ndab Ah Yes, Medical School: For Sale: My Soul

Wednesday, October 05, 2005

For Sale: My Soul

Last week, during another one of our Doctoring classes (that class that every medical school has where they try to teach us how to be sensitive, caring doctors informed on relevant medico-psychosocial issues - by the way, can you actually teach a grown adult to be sensitive? If you haven't developed any sensitivity by the time you're in your 20's, are you going to ever? I think you see where I'm going with this.), we had a three hour discussion devoted to Big Pharmacy, that evil seductress in all her tight black leather naughtiness, and how we as (fake) doctors are being manipulated by pharmaceutical companies for their own bottom line at the expense of our patients. Were we responsible for the deaths of patients who received drugs that were not up to par but we still prescribed based on false information given by the drug companies (i.e. Vioxx)? Are we allowed to advocate one drug over another for reasons other than those based purely on drug efficacy? Should we receive gifts from pharmaceuticals, from the smallest pen to the largest free trip to Hawaii? Is it undeniable that the erectile dysfunction drug reps are some of the most ridiculously hot women on the planet?

As you might imagine, not one of these questions was answered (and that last one wasn't even addressed...but it's so true.). In fact, our group spent so much time just trying to define a set of rules that allowed us to receive some gifts and allow some drug rep influence but reject others, that we never really got to any heart-of-the-matter concerns. I walked away from that meeting dissatisfied, yearning for some guidance on how to proceed with the big drug companies hovering over my shoulder like a dark shadow leading me into night. Was that dramatic enough? Anyways, I thought I would explore this topic here, because I think it would be useful for you all to see how easy it is to judge doctors with respect to this topic, but how hard it is to actually deal with the challenge at hand if you're in this position.

Like I mentioned above, finding some sort of middle ground in dealing with drug companies and their attempts to brainwash us into using their products was a pretty futile affair. Our group got so bogged down in different scenarios, with each of us harboring our own opinions, that it was evident no clear-cut rule was to come of this. Given that, it is clear to me that doctors really only have two options, and I'd like to take each option seriously (or as seriously as I can):

(1) Reject any and all efforts by the drug companies to buy us out - By adhering to this philosophy, you must reject any gestures by drug companies to influence your decision-making. This means no free lunches, no free pens, no informative brochures, no funding for drug research to be carried out at academic institutions and, most importantly, no harmless flirting with the female drug reps. Now, any non-medical professionals out there might think this is a reasonable goal to strive for, because after all, we are there for the patients and not anyone else (and, after all, this notion of not accepting gifts works so well in other facets of modern life, like our government). However, even though I've only been in the chaos that is your average hospital for a few months now, I realize how daunting of a task this is to actually achieve. Lets take the "no pens" rule as an example. No pens. Seriously, this seems so easy a retard could do it (wait, what was that thing about sensitivity I was talking about? Oh, whatever.) Seems easy, but picture this scenario (which actually happened): You're the attending physician in a ritzy urology practice. You just finished interviewing a patient, but realized you have no nice pen to document the encounter. Just then, a ridiculously hot woman arrives, rolling a small suitcase full of Levitra goodness behind her. She gives you a kiss on the cheek and offers to skip her pitch because she knows you are really busy. You then realize you are completely out of pens, and kindly ask if you can have one of hers. She offers you the Levitra pen, so futuristically designed that when you press a button, the pen literally mimics a penis going from the flaccid to erect state while revealing the ink dispenser (yes, they actually have these pens). You take the pen, write your note, and mindlessly shove the pen in your pocket, only to find yourself prescribing Levitra over other equal drugs at a later date without even thinking about it. Congratulations, you have just been claimed as sucker #23478925782398547, and you didn't even notice. What point am I trying to make here? You're about as likely to make it through an entire career in ANY medical profession (doctors, nurses, techs, etc.) and be able to withstand even the slightest drug company pressure as I am of convincing a few of my newfound readers that I'm not actually a pervert and that I don't go around giggling, pointing, and screaming "FISH TACO!" every time I see a vagina in an ob/gyn clinic. So this extreme is, quite simply, not a viable option.

