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Jerry Avorn, MD, Professor of Medicine, Harvard Medical School, Co-founder and Special Adviser, NaRCAD, Author, “Rethinking Medications: Truth, Power, and the Drugs You Take.” Tags: Evidence Based Medicine, Jerry Avorn Photo: Tim Gouw, via Unsplash For twenty years, I gave an end-of-year talk to members of our growing Division of Pharmaco-epidemiology (DoPE) at Harvard, the birthplace of NaRCAD. The other day, because we are about to be evicted from our offices to make way for programs that will generate more clinical revenue, I was cleaning out some old boxes whose contents spanned decades of my career, and found the following document. It was the text of a talk I gave to our faculty and staff exactly ten years ago, in December of 2015. Like now, that was also a time of stress; our work was often stymied by a staunchly conservative Congress that took every opportunity to limit federal spending, including for medical research. (Sound familiar?) But DoPE and NaRCAD were blossoming, and back then I tried to offer the group some solace based on the insights of a wise old man who had recently died. I hope this brings a smile to your face in this new stressful time. Feel free to circulate it to colleagues, friends, and family – especially the last paragraph. –JA December, 2015 Dear colleagues, Season’s greetings. Mentoring has always been an important value in our Division, and one reason our research has gone well is that members of our group nurture one another so effectively. I never really had a mentor of my own; the closest I came was a vicarious relationship with someone I never met, baseball star Yogi Berra, even though I have absolutely no interest in baseball. Berra died earlier this year [2015], and upon his death USA Today published a collection of his most famous quotations. His words can provide some perspective as we look back on our challenges and accomplishments of the past year, and look forward to our work in the next. It's not widely known, but Berra made several keen observations about epidemiology and the documentation of clinical choices: “You can observe a lot by just watching.” “If I hadn't believed it, I wouldn't have seen it!” He warned us of the need to be cautious about projecting our findings onto new outcomes, a problem I've previously described as "premature extrapolation": "It's hard to make predictions, especially about the future.” But to be fair, like too many of us he wasn’t always so precise in his quantitative analysis: "Baseball is 90% mental and the other half is physical.” "You better cut the pizza in four pieces, because I'm not hungry enough to eat six.” Yogi liked to reminisce about his early career, reminding me of the initial days of our own programs before academic detailing and pharmaco-epidemiology were respected fields, and before we had so many talented collaborators: [on the 1973 Mets]: “We were overwhelming underdogs … and we made too many wrong mistakes.” A fine group of smart young people joined our programs when they were just starting out, including NaRCAD’s Mike Fischer. Each year, more and more bright newcomers join our movement: "It's like déjà vu all over again.” So that now, “We have deep depth.” Our programs have brought together physicians, pharmacists, nurses, other clinical professionals, epidemiologists, and health services researchers, among other disciplines. Some of you are two or three of these at the same time. Yogi could have been referring to many in the field when he said of one player, "He hits from both sides of the plate. He's amphibious.” Berra anticipated our interdisciplinary work groups when he told his players, "Go and pair up in threes.” In these difficult times for health care in general and for academic detailing in particular, it helps to remember this advice: “Somebody's gotta win, somebody's gotta lose. Don't fight about it. Just try to get better.” Many interdisciplinary groups have trouble making this work, as Yogi explained about one gathering he attended: "It was impossible to get a conversation going, everybody was talking too much." Today, our funding is harder to get, and budgets are more constrained than ever. In his words, "A nickel ain't worth a dime anymore.” We can get frustrated that it sometimes takes several tries to get much-needed support for our activities. So it helps to have this attitude: "Slump? I ain't in no slump… I just ain't hitting.” "I never blame myself when I'm not hitting; I just blame the bat. If it keeps up I change bats. After all, if it isn't my fault that I'm not hitting, I can't get mad at myself.” He advised us to relax into our work: "You don't have to swing hard to hit a home run. If you've got the timing, it'll go.” And he offered perhaps the wisest insight for anyone in this line of work: "You've got to be very careful