Medical students and residents are manipulated, befriended, and constantly contacted by representatives from the largest drug firms, reports a new first-of-its-kind Harvard University and Edmond J. Safra Center for Ethics national study. The research finds that despite recent efforts by medical schools and academic medical centers to restrict access of pharmaceutical sales representatives to medical trainees, medical students and residents still commonly receive meals, gifts, and industry-sponsored educational materials.
Are most medical students soon made aware of the fields of pharmacoepidemiology and pharmacoeconomics as fields of research where ethics, economics, and big business meet and marry medicine? The study did not mention any natural, organic, whole-food nutrition, restorative, supplement, and functional foods movement that is able to offer equal access to medical students or medical school newly graduated residents on how food can be used instead of prescription drugs to remedy a deficiency in someone who's not absorbing nutrients from unprocessed foods.
And no one is talking with medical students about dietary approaches or using food for helping those with metabolic and genetic issues that can be changed when diet is changed. The research focused on the frequency of interactions with pharmaceutical firms and medical students and the newly graduated residents. The study is published in the Journal of General Internal Medicine. Also see another study, "When Do Older Adults Turn to the Internet for Health Information? Findings from the Wisconsin Longitudinal Study (pages 1295–1301)."
Health policy researcher with an M.D. and a J.D. and an M.P.H. along with a team completed the study
The study was completed by a team of researchers led by fourth-year Harvard Medical School student Kirsten Austad and Aaron Kesselheim, M.D., J.D., M.P.H., an internist and health policy researcher in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital and is scheduled to publish online this week in the Journal of General Internal Medicine.
"In medical school and residency, as trainees are learning the fundamentals of their profession, there is a need to ensure the education they receive is as unbiased as possible," said Dr. Kesselheim, according to the February 26, 2013 Harvard University news release, National Survey shows medical students have frequent interactions with pharmaceutical companies. "However, it is well known that promotional information and gifts from pharmaceutical companies can encourage non-evidence-based prescribing. Though many institutions have tried to insulate trainees from these effects, trainees' exposure to industry promotion is still quite high." Also check out the sites, "Development of a Prescription Medication Information Webliography for Consumers (pages 1313–1316)," and "Description of a Research-Based Health Activism Curriculum for Medical Students (pages 1325–1328)."
Medical residents may get gifts from pharmaceutical industry representatives but not from nutraceuticals or whole foods firms
The surveys were completed by a randomly selected subset of more than 2,000 medical students and residents representing every medical school in the United States. Students answered questions about the frequency of their interaction with pharmaceutical representatives, the types of gifts pharmaceutical representatives gave them and whether they thought these interactions affected their learning.
One-third of first-year students and more than half of fourth-year students and residents reported receiving industry-sponsored gifts. A majority of students reported that pharmaceutical industry interactions provided them with valuable education, even though a majority of students also acknowledged the interactions opened them up to bias. Additionally, a majority of students supported measures that would further reduce access of industry sales representatives to trainees.
"Medical schools and academic medical centers need to continue to work on separating students from industry promotion at this highly impressionable time in their professional development," said Austad in the news release. "As an alternative, medical schools should provide students with more education about how to interpret clinical trials and ways to approach evidence-based prescribing so trainees can learn to critically evaluate industry promotion when they become practicing physicians."
A grant from the Edmond J. Safra Center for Ethics at Harvard University funded the research. Dr. Kesselheim is supported by a career development award from the Agency for Healthcare Research and Quality and a Robert Wood Johnson Foundation Investigator Award in Health Policy Research.
Pharmaceutical firms may hire doctors held in high esteem to write marketing-related or promotional articles about prescription medicines
Doctors held in high esteem by other doctors may be hired to write marketing-related or promotional articles about specific drugs rather than about how various foods, nutrients, micronutrients, phytonutrients, or dietary regimens can help heal certain deficiencies, sometimes related to an individual not being able to absorb nutrients from foods or eating foods that are not good for the health of that individual. Not many doctors are given talks on tailoring diets or food menus to an individual's metabolic or genetic signature and expression.
Some highly-trained, long-experienced doctors, including medical school faculty members held in high esteem by other doctors, are hired to write marketing-related or promotional articles about specific drugs that other doctors supposedly will read. Some doctors speak or write for several different drug or medical device companies in addition to earning their usual income practicing medicine as doctors in their regular full-time jobs.