(2) Throw yourself at the mercy of the drug companies, latching onto every free piece of crap that you can find - Now we're talking! By adhering to this philosophy, you accept the fact that drug companies are pervasive in their marketing and will not just go away, so the only way you can combat that is by accepting EVERYONE'S crap and ensuring that you can't be biased towards any particular drug because you took free stuff from everyone. Hold onto every Levitra penis pen around. Take every free trip they'll give you. Soak up all the commercials you can*. Hell, you could be even more subversive: take everything you can, and then prescribe no drugs at all ever! (OK maybe that's going a little too far, but as one reader pointed out to me, it's very true that US doctors seem to rely too heavily on pills and less on non-pharmaceutical methods of healing.) Sounds good, right? Wrong. Lets take this a little farther, because you all know this is going to happen eventually as we teeter down this extreme path. Soon the companies catch on that you're just taking their stuff and not actually giving their drugs to your patients over he other company's drugs. So what do they do? Make you look even more ridiculous. I'm talking automated drug reps in patient waiting rooms. Drug logos emblazened all over your white coat, NASCAR-style. And just imagine the day you sink low enough to where you have to start saying stuff like this:

"Please lower your pants and I'll perform the rectal examination. I would like to remind you that this rectal exam is sponsored by the good folks at ExtremeRestraints.com, makers of quality anoscopes used by hospitals and anal fetish proponents worldwide. If you would like to purchase a home anoscope device, please talk to our receptionist outside. I will now insert my finger into your rectum."


Anyways, I hope you are starting to appreciate the bind we're in as medical professionals. I realize that, as patients, you probably still don't care so long as you get the best medical treatment you can without the sense that your doctor has been bought out by some random drug company. But please at least think about these issues, and if you have any bright ideas on how to pursue an even path, let me know. And if you're a drug rep for those erectile dysfunction drugs, I'd just love to hear from you (and hear about your drugs blah blah blah).

*Except for that goddamn Celebrex commercial. I swear every time I hear that jingle I want to break something. Crap, just thinking about it has that song in my head. Nice move.


Anonymous Anonymous said...

Why isn't there a pill for that? The anti-jingle pill.

11:15 PM  
Blogger pj said...

that's really funny. I studied marketing in college and the joke was that all of the marketing faculty and students had no morals.

D'ya know. That's quite true.

Your soul's for sale but mine's like the tatty dregs of the $2 discount bin.

12:57 AM  
Blogger JR said...

very funny blog.... the first thing that popped into my mind when i read that entry was the TV show "scrubs". thanks for a good read.

1:07 AM  
Anonymous Anonymous said...

As an ER Social Worker I find this blog to be good stress relief after I get home from working a long night shift. I am so glad it's not just me that notices how shallow the gene pool is getting in places, and I can appreciate your insights and sarcastic humor! I love the blog, can't wait to hear about your ER experiences, I think anyone who has ever worked in an ER has stories the normal person would never believe.

3:35 AM  
Blogger Ultra Toast Mosha God said...

I'm going with scam to fleece those drug companies for everything you can.

Don't prescribe their drugs to patients, just sneak them out the back door, then shift them at street level. tax free profits baby!

I'm not a doctor, by the way, and my advice should not be taken as medical fact.

err. take prozac!!

5:41 AM  
Blogger Physician Executive said...

Using ' professional ' and Medicine in the same sentence is somewhat of an oxymoron.
Doctors, dear boy, barely rise to the level of a ' trade '.
Most tradespeople such as electricians, carpenters, plumbers, etc. will leave the job with a reasonably good functioning product to show for the money spent.
Can the Medical Guild say likewise?.
Not even to the level of a trade do medical doctors rise. >> The Doctor.

5:44 AM  
Anonymous Anonymous said...

Is this the way it really is?

6:48 AM  
Blogger High Power Rocketry said...

Maybe its not the best thing to mix big business and corporations with health care. Maybe it should be about the top care, rather than profits.


7:13 AM  
Blogger Jonathan said...

Enjoyed reading your post! As an intern in internal medicine (going into anesthesiology), I've actually leaned toward your former option. No drug rep dinners (no matter how fancy the restaurant), no gifts, no pens. I bought a 20-pack of nice click-pens from Sam's so I never run out.

