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When Chris Thompson received a free textbook in his Eyes, Nose and Throat class he took a look at the logo in the corner and rolled his eyes.
The symbol was for Daiichi Pharmaceutical Corporation, which distributes an ear infection solution called FLOXIN Otic. The company gave a grant for the book to be updated and distributed.
“Primary Care Otolaryngology” was given to second-year medical students on Oct. 19 and is part of a much bigger problem — the unhealthy collusion of medical education and the pharmaceutical industry, Thompson said.
The University of Minnesota does not have guidelines in place to restrict such gifts, Dr. Mark Paller, executive vice dean of the Medical School, said. A draft of a conflict of interest policy will be finished in the next couple of weeks which probably would not allow gifts to be given to students, Paller said.
He said the textbook is an attempt by the industry to curry favor with future prescribing physicians.
“If [the company] really wanted to do it for educational purposes, they would give a donation to the University and allow the curriculum committee to decide how to use the money,” Paller said.
Center for Bioethics professor Dr. John Song was a member of the conflict of interest task force created by former Medical School Dean Deborah Powell. The task force’s final report from August 2008 recommended against gifts like this, Song said.
But the report was condensed into a two-page document which left out the suggested policy.
Song said pharmaceutical influence in education has become less common in the past few years.
Thompson said he has not received any other textbooks with pharmaceutical logos or heard of any other instances of gift-giving.
Third-year medical student Hannah Shacter said to her knowledge she never received any gifts from pharmaceutical companies.
Paller said the students can choose not to take the book.
“Medical students are mature adults, they can make their own decision,” he said. “It’s not as if their diploma has a pharmaceutical logo on it or something like that.”
Thompson said it is difficult to tell whether the material in the book is unbiased.
The basis of the book was written by Dr. Gregory Staffel in 1996 and was revised and edited by members of the American Academy of Otolaryngology - Head and Neck Surgery. The educational content does not mention Daiichi.
But the beginning of each chapter says Daiichi Pharmaceutical Corporation distributes FLOXIN Otic solution and gave a grant to the American Academy of Otolaryngology for the revisions and distribution of the book.
“The authors and editor had sole responsibility for the subject matter and editorial content,” the introduction by Daiichi Pharmaceutical says.
Although the textbook’s content may not push the pharmaceutical company’s product, having the mark of the company creates an “unfavorable impression,” Thompson said.
It’s important to convey that “we are professional people, and the medicine we practice is not biased, is not influenced by the industry,” he said.
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This article has been praised by J-School prof
Gary Schwitzer on his excellent health news blog:
http://blog.lib.umn.edu/schwitz/healthnews/2009/11/medical-conflic.html
"Meantime, it doesn't take the NY Times to dig into conflict of interest issues. A student journalist with the Minnesota Daily points out how medical students receive free textbooks from drug companies promoting their products. Case in point: an otolaryngology text given out by a company making an ear infection drug - with the company's logo on it, and with the beginning of each chapter crediting the drug company."
"The student journalist also pointed out that the University of Minnesota has no policy to ban such practices."
"It's good that this student journalist starts looking at conflict of interest issues now. If she stays on this beat, she's going to be busy on COI stories for a long time."
_____________
Congratulations, Ms. van Berkel!
The comments cited by Dr. Paller - the new capo di tutti capi in the med school - are especially telling.
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Is it really a conflict of interest?
This is very interesting and I was not aware that it was happening. But, I wonder if this is really a conflict of interest. Medical students are mature adults and conscious of the necessity to remain unbiased despite various brands trying to throw their names at them. Ask any doctor and they'll tell you about all the freebies they are offered by major pharmaceutical companies on a monthly, if not weekly, basis. Ask them about the attractive reps that come to their offices with lunch and freebies, enticing them to prescribe their company's products. If you ask me, having a pharma company logo on a textbook is just an introduction to what these students will experience on a regular basis once they become doctors. The only thing that needs to be strictly prohibited is any bias the books may contain as a result of the company's sponsorship, so there needs to be some sort of independent review of the books before they're distributed to students. -Matt P. from Maine Movers
I am going to make an assumption
that this comment is naive and well meant.
You might want to do a little reading up on the subject, however. It has been much discussed over the past few years. A sea-change is underway. One in which we could have been a leader. But we have been reduced to a follower by the weary negligence and foot dragging of our administration.
Freebies are about gone, my friend.
As for the influence of trinkets on behavior, you might want to look at the following pdf co-authored by a former U of M bioethics faculty member, Art Caplan:
http://www.masspirg.org/uploads/6m/82/6m82oGqrFl5MaNp6bNDBmg/Caplan_2003...
All Gifts Large and Small
Toward an Understanding of the Ethics of
Pharmaceutical Industry Gift-Giving
From the abstract of the paper:
Much attention has been focused in recent years on the ethical acceptability of physicians receiving gifts from drug companies. Professional guidelines recognize industry gifts as a conflict of interest and establish thresholds prohibiting the exchange of large gifts while expressly allowing for the exchange of small gifts such as pens, note pads, and coffee. Considerable evidence from the social sciences suggests that gifts of negligible value can influence the behavior of the recipient in ways the recipient does not always realize. Policies and guidelines that rely on arbitrary value limits for gift-giving or receipt should be reevaluated.
From Ivan Oransky, MD
For whatever reason, Ivan was not able to register and post this comment himself, but asked me to post it:
The U of M student journalist might be interested to know that a former student journalist named Joshua Sharfstein -- the name will be familiar because he is now principal deputy commissioner of the FDA -- took up the pharma-sponsored textbooks as a Harvard Med student in the early 1990s:
http://www.thecrimson.com/article.aspx?ref=116513
Ivan Oransky, MD
Executive Editor
Reuters Health
www.reutershealth.com
http://twitter.com/ivanoransky
The real context of the textbook situation
Unfortunately, the reality of the situation in which these textbooks were offered was not accurately depicted in this article. First off, there was not a required textbook for the ENT course in which these textbooks would have been useful. Rather, the primary source from which to gain the required knowledge for the course is a 238 page course packet which was created by the course director. The book, when offered to the students, was stated to be optional supplementary material. As such, use of it is absolutely unnecessary to excel in the course. Additionally, the book was never endorsed by the faculty as the premier source of information but simply as another potential source of information if one so desired to utilize it. The presentation of the whole truth is vital to one's ability to assess the whole situation regardless of whether or not you feel that a conflict does exist.