Does this type of 'moonlighting' influence patient care, physician's prescribing habits, and raise the cost of treatment? Maybe, but some doctors have huge loans taken out to pay medical school bills and families to support, let alone the insurance bills. What really influences patient care, the large pharmaceutical companies or patients' requests that their physicians be trained in complementary care?
Consumers are interested in researching the prescribing habits of most doctors. They want to know to whom their doctors listen, and it seems to be prestigious medical school faculty hired part-time by some of the drug companies to give lectures to other doctors that promote and market certain drugs. Check out the video, "Pharma corruption of medical science by Beatrice Golomb. - YouTube."
Some doctors now are paid by drug and/or medical device companies amounts exceeding five figures to give marketing speeches at dinners or luncheons
Other doctors are invited. The luncheons could be in a restaurant or at a medical conference where other doctors are gathered. Medical schools are not happy about their prestigious faculty members giving marketing speeches and promotional talks for drug companies. Is it ethical for doctors that teach other doctors to become specialists or generalists in medicine to promote drugs to colleagues who then pass the drugs on to their patients? The problem also is the use of private firms that "act as conduits" between pharmaceutical companies and university doctors.
There's a conflict of interest. Sometimes those conduits can be freelance medical writers who write the marketing copy for pharmaceutical firms that are read by doctors. But freelance marketing writers that write the ads that go into magazines and pharmaceutical publications are not influential unless they're ghostwriting articles in scientific journals under a physician's name.
Is there a conflict of interest between those who heal with a change in foods and nutrients and those who promote high-priced drugs?
Diagnosis and prescription could be reduced to a free-association word game played by doctors to reduce work stress, but discussing how doctors unwittingly create addicts by writing too many opioid painkiller prescriptions is serious. Patients take drugs in the first place to be in control of their bodies.
See the World News broadcast transcript, "Doctors Concerned About Rise in People Addicted to Painkillers," (The World Today), an Australian program that reminds doctors to be aware and concerned about the dramatic increase in the number of patients addicted to prescription (and sometimes over the counter) painkillers.
In the old days, many large, USA pharmaceutical corporations wined and dined doctors while paying for their trips to medical conventions in palm-latitude resort hotels or in Europe. Currently, there's a new twist. See the article, "Drug Firms Wine, Dine, and Pay Up for Doctors' Speeches, at the Health & Fitness site posted January 12, 2009.
Prestigious and influential medical school faculty from schools held in high-esteem are hired part-time by drug companies to give talks and/or to write articles
If anyone has credibility in the eyes of many doctors, it's the medical school faculty--colleagues or alumni, including faculty from those prestigious medical schools that doctors listening to the speeches wished they could have attended. Doctors with the highest reputations and rank on the faculties of medical schools are recruited by drug companies to moonlight.
Doctors held in high esteem often are hired to give speeches promoting or marketing drugs to other doctors over dinners, banquets, or luncheons in plush restaurants or at medical conventions. University doctors, medical faculty, whose job is to teach in medical schools are very influential on the prescribing habits of other doctors.
Medical conventions and conferences are run somewhat different from dinners where doctors sit and listen to another doctor act as a spokesperson for a drug company. The type of marketing or promotional lectures about drugs given at medical conferences are presented as serious learning forums for doctors and other healthcare professionals.
Painkiller addiction and the prescribing habits of some doctors
The specific and serious problem with the prescribing habits of doctors is the surging number of people addicted to certain prescription painkillers such as the opioid painkillers. Examples are morphine and Oxycodone. Why are some teenagers (when brought to some doctors' offices with their parents) still offered potent prescription drugs such as vicodin for mild sprains when simpler pain-relieving solutions also work? For the past decade a steadily increasing number of prescription painkillers have been prescribed by doctors to average patients as well as to the rich and famous.
Who influences the values and ethics regarding prescribing habits of doctors?
And how influential are integrative and complementary medicine marketing when doctors aren't studying courses in nutrition especially holistic nutrition in medical school or in premedical programs? In the early 1990s I attended several medical conventions as a medical news correspondent for a magazine to cover conferences of doctors and nurses discussing and debating pain control strategies. At that time nurses felt responsible for controlling pain in a face-to-face hands-on environment with patients that have been prescribed painkillers by their physicians.
