From investigating pharmaceutical sales tactics to combating asthma, presenters unveiled their innovative public health work at Sunday’s Poster Session. Some drew upon their lived experiences, while others dove into affected communities. Attendees left informed by the latest research in fields related and unrelated to their own.

Combating pharmaceutical sales tactics

Gail Scott changed careers after 16 years as a pharmaceutical sales representative. Her master’s of public health education inspired her to work toward positive change in pharmaceutical marketing. She was a whistleblower in a False Claims Act case against her former employer and testified as a fact witness in the Purdue Pharma opioid lawsuit. Scott’s poster presentation suggested new public policies to combat the pharmaceutical industry’s increasingly sophisticated marketing strategies. 

“A lot of the early part of the opioid epidemic was driven by prescription drug marketing, and I saw it happening as a participant,” she said. 

Scott served as a primary source on the evolution of prescriber targeting in pharmaceutical sales. One newer tactic is the use of advanced data analytics to create in-depth profiles on individual prescribers, even mining data from social media to inform a sales representative’s strategy. Scott suggests regulating data mining and examining purchasing of this data and its usage. Another of her proposals is to mandate a database on pharmaceutical marketing pieces “to crowd-source scrutiny,” she said, by researchers, patient advocates and journalists.

The Physician Payments Sunshine Act created the Open Payments database to track payments made by the pharmaceutical industry to physicians. Prescribing guidelines have historically been heavily influenced by the industry donating money to organizations that influence policy, such as patient advocacy organizations. While payments to doctors are now tracked, it is difficult to detect a conflict of interest in such organizations because there is no open information about how much they are paid, Scott said. She recommends expanding open payments data to include these organizations.

Scott further suggests requiring professional licensing, ethics codes and independent continuing education for sales representatives. She noted that pharmaceutical sales representatives were not required to have a pharmaceutical background. Scott gave an example: One drug that was supposed to work for 12 hours was actually shown to work for only eight hours in a high percentage of people. Scott was focused on selling the drug using marketing materials from her company, but only found out the hours discrepancy from a newspaper investigation.

“Our information comes from biased opinions,” Scott said. “We may believe it sincerely, and I did, but we don’t know what we don’t know because we’re not getting independent information.”

An educational intervention against asthma

Asthma can mean missed school and trips to the emergency department — time wasted by not knowing how to get a child’s asthma under control. Meanwhile, medication adherence is a major barrier to care, with children often not knowing how to articulate their symptoms, said presenter Erin-Leigh Gallop. She presented an educational intervention against asthma that aims to teach parents how to take care of their child with asthma. 

As a mother of a child with asthma, Gallop’s approach focused on “the mother-child dyad,” treating the mother as the primary caregiver. For her dissertation, she developed a tool meant to assess a mother’s knowledge while working on an intervention to predict health outcomes based on a mother’s knowledge. The test consists of 40 true-false questions, but the secret is that all the answers are true. The tool functions as an educational intervention and an assessment.

“We know asthma is the No. 1 reason that children miss school. It is impacting our children’s education; it is impacting their ability to simply draw breath,” Gallop said. “We need to attack it not just by throwing information at people, but by really assessing how much of that information they’re retaining.”

According to Gallop, allergists and immunologists base their health outcome predictions on how much asthma medication they prescribe a child. For instance, a doctor may tell a patient to come back in two months after taking a medication, counting on it being used exactly as prescribed. But they are assuming that the parent knows how to administer the medication and that they know what each medication does, Gallop said.

Gallop’s test can function in tandem with a doctor’s care, offering parents a check-in and translating medical jargon.

Based on this pilot study, Gallop hopes to stratify the test based on severity of symptoms, differentiating between mild asthma and severe asthma. She also wants to shift from the test’s online format to one that engages directly with communities.

Gallop’s work won the Society for Public Health Education’s Graduate Student Research Award in 2021.

Pharmacy partnership for blood testing in Flint, Michigan

Flint, Michigan, drew national attention for the dangerous levels of lead found in the city’s drinking water. Pharmacy student Brittany McMahon presented a model that pharmacies could use for screening people’s lead levels.

For three months, three pharmacies in Flint offered free blood testing for lead. Anyone could walk into the pharmacy, get a finger stick and have their sample analyzed by a Magellan LeadCare II Analyzer in about three minutes. If their lead levels were above the accepted lead limit established by the Centers for Disease Control and Prevention, the pharmacist would refer them to their primary care physician or the public health department. Fifteen of the 77 individuals tested were above that limit.

McMahon noted the importance of increasing access to lead screening because a lot of the patients were minorities who historically had not had access to clean water. The main takeaway was that this method of community testing was highly feasible and took advantage of other models for point-of-care testing already in pharmacies.

A limitation of their study was that no follow-up was conducted to track whether patients with high lead levels went to their primary care physician. McMahon hopes that this service could be covered by insurance or Medicaid, especially in the case of another water crisis in a community.

“Pharmacists are one of the most accessible health care professionals,” McMahon said. “So, by getting patients to come into the pharmacy and ask their questions, they realize that we are trustable people and they can get other testing from us.”

What viewers learned

Two midwife-researchers, Noelene Jeffers and Christina Marea, focused on exploring maternal health posters. Marea was interested in perinatal health inequities and how interventions in health care settings can improve health outcomes.

“I found a couple of cool examples that had similarities to work that I do,” Marea said. “I got to connect with researchers around implementation of doulas, around use of community health workers, and implementation of integrated social support for postpartum perinatal mental health issues.”

The research on use of doulas to improve maternal health care also interested Jeffers, who focused on learning more about maternal health research related to issues of racism and social determinants of health.

Check out the next poster sessions on Monday and Tuesday.

Photo: Erin-Leigh Gallop. Photo courtesy of Kayla Yup.