Here's a new one: Doctors with ethics.

[buttmunch]

By G. Jeffrey MacDonald, 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.

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).

STUDENT PERSPECTIVE

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 Paul Antony, PhRMA's chief medical officer and himself a doctor.

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."

DECISIONS

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 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, 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."

[Grimmlok]

right. Let's see how long this lasts when the gifts are cars, houses and bags of money.

[buttmunch]

Oooohhhh....you cynic, you!

[A*O]

Not forgetting the 1st class flights and accommodation to Europe and Asia for docs and their SO's to attend all those 'conferences'.

[SVZ]

it's a bit creepy to walk into a doctor's office

sit on a prozac branded table

have him use a prozac labelled stethoscope

have him write you a prescription of prozac, on a prozac note pad, with a prozac pen...

[Lil]

In my job I am not allowed to take gifts of any description, and am only able to accept hospitality in some circumstances (basically not from anyone trying to sell us anything). I work in the energy industry and it is surely far more important that doctors have no preference between drug suppliers. Call me naive but I don't understand why their contracts allow it.

[buttmunch]

I once went to a doctor who was using a Botox pen...so I swiped it (I refuse to say steal since he got it for free). It's hilarious to whip it out now in inappropriate settings...

[A*O]

I am lucky enough to have a fantastic pharmacist who will often suggest a generic (ie cheaper) drug instead of the branded version my doc prescribes. I don't blame docs, especially GP's, for taking advantage of the free pens, etc. It's a small enough reward for the general shit they have to put up with on a daily basis from shitty patients. It's not like they are being coerced into prescribing dangerous drugs - merely to favour one brand over another. So long as the drug does the job it's intended to do then as a grateful patient I really don't mind if my GP get's a notepad or keyring once in a while.

[Lil]

I agree, notepads and keyrings are fine and will make bugger all difference to anyone's purchasing choices. I have a problem with high value gifts though, and don't think they are appropriate for anyone, but especially for doctors whose decisions have more of an impact on others than my choice of a law firm or an economic consultancy might. I have duty to make decisions based on the best interests of my company, and it is harder to demonstrate that I have done that in an unbiased way if I have accepted tickets to Wimbledon or fancy dinners in London or whatever. I think it is the same for doctors - their choices should be clean and unadulterated by shiny things dangled in front of them.

And I don't feel sorry for GPs on the whole. They are well paid, and they are the only service I can think of that operates entirely at its own convenience rather than that of its customers. They don't do weekends, they don't do evenings or early mornings, hell, they even gripe about covering emergency call outs now and subcontract it.

[A*O]

Maybe the reality of the overworked and underfunded British NHS is becoming a little fuzzy for me now I can bask in the luxury of getting a same-day appointment any time between 8am-7pm with my (non-private) GP who is happy to spend half an hour going over anything I may want to discuss.

[SVZ]

And I don't feel sorry for GPs on the whole. They are well paid, and they are the only service I can think of that operates entirely at its own convenience rather than that of its customers. They don't do weekends, they don't do evenings or early mornings, hell, they even gripe about covering emergency call outs now and subcontract it.

I really hope and believe that this will change in the future. The money isn't that great, and any student who is intelligent and dedicated enough to make it through medical school is more than qualified to enter something in finance or the banking industry.

You work less hours in a bank and make the same pay. People who are in the medical field for the money are getting less and less, imo.

[sweetrebel]

At our storage facility, we have numerous drug reps that store with us. You would not believe the deliveries they get. Very few actually have samples of the meds. Most just have what I call the propoganda the pads, pens, lotion, hand sanitizer, plates, cups, mugs, mousepads...all with the drugs on them...needless to say, our office is full of pens, pads...when we first opened (2 years ago next month) they stocked us up on all of them...
My sister works for a large hospital in the lab, and every few months they have a really nice dinner sponsored by the drug companies...but I'm not aware of any true "gifts"...
And kinda OT< but these reps make really good money and all that is required is a bachelor's degree. It can be in woodworking-as long as you have a degree...also, most of them are young and very attractive...guess sex sells everywhere, huh?

[travelbug]

A woman that I used to work with is a drug rep. She is young (mid 20's) and very, very attractive, and she knows how to "work it." She is making a fortune. Yes, drug companies are hiring young sexy women.

I don't have time to rant now, but I am so against GP's prescribing antidepressants. They really don't know what they are doing and are brainwashed by the drug companies that these drugs are the answer to everyone's problems.

[pacific breeze]

^^ SOME doctors overprescribe anti-depressants, but most are responsible. They were never prescribed as an answer to everyone's problems, although that's what most people want to believe -- that a pill will magically cure their ills, physcial and mental. And drug companies are happy to make billions off that illusion because people will ASK for the drug and irresponsible doctors will give it to them.

Most mental illnesses are difficult to treat but diagnosed clinical depression is treatable, and anti-depressants are highly effective if taken correctly and used in conjunction with therapy. I am living proof, and so are many people I know. ONE in 10 people will suffer from some form of mental illness in their lifetime, and frankly, I would much rather take a pill than suffer as I did for so many years. I have a completely normal range of feelings, I just don't bogged down in pits of despair for years at a time, and my life has improved immeasurably.

If you had diabetes, you would take insulin. Why is it any different for people with illnesses you can't see?

[travelbug]

I have had depression as well, but I can't take anything like Paxil or Wellbutrin because it makes me sick as a dog. I TOLD my GP that and she STILL prescribed Effexor for me, telling me it was different. Guess what? After 1 day on the drug I was a zombie.

I just don't buy this "chemical imbalance" horseshit? OK, so where's the test for it? Oh, there's not one!? You mean that millions of people are being treated with drugs that permanently alter their brain chemistry based on a theory?

I know that antidepressants help a lot of people, I don't deny that, I'm not a Tom Cruise. I just think that they should only be prescribed by qualified mental health specialists, not your everyday GP who listens to people talk about how down they are for *maybe* 5 minutes and then decides to prescribe a serious drug based on a theory that they have a chemical imbalance. I had to hospitalize my mom because she had adverse reactions to the antidepressant cocktails her GP prescribed. Oh, that didn't work? Try this one. Oh, that didn't work? Try this one. When I found her she was 98 lb. and hadn't slept in God knows how long.

The drug companies tell you these drugs aren't addictive, that's bullshit too. Do an internet search and you will find thousands of people who cannot wean from them.