PHA-Exchange> Backstory: A pill they won't swallow

[Claudio]

> http://www.csmonitor.com/2005/1228/p20s01-lire.html?s=hns
>
> from the December 28, 2005 edition  Backstory: A pill they won't swallow.
> By G. Jeffrey MacDonald | Correspondent of The Christian Science Monitor
>
> BOSTON - Dutifully wearing collared shirts, ties, and the short white
> coats meant to keep all medical students humble, Chen Kenyon and
> Dustin Petersen don't look like rebels. They look scrubbed and eager
> to learn from any doctor in a long white coat.
>
> But in the pockets of their shorter garments lurk symbols of a
> movement aiming to topple one of medicine's most entrenched
> traditions. Their pens read "PharmFree," which means they don't take
> personal gifts of any size from the pharmaceutical industry. And that
> is touching off a quiet ethics war reverberating through the halls of
> academia and hospitals across the country.
>
> Messrs. Kenyon and Petersen are among a growing band of
> stethoscope-wearing students who believe the medical profession needs
> more detachment from big pharmaceutical firms.
>
> Consequently, they're turning down everything from free catered meals
> to notepads, provoking debates among fellow students and quizzical
> looks from doctors.
>
> "People will often ask, 'why didn't you take the pen? Or, why didn't
> you eat the lunch?'," says Kenyon, a Boston University medical
> student who packs a sandwich, apple, and granola bar almost every day
> so he won't have to eat meals sponsored by drugmakers.
>
> "It gives you the green light to talk about it when somebody asks,"
> adds Petersen, who swears his home-cooked pot roast and clam chowder
> leftovers taste better than the catered meals he refuses each week.
>
> 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.
>
> 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).
>
> ***
>
> Against this backdrop, 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."
>
> Others feel the same way. For the first time this year, between 500
> and 1,000 students at 150 medical schools are canvassing 40,000
> physicians nationwide. Their aim is to steer them to independent
> sources of information about drugs.
>
> This "counter-detailing initiative" takes AMSA's three-year-old
> PharmFree project out of medical schools and into the trenches of the
> profession, where students hope to pique the consciences of future
> colleagues.
>
> Other phases of the movement have been more brazen. Last year, for
> instance, a brigade of students marched on Pfizer offices in New York
> and dumped thousands of logo- emblazoned pens, given to the students
> by the company as gifts and intended as advertisements in their
> hands, back on the firm's doorstep.
>
> Activist students insist their beef is more with the medical
> profession, which, they say, has come to feel it's entitled to the
> giveaways, than it is with the drugmakers. Even PhRMA distances
> itself somewhat from the practice, saying its member firms honor AMA
> guidelines to keep gift-giving at modest levels. "Any physician can
> decline a gift at any time," says Dr. Paul T. Antony, PhRMA's chief
> medical officer.
>
> Challenging medicine's status quo, however subtly, often comes at
> personal cost. Example: Last year in Philadelphia, Kenyon wanted to
> make a good first impression with his new supervisor on a medicine
> rotation. But after the firm handshake, things deteriorated as the
> attending physician suggested they grab lunch - at a seminar
> sponsored by a drug company.
>
> "I told him, 'I don't eat pharmaceutical lunches,' " Kenyon recalls.
> "He was sort of, like, 'Oh.' And stopped it there. In some way, it
> doesn't really matter to me, but he is the person evaluating me in
> the end."
>
> ***
>
> Kenyon's predicament illustrates the heart of this struggle: Those
> making the moral case against gift-taking hold junior status in a
> hierarchical and tradition-bound profession.
>
> "While I think we're right, people don't always want to hear what we
> have to say," says Ms. Rising. "I'm not in a position to say, 'you,
> my supervisor, are wrong' " to accept giveaways.
>
> With no real standing to make their case to higher-ups, students rely
> instead on the shock power that comes with saying "no thanks" when
> offered coveted freebies. Fellow students, they say, respond with a
> mixture of surprise, curiosity, ridicule - and lots of discussion.
>
> Take the case of Chris McCoy. A 2004 graduate of Case Western Reserve
> University in Cleveland, Ohio, Mr. McCoy had earned a reputation as a
> stickler for ethics by complaining when fellow students proposed to
> get drug companies to sponsor the medical school's social events.
> After the proposal was defeated, students kept eating meals provided
> by drug firms, but discussion about the ethics of doing so lingered
> like garlic.
>
> "They'd say, 'What would Chris think if he saw us eating the drug
> lunch?' " McCoy recalls.
>
> Where tensions arise, activists say, is when a student sets a higher
> ethical standard than a supervisor. No words need be spoken for a
> supervisor in a buffet line to feel a bit snubbed when a student
> settles for a granola bar instead of "tainted" pharmaceutical food.
>
> "In a lot of cases, people feel like you're pulling the moral high
> ground," Kenyon says.
>
> Students who dream of higher ethical standards for medicine expect to
> pay higher personal prices as time goes by. As medical residents,
> they'll be among peers who feel they've "earned" drug-industry perks,
> says Bob Goodman, founder of "No Free Lunch," a physician group that
> urges colleagues to stop taking gifts from drugmakers.
>
> What's more, residents with low salaries and high debt levels are
> famous for relying on drugmakers to keep them fed during long shifts.
> Residents say "once you see the reality of the way medicine is, you
> won't be so idealistic," says Yavar Moghimi, a George Washington
> University medical student. "I worry about that. [But] family members
> always congratulate me and tell me how important they think this is."
>