if you don't know where you're going, because you might not get there.” Berra also had good advice for those of us who are more senior: "If you ask me anything I don't know, I'm not going to answer.” And for those of us who are getting on in years, this suggestion: "Always go to other people's funerals, otherwise they won't come to yours.” There was this on being humble and not resting on your laurels: "Even Napoleon had his Watergate.” We all have our skills and our flaws, as Yogi understood: "So I'm ugly. But I never saw anyone hit with his face.” I should wrap up this short talk now. It's December, and the days are getting shorter, as he observed: "It gets late early out here.” Pharmacoepidemiology and academic detailing have come a long way from their first origins back in the 1980s. Now the field has many more participants… perhaps too much so! As Yogi said about a popular nightclub, "No one goes there anymore, it's too crowded.” We’re closing out a difficult year of 2015 and there’s no guarantee that the next one will be any easier: "The future ain't what it used to be.” But as we move together into the coming year, let’s remember one of Yogi's wisest and best-known aphorisms: "When you get to a fork in the road, take it.” That advice wasn’t as goofy as it sounded. I’m told he lived at the top of a hill, and the road to get to his house divided into two branches, both of which ended up at his door. So there was good advice there, both geographically and spiritually. Finally, as Yogi said at a commemorative event to honor him, "I'm a lucky guy and I'm happy to be with the Yankees. And I want to thank everyone for making this night necessary.” As for me, I'm proud to have had the privilege of working with you all throughout 2015, and I look forward to the coming year, with all the ups and downs it will bring. As we confront the stresses of the moment, let’s remember one of Yogi’s most famous insights: "It ain't over till it's over.” December 2025 postscript : Striking a blow for evidence-based medicine: NaRCAD and DoPE continue to work hard to improve prescription drug use, but suddenly those values seem to be drowning in chaos at the national level. I’ve tried to bring some sanity to these issues in my book “Rethinking Medications,” and will be donating a portion of its proceeds to charity. So I’m not embarrassed to ask you to consider giving it as a gift to family, friends, and colleagues. That could help spread a bit more understanding of how all of us – patients, clinicians, policymakers, regular citizens – can use science and not ideology to guide the way we regulate and use medical interventions. And it has a whole chapter on academic detailing: Chapter18, ‘Better Signals.’ More information is at www.RethinkMeds.info. Warm wishes for the holiday season, and for a healthy, fulfilling, and less deranged new year. –Jerry A. Biography.
Jerry Avorn, MD, Co-Founder & Special Adviser, NaRCAD Dr. Avorn is Professor of Medicine at Harvard Medical School and Chief Emeritus of the Division of Pharmacoepidemiology and Pharmacoeconomics (DoPE) at Brigham & Women's Hospital. A general internist, geriatrician, 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, particularly in the elderly. Read More. Podcast 21: "Pathways of Collaboration and Communication: Breaking Down Silos in Addiction Medicine”11/26/2025
An interview with Christine Fishman, RPH, MPH, Academic Detailing Lead, MetroHealth
A good detailer has their finger on the pulse of what a frontline clinician really needs.
This episode's guest speaker, Christine Fishman, RPH, MPH, Academic Detailing Lead, works at MetroHealth in Ohio, and she shares her insights about the ways in which knowledge, rapport, and service all help frontline clinicians to provide the best care for their patients who have substance use disorder.
Looking at the necessity for strong relationship-building within a hospital system, Chris discusses the critical importance of humbly admitting when you don't know the answer; showing up consistently for clinicians who are overwhelmed with the unique needs of patients struggling with SUD; and igniting practice transformation in the field of addiction medicine. Chris shares insights about the key skills needed to make an impact in our field. Most importantly, she highlights the fact that being an expert in addiction medicine isn't the key characteristic of a successful detailer. Instead, it's understanding the challenges a clinician faces in terms of their clinic workflow; navigating gaps in resources or tools; and clinicians' needs for technology that makes it easier to identify vulnerable patients requiring specialized care or treatment. Perhaps most important of all is the key role a clinical educator plays in providing compassion, empathy, and encouragement as clinicians face daily stressors, both expected and unexpected.