At the same time I recognize the good that pharmaceutical companies do, as well as the necessary task of educating physicians about new drugs. I think learning to read the literature critically goes a long way in discerning scientific research from disguised propoganda. Your medical school will hopefully help you with this.

And "Physician Executive's" comment made me smile. It seems to be written from an internist's perspective, where all too often the patient is sabotaging the advice and efforts of the physician with his or her diet and lack of exercise. However, to see a patient revived from a code, or even something as simple as a life-saving appendectomy, definitely raises my respect for medicine as a trade!

7:38 AM  
Blogger Lauren said...

Thanks to Sheri at http://daysofdeerledge.blogspot.com for sharing your blog with me. I've laughed, I've cried, I've oredered my ana... never mind...

My rheumatologist's office has a catered lunch every single day of the week sponsored by drug companies. I've resisted her push to get me on Plaquenil -- I'm guessing that's who provides the lunches! Maybe if she'd INVITE me to one of the lunches, I'd acquiesce.

Anyhoooo... love the blog! Keep it up!

8:10 AM  
Anonymous Anonymous said...

Well I alway know that drug people were trying to by all doctors out. Only in my mind to I call those doctors that have sold out Drug pushers. I hope you can find the answer you are looking for cause I have no ideas in which to help you with it.
Much luck to you and thanks for caring,
a friend

8:34 AM  
Blogger Chackler said...

I want a penis pen.

8:37 AM  
Anonymous Anonymous said...

Please, please, please give serious consideration to a career in restaurant management, or as a tour guide. I'm sure there are some wonderful places where you would fit in, but quite honestly, if you are not sensitive, you don't belong in the medical profession. If someday you get a cancer diagnosis, you will learn what I mean, but in the meantime, please, please, consider restaurant management.

9:33 AM  
Anonymous Anonymous said...

I take their pens and their food, and I even have a Viagra tie (it's awesome!). The key is that when you interact with a drug rep you are not the buddy or pal, you are their livelihood. They are going to say whatever they must say to get you to use their product. If one is able to display a little critical thinking (like Jonathan mentioned) it would help you untangle the fact from fiction.

As far as ED drugs go, you should tell your patients to drop 10 pounds and get control of his diabetes before you'll give him any Viagra/Levitra/Cialis. I guarantee he'll lose 15 pounds and become a blood sugar Nazi, and then Mr. Happy will come out to play on his own and you won't even need the drugs! It's all about proper motivation...

9:36 AM  
Blogger tim andren said...

The side effects of Celebrex jingles are nausea and discharge.

9:56 AM  
Anonymous Anonymous said...

i concur with jonathon. as a student working on a doctorate in public health, i have accompanied physician friends to numerous drug advertising dinners where they present carefully selected research findings.

there is usually the homage to the god of all - a statistically significant finding - however, there is no discussion as to the limitations of the study (not all the research presented is on randomized trials).

i realize medical schools have a lot to cover, so if they don't get to it themself, please do take the time to learn and practice critically reviewing scientific literature!!

FANTASTIC BLOG -- please continue this into residency!

11:18 AM  
Anonymous Anonymous said...

You arent the only one they are after. I am in grad school for Clinical Psych and they hunt us down too... and we can't even write scripts! Free lunch, hell yeah. Ask someone to get on your drug? Give me another free pen and I'll think about it. Great blog, by the way. It is a great distraction between clients.

3:11 PM  
Blogger Erin said...

I love those pens!!!!! Yup, I'm such a pharma rep whore.

That being said, I have lots of opinions on this matter (which perhaps I should post to my own blog) but in short: advertising is a fact of life. We wouldn't ever know about new drugs unless someone advertised them. Drug companies need to get out the word. I think pens and sponsored lunches are a fairly minimally invasive form of advertising. But doctors need to be responsible about their choices, actually listen, and not just take pens and lunches (like I do..bad medical student, bad!) and then next time they come across an ED patient write a Levitra scrip happily just because they have the coolest pen. Drug reps do good and bad things; good = nifty free stuff, food, eye candy...sorry, I guess I should say good for the patient = provide useful information to physicians on new products and new developments, provide samples that can help (when used appropriately) to save people money. But on the bad side, they do have the effect of biasing doctors. I think ignoring them completely would be a mistake, taking away important learning opportunities and business interactions (not to mention, as you point out, impossible); but then again, if you're completely incapable of not being swayed by a pretty face and a sexy pen, maybe you should...