Nurses were required to fill out endless paperwork while monitoring patients, sometimes standing in place of what should have been a counselor, but had no control over what painkillers outpatients collected once out of the office or hospital. Are big pharmaceutical marketing and insurance company pressures forcing doctors to form habits to keep their jobs, their insurance, or their standard of living?
Nurses at the medical conference were the key speakers on the subject of pain control, expressing deep concern about the hoarding of painkillers by patients that might be pharmacy shopping. There were no pharmacists speaking, and doctors reiterated being trained to diagnose and prescribe.
Each speaker approached pain control from the box he or she had been trained
No speaker stepped out of that box or mentioned turning to high technology for pain control rather than pharmaceutical solutions. Currently, more than a decade later, the subject of pain control includes a media storm about the dramatic rise in the number of painkillers being consumed globally by all levels of the population of the USA and other industrialized countries, for example, Australia. The facts point to a rising number of prescription drug overdose deaths.
Adverse reactions from prescription medicines of all types is the number three reason in the USA for emergency room visits. And sometimes deaths result from adverse reactions or allergies to some prescription drugs that the patient's doctor prescribed in good faith to relieve pain or in other ways to heal the patient.
You never know how your body will respond to a painkiller until you're given that drug. But most people given painkillers do survive safe doses that are not mixed with other drugs that have known interactions.
A person can become allergic to a drug at any time without knowing it or have an adverse reaction. One alternative solution to chronic, serious pain might be an implant that prevents pain by stopping the nerve impulse that's delivering the pain from reaching its goal. Another solution is physical therapy, including high-tech approaches to pain control such as low-level lasers and infra-red treatments, but not everyone can afford physical or occupational therapy.
Pain control is big business and necessary
Most often, pain control becomes the day-to-day, 24-hour monitoring responsibility of the caregiver in the home or the nurse in the hospital. The problem is that deaths from prescription painkillers and other potent prescription drugs are outnumbering street drug overdose deaths, for example, deaths from heroin overdoses. The gap is widening.
Sometimes doctors feel their hands are tied when they're caught between patients coming in to the office to relieve chronic pain and what happens when the patient becomes addicted to ever increasing doses when the drug no longer works at the lower or safer dose.
If doctors are accidentally creating drug addicts by over-prescribing potent painkillers and other drugs such as numerous anti-depressants, barbituates, and anti-anxiety medicines, patients are turning to nurses to discuss pain control alternatives.
Doctors want to see more information on databases but may not have the time to check out enough material for a particular patient's needs
When reporters ask the doctors whether they think they're creating drug addicts and setting up patients for potential overdosing either on painkillers or anti-depressants, doctors often reply that they're unaware of it but want to see more information, such as databases with statistics and studies. When you question physicians about what drug is most often overdosed, usually the answer usually is methadone, a drug that is increasingly in demand in the USA and in other countries.
And methadone is prescribed for various purposes, one being to get people already addicted to other drugs such as heroin, off those drugs. Methadone also is taken by patients for other reasons than former addiction to heroin. The problem is that methadone when combined with other painkillers could be lethal.
Competition as far as demand exists between prescribed medicines and street drugs
Pharmacy shopping and doctor shopping are common ways people accumulate pills. It's not only people with wealth and fame acquiring prescription painkillers. Famous names in the papers are frequently linked to prescription painkillers overdoses going back to the 1960s. Before that, the drug of choice to overdose on had been sleeping pills, particularly barbituates.
In some areas of the USA, people without insurance, savings, or income have a very difficult time getting an affordabe prescription for painkillers or at least the type of painkillers that work for them. The only way to find out whether requested painkillers are actually given to those without funds is to interview the patients. Many complain that their doctors aren't giving them pain medication post surgery or for serious pain.
The demand for prescription painkillers is one factor. Another is the drug manufacturers that try to make their medicines available to those who don't have medical insurance. Doctors want to look at emerging trends, but information is difficult to find online or in most medical journals.
Doctors that have treated heroin addicts with methodone may not realize that they could be creating addicts from some average patients that would never dream of taking a recreational or street drug. These patients are looking for relief for chronic pain such as the pain from a broken bone or from post-surgery pain.
Painkillers wide usage
If you look at the majority of employed people with reliable and credible histories and middle-class lifestyles, it's easy to become addicted to prescription painkillers just by putting your life into the hands of your doctor. You figure that you have to trust your doctor to prescribe what will take the pain away and heal you. After a time, the prescription painkillers don't work, and the dosage has to be increased.