Click here for the audio transcription. Learn more about Christine's work at NaRCAD's June 2025 Summit Session: "Integrating Navigators into AD in the ER: The SUN Program at MetroHealth to Better Support Patients with Substance Use Disorder" Slide Deck PDF | Video Recording.
Biography.
Christine Fishman, RPH, MPH, Academic Detailing Lead MetroHealth Christine Fishman began her healthcare career in 1998 working as a pharmacist, serving patients in communities throughout Ohio and Michigan. She earned her Bachelor of Science in Pharmacy from the University of Toledo. While taking a break from her pharmacy practice to focus full time on raising her three children, she became increasingly alarmed by the worsening opioid crisis. Determined to be a part of the solution, she shifted her focus to serving the community and earned her master’s in public health from Kent State University in 2020. She was hired to pilot and lead the AD program at the MetroHealth System’s Office of Opioid Safety almost five years ago and is here to share insights and lessons learned. Christine is currently working to earn her PharmD from the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of Colorado.
An interview with Mike Fischer, MD, MS, Director & Founder, NaRCAD
When our community comes together, we get back to the essence of why we do the work we do: building trust with clinicians and their patients.
Join us as we chat about the magic of our annual international conference, with this year's 13th annual just around the corner. You'll hear from our director and founder, Mike Fischer, about the importance of this annual event, a sneak peek of what's on the menu, and what the bottom line of good detailing and relationship-building is all about: trust. Stay tuned 'til the end for an opportunity to get free registration at this year's event. "We have people from all different parts of the country [...] from city health departments, state health departments, private healthcare systems, nonprofit organizations that promote health topics, rural health departments...each of them is going to have a unique story to tell about how they do academic detailing." Jerry Avorn, MD, Professor of Medicine, Harvard Medical School, Co-founder and Special Adviser, NaRCAD, Author, “Rethinking Medications: Truth, Power, and the Drugs You Take.” When I was younger, I used to think "provenance" referred to a lovely part of southern France, or maybe to a divine presence that was watching over us all the time. Then I learned it actually means the source of something: a work of art, a book, perhaps an idea. And that such provenance has two key dimensions: how rigorous is the information on which it’s based, and who is trying to purvey that art or idea to a potentially unsuspecting customer. For decades, my colleagues and I – at NaRCAD, Alosa, and throughout the global academic detailing community – have obsessed over issues of provenance in trying to develop the very best messages we could about the benefits and risks of medications: Where was that study published? Who did the work? And by far the most important: How rigorous was its methodology? Like-minded evidence synthesizers around the world would focus on confidence intervals, effect sizes, control groups, and clinical implications, trying to boil down these complex and often delicate ideas to help busy clinicians do the best job they could in making therapeutic decisions for and with their patients. Then came 2025, and the nation went through the looking glass. Legally constituted laws were overridden, constitutional rights were no longer sacrosanct, official budgets turned out to not really be budgets after all. In our world, some of the most basic principles of medical science describing the effectiveness and harms of medical products got tossed aside at the highest levels of government. In statements that would have seemed familiar to George Orwell, in discussing topics from vaccines to mifepristone federal and state officials could in fact declare that 2 + 2 = 5. We should have seen this coming years ago, when a presidential spokesperson introduced the toxic concept of “alternative facts,” or the nation’s most widely-watched news channel got caught repeatedly lying about imaginary plots to rig voting machines. Truth just isn’t what it used to be. For our community of academic detailers, that’s a problem, and an opportunity. As we’ve seen, autism has become a focal point for medical product disinformation. Citing a very thin evidence base that none of us would consider reliable, senior administration officials recently declared leucovorin to be a promising treatment for this challenging condition. And the chief of the nation’s health apparatus, with no training at all in science, continued to claim that vaccines cause that condition, while the President himself blamed it on a mother’s use of acetaminophen during pregnancy – a contention that was as cruel as it is baseless. This