Cynics be banned! Posted by schnro at 01/03/06 03:28 PM

People tell me they fear for the future because young people don’t seem to give a hoot about anything. (I wonder whether this is because the people I know are developing a bad case of cynicism!)

All is not lost!

Case in point: there’s a group of medical students who are doing battle against free pharma giveaways – they simply refuse to take free stuff from drug companies.

You know the stuff: the pens, pads, diagrams of the human body, and other stuff that litters your doctor’s office. (This is what those nicely dressed young men and women in the waiting room – a/k/a “drug detailers” – happily give out to doctors while pitching their company’s latest and most expensive new drugs).

Last year, I attended a conference put on by the American Medical Students Association (AMSA) in New York. Part of their meeting included a “pen amnesty” where they collected drug-maker pens from the hospitals and offices where they worked and returned them to drug company employees.

Frankly, I couldn’t believe my eyes. They had collected thousands of pens for every drug you had ever seen, and for scores of drugs you’ve never heard of. They marched to Pfizer headquarters and started handing these back to Pfizer employees who were amused, confused, or miffed.

In today’s USA Today it looks like the med student are at it again.

Why do they do it? After all, how can one pen, or one lunch or dinner, affect the decisions of highly-trained physicians?

. . .students are still convinced their cause is worth fighting, even if it means giving up a hot meal every day. "I don't think patients can trust us anymore," says Kristin Rising, a medical student at the University of California, San Francisco. "By accepting gifts, we're taking in biases that are going to affect patient care.

AMSA is taking a principled stand, based on a realization that, as the prescriber, doctors should be beyond reproach in the role of objective adviser about the medicines we – their patients – take:

Behind the modest rebellion is the belief that taking gifts from drug companies creates a conflict of interest for doctors. The argument: To accept handouts is to feel indebted, and doctors indebted to drug firms may not be prescribing medicines based solely on what's best for their patients. The 60,000-member American Medical Student Association (AMSA) urges students and doctors alike to just say "no" to all personal gifts from drugmakers.

Just to be clear, these are medical students – not full-fledged doctors – who seem to have a far smaller problem taking drug company stuff. The American Medical Association’s ethical guidelines permit gifts that, as they say “primarily entail a benefit to patients.” As the USA Today article puts it:

Doctors on the whole seem far less worried about the practice. The American Medical Association condones gift-taking from pharmaceutical representatives as long as no single gift is worth much more than $100. And drug companies seem to be finding plenty of takers: spending on marketing to physicians jumped from $12.1 billion in 1999 to $22 billion in 2003 ($16 billion of which was in free samples), according to data from Pharmaceutical Research and Manufacturers of America (PhRMA).

So what’s the harm in a few lunches? Plenty.

Gifts affect what doctors prescribe: if marketing to physicians didn’t work, drug companies wouldn’t spend billions every year and deploy thousands of “drug detailers” cutting in line at your doctor’s office. And drug detailers are all about pushing the latest and often most expensive new drugs, regardless if they are safer or more effective than other drugs currently on the market. I guarantee you: you’re not likely to see a clean-cut, well-dressed drug detailer waiting in your doctor’s office to convince the doctor to prescribe generic.

Free pharma stuff pushes up what we all spend on health care, and it undercuts the trust patients have with their doctors.

So I say three cheers for AMSA and these idealistic med students. And to all my cynical friends: the kids are all right!

comments (2)

1 Posted by citizenactivist at 01/17/06 04:38 PM

Thanks so much for this article. And thank goodness for the bravery of the young. They approach the world with fresh eyes and are willing to call it as they see it.

At every single gathering I have been to in the last 2 months, people end up talking about how the health care system is broken. Premiums are going up, and services are going down. And one of the big reasons is the hundreds of millions of dollars the medical industry spends on marketing and advertising. Add to that the hundreds of millions spent lobbying Congress for even MORE goodies, and you can see why the system is broken - it is corrupt.

Good for these young people, they are doing their part. The media is even doing it's part by reporting on it. But what can the rest of us do?

2 Posted by peteraleff at 02/18/06 08:58 PM

With all due respect for the students at AMSA who return promotional trinkets, such gestures are as showy and futile as putting a nicely decorated bandaid on a heart attack victim. When it comes to weed out real medical bias and fraud, AMSA students behave no better than their wagon-circling teachers who will deny any wrongdoing when exposing it would hurt the profession's image.

I have alerted the "bioethics" interest group of AMSA to the ongoing mistreatment and reckless blinding of premature babies caused by several clinical research frauds which are fully documented at retinopathyofprematurity.org, but none of these students who proclaim their alleged concerns about medical ethics have bothered to react to the blatant frauds in the neonatologist doctrine which keep harming many preemies. Real ethics would require more than making a show of returning trinkets, and I am sorry to say that cynics remain as necessary as ever.