Harvard Catalyst Profiles

Columbia University , New York	B.A.	1969	psychology, pre-med
Harvard Medical School, Boston	M.D.	1974	medicine
Cambridge Hospital , Cambridge		1975	internal medicine internship
Beth Israel Hospital, Boston		1977	internal medicine residency

My work has focused on (a) defining patterns of medication use by physicians and patients, and the outcomes of such use; (b) quantifying the benefits, risks, and cost-effectiveness of specific drugs to help build an evidence-base for rational prescribing; and (c) developing, implementing, and rigorously evaluating innovative educational approaches to improve prescribing practices.

I have addressed these problems in several complementary ways, including: (1.) developing new methods for computer-assisted analysis of large population databases to study adverse drug events, patient non-compliance, and patterns and predictors of physician prescribing practices; (2) creating new approaches to teaching physicians about optimal drug use, testing these approaches in randomized controlled multi-site studies, and then implementing such programs on a wide scale; (3.) measuring the effect of health care system changes on physician prescribing and patient outcomes; and (4.) conducting cost-effectiveness analyses of specific medications. My group was among the first to use large-scale electronic medication-use and clinical datasets to study drug utilization and outcomes, and patient adherence.

An educational method I developed, known as "academic detailing," applies social marketing theory to provide evidence-based educational outreach to physicians in order to improve prescribing. This intervention develops critical reviews of the literature on drug efficacy, safety, and cost-effectiveness and disseminates this material using the effective adult-learning and behavior-change strategies that have been employed by pharmaceutical companies to change physicians' prescribing practices. We have documented the effectiveness of this method in randomized controlled trials involving hundreds of physicians in primary care, nursing homes, and teaching hospitals. These studies have demonstrated this to be an effective way to educate clinicians about rational prescribing and improve medication use. My initial work has now been widely replicated and adopted by large health care systems and governmental health services in the U.S., Great Britain, Canada, and Australia, and in the developing world.

In 1998 my research, teaching, and clinical activities came together when I established a new Division of Pharmacoepidemiology and Pharmacoeconomics within the Department of Medicine at the Brigham and Women's Hospital and Harvard Medical School. In this role, I developed several new research programs to define patterns of medication use and outcomes, study the regulatory science aspects of medication approval and use, and create innovative educational interventions that teach physicians about appropriate and cost-effective prescribing. Our division now comprises 24 full-time faculty members and 60 research support staff and trainees, and has become one of the pre-eminent centers internationally in the study of drug safety, methodological advances to improve the validity of observational studies of medication effects, health policy concerning medications, the development of programs to improve the use of prescription drug by physicians and patients, and the training of the next generations of researchers in these areas.