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The Daily Rhino
Tuesday, November 21, 2006

F1. It's fun: Drugged up and in demand
Originally published in the November issue of Medical Student Newspaper.

WHEN I was a student, I thought I was a bit of a bum. This was predominantly because I was, in fact, a bum. On those rare occasions when Jupiter was in the House of Saturn and the Moon was waxing, I decided to show up to whatever firm I happened to be doing. A combination of my overt ineptitude and uncontrollable humming of the Rocky theme music made me feel like I was little more than a nuisance, constantly getting underfoot of the people actually working.

With the exception of some fantastic doctors I encountered, a large amount of hospital staff made students feel particularly unwelcome on their clinical attachments. Now I've got that magical 'Dr' in front of my name, I'm treated very differently. For the first time in my life, I'm in demand.

I am endlessly courted by drug reps. No matter how many times I tell them I'm not that type of boy, they continue to thrust their increasingly bizarre freebies into my alco-wiped hands. For example, I recently experienced a glorious period in my life: I didn't pay for a single lunch all week. For whilst my position in the hospital has changed since I graduated, my cheapskate tendencies have remained entirely unabated.

I revel in my free lunches, but all Medical Student Newspaper readers will know that there is nofreelunch.org.

The NoFreeLunch movement and its related anti-Big Pharma (spit) efforts have been covered extensively in the paper, so I shan't re-tread old ground other than to say that the website is thoroughly worth checking out. It has a specific section for medical students - you are identified as a key asset, after all, you have more prescribing years ahead of you than anyone else.

I was a devotee and a committed NoFreeLuncher; I wanted nothing to do with the godless, evil drug companies (spit). I made sure to give a stern lecture to my colleagues who expressed even a passing interest in picking up a free pen. So why am I now munching on free lunching? The honest answer is because I'm weak. The supplementary answer is because it's far easier to stand steadfastly against the pharmaceutical industry (spit) when you are a student.

The freebies are so diverse and relentless in their onslaught that it is nigh impossible to avoid utilising at least a pen, especially with the inordinate amounts of writing an F1 does. When a drug company offers you dinner in a restaurant so swanky that patrons are given four types of fork, it isn't easy to say no. They have free booze (now you understand).

I tell myself that I'm actually doing the anarchic thing and consuming pharmaceutical company resources by eating their food and using their pens. But for every item of branded paraphernalia I accrue, I am subjected to a few minutes of rep-chat.

They show me Fisher Price-style bar charts explaining why their drug is better than sex and everything else KILLS you slowly. I worry that no matter how hard I try not to listen before saying "yeah yeah OK, can I have a meal ticket?", some of their hard-sell has subconsciously filtered through to the prescribing centre of my brain. Indeed, observational studies have shown that promotions and interactions with reps does affect prescribing patterns.

Along with my firm-partner, Ellie, I'm trying to get a journal club up and running (mock me not, I have a CV to worry about here). As I'm sure you already know, doctors need an incentive to turn up to anything that removes them from the mess. Chiefly, food. Who is happy to provide Ellie and me with food? Those good old drug reps. What, free of charge? Nay! They want us to present a paper that just so happens to be pushing their latest pill. Funny, that. At the very least they would want to be present to leaflet attendees with 'evidence' concerning the drug they happen to be dealing.

Our grand rounds are sponsored by pharmaceutical companies, as are the weekly GP lunches. Whilst admirable American bodies such as NoFreeLunch advocate a complete embargo on sponsorship from drug companies for talks and meetings, the British NHS does not have a vast pot from which to withdraw for such events. Use of money to feed doctors when alternative sources of funding are available might be seen as irresponsible.

Comparing the profession we have chosen with others can be depressing. Those in the world of finance train for a shorter time than us and are wined and dined frequently. But the relationship they have with clients is not the same fiduciary interaction that exists between doctor and patient. A more apt comparison would be a politician and the electorate. As the Labour Party has demonstrated recently, politicians are not supposed to accept gifts from lobbyists. These are people who want to effect change in politicians' behaviour, much in the same way reps are trying to affect doctors.

Where you stand is a decision you will begin making now, while you are a student. All I can say is, as I use my Imdur optical mouse, my Bisoprolol LED mouse-mat and my Viagra wrist support (hehe), that the person able to resist any of the goodies on offer may well be a better doctor than me. But hey, I'll have cooler stuff.

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JournalReview.org is an internet resource that facilitates open peer review and discussion of medical literature. It has been presented at several international medical meetings and has received awards for the services we provide. JournalReview.org has no political or commercial affiliations and was created by physicians for physicians. Essentially an online journal club with free membership, JournalReview.org provides a venue which improves communication and fosters commentary about published scientific research.

How does it work? Simple: By navigating to the journal and article of interest, colleagues can initiate, read, or add to a discussion as they see fit. Corresponding authors along with up to ten other experts can be notified instantly of comments to facilitate timely and informative discourse.

How can we help you? JournalReview.org can enhance your existing journal club, and save you time! It will stimulate reading, and provide an opportunity for young clinicians to ask questions, and obtain answers from experts around the globe. We help to disseminate your ideas quicker, easier, and to a much larger audience than via a traditional "letter to the editor."
Aye Doktor Francis... Howsee doin?
Well it is good to see that you have come to a realization about the problem. Drug companies are relentless in pursuit of a sale, and many doctors accept gifts far more elaborate than a pen or a lunch.
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