3:12 PM  
Blogger Erin said...

This comment has been removed by a blog administrator.

3:13 PM  
Blogger Anika From Darwin said...

You are a great writer!!! I love this blog! Keep up the excellent work and I love the fact that you refer to yourself as a fake doctor, absolutely hilarious!!!

I want one of those penis pens too!!

4:26 PM  
Blogger Pippa said...

There is nothing wrong with Drug Company Freebies. If you are in Oncology and you work with drug companies to develop new treatments for otherwise hopeless cases, as a recruiter you need to be informed as to what dose to use, how effective it is and how it differs from alternative treatments available on the market. So a free trip to an international conference to present a paper on you findings does not compromise your integrity.

Nor does it compromise your integrity to accept every free pen on offer along with the goody bag of stress balls, post-it notes and funky paperweights. do you feel that you really would be inspired to prescribe a drug merely because you are carrying around a pen? that is extraordinarily unlikely especially if you are aware that another treatment is more efficacious.

The argument that you become a mindless zombie to the pharmaceutical companies merely assumes that as a doctor, you are greedy and have no free will. Take a look inside, are you really that shallow, and grasping? It is such nonsense if you are a good doctor you will continue to be so whether or not you get a trip to Paris, you just might be a little less morose if you don't have to self-fund symposiums that help you keep up to date with the latest treatments.

5:15 PM  
Blogger Reese The Law Girl said...

Wow, you guys would sell your soul for a pen? Take a cue from us lawyers- sell your soul for lot's of money instead. At least then, you're getting the most mileage out of your soul.


7:36 PM  
Blogger kashyapp said...

i agree with mekheieh that advertising is an unescapable aspect of life, whether one is a physician or not. however, it is crucial to learn to evaluate the quality and biases of the information reps are attempting to feed.

most importantly, i don't believe that the marketing always offers the comprehensive scientific information a physician needs in order to decide whether or not to prescribe a certain drug. case in point: all those drug companies who classify their research, releasing only what suits them..... until they are forced to reveal previously unreported adverse events during trials when people start dying.

but seriously, can you post a picture of that levitra pen?

7:41 PM  
Blogger Kate said...

Great blog! Reminds me of my own experiences as a med student.

9:34 PM  
Anonymous Anonymous said...

I probably don't have to type this as you seem to already have quite a following, but I'll type anyway and let you know I really enjoyed stumbling on to your website. I'm glad to see your sense of humor hasn't been stiffled from med school. Keep having fun! You'll have to reveal at some point what speciality you decide to do a residency in. I just finally graduated from med school this past summer but I still feel like a fake doctor - I don't know if that feeling is ever going to go away.

9:56 PM  
Blogger Daphnewood said...

just go to the dinner, get your pen and then listen to their lecture. If it sounds good, research it some more. If it doesn't then ask for your dessert to go. You don't have to sign anything. Most of those dinners are closed menus (they order for you) with no dates allowed. So it isn't like you're taking advantage of them and feeding your entire family on their dime. And the Holiday Inn gives out pens so what is the big deal if you happen to get one with Viagra plastered all over it?

10:08 PM  
Blogger Jillene said...

Questions about drugs....ask the pharmacist. And yes, drug reps visit us too. Do they feed you the same lines they feed us?

10:11 PM  
Blogger Et al said...

Nothing quite like the humor of the medical world! If you find any way through the maze let us all know. The carefully chosen research and the false faith we have as a result of advertising is something I still fall for all too easily. I'm not a doc, not even a fake one, but I know the power of The Pen!

10:23 PM  
Blogger 4Sanity said...

Hi this is my first time to your blog but my "non medical profession" thoughts would be to use your own judgement.

If it's a good drug prescribe it if it's not don't. Take what they offer within reason and keep everything on an even keel.

Godd luck with that!

11:01 PM  
Blogger Ambivalent Engineer said...

American Science is screwed up in a couple of obvious ways, and you are seeing one of them.

