Unleash the medical students.

I just found out that, should I pass my finals and make it to third year, within just a few months I'll be able to prescribe things and order some lab tests.

Here I thought you had to be a doctor to do those things. But no, they'll be letting me and my classmates, fresh out of the pre-clinical years of med school, play doctor. With real patients.

The best part is they're giving us plenty of time between us learning how to do these things... and us actually being on the wards.

That's right. Rather than putting us in the hosptial as soon as we have written our finals, which is when we have proven that we know which lab tests to order and which drugs to prescribe....ok, well, we've really more just demonstrated that we can memorize thousands of PowerPoint sides containing millions of trivial details (example: "in UK, 1 unit is defined as 8 grams absolute alcohol = .5 pint ordinary beer")...they've chosen to give us an entire summer to forget the relevant parts of medicine before they set us on the wards.

I'll even be allowed to order some investigations without permission: X-rays, electrocardiograms, most blood tests and cultures.

Don't get too concerned, though. I won't be handing out scripts for narcotics, heart medications, or medical marijuana anytime soon (note to friends: notice that last one, and please stop asking). Here's what I will be allowed to prescribe without permission:

• Non-controlled analgesics and anti-pyretics (examples: aspirin, tylenol)
• Shampoos, dermatological preparations other than those containing steroids (examples: head & shoulders, pert)
• Vitamins (examples: umm... Vitamin C, Flinstones multivitamins)

Okay, you're probably a lot less worried now. And I'm not sure they even call it "prescribing" - it's no secret that anyone can buy all those things at a 7-11.

Still, I'll be able to write those things in the patient's chart...me, who doesn't really know anything about medicine yet...and the nurses will actually go ahead and give it to the patient.

Those poor, poor nurses.

I'm not sure who I should feel more sorry for... the nurses? or the patients?

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You thought the pharmaceutical industry was slimy... version 2

In this season where time is valuable and finals are so close, I'm resorting to a sneaky measure basically the same as re-gifting... putting some nice new wrapping paper on a previous gift and handing it off as something new. Yes, I'm re-dating a blog post as if I just wrote it today.

Okay, not really. I'm just kindof supplementing it. There's a reason to this, beyond the fact that I'm too busy to actually write a whole new post: it's that though my daily study time devoted to procrastination, I found another incredible article about drug reps. It's hefty, but well-written and choc-full of fascinating and jaw-dropping anecdotes.

Take, for instance, the drug rep who arranged for a doctor to receive an "unrestricted educational grant" of $35,000 from a drug company...the doctor requested the cash so he could install a swimming pool in his back yard.

This whole crazy world of drug reps is one that I'm just starting to learn about. As a medical student, it's a little scary. I'd like to say that I'll be immune to it, but if I'm faced with accepting the kleenex box with a drug company's name on it, what's wrong with that? And if that's ok, then what's wrong with taking the pen? then the anatomical poster - it's for my patient's benefit! then lunch for my office staff, and then the dinner at a steakhouse, then a trip to Paris, and then asking for an unrestricted educational grant of $35,000??

Here's the link to the article.

And here's the link to my previous blog post, in case you missed it.

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You thought the pharmaceutical industry was slimy before reading this post?

You're a drug rep selling psych meds (hey, had to make the post fit this week's Grand Rounds somehow!), and you have to meet your quota. The family doc whose office you're walking up to right now, though, is 100% hardass.

You can bet that you won't even get the chance to have any face time with him - even though his secretary always cleans out your briefcase full of samples (this doc's one of the "sample-grabbers" you heard about in training), this doc will only see you if it's by accident, and even then, pretend you don't exist.

Which of the following best describes your attitude?

a) Scared stiff.
There's no way you can up sales if you can't even see the doctor.
b) Pretty nervous.
What if he's behind the counter when you come in and he yells at you?
c) Pissed off.
This is going to be a waste of an appointment.
d) Thrilled.
You know you can accomplish your objectives - probably even better - even if you only talk to the secretary.

If you answered D, you're a slimy lizard, and you'll make an ideal drug rep.

