Teaching Clinicians about Drugs: 50 Years Later, Whose Job Is It?

From the New England Journal of Medicine

By Jerry Avorn, MD

SUMMARY: In this NEJM Perspective, written on the 50th anniversary of US legislation that transformed prescription drug approval, Dr. Avorn examines the still-unresolved question of who should be responsible for teaching clinicians about drugs. In 1961, the FDA gained authority to require proof of efficacy, creating a new need for authoritative, evidence-based drug information to reach prescribers. Half a century on, the pharmaceutical industry remains the dominant provider of drug education to physicians — through sales representatives, sponsored continuing medical education, and journal advertising — despite evidence that industry-sponsored education shapes prescribing in ways that serve commercial rather than patient interests. The piece traces the history of academic detailing as an alternative model and argues that this question has never been more urgent.

BACKGROUND: Legislation in 1961 transformed US prescription drug approval by requiring proof of efficacy and creating a regulatory basis for modern pharmaceutical oversight. It also raised — but did not resolve — the question of who should educate clinicians about drugs.

KEY FINDINGS: Half a century after the 1961 legislation, the pharmaceutical industry remains the dominant provider of drug information to clinicians, despite evidence that industry-sponsored education systematically shapes prescribing toward commercial interests.

IMPLICATIONS: The question of who educates clinicians about drugs is critical to prescribing quality. Academic detailing and other independent educational models offer alternatives, but require sustained institutional and policy support to compete with industry's resources.