PLoS Medicine: How Drug Reps Make Friends and Influence Doctors

Clinical Cases and Images shares a refreshing insight into the manipulative drug rep mentality from the POV of an ex-drug rep.

This article reminded me a lot of a book a friend loaned to me about the way physicians are "bought out" to sell drugs. Unfortunately, I cannot remember the name of that book now... but it made some good points that made me wary of drug reps before I entered medical school.The thrust of the book was that it is unethical to accept gifts from drug reps because they would unconsciously influence prescription writing in their favor. Doctors are not as objective as they would like to think.

However, I was met with an uncomfortable scenario as early as my third day of orientation week in medical school. We had a recruitment fair and some organizations gave out "free stuff" with pharmaceutical names stamped all over them. I wanted free stuff. I didn't want to turn my Ethical Upbringing into a big deal. As a result, I came up with this reluctant compromise... I would be OK accepting small gifts (pens, pads of paper, etc.) as long as I erased the name from their free products.

I bought some acetone that afternoon and scrubbed the names off of those products. I can tune out the names pretty well... but I do feel conflicted if I learn about a new drug in school and I go "hey, that's just like the name on those sticker tabs!" I'd like to come up with a better solution for dealing with drug reps when it really counts.

Saccular aneurysms

A quick and dirty way to remember the risk factors for developing berry (saccular) aneurysms

MEN HAS sac(cular aneurysms)
Marfan's
Ehler-Danlos
NF-1
HTN
ADPKD
Smoking

Berry aneurysms are outpouching of blood vessels that exploit developmental defects hidden in the lining. They occur within the Circle of Willis, a series of connected arteries at the base of your brain that provide collateral blood flow just in case something fails. These puffy red berries can burst and bleed out into the brain causing a hemorrhagic stroke.

The Big update

I've been pretty busy lately. I have exams coming up next month (11/3-6, 3 3 hr long essay/multiple choice/lab exams, 2 4 hr long NBME neuroscience, neurobehavior exams), but I had to put some time aside to prepare for the Medical Student Mentorship Program's (MSMP)1st Annual Ethics Workshop.

The idea was proposed by one of our senior officers and I immediately jumped at the opportunity to help organize it. I made a shortlived effort to start up an Ethics club last year; I realized that I didn't have the time and energy to commit myself to another club since I'm already an officer for MSMP and the Family Medicine Interest Group (FMIG). We put together a Problem-based learning case on ethics. I found this great case about Andrea, a "locked-in" patient from an article in the Discover Magazine's Vital Signs column. "Andrea Beauchamp" helped the students talk through such difficult topics as advanced directives, access to medicine, universal health care, and physician assisted suicide.

The Ethics Workshop was a great success; a local MD/JD came out to give a primer on medical ethics and opened the room up for questions. At first, no one really asked anything, but then a few brave people started asking some really good and insightful questions. I was impressed! We split up into small groups to work on the cases.

I hesitate to post the case here online... most of the text is taken verbatim from the Vital Signs column. I will email the case to anyone who is interested. We put in some tutor prompts and background information and it is a good ethics case for anyone from pre-med to doctorhood, IMO.

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On a completely different note, I got the results for our practice NBME exam last week. It's the big exam that we take at the end of the second year to qualify for medical licensure. I got a 66/100 (a weighted score), which translates to a 190/300 (185 is a passing score, anything above 220 is considered competitive, I believe.) So... without any formal Board studying, I passed!

Woo hoo! :) The only downside of that is the ego boost and dangerous overconfidence that comes with hubris. crap.

Branches of the ECA & ICA

Branches of the External Carotid Artery (ECA)
STAPLe OF PAM ST
Superior Thyroid
Ascending Pharyngeal
Lingual
Occipital
Facial
Posterior Auricular
Maxillary
Superficial Temporal

Branches of the Internal Carotid Artery (ICA)
OPAAM
Ophthalmic
Posterior Communicating
AChor
ACA
MCA


References
Moores Clinical Anatomy
Blumenfeld's Neuroanatomy through Clinical Cases