In fact, you'd make an even better one if you believe that there's a "d) thrilled" answer for every single type of doctor - from those who prefer competing drugs, to the skeptical, to the high-prescribers, to the friendly and outgoing, to the ones who won't even meet with drug reps.

That is, after all, how the drug companies train their reps to think.

Thanks to a new journal article out called "Following the Script: How Drug Reps Make Friends and Infl uence Doctors," available to anyone here at the PLoS online peer-reviewed journal, you can get an eye-opening glimpse into the mind of a pharmaceutical drug rep.

The article concludes, "Physicians must rely on information on drugs from unconflicted sources, and seek friends among those who are not paid to be friends."

I'll admit, reading this made me a heck of a lot more wary. Even just a few months into medical school, I've already seen drug reps in action at the family practice clinic I go to for class an afternoon a week. I've seen everything including pens, patient chart notes, and Kleenex boxes supplied by drug companies, with their logo stamped thereupon (though I honestly can't remember any of those sponsoring companies...then again I haven't been prescribing very much yet). I've also gotten a couple free meals thanks to drug companies, and there are students in my class (who instill much jealousy within me) that have clinic at a group family practice office and a different drug rep each week brings lunch for all the docs and staff there.

I strongly encourage you to take a look at the article, even if it's just to browse the fascinating table explaining how a drug rep approaches each of the doctor types listed above. If, like me, you had little to no idea what's going on - or, if you're routinely visited by these reps - you need to at least give this article a glimpse.

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By the way, I proceeded to write about this again - link to Version 2, here.

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Milestone: First Dinner Paid For by a Pharmaceutical Company

I went to a Resident's Research night the other night at a fancy business club downtown. I was attracted by the possibility of the free cocktails, the free gourmet dinner, the experience of seeing this fancy club for free, and not one bit by the free research speech in between.

We arrived, suitably conforming to the club's dress code, and were pointed to a conference hall in the public area of the club. I never did get to see the private member's area with the billiards tables and the swimming pool and the brandy and stacks of the Wall Street Journal. Strike 1.

After that, the first thing we noticed is that there was a price list beside the bar. By "Cocktails 6:30 - 7:00" on the invitation, they meant "Cash Bar 6:30 - 7:00." BIG difference. Strike 2.

At the end of the speech, though, which was mostly out of my league (but it kept my attention because the resident spoke so fast) they served a fabulous and delicious three-course dinner with all the wine we could drink. Outstanding. Reset the count; 0 balls, 0 strikes.

And the best part: right before they served it, they told us that a pharmaceutical company was paying for the dinner. I had been wondering how long it would be before I was getting food from the drug companies; my time had come. I have pretty much arrived. (And I don't feel coerced one bit: to be honest, other than mentioning the name once, they did a bad job of making an impression. I can't even remember the name of the drug company. That makes it OK, then, doesn't it?)

It was well worth going just for the (free) dinner, but the best part happened after dinner. Two young psychiatrists came and sat down at the table where I was sitting with about five other first-years from my class. They told us a lot about psychiatry, answered our naïve questions ("Do you have a couch?" - answer: only about 3 shrinks in the entire metropolitan area use couches), and joked around with us, and gave us some great advice.

Before I get to the advice, let me make this clear: I know absolutely nothing about psychiatry, and in fact, in all seriousness, I am a little bit frightened by the thought of being around psychotic patients. Okay, I know that statement is laden with ignorance and so forth. Go ahead and make your judgments... Strike 1, against me... but hear me out:

Despite my ignorance, I am really interested in actually overcoming my ignorance and getting to know what the profession is like (reset the count against me, 0 balls, 0 strikes). I got the doc's contact info and I'm looking forward to shadowing them in the near future to get a handle on what they really do.

All that being said, however, the most valuable part of the entire evening was the advice that the psychiatrists gave us. I'll leave you with that; it should be helpful to anyone trying to figure out what specialty they should enter.

"No matter what fascinates you now, it is going to become routine after you do it day in and day out. So, when you're in a rotation or shadowing, take a close look at the residents in that field, and see if their level of happiness, their lifestyle, the things outside of what they do for work, jive with what you're hoping for in your career. If they don't, then look for another specialty."

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