As a side note: as future physicians, we are expected to be scholars as well. This implies a responsibility on our part throughout our careers to discern between that information which is of high quality and that which is flawed or useless. We have a professional responsibility to analyze and understand the data relevant to our practice of medicine. It is certainly hard to argue that all of the information we will be presented with throughout our careers will not have some sort of bias. A bias is almost inherent in any sort of work. The researcher who is working on a new gene therapy here at the University of Minnesota is almost certainly going to have a slight, maybe even unrecognized, bias that his development is an improvement over the therapy developed by another researcher. It is hard, if not impossible, to believe that every researcher is completely altruistic; yet, this is the expectation many individuals possess. The point here is that it is ridiculous to argue that bias can be fully eliminated. As humans, it is an inherent part of who we are, and rather than making what sometimes amount to ridiculous and futile attempts at eliminating all forms of bias, we as physicians and scholars should work towards learning to recognize it so that we can effectively account for such biases when they are present so we can best treat our patients.
You seem to have completely missed the point...
Or perhaps this was deliberate, given your nom de guerre, neoconsinexile?
"When Chris Thompson received a free textbook in his Eyes, Nose and Throat class he took a look at the logo in the corner and rolled his eyes."
Did this actually happen? What in the hell is a course director doing offering medical students an expensive textbook which has a notice at the beginning of each chapter about the company providing it and the name of one of the drugs it peddles? Why not just pass out sales literature?
Your diatribe about it being impossible to avoid bias is a straw man. No one made that argument here. Daiichi could be passing out the Q'uran, the Bible, or the Tao Te Ching and, if their little advertisement for FLOXIN Otic was at the beginning of each chapter, it would be inappropriate. As Dr. Paller clearly admits in the article, the purpose of the gift was to curry favor with medical students. The trinkets being offered up have an effect on the objectivity of receivers. And you are welcome to deny it until you are blue in the face.
Better get used to no trinkets if you plan on practicing medicine as a career. You could go into psychiatry or orthopedics. I understand there is a lot of consulting money in these fields for those so inclined. That way you could afford your own trinkets. You may wish to consult Drs. Polly and Schulz about this.
Or you could go to work full time for pharma or the medical device industry. They should have a lot of surplus trinkets by the time you are fully trained.
Right on the "money"
The previous comment is just another example of the use of incorrect or misleading statements or the lack of facts. No where in the article does it state that the textbook "has a notice at the beginning of each chapter about the company providing it and the name of one of the drugs it peddles." Your information is taken from a blog, which is hardly a credible source. I sincerely hope that is not what counts for a credible source in "J-school" otherwise the journalists may have to do a little more introspection about ethics than the medical people. Also, it seems to be bad form as a journalist to use hype as a method of driving home an opinion.
I disagree with you; the argument about bias hits at the root of the problem. The real problem is not whether or not conflicts will exists. They will always exist in one form or another. The reason people are so concerned about conflict of interest is that they are concerned that physicians will become biased towards the use of certain medications or medical devices with a less objective regard for their efficacy or negative side effects.
As for the potential effect gifts may have, I never once denied that. The research certainly does point to the fact that it may indeed have an unconscious effect on the person. That is our goal as physicians: evidenced based medicine. My primary point was that one must present ALL the facts in order to forward their argument. It makes for good science and good journalism. And as long as we are on the topic of ethics, because that is what this is all really about, it is most certainly unethical to present only the information that paints your story in a positive light. My second point was that we should be more aware of the potential for these occurrences rather than going for the jugular every time some professor who is just trying to help out his medical students who are going to be roughly $200,000 in debt when it is all said and done offers them a free book. By being PERSONALLY vigilant for the potential for such conflicts within our OWN practice, we will do a much better job of eliminating their effect on our practice rather than waiting for someone to hold a book burning every time some individual sees a "logo in the corner and [rolls] his eyes."
Interestingly, I had not even looked at one of these books until this article came out.
I think it is rather funny how your comment quickly dives into a personal attack. The practice of medicine is about helping people, more importantly, the individual patient; it is certainly not about the financial or personal gain as you are so ready to insinuate. You assume you know someone based upon your perspective of their principles without actually having ever met them. Take a deep breath and relax. Maybe count backwards from 10. And, this may seem odd coming from someone with the screen name of neoconsinexile, but don't judge someone before you've even met them. It would appear that you were blinded by your own prejudices, possibly derived from my "name of war."
I've not seen the book
From the Daily article (not a blog):
"But the beginning of each chapter says Daiichi Pharmaceutical Corporation distributes FLOXIN Otic solution and gave a grant to the American Academy of Otolaryngology for the revisions and distribution of the book."
If this is incorrect, take it up with the Daily.
The rest of your response seems to be what is called special pleading. "Certainly not about financial gain?" As I said, talk to Drs. Polly and Schulz.
The blog I referred to is written by Professor Gary Schwitzer, a J-School prof who was a member of the so-called conflict of interest panel that supposedly was going to come up with a new policy. I assume you know all about that fiasco? If you don't, you should. I'd be happy to further enlighten you if you can't figure it out.
Google "University of Minnesota Medical School + Conflict of interest." Try "Deborah Powell + Pepsi" Or maybe "Polly + Medtronic" Or "Schulz + seroquel" Or "Furcht + conflict of interest" Are you proud of this kind of behavior in our medical school? Tell me, if you can, that this is acceptable behavior. Count to ten with me right now?
Your argument seems to boil down to: Trust me, I'm a doctor.
Or maybe, trust me, I'm a medical student?
Ah, that would be no...
Clarifications
You have a false impression about this book that should be clarified. Firstly, this is not an "expensive textbook." The book looks more like a pamplet than a textbook. It is half a sheet of paper in size, only about 100 pages in length (maybe 8 millimeters thick) with giant font and lots of pictures. Secondly, there are no Floxin advertisements at the beginning of each chapter. The only place in the book where I can find Daiichi-Sankyo's Floxin mentioned is on the back side of the cover, along with all of the publishing information. Moreover, the message reads more like a disclosure statement than an advertisement.
Had this article not come out, I would not have even known that this book was a gift from a pharmaceutical company. When the medical school informed us of the books, they did not mention that it was sponsored by a company; they merely said "The ENT Department has been able to obtain free copies of the Primary Care Otolaryngology book for you!" Additionally, the logo in the bottom corner of the cover is nearly imperceptible, and since I never read the publishing information page, I would have never noticed that the book was paid for by a company.
Regarding the assertion that the relationship between pharmaceutical and the medical school is too close and needs to be reevaluated, this is the FIRST instance of any sort of contact being made to us by pharmaceutical company that I have experienced so far in my first few years attending this medical school. I agree that it is inappropriate for pharmaceutical companies to solicit to medical students at this impressionable point in our education, but this situation seems to be being blown way out of proportion.