The genetically modified foods folks were all talk about making nutritionally complete rice to save hundreds of millions of starving people. Last I heard, it still hasn't been deployed. The Terminator gene (which keeps farmers from using their own seed and thus being free of Hi-Bred) was much higher priority. This state of affairs is a failure of the market to serve society's needs.

I have read that drug companies spend more money on advertising than on R&D. But that's not the worst of it. Even worse is how they prioritize research. Flu vaccines (or any other vaccine)? Bottom of the list. The U.S. can barely make vaccines at all anymore, because vaccines are used just once per patient, and because they are bought en masse by governments with lots of purchasing leverage. But what about ED drugs that must be taken daily by folks who want to have sex? Whooboy that's a seller! Top of the list! Even if there are already two working ED drugs out there, they still get top priority.

None of this would matter except that medicine in the U.S. is getting so inefficient, so quickly, that it's chewing up GDP faster than our productivity is increasing. Essentially, big pharma and the associated problems they drag in are threatening (one) American dream of having your kids live better than you.

The answer is to have *all* drug research in the U.S. done by NIH. More specifically, ban drug advertising completely (docs can learn about drugs from journals, or pay their own way to conferences), have the NIH do basic research, and have the NIH contract out drug development, trials, and manufacturing. Ban patents on drugs.

I'm sure a lot of people hate these ideas. One reason so many people dislike these ideas is because a lot of them would lose their jobs, and a lot of jobs would get a lot less perky. It's a ton of people: $221 billion was spent in the U.S. last year on retail prescription drugs. If half of that gets deleted, that's 1 million people formerly making $110k/year out of work. (Okay, that's a massive simplification, but it gives scale to the problem.)

11:50 PM  
Blogger annwho2 said...

Hmmm. Quite alot of material there. Couple of things......Best doc I know gets all the samples He can and helps His Patients try a therapy....free. Worked out real well for My Dad when He had cancer and was on a fixed income. So catch your reps and let them help You help Your Patients. Pens are a sideline. Don't have any opinion on the female stuff, but if You are thinking of fish tacos, wouldn't recommend You head into OBGYN. Have worked in the medical field for 35 years and never heard that very unprofessional term befor. Worked for a GI doc once and You might like that. Best recommendation if You want a life...is work for Kaiser where You have backup and share call. Or work as Medical Examiner,...or Lab Path. Get real time off. Last idea to share. Suggest Your paitents take COQ10 when they are on meds to lower cholesterol. The heart muscle uses it and We don't create enough as We age. Some of these drugs interfer with our bodies ability to make it. It is usually low in CHF and Heart attacks. Alot of those patients are on therapy to lower their levels. One nutritionist said it should be malpractice not to have patients on both. good luck. I'm sure You will get over the "hump"

12:59 AM  
Blogger F. said...

How can I get a Levitra Penis Pen, please? I am not a doctor, nor even a man. I would like to lend it to my boyfriend next time he asks for a pen.

6:15 AM  
Blogger cathy_sampson said...

well i think all you dingleberries are nutz! I can't even swallow pills and if i could it would get caught anyway and i would gag probably. let alone one for the crotch! i mean come on. the only one laughing at this is Mother Nature. You aren't even supposed to do that anyway.

11:21 AM  
Blogger naudy said...

yer killin' me! As an eight-year pharmacy tech I know exactly how tight and short those drug rep's skirts are!

and as for the moral dilemma, (as I contemplated it over a four-course gourmet meal to be followed by a lecture about the newest 3rd generation antibiotic) really all you can hope for is to "Do No Harm." Take the insiduous pens and high-calorie food and then do some research. If you can prescribe stuff that helps and dosn't hurt then you're already ahead of the game -- and you've got an endless supply of Post-It notes in the bargan!

12:15 AM  
Blogger Unknown said...

