[afro-nets] Backstory: A pill they won't swallow

[Claudio Schuftan <claudio@hcmc.netnam.vn>]

Backstory: A pill they won't swallow
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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 Ken-
yon 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 tra-
ditions. Their pens read "PharmFree," which means they don't
take personal gifts of any size from the pharmaceutical indus-
try. 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 stetho-
scope-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 al-
most every day so he won't have to eat meals sponsored by drug-
makers.

"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 drug-
makers.

Doctors on the whole seem far less worried about the practice.
The American Medical Association condones gift-taking from phar-
maceutical 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 Pharmaceu-
tical 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 in-
dependent 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 advertise-
ments 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 dis-
tances 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 de-
teriorated 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 re-
calls. "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, stu-
dents 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 spo-
ken for a supervisor in a buffet line to feel a bit snubbed when
a student settles for a granola bar instead of "tainted" pharma-
ceutical 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 ex-
pect 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."