I think you need to take a (Daiichi-Sankyo Brand) chill pill wbgleason.
Right on the Money
See the first video in this link:
http://ptable.blogspot.com/2009/07/were-not-violating-legal-statute-i.html
As the book sits in front of me...
I have to completely agree with peanutbutter. I was completely unaware the the book came from a pharmaceutical company until I read the article in the Daily this morning, and being that the drug company logo is the smallest thing on the front cover, I don't think I would have ever noticed it.
Not a single chapter of the book starts off with an advertisement or any mention of Daiichi-Sankyo. I don't know where the Daily got their information, but maybe they should check their facts and get a copy of the book in question, rather than writing false statements that obviously infuriate people like wbgleason.
So, being that the company's name is printed in the book a grand total of 2 times, both in areas that do not contain educational content and therefore are not on my radar, and their drug name is mentioned once- in the same area, I had no idea this book was able to be updated and redistributed (NOT written- it already existed) because of a drug company educational grant.
I agree that conflict of interests need to be addressed, but spreading false information and getting people worked up over a book that was offered to us as optional and not in any way expensive, doesn't seem like the right way to address them.
If you really want to take on questionable ethics aimed at students, take a look at the dental school! My roommate (a D2) came home today with 3 toothbrushes, 3 tubes of toothpaste, and a t-shirt from 4 different dental product companies! This happens all the time- they even got free electric toothbrushes!
As I said
if the Daily's statement that I quoted is incorrect, please let them know this.
[Couple of other folks have shown up. Thanks for your input. This was originally written in response to "neoconsinexile." I didn't realize that peanutbutter was now batting. Sorry for confusion.]
You, yourself, finally and grudgingly concede that soliciting medical students in this manner is inappropriate and are reduced to arguing that it has been blown out of proportion.
And how did your Googling go, Doc? If you actually did as I suggested then you would be the one who needed a "chill pill."
Since you claim to be so interested in the welfare of patients, I ask you again: Is this behavior acceptable in our med school?
And do you support a new conflict of interest policy that will prevent this kind of behavior in the future as well as trinkets to docs and med students?
As Mark Twain famously said: Denial is not just a river in Egypt. You seem to be well on the way to mastering it.
Grudgingly concede? I think I
Grudgingly concede? I think I can speak for most medical students in saying that we have always believed that pharmaceutical solicitation in this manner is inappropriate...this point was never being contended. I am not here trying to beat you in an argument, I am just providing clarification of the facts in this story so that other readers can have a more neutral perspective from which to form opinions.
And again, as I tried to emphasize in my last post, we medical students do not receive trinkets and handouts from these companies like you make it sound; this book is the first occurrence of contact between a pharmaceutical company and medical students that I am aware of. Since I began medical school, I have always had the understanding that there are rules in place preventing pharmaceutical companies from soliciting to us (thus I was surprised to learn that the book was paid for by a pharmaceutical company).
Thanks, pb
I got a little confused there before I realized that you had jumped in. I appreciate your clarification because I was going on the original Daily report and have never actually seen the book in question.
I think if you check into it, you will discover that right now gifts from pharma to med students are not prohibited. This was in the first draft of the new COI statement, but when it shrunk down to two pages, it was no longer there.
I'm sure it will go back in during the next iteration. God knows when that will be.
I think most med students see the handwriting on the wall and that this will, hopefully, get worked out in the next couple of years. I am just disappointed that we couldn't be leaders rather than followers at the U of M in COI policy because of foot dragging and weary negligence of...
Well, you know.
What has been going on at our med school in the past few years has been pitiful. If you get a chance do the Googles suggested above. This kind of behavior is not going to do any of us at the med school any good in the long run. And of course it is not right. First, do no harm and all that.
Best,
Bill
Image
Gleason has a right to be upset--- recommended "textbooks" published by Pharma is just the tip of the iceberg.
The book might have been presented as "optional", but it was the only textbook that was recommended, to my knowledge.
The fact that the book was published by a Pharma presents two dilemmas. First, we see the ad for the company's ear tonic-- as we learn about ear pathophysiology. But this is the minor issue.
A major problem is that it casts doubt on the reliability of the whole book. Perhaps there's no bias-- but I'd rather pay for a book so that I don't have any doubts. I'd also rather not have the public have doubts in my capability as an independent thinker. A "textbook" published by pharma presents a poor image.
Perhaps you can draw a line... was it crossed? I don't really care. I'd like to clearly present myself as someone who practices unbiased medicine-- therefore I will accept no gifts from Pharma, especially "textbooks." So professional image is important-- after all, we tuck in our shirts before we see patients. Why not refuse to accept gifts from Pharma?
Student Council has a role to play-- they shouldn't wait for the school to make a policy banning gifts to students.
Did you read the syllabus?
First of all Chris look on page 3 of your syllabus there is a list of four textbooks that are listed as "good textbooks". If you didn't like/want the free textbook don't take it or use it. I personally like the textbook and found it helpful and fun. At this point of your education you should be able to distinguish between biased and unbiased information. The entire world is full of biased information and it's impossible to eliminated it all. Also remember even so called "unbiased" textbooks are biased because they are written by professors who have an opinion.
Biased?
I know your response was directed to Chris, kittykat.
But I'd just like to point out that even if the material were "unbiased" - whatever that is - that the problem is that it is a "trinket" and you know who gave it to you and the drug they peddle if you even give the material more than a cursory glance, which you ought to if you plan to use it to learn medicine.
For example, there is a difference between being pro- or anti- hormonal treatment for post-menopausal females. And this is apart from the question of whether money from pharma has influenced your decision. Whether one has a "bias" on these or any other controversial medical topics is quite a different question, as far as I am concerned, from the trinket issue.
This matter is fairly minor and I am confident that it will go away soon. The other problems mentioned above are not. It is past time for our medical school to have a decent conflict of interest policy in place, so that we are not embarrassed by inappropriate behavior here in the future.
Best, Bill
(who is suffering from the loss of his cat - last week...)
Online Textbook
No I didn't read the syllabus-- so Diachii was presented along with other textbooks? Great!
I assumed that Diiachi was the one to read, since on the class's Moodle site there is a link to Diiachi's online version of the text. The link is very prominent-- next to the class schedule, and online lectures.
Um... I am recognizing and trying to reduce my exposure to bias. A "textbook" published by Pharma suggests bias. Or maybe there is none... I'd rather not have to think about it.