Ok, Fake Doc, ya had me going into fits of Asthma with my laughing! (controlled by 2 maintence inhalers - steroid & dilator) and 1 emergency one) not to mention a night time mon-te-LOO-kast. I, too, have the wonderful times of often daily (NOT QD) free lunches (Metformin hydrochloride)and the pens. All who want the penis-pop-up can find them on the auction sites under "Drug Rep Pens". I am the nurse manager of a large clinic and they also try to recruit me. Without my say so they do not get in, and unfortunatley they know this. We have a book whereas we take 2 "reps" a day only.
But right now I sit here with my "blad-blah" mouse pad and pens and pen holders and cooling eye mask, disposible camera, sitckey notes, freebies of protein drinks,(we don't take samples but you can leave me free vouchers)...etc.... Ethics are nice to discuss, but patient care is numero uno. As long as most/all health care workers keep that in mind, I say, "go for it".
My 'beef' is that these companies should make their patient (free medications)assistance programs for low income families as easy for people to qualify for and acutally GET as their pens.

3:20 PM  
Anonymous Anonymous said...

You forgot the biggest downside to the "take their stuff option"--the PATIENTS pay for your free trip to Hawaii. The "free" benefits you take from the drug reps (just like the television commercials, which should have stayed illegal) increase the price of the drugs. When the drug is still patented, and is actually the only good drug of its kind currently out there, the patients who need that drug HAVE to pay for your vacation. Now, some marketing (say pens, brochures) may actually be cost effective for the company, so the cost doesn't go up much. However, if every doctor said no to Hawaii, the drugs would be cheaper. If a doctor goes and then doesn't prescribe the drugs (imagining he or she is only hosing the company), well, that eliminates the marketing-is-more-cost-effective argument completely, and those patients who end up with the drug solely because it is the best drug have to pay even MORE.

7:45 PM  
Blogger kero said...

same thing happening here in my country. med reps are everywhere, waiting for the kill, i.e., us, doctors so they could brainwash you to prescribing their stuff. what i do is, i take the pen, then nod my head as if really listening to what they're saying, then prescribe what i think is still best for the patient. it's a sure way NOT to get free tickets to hawaii.

6:28 AM  
Blogger Annie said...

Drug companies are so evil, and marketing isn't even the half of it - at least the marketing and advertising is (usually) easily identified as such. Up until a few months ago, I worked at a PR firm where my main client was one of the world's largest pharmas. All we did all day every day was try to get the media to write stories about certain diseases in order create more of a demand for certain durgs. I won't name names, but all I can say is don't believe that just because you read something about a medical condition or drug in the newspaper or a magazine or even a medical journal that it's true. Likely it's just a different, more underhanded type of "marketing" - a.k.a. manipulation.

Great blog, by the way, I'll definitely be back to read more.

2:22 PM  
Blogger "Texas-Buddha" said...

Muahahaha I fall for the pen thing all the time....But you know what sometimes down in the ER we milk it, I mean when some one has free pens and occasionally free food in an environment where if you do get a break you get the feeling of impending doom. It's nice to have something that you don't have to trod a mile and a half across the damn hospital through maze after maze of hallways that somehow came out of the mess of a pothead german architects head.

In response to Physician Exec- sure medicine is no trade its a art, one which we all know is far from perfect.

Great Blog.

With Mucho Respecto,
ON the way to being a fake doctor.

4:05 AM  
Blogger Cie Cheesemeister said...

People in the U.S. are addicted to quick fixes. I'm not being hypocritical and saying that meds are never necessary. I take a low dose of Lithium for Bipolar II. It's the only thing that relieves the negative symptoms. But in my curiosity about mental illness, I have encountered people that are on (for instance) three seizure meds, two antidepressants and perhaps an anti-anxiety med or two. And they're still experiencing severe negative symptoms. That would lead me to believe that the current path of treatment isn't working and while maybe a new med needs to be introduced, maybe some of the others need to be reduced or eliminated.
I work in a retirement community. The amount of meds dispensed to some of these people borders on insane!
And then you have doctors like the one who wanted to put my father on Warfarin in spite of his history of hemmorhagic stroke, because he has a mild A-fib. I may only be a mere EMT and nursing, but it's my understanding that past a certain age, most of us develop A-fib to varying degrees. And who in their right mind prescribes Warfarin to a person with a medical history that includes hemmorhagic stroke??
Anyway, thanks for speaking out about the drug companies. Personally, I don't think they should be allowed to advertise.

12:04 AM  
Anonymous Anonymous said...

Refer to Diabetes for
useful information

1:04 AM  

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