At some point, the patient becomes addicted because the dose needed has become so high to relieve pain, that toxic results are inevitable. When safe doses no longer work, it's up to the doctor to remind the patient that a different approach must be taken, perhaps a pain implant, physical therapy, or other medicines that are less likely to addict the prescription drug user. The patient at that point might blame the doctor for creating drug addicts with prescriptions meant only to heal or relieve pain.
Do patients blame the doctor or the drug for adverse side effects?
If addiction to prescription painkillers becomes the problem, the patient tends to blame the doctor for creating a drug addict by increasing the dosages of pain medications or other prescription drugs that the patient is told are legal and will help control what is out of control inside the patient's body.
As a person's body gets used to the medicine, higher doses are needed to control the pain. At that point, the patient realizes that he or she is addicted to prescription painkillers. Alternatives need to be offered before legal prescriptions create an addict.
The patient feels caught off-balance when the physician or the pharmaceutical corporations let the patient think that the drugs are not addictive. One result could be pharmacy shopping or doctor shopping where the patient visits several doctors to collect prescriptions. The media is full of sensational news stories on celebrities in rehabilitation for prescription drug addiction, usually for painkillers.
Physicians remind patients that what's out of control in their bodies must be put under control with prescriptions. But the cause of being out of control usually is a chemical imbalance due to a problem not related to a deficiency of drugs.
Doctors who put a patient on one drug for life or ignore the patient's complaint about side effects
Sometimes when a patient complains about side effects, the doctor insists that a particular drug doesn't have those specific side effects. Then months later, when the patient comes in with a complaint, for example, blood pressure rising instead of falling on a certain drug, the doctor finally takes the patient off the drug.
When the patient asks for an ultrasound of arteries, the doctor may say the particular HMO only gives an ultrasound after someone has had a stroke, for example. Then the patient comes in a few years later having had a stroke. But no preventive care was given other than prescribing the 'wrong' high blood pressure drug that resulted in the patient having even high blood pressure.
That's just one example of what may go on between doctor and patient. Some doctors at HMOs work part time because they're raising small children at home and have only trained in prescribing conventional medicines rather than suggesting a different diet or lifestyle for the patient. If the patient suggests a supplement such as COQ10, the doctor, not having been trained in its use may reply with, "but it's not natural," when COQ10 is manufactured by the body when the person is young and wanes with age.
Since the doctor has not been trained in the use of a supplement such as COQ10 or has been told fish oil is good or bad to suggest, the patient is left to research independently from conventional medicine in complementary ways of restoring balance and health. Why would a patient be told he or she will have to remain on a specific drug life-long when the drug may be putting a bandage on a symptom rather than finding the cause of the imbalance? It's easier on the patient to look at frequent test results.
The loop that starts with pain control
It's a loop that keeps on recycling. The loop starts with pain, increased dosages, more testing, addiction, overdose, new drugs, or new doctor. Too many patients think that doctors have to treat their addiction to painkillers in the same way as society treats heroin addicts.
The approach needs to change. Pain control is a problem to solve, and the approach has to be different and based on information easily available to doctors on why prescription drug overdosing and addiction is increasing so rapidly around the world.
At medical conferences reporters listen to nurses that have approached doctors for improved solutions that get measurable results. Pain control, especially of cancer patients, is a deep and continuing concern of caregivers. And doctors say their deepest needs are for finding information in databases. Doctors want to see prescription addiction statistics.
Patients are demanding higher and stronger doses of painkillers due to changes in their brain chemistry
Why aren't doctors considering prescription addiction? This has become a topic for family discussion. At family reunions the doctors socialize with the friends with whom they went to medical school. As a group, some doctors as relatives and friends may repeat the same types of answers to me that they give to their patients, "In medical school, we were taught to diagnose diseases and write prescriptions." We got to talking about choices patients have when patients ask for help and the doctor responds with, "All I can offer you is conventional medicine."
I asked them, "Were any of you ever taught in medical school to think outside of that box?" They often smile and answer, "No." Some relatives that are physicians still attend medical conventions in different cities and almost automatically respond with the name of a drug when a symptom or disease is mentioned. It's a game we play at the dinner table. I say, "enlarged prostate," and automatically, my son-in-law, the internal medicine physician, pops out the word for one of the prescribed drugs, "Adovart" or "Flowmax." Sometimes they use the generic name, but that's when we play might play scrabble.