Like I said in the article, this free textbook is a sign of a larger, well-recognized problem-- an unhealthy relationship between some doctors and Pharma. On average, doctors prescribe medications worth $320,000 per year. So don't be naive about the desire of a company to curry favor with future prescribers.
I'm not questioning anyone's ability to refuse a free gift. I would think everyone would refuse free gifts from Pharma. So why don't we just make this policy? Student council can take the lead, since our school is moving slowly.
If you pay for a textbook, you can select any textbook in the entire world. Thus you can select the least biased, and best textbook.
Money
So a doctor directs about $320,000 towards pharmaceutical companies every year (on average). This is my own back-of-the-napkin calculation. Simply divide the total drug sales in the US, by the number of practicing physicians (740,000).
All the ads that you see on TV for cars? Those are ads meant to influence your annual expenditure of perhaps $5,000 (since you don't buy a car every year, the annual expenditure isn't $30,000.)
This is a rough model, but it's meant to give a sense of the scale that we're talking about. $300,000 is 60 times larger than $5,000-- car ads are fairly ubiquitous.
This is why we need to be vigilant as doctors. The best source for unbiased medical information is through peer-reviewed, respectable journals and textbooks that are published by publishers who make money by providing high-quality, relatively bias-free info. Respectable journals require their contributors to declare conflicts of interest.
This debate is also about the rights of patients. I may want a free gift as a doctor. But my patients would see that as suspect. Let's be pure-- no gifts.
--Christopher Loren Thompson
Smoking gun...
OK, folks. I've not seen the hardcopy of the book under discussion. And so I was a little surprised over the controversy about what was at the beginning of each chapter.
But Chris's reference to the link to the on-line version being prominently displayed on the course's Moodle site got me thinking....
Have look at the link to the first chapter of this thing on the web:
http://www.entlink.net/EducationAndResearch/upload/Chapter-1-Introductio...
Where you'll read prominently at the beginning of the Chapter:
Daiichi Pharmaceutical Corporation, marketers and distributors of FLOXIN Otic (ofloxacin otic) solution, 0.3%, provided an educational grant for this book to be updated and distributed. The authors and editor had sole responsibility for the subject matter and editorial content.
_______________
Sorry folks. Does not pass smell test. Should not be linked on course web site. Periscopes down.
The other chapters have the same notice.
Not appropriate in my opinion. Fire when ready...
enough with the patronizing tone...
Wbgleason, I believe your arguments about the danger of influence and connections between pharma and the medical school are sound. As a future physician I take pride in the nobility of medicine as a profession and believe that we should strive to be above reproach. The textbook fiasco was overblown in my assessment, but the larger problem of conflict of interest is important and obviously has not been adequately addressed. You seem to have a great deal of knowledge about this subject. However, I am disappointed that someone with more than a casual interest in the medical profession, such as yourself, shows such little respect for medical students. At several points on this discussion board you have shown inappropriate disrespect that I found offensive.
Firstly, “I'd be happy to further enlighten you if you can't figure it out.” If we have the potential to “figure out” how to save your life when you choke on all that righteous anger, I think we can handle whatever you have to throw at us. Thanks.
Second, “Your argument seems to boil down to: Trust me, I'm a doctor. Or maybe, trust me, I'm a medical student? Ah, that would be no...” Glad to know that all of this training that I’m putting my heart and soul into is completely unworthy of your trust. I hope I will earn your trust someday when I provide excellent and compassionate care to you or a loved one with the knowledge that I proudly learned at the University of Minnesota Medical School.
Next, “Since you claim to be so interested in the welfare of patients,” It makes me so sad every time someone calls into question the main reason that we are all here. My classmates and I put aside our own lives and incur considerable personal debt to work to gain knowledge that will someday help our fellow humans. To imply that we may not have our patient’s welfare at heart is unreasonable.
Again, “First, do no harm and all that.” You suggest here that we need reminding of the responsibility that comes with people placing their lives in our hands. Your glib reference to the guiding principle of our profession may have helped you prove your point, but I assure you that it is no punch line to my colleagues and I.
Lastly, let’s discuss something I can speak to directly; how to effectively learn medical knowledge. You state “if you even give the material more than a cursory glance, which you ought to if you plan to use it to learn medicine.” Do not imply that you have an understanding of how one should take on the task of learning medicine. Leave that to the experts please.
On a separate note, I’m sorry your cat died. I know firsthand that loosing a pet is very difficult. May his/her shenanigans be remembered with laughter and fondness.
Thanks, Kelly
My previous remarks were addressed to the specific medical students to whom I was responding.
Most people have been very civilized despite the fact that we probably don't agree about everything. You'll notice that there has been no response to my request for Googling some topics of relevance to what has been done in OUR medical school! I ask again if this is acceptable behavior? This behavior is primarily the reason that I am upset, not necessarily this textbook issue although it is just an example of people not really thinking deeply enough about the implications of distributing this material, especially through a course web-site.
If you want to know where I'm coming from, have a look at this:
http://ptable.blogspot.com/2009/07/were-not-violating-legal-statute-i.html
Do the experiment I suggested earlier: Google "University of Minnesota Medical School + Conflict of interest." Try "Deborah Powell + Pepsi" Or maybe "Polly + Medtronic" Or "Schulz + seroquel" Or "Furcht + conflict of interest" If what you find doesn't upset you, then I am obviously wasting my time. This is OUR medical school and this kind of behavior is not appropriate.
My earlier comments on this site are NOT addressed to all medical students. The vast majority would never make the "trust me, I'm a doctor" argument. I've probably had literally hundreds of pre-meds pass through my lab doors over the years while teaching at Carleton, St. Catherine and the U. Many of these folks are now med school professors. They went to some of the best med schools in the country INCLUDING the U of M. They were ALL fine people. I am grateful that people like you are willing to use your time and talent in this extremely difficult profession. I am very concerned about the debt load incurred and am especially aware that this serves as a barrier to some of the students I've had who feel that the barrier is insurmountable. And these folks would have made marvelous docs. The debt load can also cause specialty choices to be made for economic reasons. Family docs are undercompensated.
My personal physician is a woman, a graduate of the U of M, and a damned fine doctor. I would not be writing this if it were not for her.
I hope I make myself clear that I was not trying to disrespect all med students or doctors in my remarks.
With best wishes that you attain your goal of becoming a compassionate and caring physician. You will be further evidence for the fact that the U of M turns out great docs, despite the problems alluded to above.
Sincerely,
Bill
U of M faculty member (Med School)
U of M grad - 1973
Really?
