conflicted academic detailers, whose only duty is to communicate the fairest evidence summaries as effectively as possible. Like lightweight clothing in an era of global warming, it’s a need that’s only going to increase.

Thoughts? Reactions? Sound off below.

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Biography.
Jerry Avorn, MD,​ Co-Director, NaRCAD
Dr. Avorn is Professor of Medicine at Harvard Medical School and Chief of the Division of Pharmacoepidemiology and Pharmacoeconomics (DoPE) at Brigham & Women's Hospital. A general internist and drug epidemiologist,  he pioneered the concept of academic detailing and is recognized internationally as a leading expert on this topic and on optimal medication use. ​Read more.

Nora Gurun
10/10/2019 08:35:38 pm

HSV1 & HSV2 Negative.
Saying that, herpes virus is not curable is because you have not seen the right person to help you get rid of the virus. I testify because it's only someone who have experience this virus that konws what it means to be in this situation. After my marriage to Loe my hubby, i noticed one day that I had sudden Cold Sores in my genital part. I went for test and the doctor confirmed me being HSV2 positive.
I felt my life and happiness with my hubby was finished. But to my greatest surprise my husband had contacted this virus and was later confirm HSV1 positive. I started noticing symptoms like cold sores, sore throat, fever blister, weakness of the body, runny nose, cough and finally the was a serious Outbreak. So I started looking for a remedy to our situation because the phamacytical drugs and the pains was too much for I and my hubby. I was looking for remedy online and different website when i saw a testimony about Dr. Akintunde and the herbal medicine that helped Erica to get rid of HSV2, I remembered my doctor told me the is no cure to this virus, I had to contact Dr. Akintunde on his WhatsApp number and told him about us and the virus, he promised to cure this virus with his herbal medicine. And he prepared four bottles of the herbal medicine and send to me through UPS delivery with instructions on how to take it. And only first week of my start, I noticed the outbreak and all the symptoms was off so, I told Dr. Akintunde about it and he said the medicine will eradicate the virus and boots my immune when i complete my medication. After I took the medicine I went back for retest and my doctor was surprised with my new status HSV2 negative my hubby also was cured. Thanks to Dr. Akintunde I am proud to say you safe our life and we remain greatful and we support your mission on humanity Sir, Do you experience such too?
Tell Dr. Akin your health problem and be sure of total cure with his natural roots and herbs. Like Erica did testify to me I also testify for everyone who need help to be free from this inconveniencing virus, and any other health challenges you're having is curable believe me. All the best.
Dr. Akintunde email and WhatsApp number below.
Via email:-
drakintundehomecare@gmail.com

WhatsApp number:. +2347035245593

best herbal doctor worldwide
4/16/2020 06:24:42 pm

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Matthew Thomas
7/16/2020 02:00:35 pm

I WAS DIAGNOSED OF HERPES/ KNOWN AS GENITAL WARTS ,I SPENT A LOT OF MONEY ON MY MEDICATION TILL A POINT I EVEN LOST HOPE, I WAS SO DESPERATE TO GET BACK TO NORMAL, I NEVER BELIEVE IN HERB BUT, I KEPT MY HOPE ALIVE, I CONTACTED ROBINSON BUCKLER VIA HIS EMAIL, HE REPLIED, THEN I PURCHASED THE HERBAL MEDICINE,HE SENT ME THE HERBAL MEDICINE THROUGH COURIER SERVICE, WHEN I RECEIVED THIS HERBAL MEDICINE I USED IT FOR 2 WEEKS AND NOW I AM TOTALLY CURED LIVING FREE AND HAPPY AGAIN, CONTACT HIM VIA EMAIL_______________________Robinsonbuckler {@} yahoo. com…..,,,

((Relationship Problem))
((Hepatitis B and C))
((Herpes))
((Cancer))
((Infertility))
((STROKE))
((Erectile Dysfunction))________________________

Nora Gurun
10/10/2019 08:36:20 pm

HSV1 & HSV2 Negative.
Saying that, herpes virus is not curable is because you have not seen the right person to help you get rid of the virus. I testify because it's only someone who have experience this virus that konws what it means to be in this situation. After my marriage to Loe my hubby, i noticed one day that I had sudden Cold Sores in my genital part. I went for test and the doctor confirmed me being HSV2 positive.
I felt my life and happiness with my hubby was finished. But to my greatest surprise my husband had contacted this virus and was later confirm HSV1 positive. I started noticing symptoms like cold sores, sore throat, fever blister, weakness of the body, runny nose, cough and finally the was a serious Outbreak. So I started looking for a remedy to our situation because the phamacytical drugs and the pains was too much for I and my hubby. I was looking for remedy online and different website when i saw a testimony about Dr. Akintunde and the herbal medicine that helped Erica to get rid of HSV2, I remembered my doctor told me the is no cure to this virus, I had to contact Dr. Akintunde on his WhatsApp number and told him about us and the virus, he promised to cure this virus with his herbal medicine. And he prepared four bottles of the herbal medicine and send to me through UPS delivery with instructions on how to take it. And only first week of my start, I noticed the outbreak and all the symptoms was off so, I told Dr. Akintunde about it and he said the medicine will eradicate the virus and boots my immune when i complete my medication. After I took the medicine I went back for retest and my doctor was surprised with my new status HSV2 negative my hubby also was cured. Thanks to Dr. Akintunde I am proud to say you safe our life and we remain greatful and we support your mission on humanity Sir, Do you experience such too?
Tell Dr. Akin your health problem and be sure of total cure with his natural roots and herbs. Like Erica did testify to me I also testify for everyone who need help to be free from this inconveniencing virus, and any other health challenges you're having is curable believe me. All the best.
Dr. Akintunde email and WhatsApp number below.
Via email:-
drakintundehomecare@gmail.com

WhatsApp number:. +2347035245593

williams pater
6/30/2020 01:57:17 am

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Comments are closed.

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