We used to play free association medical word games at dinner. Name a symptom or a disease, and out comes the word in a split-second, the name of a drug as a free association response. And that's the time the conversation around the dinner table changes to what are the latest materials they've read in the field of integrative, functional, preventive, or complementary medicine.
Who else might influence from behind the scenes the prescribing habits of doctors? It's the medical clinical trials ghostwriter and/or the medical marketing writer.
Medical Journal Article Ghostwriters for Physicians
The American Medical Writers Association's job listings database for members might show recruiting (job listings) at Jobs Online for freelance ghostwriting for medical journal articles with a physician's byline and for full-time pharmaceutical marketing and advertising writers and editors.
Medical marketing writers come from a wide variety of education combining life sciences with communications courses and experience. You have regulatory medical or pharmaceutical writing and marketing medical and pharmaceutical writing for various journals. There are medical ghostwriters who write books for physicians and freelance, independent medical writers who write articles for some medical journals under a physician's name, where the writing is checked by the physician.
Two types of medical ghostwriting fields hire freelancers--regulatory and marketing. Regulatory writing means writing and/or editing for the medical journals. Marketing writing means writing advertising or promotional copy. Marketing writing usually is done for the pharmaceutical companies that publish information about drugs in journals read by physicians and scientists.
Careers in in pharmaceutical copy writing or in medical regulatory ghostwriting for journals have a need for independent (freelance) writers as well as full-time employed writers on staff. Medical journals do use freelance writers to ghostwrite clinical trials and other regulatory writing for physicians and various research scientists.
Medical book indexers, proofreaders, and editors also are hired on a freelance basis. They're also called biomedical editors or indexers. See the publication Deciding to Become a Freelance Science Editor. Or contact one of the numerous associations listed online for independent biomedical editors, proofreaders, indexers, and writers. There's also the World Association of Medical Editors.
Start with the American Medical Writers Association. There are opportunities to write for publications in other English-speaking nations such as the Australian or Canadian medical journals.
Are doctors unknowingly creating prescription drug addicts?
If doctors are unknowingly creating prescription drug addicts, they're practicing what they've been taught in medical school. Look at what is influencing the doctors' prescribing habits. It's using familiar faces or reputations, prestigious medical school faculty as speakers to market or promote drugs for the pharmaceutical firms. To change the situation, start at the roots, the medical school where doctors could be trained in offering patients a wider variety of safer choices that work better.
Should a patient pop a pill, take an infra-red sauna, eat a 50 percent raw veggie and fruit diet, or check out low-level laser treatment and high technology, for example? Are implants better than drugs for pain control?
Or are there many other solutions often hidden from average consumers? After all, the goal of all types of drugs is to control (as in control the pain, the high blood pressure, the feelings, the tremors, the behavior, or the symptoms). Patients want, above all, to be in control of their health care choices by finding the cause, not only covering the symptom.
Neurostimulation painkillers instead of pills
One possible alternative painkiller is neurostimulation, a removable therapy that delivers precisely controlled, low-voltage electrical stimulation to the spinal cord through a carefully placed insulated medical wire called a "lead." The lead is connected to an implantable pulse generator that has a battery and electronics.
The stimulation blocks pain messages from reaching the brain. Instead of pain, the patient feels a "tingling" sensation. According to the site, most HMO's insurance covers the approximately $10,000 cost.
According to the article, Jerry's Story, On April 20th, 2002, celebrity, Jerry Lewis had a permanent neurostimulation system implanted by Dr. Ben Venger, a neurosurgeon in Las Vegas. Research this alternative. For further information on the details, see the Jerry's Story site and view the Video Interview with Jerry Lewis.
Remember, every patient is different. According to the Jerry's Story site, "Jerry takes no other pain medication and has suffered no side effects, but side effects are possible and can happen. Because the system is surgically placed, risks of infections do exist. Device complications, such as lead displacement causing an interruption in pain relief, also exist."
The point is there are alternatives. If one solution doesn't work, there may be another out there as yet hidden from the average consumer. The goal is to find what works for a particular individual. Hopefully, the future will bring non-invasive solutions through technology. The outcome for medical students and patients is that prestigious and influential medical school faculty from schools held in high-esteem are hired part-time by drug companies to give talks and/or to write articles that patients may read online.
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