Chris—
Are you actually interested in eliminating conflicts of interest within the medical school or simply in involving yourself in the news? There are several systems in place for addressing perceived problems in your education. Perhaps it would have been more effective to take up the issue with the course director, the administration, or the student council instead of running straight to the Daily.
My letter to the editor
Since it doesn't seem that the MN Daily is planning on running it, here's my letter:
There was a small uproar in medical school lecture halls today as we passed around the article "Questionable ethics: a textbook case". As medical students we are well aware of the rich history of influence pharmaceutical and medical device companies have had on doctors in the past, and are all in favor of reforms that will ultimately benefit patients. Yet the target of the article, a text book given to second year medical students, was merely a straw man, meant to generate overblown and misdirected anger. The book itself was first published in 2001, a full three years before the grant was given by Daiichi, the pharmaceutical company in question, to allow for its distribution to medical students. The article also incorrectly states the amount of influence peddling that occurs in this book, to a massive degree. Nowhere past the first page does a reference to Daiichi or its products exist in the 112 page text, even in sections that pertain to conditions they treat. Finally, the article makes the implication that anything that a drug company sponsors cannot possibly be correct or even helpful. But what good could a doctor do without drugs of some kind to prescribe? There are real life conflicts of interest out there - ghost writing of papers, kickbacks to doctors - that need addressing because they can do serious harm to patients. This text book is not one of them, and inciting anger towards it does nothing in the service of patients.
My letter to the letter to the editor
Actually I wasn't just interested in being in the news... although I see the allure now. This discussion is delightful!
I happened to mention the textbook to a journalist from the Daily, while we were having a conversation about health care reform. Since I had organized Policy and a Pint, the Daily wanted to talk with me about "what medical students think about healthcare reform." Whatever I said about that healthcare reform was apparently too boring to print.
The reporter smartly pounced on the textbook-- as a window into the larger issue of conflicts of interest reform at the U of M. I respect her for publishing the article, which was entirely factual. And I stand by my innocent comments despite the "uproar". This article was entirely initiated by the Daily.
Why doesn't the medical school just polish its policies a little? I really do care about our school, and protecting its poor policies is a false loyalty. So stop trying to define a fuzzy boundary for the school's sake-- accept NO gifts. That's clear-- your future patients will appreciate it. Plus if we tackle the little stuff, the bigger fish will be easier to fry.
My grandfather was a doctor and later worked for a pharmaceutical company. His brother was an anesthesiologist and invented a device called the Thompson Retractor. So I understand the desire of a doctor to be inventive and productive. But free textbooks from Pharma? That's a no-brainer-- the answer is "no".
Before I started medical school, became concerned about the reputation of the school because I came across all those articles online that Gleason mentioned.
And in regards to the textbook being "overblown", here's what I said:
[“Primary Care Otolaryngology” was given to second-year medical students on Oct. 19 and is part of a much bigger problem — the unhealthy collusion of medical education and the pharmaceutical industry, Thompson said.]
This is true... the textbook (although suspicious) is a minor part of a larger problem. "Continuing Medical Education" at the U of M is entirely paid for by Pharma. This was the larger problem, I was referring to.
--Christopher Loren Thompson
A scent of arrogance..
...lingers through a lot of this.
It disturbs me that those posting as medical students in these comments seem to whole heartedly believe that AS medical students, they are "above the fray" in terms of being able to identify bias and to, well, be "perfect." The argument basically goes as such: "We're so intelligent because we're medical students that all this conflict of interest stuff won't affect us!" Except, that's not really what I see to be at stake here.
The ability for med students to use their intelligence to ignore potentially "biased" information through big pharma gift giving is only a small part of all this. I'm sure most med students would be able to do this. Not just anyone is let into med school. Then again, we need only look to the headlines to see a constant parade of doctors and researchers, all VERY intelligent I'm sure, falling prey to the influence of money at the potential expense of patients (e.g., Dr. David Polly). As my father would say, "pride cometh before a fall."
So here's the real issue: trust. And not trust between doctors and teachers. Not trust between students and textbook publishers. Trust between doctors and patients. When I visit my primary care provider, I want to be able to believe that the care I am given is in my best interest, not in the best interest of some pharmaceutical company. This is exactly the problem with a textbook in medical school having any sort of affiliation with a pharmaceutical company. It isn't that the information contained in it is wrong, biased, or works for the benefit of the company. That stuff is dangerous, but something greater is at stake. What really matters is that it suggests there is a connection. This suggestion, even something as small as a logo in a corner, all works to create a culture of distrust between patients and doctors. And, as future doctors, if the care and well being of patients is really at the center of your whole purpose for being a doctor, this trust should not and cannot be taken for granted. Only in a doctor-centric worldview would none of this matter and we could treat conflict of interests as working "behind the curtain" where most patients won't see it. Except...they do. A culture of inappropriate influence and the distrust it creates needs no smoking gun; mere suggestions will work. Therefore, any hint, any scent, any suggestion of a conflict of interest, no matter how small or how seemingly insignificant, adds to the problem. If we're going to be serious about "service to patients," then yes, things like this indeed do matter, and matter a great deal.
Trust
"Therefore, any hint, any scent, any suggestion of a conflict of interest, no matter how small or how seemingly insignificant, adds to the problem."
This is key. I always saw the textbook and other small gifts as minor-- but they become symbolic. A no-tolerance policy for gifts would be morally clear. And it would increase our patient's trust.
Sure, lots of doctors can successfully navigate conflicts of interest-- and there is the desire to maintain this privilege-- but why not send a clear, categorical message. No gifts.
In regards to using other channels to achieve more stringent conflicts of interest policies: I ran for student council vowing to strengthen our conflicts of interest policies. I didn't win the election... and the incoming council dropped the issue.
The administration received the conflicts of interest task force recommendations about a year ago. But they are still wrapped up in a series of "drafts." With such a long timeline, and no involvement from students (that I'm aware of), it's hard to understand what's happening.
So when the Daily initiated a conversation about conflicts of interest policy... I told them what I thought. The article seemed mostly about policy in general, and not the textbook in particular. I certainly thought of the textbook as a window into a larger debate-- not the other way around.
--Christopher Loren Thompson
Now I'm REALLY excited for period 6!
Wow, wbgleason. I am amazed that a faculty member would write such demeaning comments to his students. Even if your comments (i.e. unprovoked personal attacks) weren't addressing "all medical students," look at who they WERE addressing; your future students who were simply trying to clear up the falsities of a University newspaper article.
