Nurse Practitioners: The Next Frontier?

Elissa Ladd and colleagues from Harvard have published a study:
http://www.ajmc.com/issue/managed-care/2010/2010-12-vol16-n12/AJMC_10decLadd_WebX_e358to62

--on attitudes among a national sample of nurse practitioners regarding interactions with the drug industry. We have seen reason to believe that in recent years, physicians have become at least slightly more skeptical regarding industry marketing overtures (http://brodyhooked.blogspot.com/2010/11/are-physicians-taking-fewer-bribesgifts.html). We have also seen some evidence that the industry has increasingly targeted nurse practitioners, who have prescribing privileges (http://brodyhooked.blogspot.com/2008/02/nurses-soft-targets-for-pharma.html and http://brodyhooked.blogspot.com/2007/10/if-you-dont-feed-them-they-wont-come.html). Ladd's group did the first extensive national survey, which was marred by a very low response rate of 9%, though not that atypical of online surveys. If we can assume their sample was somewhat representative, a number of worrisome conclusions emerge:

• 96% have regular contact with sales reps
• 83% think information provided by reps is reliable
• 93% believe themselves uninfluenced by reps' free gifts
• 78% think free meals provided by industry are a good/excellent way to learn about new drugs
• 83% think industry-sponsored continuing education is a good/excellent way to provide reliable education at affordable cost
• 90% think it ethically acceptable to attend industry sponsored meal events
• 75% think it ethically acceptable for speakers to be paid by drug companies
• 61% think taking small gifts and meals is ethically acceptable

If one equates (as I do) considerable doubt and worry related to the influence of industry marketing over medical practice with a high level of professional ethics, then it seems that while we may have made some slow and modest inroads in favor of heightened professionalism among physicians, we still have a long way to go with NPs. As seems quite reasonable, folks like me who bear the dreaded moniker of "MD" are unlikely to be able to exert any real influence; it is up to NPs themselves and nursing educators more generally to take up the cause. It also seems clear that as is usually the case, if the rest of us have been slow to wake up to the concerns presented by NPs and close relationships with drug marketers, the drug industry has been not at all slow to seize the opportunities this presents.

Finally, it is worrisome, as Ladd and colleagues point out, that while the new sunshine provisions of the health reform law (PPACA) require as of 2013 that all payments to physicians be reported, payments to NPs are not included under its provisions.