is what medical risk-benefit communication has come to in 2025. Paradoxically, this loss of respect for rigorous evidence comes as both bad news and good news for evidence-based academic detailing. Bad news, of course, because overworked primary care clinicians now have to spend precious time they don’t have on new conversations like, “No, Mrs. Jones, little Jimmy’s autism is not your fault,” and explaining that mifepsristone is an effective way to terminate a pregnancy, and vaccines are among the safest and most effective treatments we have to offer, even if the Surgeon General of one state (Florida) is now moving to abolish mandates for their use in children. The situation at present is much healthier in countries where evidence-based medicine and unbiased educational outreach aren’t at risk of being mowed down by demagoguery and autocracy-defined science. But even our international colleagues shouldn’t become too complacent; a year ago I never would have expected these grotesque distortions to have become entrenched so quickly here, either. So where’s the good news? The current chaos makes what we do even more vital, and even more precious. Just as sources of nutritious food and clean water are most needed when people are hungry and surrounded by contaminated slop, a pure source of information untainted by ideology or junk science is even more valuable when people are getting constantly spammed by medical untruths. If it ever were to happen that randomized double-blind trials (an increasingly quaint concept) do one day show that leucovorin cures autism, I know our academic detailing community would be out there educating people about its proper use. And if there is solid epidemiologic evidence that perhaps healthy young people don’t all need constant Covid boosters (which may well be true), we’ll be out there saying that too. Unlike our leaders in Washington, our academic detailing programs will continue to encourage evidence-based medical policies, not policy-based medical evidence. As NaRCAD has been saying for years, we’re just ambassadors of the best data, wherever that leads. And at a time of rampant disinformation, that will be more important than ever. Read more of Jerry's recent media pieces here: "Corporate support cannot make up for threats to the NIH budget: Pharmaceutical money comes with strings" Stat10 | October 22, 2025 WBUR's OnPoint Podcast: Will TrumpRx Actually Lower Drug Prices? On Point with Meghna Chakrabarti, featuring Jerry Avorn, MD | October 16, 2025
A conversation with Vishal Kinkhabwala, MD, MPH, Training Consultant & Expert Facilitator
Being a successful detailer is about so much more than conveying good evidence, or reaching the most clinicians.
Come and chat with Vishal Kinkhabwala, MD, MPH, a Training Consultant and Expert Facilitator at NaRCAD, as he drops wisdom nuggets about the importance of camaraderie, deep listening, being of service, building rapport, and approaching clinicians as "just a new friend I haven't met yet." Vishal shares his experiences as a detailer in the area of infectious disease prevention, his tips for building relationships, and the importance of true presence, not "acting like you're listening." A great episode to tune into for new and veteran detailers alike, and anyone who wants to learn more about the impact of 1:1 clinical outreach education visits in clinicians' own frontline environments. "And I think that's [...] one of the beautiful things of this, because at the end of the day, [...] you both leave a little more enriched, because the clinician you're talking with can leave with a little less heaviness, because they were able to share this with you. But at the same time, you've gained a much deeper understanding into the mind of what a clinician is looking for, [...] and how I, as a detailer, can fill in these gaps even further." Click here for the audio transcription.
Biography: Learn more about Vishal on the Our Team Page.
A conversation with Paul Fanikos, RPh, MPA/HA, COO, Alosa Health, hosted by Bevin Amira, Deputy Director, NaRCAD
Making sure older adults receive a holistic, evidence-based approach to care: learning from Alosa Health.
On our August 2025 episode, we chat with Alosa Health's COO, Paul Fanikos, RPh, MPA/HA, about all things detailing, with a focus on Alosa's recent campaign to support older adults, their providers, and their caregivers in managing the challenges of dementia and Alzheimer's with care, compassion, and connection to the best evidence, resources, and community supports. Paul shares his insights into the importance of caring for older patients with such complex needs by recognizing that their clinicians and caregivers have equally complex challenges. Tune in for a conversation that highlights a critical detailing campaign that expertly bridges the best guidelines for care with the humanity, patience, and kindness that must be present when supporting older patients who need memory care.