You are obviously very passionate about the image of our medical school and I can respect that. True conflicts of interest, like the ones you so respectfully pointed out, tarnish our name, potentially endanger patients, and degrade the trust that is so integral in the doctor-patient relationship. However, I think you should reexamine your tactics (and ensure you have your facts straight) if you actually expect us to rally behind you on this issue. Calling into question our intelligence as students and our integrity as future physicians isn't a very good way to garner support.
After doing a little research on your publications (yes, my medical student brain can handle the complexities of Google...), my guess is that you will be giving some of the blood pharmacology lectures this spring. If your lectures are going to have the same contemptuous tone that has colored all of your comments thus far, I'm sure I won't be the only "naive," trinket-taking, "master of denial" who will learn the material from home rather than risk giving the impression that I support a professor who has such a low opinion of his students.
Sigh...
Mr. Daiichi,
You are wrong about a couple of things.
Go back and read my comments to Kelly. They pretty much summarize my attitude toward medical students and doctors. And I stand by them.
If amplification is needed, please see:
http://blog.lib.umn.edu/bgleason/pt/2009/01/medical_school_ethics_is_not...
especially the third full paragraph.
Your surmise that I will teach blood pharmacology is totally incorrect. I have never taught the course nor do I have appropriate background. So much for your research skills?
I know that medicine is a profession where you sometimes have to shoot from the hip. Please don't start doing this until it is really necessary.
Best,
Bill
Unprovoked Personal Attacks
I don't like personal attacks either... like the one from "kittykat" that questioned my motives for sharing my opinions with the Daily. Act with integrity-- don't take a anonymous swipes.
Take the high ground, and stick to the issue: Should we allow Pharma to gift students?
Since the administration has taken two years or more to consider implementing such a ban-- I would call on student council to take the lead. U of M could be as reputable as the best schools in the country. But we have to be bold, be leaders.
Sure we'd be giving up a little privilege we currently "enjoy". But it's kind of worthless, tiny privilege... and giving it up would send a strong, symbolic message-- we practice medicine untainted by Pharma.
My sense was that Bill was condescending towards a few students or doctors who would gleefully accept gifts from Pharma. Those students tarnish my reputation as a med student... so my response is-- go get 'em tiger!!
-Chris
I'll be paying close attention to my syllabi
Well wbgleason, whatever it is you teach, I will be checking my syllabi to ensure I don't attend your class. No matter what you say your "attitude about medical students and doctors" is the fact of the matter is you were rude to my classmates without any provocation. They may not have their PhDs, but they weren't treating you with disrespect. Can you say the same thing?
Forgive me for assuming that your research on heparin and blood coagulation would fall in the "blood" category of pharmacology. I guess I don't know what it is in which you have an "appropriate background." My guess is not effective interpersonal communication.
Ah there he goes again... Dr. (to be) Daichi
Doc, you don't know me from Adam, so don't pretend you do.
It makes you look foolish.
I have a long and distinguished career as a teacher, including at places where real value is attached to good teaching, like Carleton and St. Kates.
Did you go back and read my response to Kelly? What do you have to say?
You are (apparently) one of the 5% that gives docs and medicine a bad name.
Have a nice day.
Bill
The cost of distrust
I find it disturbing that many of the comments seeking to downplay the importance of the COI issues at play here are unsigned and with usernames that were recently created and that essentially lead to no where (full disclosure, I recently created this username, but only in the interest of making it easier to personally stand behind any comments I make).
How do we know all these highly anonymous comments are indeed from different people? How do we know they are not just a single person creating new usernames to write different comments and to attack anyone trying to illuminate COI issues? And, perhaps most chillingly, how do we know that this person writing these comments is not a paid shill for Daiichi Pharmaceutical Corporation itself?
We don't know, and that is exactly the problem. It is within this ambiguity that we don't know whose best interests are in mind. It is within this ambiguity that we don't know why people act the way they do. And, most importantly, it is within this ambiguity that trust is lost. And that is ultimately what this is really about. By not taking the lead on COI issues, we actively cultivate a culture of distrust between patients and doctors. Ignorance in this instance is a verb, not an adjective. It amounts to actively choosing to ignore what is at stake--stakes which no one needs to be reminded are incredibly high when we're dealing with medicine.
I personally find it tragic that medical students (at least in this thread) seem to be of the opinion that this is someone else's problem to fix. The sentiment that people should respond in "correct" ways to such egregious ethical transgressions before they will "rally behind" someone is unfortunate. This will be your field very soon. To sit this one out is to simply assent to what is going on.
Lay off wbgleason. You don't
Lay off wbgleason. You don't know me from Adam either, so please don't tell me I "give medicine a bad name." I haven't done anything wrong. I already gave you a response to your comments to Kelly; no matter what you STATE your attitudes are toward medical students I feel that your attitude on this thread has been presumptuous and disrespectful.
No one on this thread has said that conflict of interest is not an important issue at this school. No one. We were just trying to say that this particular issue of the otolaryngology "textbook" has been blown way out of proportion. You may think that we are burying our heads in the sand, but we're the ones who know firsthand that this issue with the ENT books is NOT what you and Chris are making it out to be. The problems our school has faced regarding conflict of interest will not be fixed by hyperbolic statements about pharma doling out "sales literature" to students. Please don't make this something it is not; it makes you look foolish.
Dr. Daiichi
So, let's see...
I'm going to teach blood pharmacology...
Aren't you even a little embarrassed about this? No, I guess not.
I'm disrespectful to all medical students/doctors, even though I've given pretty good evidence that this is not the case, I'm the great Satan...
You get the idea.
Your choice of name alone, Dr. Daiichi, gives everyone a pretty good idea of where you stand.
Take the trinkets. You deserve them. You're God, er, a doctor. Or at least - as pointed out earlier - one of the very small number who give medicine a bad name.
Trinket time will soon be over - for the vast decent majority of medical students who realize that this has to stop, as well as for people like you.
Ciao,
Bill
Where I stand? Give me a break!
Where I stand? Give me a break! My sarcasm is apparently lost on you.
I will gladly throw this "textbook" into my garbage disposal (it would easily fit, if that gives you an idea how much of a "textbook" this is) if it will convince you that I am not in the least bit interested in taking "trinkets" from pharmaceutical companies. I am on your side, why can't you see that? I too want to protect the integrity and reputation of my future profession. Perhaps you won't be happy unless I'm picketing outside the administration office.
And no, I'm not embarrassed about thinking you would be a period 6 pharmacology professor. What a weird statement! What does it matter which particular lectures you teach? My point was that you are our faculty and yet you talked to us with contempt before even meeting us (and continue to do so).
