Who’s been talking to Nurse Jackie?

Pharmaceutical companies are increasingly targeting nurses when it comes to industry-sponsored events.

Although nurse-only events are still uncommon (5% of all events), nearly twice as many pharma-sponsored events in Australia now have nurses present than have GPs.

Research by the University of Sydney, published in JAMA Internal Medicine today, examined four years of industry-sponsored events to 2015. A total of 116,485 events were reported by pharmaceutical companies who were members of Medicines Australia.

Nurses were present at 40% of all events, GPs at 21%, while specialist physicians came in top, at 69%.

Of events aimed at a single profession, 5% included only nurses, 9% only GPs, and 18% only specialists.

Nurse-only events were decidedly cheaper for the sponsors:  The per-person cost was only 39% of the amount spent at doctor-only events. Events where nurses were present were significantly less likely to include a served dinner, or to be held overseas.

So, why is money being spent on nurses, at two in five events?

For an industry whose profits come from prescription turnover, at first glance it seems odd to target a profession that doesn’t prescribe. The exception would be nurse practitioners, but in Australia they account for only 0.005% of all nurses, and were present at less than 1% of these events.

I suspect the industry is aware that nurses have more sway over prescription choices than most doctors suppose. This is particularly so in hospitals, which employ the majority of Australia’s 271,000 nurses.

Quite appropriately, nurses are present at many of the decision-making points in hospitals; from large-scale purchasing orders, to operating theatres (where medical device company reps play an important marketing role), to educating individual patients about pills, puffers and injections.

However, primary health care also involves plenty of drugs that are nurse-influenced, even if not nurse-prescribed. The education of diabetes and asthma nurses is an increasingly valuable area of influence for pharmaceutical and device companies, who sponsor everything from the events to the educators, as well as the overarching bodies who oversee those areas.

Hepatitis is a recent example of where a nurse sub-specialist may know more detail than an occasional GP prescriber, so the industry may see substantial return on their investment. Wound care educational events, where promoted products can cost many times more than traditional products, have long been popular among sponsors.

Broader transparency.

Although recent focus has been around the transparency of doctors and pharmaceutical payments, perhaps similar scrutiny should apply to nurses; particularly those who influence significant purchasing and educational decisions. Transparency doesn’t resolve conflict-of-interest issues, but at least it gives them a good airing.

As the authors suggest in JAMA, “the high prevalence of nurses’ attendance suggests that transparency regulation and conflict of interest management should routinely include nurses and other health professionals.”

This article was first published in Medical Observer, Sept 2016