"And then what we DID notice, most importantly, were the caregiver resources for patients and also aligning them to local resources that are inexpensive or low cost. And that was something that was incredibly valuable to prescribers and their offices and others, and obviously families. It's a tough disease. It progresses. And to do that in a way that's with dignity for older adults."
-Paul Fanikos, COO, Alosa Health
Host: Bevin Amira, Deputy Director, NaRCAD
A conversation with Zack Jenio, Program Manager, Mile High Behavioral Health/"Dr." Zacharina Jenny-hoe, Drag Queen For patients who don't feel safe inside the clinic,
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A conversation with Alexandria Stevenson, MPH, Academic Detailer, Florida Department of Health in Broward County.
Tag: Podcast Series, Harm Reduction, Opioid Safety
How can meaningful conversations impact the opioid crisis?
Academic Detailer Alexandria Stevenson from the Florida Department of Health in Broward County discusses her team’s important work on opioid safety and overdose prevention. Funded by the CDC's Overdose Data to Action Local Grant, Alexandria shares how her team collaborates with clinicians and community partners to promote harm reduction, distribute free naloxone kits, and educate the community.
(Click here for the audio transcription.)
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"So often I'll hear comments and stories from attendees at our presentations or at community events about someone they know or how something I explained changed their way of thinking. That’s my goal with community events and detailing — to truly connect with people." -Alexandria Stevenson, MPH Academic Detailer Florida Department on Health - Broward County |
This year's event takes creative AD approaches to the next level. AD programs from across the globe will share their important work on myriad topics, from opioid use disorder to gender-affirming care; from preventing detailer panic to encouraging clinician use of person-first language in support of patients who deal with highly-stigmatized conditions. You can take a peek at our agenda here and see what we've got planned for you!
We'll also be exploring key adaptations to the model itself. Successful programs will share their innovations in delivering detailing sessions to alternative target audiences, branching out beyond frontline clinicians to community-based organizations who also play a key role in supporting patient safety. Want to move around during your breakout? You'll get a chance to try medical improv with seasoned detailers who are also experts in the world of theatre! And our Global Perspectives session will feature successes and diverse approaches to AD from our colleagues in Japan, Norway, and Canada.
And we'll be leading the charge in keeping the energy of excitement alive as we all prepare for the year ahead--2025 will be packed with opportunities to learn new approaches to clinical outreach education, train your team in the nuances of persuasive communication, and build new relationships with clinicians who need your expertise to provide the best evidence-based care to the patients who trust them.
See you in six weeks!
Bevin K. Amira
Deputy Director, NaRCAD
*Be the first 15 blog commenters below and win a free registration to the in-person event!*
A conversation with Debra Rowett, PSM, BPharm, Adv Prac Pharm, FPS, Advanced Practice Pharmacist, Drug and Therapeutics Information Service
Tag: Podcast Series
What lessons can three decades of AD teach us about adapting to change?
Hear from Debra Rowett, an advanced practice pharmacist and academic detailing leader in Australia for over 30 years. Deb shares the origins of AD in Australia and how it has evolved to support health professionals across various therapeutic areas. She discusses the importance of building trusted relationships with clinicians, particularly in rural areas, and how her team has adapted to challenges through the years. Deb also highlights the future of AD, emphasizing co-design, collaboration, and the role of technology. Don’t miss her insights on how AD continues to evolve and make a meaningful impact on patient care.
(Click here for the audio transcription.)
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"The future of academic detailing lies in co-design—working hand-in-hand with clinicians to shape the programs and solutions that best meet their needs." -Debra Rowett, PSM, BPharm, Adv Prac Pharm, FPS Advanced Practice Pharmacist Drug and Therapeutics Information Service |
Want more? Follow us on Spotify!
Tags: ADvice, HIV/AIDS, Sexual Health, Gender-Affirming Care
In this edition of our AD-vice series, we delve into the critical role of community partnerships, approaches to address stigma, and evidence-based practices in HIV prevention and sexual health, empowering clinicians and patients to work together to make informed health decisions.