I never said I was God, I never said you were satan, and I don't give medicine a bad name. I'm beginning to see that my classmate was 100% correct about this article generating overblown and misdirected anger.
Dr. Daiichi
You are a bonehead.
I'm not saying this about all medical students, I'm saying it about you. You're right, I don't know you from Adam. The reason I am saying it is because of what you've written on this board.
We'll let the readers make their own decision on the matter.
I am finished wasting time on your sad self.
Bye,
Bill
This is ridiculous
Bill, I can't believe you work for this school. You have directly and indirectly insulted a number of my classmates. You have also put down the people who agree with them by demeaning their positions while completely ignoring their content. This includes me.
I have up to this point been impressed with the faculty of this school. But your ad hominem arguments have gotten uglier and uglier, and its become a stain on the faculty here. I hope that when not in front of a keyboard you're a much deeper, more thoughtful person.
I feel for my classmates who have consistently argued the issues while you attacked their character. But this is gone on long enough.
You, my friend, are a jerk.
To Indignant NRschoeneck
"and its [sic] become a stain on the faculty here."
Tell that to Drs. Polly, Schulz, Furcht...
I could go on.
Have a look at this sweet one:
http://ptable.blogspot.com/2008/12/conflict-of-interest-at-u-med-school....
What do you think of this, Mr. Schoeneck? Is this a stain on the faculty here? Is this more egregious than my going after COI at the med school and hurting the feelings of sensitive souls like you and Daiichi?
Why don't you direct your righteous indignation to the place that it belongs? Show us how much the medical students really care about conflict of interest policies? Talk is cheap. Or just continue to sit on your behind and whine when someone rubs your nose in it. Perhaps tap out the occasional nasty note on your mac about how high minded and dedicated you are...
As I said to Dr. Daichi, I have spent enough time on folks like you. I can live with what is above and let people make up their own minds about the matter.
I do believe that the vast majority of medical students support no trinkets and COI reform. I can live with your enmity. I'm a jerk? Wow, that is impressive. Grow up.
You are going to have to face a lot more difficult situations than this in your medical career without ungracefully losing it as you have here.
Fairly soon another sick old codger is going to tell you that you're full of it. How are you going to handle that? Call them a jerk?
Hasta, Nathaniel
Unmask Yourself Dr. Daiichi
Use your real name-- you're going to be a doctor after all.
And if you're still saying I'm blowing the textbook out of proportion, then you're not listening. As I said before, your Daiichi textbook is a minor infraction-- but it illustrates the larger problem. That was the gist of the article. How are we going to address the larger problem? That's the issue that should be under discussion. Any idears??
-Chris
Since when am I Dr. Daiichi?
You know what I'm going to do about it? Sit on my ass and wait for a whopping two weeks:
"A draft of a conflict of interest policy will be finished in the next couple of weeks which probably would not allow gifts to be given to students, Paller said."
Straight out of your precious article. Case closed. This was likely a one time thing. I hope you had fun, Chris.
Since when am I Dr. Daiichi?
You know what I'm going to do about it? Sit on my ass and wait for a whopping two weeks:
"A draft of a conflict of interest policy will be finished in the next couple of weeks which probably would not allow gifts to be given to students, Paller said."
Straight out of your precious article. Case closed. This was likely a one time thing. I hope you had fun, Chris.
Fun?
It's no fun when feelings get hurt... and you're hurting my feelings with your comment about my "precious article." Another anonymous swipe....
The administration has been thinking about proposing a ban on gift giving to students for 2 years. The COI task force finalized their recommendations about a year ago.
I'll be pleasantly surprised if they announce a change in policy in 2 weeks. I actually think they came up with this timeframe on the spur of the moment-- like seconds after the reporter asked about the timeframe.
But wouldn't it be better if student council beat them to the punch and announced a self-imposed ban? Although students help direct the task force, the administration has dropped the ball.
I think I'm done with this discussion....
--Chris
Another ethics problem at U. of MN Medical School
I agree that the free textbooks are an important issue.
Here's another ethics lapse, which needs resolution. Dr. Polly, a professor at the U of M Medical School, went to congress and lied about his support and funding from a medical device maker. I hope the students and faculty at the medical school will follow up on this.
http://www.nytimes.com/2009/07/29/business/29device.html?_r=1&scp=1&sq=d...
Here's one example of a faculty member who is receiving large sums from the industry. If there are more, could that explain why the faculty is so slow in moving to firm up ethical guidlines?
Has Dr. Polly received any sanctions from the Univ. of Minnesota?
Other than inviting him to lecture on conflict of interest
in the mini-Medical School, none that I'm aware of.
[Please note: "went to congress and lied about his support and funding from a medical device maker." I'm not sure that this is an entirely fair description of what happened. In fact, I'm not even sure he did anything illegal by the standards at that time. And that's exactly the problem. We need a stronger conflict of interest policy so that some of these obvious conflicts and dubious practices are avoided in the future.]
See:
http://ptable.blogspot.com/2009/07/were-not-violating-legal-statute-i.html
I've cited this same New York Times piece in an earlier post (July 29, 2009):
http://blog.lib.umn.edu/bgleason/pt/2009/07/further_consequences_of_foot...
If this isn't enough to truly disgust you, here's one more:
http://ptable.blogspot.com/2009/07/dr.html
If any of you med students are wondering why I'm so crabby - this kind of behavior is why. The foot dragging and weary negligence on these matters is both a scandal and an embarrassment. This is your med school. Your reputation (and mine) are tied to our medical school. Do you think that maybe you could do something about this, other than watch?
There's (unfortunately) more.
Bill Gleason
Medical School Faculty
U of M alum (1973)
geez guys....
Ugh. I was really interested in the issue until around the 97th time someone called someone else a name here.
I'm so tired and bummed out by just about everyone's (with a couple exceptions) general lack of regard for one another, I'll keep this very brief, as I'm so depressed now about the future of medicine I think I need a valium.
1. Medical students like myself are human beings JUST like anyone else. To claim that somehow we ought to be afforded some sort of respect BECAUSE of our status as medical students is really weird. Why? Is there something about a physician that makes his judgment and moral compass somehow superior to that of a garbage-collector or a plumber? Folks, we need to get over ourselves. Really. How can we expect to care for patients if we think we occupy a different world, or are somehow qualifiably different from them, possessed of a unique ability to reason or moralize? I am concerned that we've let the white coats go to our heads. This makes just as much sense as letting your McDonald's uniform go to your head. What you do for a living is just what you do for a living. We all serve humanity in one way or another. Our profession especially MUST be practiced with deep and sincere humility. Let's start practicing now.
