Sunday, February 27, 2011


Lately, it seems there is ratcheted up rhetoric on nurse practitioner practice making us prime targets for all things anti-NP. The WSJ reports on a study that examined the prescribing habits of NPs and whether there is Pharma influence on those habits. The study found that of the 263 surveyed NP respondents, 93% reported that free gifts had no effect on their likelihood to prescribe the medication that was being detailed by the representative. The study concludes that since many NPs had regular contacts with these reps in the form of face to face and industry backed lunches/conferences, there could be a degree of subconscious influence on prescribing habits - findings that are similar to prescribing habits of our physician colleagues.

As you can see in the comments section that follows the story on the WSJ, some are using this study to once again attack NP practice. The comments are laughable as the insinuation is that NPs aren't really educated on pharmacotherapy and therefore are likely to prescribe whatever medication that the really good looking sales rep sponsoring the free lunch is pushing.

I was curious as to why the author, a nurse practitioner, chose to focus on a fairly volatile topic of Pharma and NP practice. Some searching found that the author, Elissa Ladd, PhD, NP, is out to educate about some of the deceptive practices of Pharma. Here is a YouTube clip of her speaking about this and an on-line interview as well. She serves as the principal investigator of peRx, Prescribing evidence-based therapies. According to the website,

The program was developed to improve awareness of drug development and pharmaceutical marketing practices and to positively impact prescribing behaviors, specifically among advanced practice nurses. An innovative, multi-media, interactive web-based pharmaceutical curriculum has been developed that targets advance practice nurse students and other clinician audiences.

This looks like an interesting program comprised of 4 modules and is sponsored by The Consumer and Prescriber Grant Program. It is available for continuing education credit and I plan on soon completing them.

So here we have a Nurse Practitioner trying to promote evidenced-based practice (that should improve the whole prescribing community practices by focusing on the evidence) yet NPs as a whole are getting slammed as it presents an opportunity to take a shot.

Meanwhile, our NP colleagues (with physicians, patients and our health care allies) in Florida rallied yesterday to garner support for a bill that will allow them to prescribe controlled substances in the state. Florida is currently only 1 of 2 states that do not allow NPs to prescribed controlled substances. The quote that I love goes to Timothy J. Stapleton, executive vice president of the Florida Medical Association:

"Allowing unqualified nurses to play doctor and putting patient safety at risk is not in the best interest of our citizens.”

This one is so easy that it bears no further comment.

As more become aware of nurse practitioner practice, the attacks will also increase. I guess that comes with the territory. It's not really new though as this link to a NY Times article from 1988 referring to the legal recognition of NP practice in New York State also has it's share of opposition. You'd be hard pressed to know it was written nearly 23 years ago since the same arguments remain.


NP Odyssey said...

The Florida bill is a joke. It gives NP's the power to write prescriptions in certain situation in ONLY long-term care facilities. No clinics, hospitals or any acute settings. At a Nurse Practitioners place she wrote about it.

Anonymous said...

I think the whole media hype over pharma dinners and speaking for pharma is completely misunderstood. I would PREFER to hear a expert in that field who has written presciptions for the medication (Physician or NP) speak on the medication. You learn so much more. What they have experienced, who they have used it in, results, etc. Even better the providers who did the study on the medication before it was released. Those are the experts and you get a lot of good information. Not the sales representative who depends on the sale for his/her salary. They come by the office to leave you samples and give you some tips; but, they have no patient experience with the medication. They only know what they are told to say.

Sue Naylor Clark, RN, MS said...

It's interesting that the NP author suggests that NPs may be subconsciously influenced by pharma, and then goes on to tout her work as evidence-based. Conclusions about what MAY be SUBCONSCIOUSLY the case hardly are evidence-based, and methinks more research is in order before conclusions are advanced at all.

As a sidebar, I fully agree with "Anonymous" above, and recently returned from a national symposium where I was struck with the extent and specificity of the requirements placed on MD and APN speakers at pharma-sponsored events, to ensure their objectivity and adherence to ethical standards. Right now I couldn't name the companies that provided my meals, and while I could name some of the drugs, I would need to review them completely before I would be comfortable ordering them . . . which is exactly what I would do with any new product, whether or not it once somehow had been tied to a hotel dinner!

Anonymous said...

The article is actually from 1988, not 1998. ;)

Stephen Ferrara, NP said...

Yes it was from 1988 - thanks for the correction!