- “We send out a Weekly Special [newsletter] with a buffet of options on new evidence and information related to HIV prevention and care. We’re creating an active and robust network of professionals!” – Rocko Cook, DISH-AZ
- “It’s important to build a relationship with your state’s health department leadership and obtain an official endorsement letter from the state supporting your activities. Establishing a relationship not only positively impacts your program’s visibility and ability to gain access to clinicians, but it also helps to make sure you're aware of other outreach initiatives.” – Ashley Allison, Oregon AIDS Education and Training Center
- “When I'm talking to providers, one of the things I hear most is, ‘I wish I had other providers to talk to about gender-affirming care.’ A big part of what we do with academic detailing is connect other providers together.” – Ryan Anderson, DISH-AZ
- “Whenever I address something uncomfortable with a provider, stigma or otherwise, I try to create an environment where we can work collaboratively on the issue and the provider feels as though I am a resource for them.” – Jess Alward, MS, State of NH
- “In order to talk about PrEP, you first have to talk about risks for HIV, which often means talking about sex. I think there can be discomfort on both the patient and provider side, and sex is often still a stigmatized topic. There are also overarching resource barriers, including the fact that clinicians are extremely busy and have to address competing health needs in the primary care setting.” – Alyson Decker, NP, MPH, San Francisco Department of Public Health
- “All clinicians and staff need to be able to communicate with patients in a sex-positive way and in a way that connects with patients’ specific experiences, identities, and needs. They need to be comfortable communicating about sexual behavior, testing, and PrEP.” – Rocko Cook, DISH-AZ
- “Racial and ethnic minorities continue to be underrepresented in PrEP utilization and overrepresented in new HIV diagnoses, and I want my work to contribute to correcting this. I think PrEP can be a tool for health justice and being part of that is valuable to me.” – Mary Nagy, MPH, RN/BSN, Michigan Department of Health and Human Services
- “Providers were asked which supports would best help them to incorporate PrEP into their practice, and ‘education’ was by far the most frequent answer. In addition to the research I’ve seen indicating detailing is an effective intervention to change provider behavior, it's clear that the providers themselves agree that education is important.” – Mary Nagy, MPH, RN/BSN, Michigan Department of Health and Human Services
- “There are many places where 1:1 visits aren’t feasible due to clinic structure or culture. If I’m able to detail to a small group, it can be a way to meet with a few providers and gain insight about how PrEP might be incorporated or enhanced in their setting.” – Alyson Decker, NP, MPH, San Francisco Department of Public Health
Best,
The NaRCAD Team
Podcast Episode 7: "From Disparity to Equity: Public Health Detailing as a Tool for Change"
8/26/2024
A conversation with Jacki Travers, PharmD, Clinical Pharmacist, Pharmacy Management Consultants
Tag: Podcast Series, Cardiovascular Health, Diabetes
How can we ensure that community partnerships are front-and-center in improving patient health? Pharmacist, detailer, and trainer Jacki Travers shares insights into a five-year collaboration with the Oklahoma State Department of Health aimed at reducing health disparities related to diabetes and cardiovascular disease. This project empowers local populations by partnering with safe spaces at the heart of communities, inviting libraries, faith-based organizations, and community health workers to work in harmony with detailing to reduce health disparities and increase patient access to care, resources, and support.
(Click here for the audio transcription.)
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"The reach of detailing is so much stronger when we get those community linkages in place. I cannot emphasize that point enough. We're stronger together for sure." - Jacki Travers, PharmD Clinical Pharmacist Pharmacy Management Consultants |
Since earning her Pharm.D. degree from the University of Oklahoma, she has served in the practice settings of independent, hospital, and clinical pharmacy. She currently develops detailing materials, delivers detailing services, and analyzes program results for multiple topics as part of a statewide plan. Her program efforts focus on bridging the gap between information and application in order to provide quality health care in a fiscally responsible manner.
Highlighting Best Practices
We highlight what's working in clinical education through interviews, features, event recaps, and guest blogs, offering clinical educators the chance to share successes and lessons learned from around the country & beyond.
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