2. Dr. Gleason, et al, while I'm very concerned about COI issues, and will refuse any gift offered to me by a pharmaceutical company, I am concerned that in general, calling people names is not an effective, respectful, or compassionate way to win an argument. In fact, this isn't about winning an argument, but helping people to understand. Perhaps those of us who feel strongly that pharma has no place in the med school would do well to listen to our colleagues who feel otherwise. After all, they're not complete idiots either. And listening respectfully is the best way to learn which particular misperceptions and beliefs your opponents hold, thus, equipping you with more effective ammunition.
While I agree with what you say, I do not agree with how you say it. What good is a policy that promotes compassion if we cannot even be compassionate with one another? Why don't we respectfully listen to those we disagree with, and engage them in debate, sticking to the issues? Why not rise above the ad hominem attacks and pettiness? After all, you're right. You don't need to try and taunt your opponents into submission. Why not use the facts and stick to those? Why not invite them to see what you've seen instead of beat them over the head with it? After all, we believe in good medicine and we we believe that all people should have access to it, simply because people are inherently lovely and valuable. We do not say that only our political allies deserve it. We don't say that only those with whom we agree deserve it. As a doc, I'll treat anyone who asks me for help, because we share a common humanity. If we cannot even expand this principle of universal respect to areas of our lives like this one (this thread), how can we EVER hope to practice medicine this way?
To my fellow med students: come on let's have some respect shall we? I did hope for better from you at least. If a patient spits in my face in the ER (has happened to me), I MUST maintain my respect for him, and treat him, as if he were my own father. We've got to start comporting ourselves with respect for absolutely EVERYONE. I would argue it is in fact MOST important to respect those who are difficult to respect, difficult to like, and do not respect us, such as Dr. Gleason. This is the only way to maintain the moral high ground.
3. There is incontrovertible evidence that the pharmaceutical industry has committed a HOST of egregious crimes, sometimes tantamount to outright murder. There is also no question that the pharmaceutical industry has also saved countless lives, improved their quality, etc. The world is full of shades of grey. There is no question that there are questionable ties to the medical school still (Seroquel, Schulz, etc). My personal belief is that if for NO other reason than simple dignity and self respect (and there are hundreds of other better reasons), no doctor or medical student has any business accepting any gift, regardless of value, from any company that can profit from her or his decisions. It is beyond me how any doctor could do this and not feel downright embarrassed. This is ethics 101, and, plain common sense. We all learned the definition of bribery in 3rd or 4th grade. There are very few people who don't agree with this on either side of the debate.
I understand that some folks object to overbearing bureaucratic policies that snarl up efficiency, and I also really appreciate the neocon guy's comments about personal responsibility. He's right, and I wish more people thought like that. We WILL have to be vigilant and ultimately responsible for our OWN morality as docs. We can't ask a system to do it for us. But we can demonstrate our dedication to morality as a profession, and protect ourselves from having to worry about silly ethical dilemmas when we should be worried about caring for patients by adopting policies that protect us from the reach of pharmaceutical companies. It is vital that we present a unified front to a public that is losing its trust in our profession. I don't think the textbook was really a big deal (and I don't think Chris did either), but I DO think that the relationship between docs and pharma and med schools and med students is a HUGE deal that affects PATIENT'S LIVES in negative ways. The book was merely an illustration of a much larger problem, as Chris said.
And we'll all make good salaries. Nobody in med school is a martyr. Nobody. I am in this, in part because it will make me good money. I also like to help people, but let's not pretend to be mother Theresa here. We're not taking out hundreds of thousands of dollars of loans because we expect it will crush us. No, we have an INCREDIBLE privilege: people we don't even know want to throw money at us, so long as we pay it back. 99% of the world would KILL for such privilege, so let's not play it up like we're sacrificing our lives because we're so full of compassion. OF course, compassion and a salary do not have to be mutually exclusive. But it's just a little bit unnerving to hear anyone who is even going to own a new car talk about financial hardship when children die every day from diseases that could be cured for a couple bucks. How many children does a new Toyota cost? How bout a new Audi? How many children does a Starbucks Latte cost? Every time I buy coffee, that's 2 bucks that could have saved a child's life. Let's not sugarcoat a painful and unjust world.
The book, as Chris said, is kind of silly. I seriously doubt that it will matter much in the grand scheme of things at ALL. But I'm still proud of Chris for going to the press with it (although they clearly came to HIM, and didn't even talk about the health care reform stuff that he was actually fired up about). And I'm glad that students are at least having dialogue about the issue. That's what we do in America. A free press is the bedrock of democracy, and without public discourse, we have despotism. Attaboy Chris...
So much for brevity...
Peace, Nathan Mustain
er, a clarification
Dr. Gleason,
my apologies, I did not intend to imply that you were difficult to like or respect. In the sentence " it is in fact MOST important to respect those who are difficult to respect, difficult to like, and do not respect us, such as Dr. Gleason," I mean that you did appear to lack respect for the people you responded to. They also failed to respect you, which is equally distressing. Just to be clear...
Peace, Nathan Mustain
PS It would seem to make sense to come out and say who you are if you've got a screen name. I'd be more inclined to listen to anyone defending a company if you can demonstrate to me that you're not affiliated with that company. It would be an act of good faith to declare your identity. I've spent waaaaaaay too much time here... no more.
Thanks, Nathan
Very good points.
Best.
Bill
If you're talking about me...
Thanks for your level-headed comments, Nate. I'm not going to say much (my words seem to getting twisted, so I'm going to try to play it safe). I just figured I should at least respond to your post script. I assume it was directed at me, though hopefully only partially since we also don't know the true identities of kittykats, comment1, or peanutbutter.
I think I will keep my anonymity for one reason: that Bill Gleason clearly took the time and energy to look up Nathan Schoeneck's first name. I can't begin to know the reasons why he did this, but since he has obviously formed a very negative opinion of me (I'm not sure entirely fairly), I think I'll stick to my pseudonym.
For the record, if you look back, I was never "defending a company," I was merely trying to defend my classmates. I feel just as strongly as you do that doctors and medical students should not be taking gifts from pharmaceutical companies (I said so multiple times). I was just sick of people painting us as some kind of band of criminals when, in truth, 99% of the people who took that book probably had no idea that a pharmaceutical company was involved at all. The screen name was supposed to be a light-hearted joke.
Lastly, I'd like to apologize to Chris for the "precious article" statement. You're right, that was unnecessarily hurtful. I guess I was just tired of readers who were not personally involved in the incident taking the author's words as indisputable truth while ignoring those who just wanted to set the record straight.