Pharm Carrots. And mixed feelings about Peds wards.

So. I just came back from a lecture on menometorrhagia. It was a "lecture"... you know, where a big pharmaceutical pays a medical expert money to talk about a topic that interests them, and said doctor will genuinely believe and advocate for everything they tell you, including a plug for some drug or device that the pharmaceutical happens to supply, and we all get wined and dined as fancily as can be. I knew this is what they would do, so why did I go?

Multiple reasons. Firstly, I am a medical student away from home with long(ish) days who will take the nice free meal, thank you (shame on me, probably). Don't worry I felt a nice bout of guilt pretty much the whole time. Secondly, I'm all over the Ob/Gyn stuff, especially issues like menorrhagia which so many women live and suffer through and genuinely wanted to learn more about it. Thirdly, I mean, this was my big opportunity to see what all this "unethical pharmaceutical wooing" and "doctors getting sucked in" was all about. Now that, how could I pass up? We discuss the ethics and the awfulness of this kind of thing all the time since... pretty much high school, right through university undergrad and now in medical school. Really. Even an individual of the highest moral breed must be at least remotely curious about what that world is really all about, in terms of the very stereotypical medical marketing ploy experience, that, whether or not we like to admit, is incredibly successful at selling the good (ahem, this being the reason why they persist in their excellent sales strategy... no critical thinking can stop the wiley ways of our subconscious and all those positive associations with delicious food and other pleansantries like free samples, or that great conversation you had with that other doctor sitting next to you... am I wrong?)

So yes, I took the carrot. And like any other self-regarding medical student or resident or physician, I was so pleased with myself at taking careful and conscious note of that moment of recognition of the pharm plug exactly 2/3 of the way through the "lecture". And Intro to Clinical Sciences can give itself a pat on the back because when they said "this is not statistically significant" my first reaction (internally of course) was, "but is it clinically significant?" Of course, I will probably end up prescribing this intra-uterine device (IUD) at some point or another in my career. The question to ask is whether I would have prescribed it anyway, which I know is a resounding "Yes!" because we have been learning about this one by its trade name since our Basis of Medicine lectures as first year med students. Pharm is everywhere. You think you'll escape it by escaping a dinner?

Now, don't get me wrong, I do not think this means that one should just stop feeling guilty and attend all the dinners, stock up on freebees, melba toast packets and start binge drinking on pharma's dime (for the record, I did not touch a drop of alcohol... that would just feel too much like someone trying to get me drunk so they can take advantage of me... I know, I know, it's a total contradiction for me to feel this way about that, yet rationalize the rest, but just read me out, okay). I'm just saying that it's important to very realistically recognize that you will not get through medical school untainted by avoiding every luncheon and free pen available to you. Ideally, I would like to keep my distance from these as much as I can anyway. But recognizing that I've actually already come to think of trade names of a lot of different drugs as synonymous with the generic -I am already 'tainted' as it were -then the additional harm done by further exposing myself to more advertising is not as great (though probably still not negligable, so yes, be judicious if you decide to go down this path because it probably snowballs, etc).

But, so then if you genuinely think the topic is particularly interesting, and you don't think you know enough about a subject you would like to learn more about, and you're tired of searching PubMed and UpToDate to learn more about it because your eyes are tearing from doing this all day long, everyday, then why not. For example, today's lecture really was intersting. I didn't merely learn about the IUD being marketed, I also learned about the use of antifibrinolytics and specific oral contraceptive protocols for women with excessive blood loss during menstruation, surgical interventions and even what exactly some of the current definitions are -and all the wiggle-room within them -of 'irregularity' and 'too much blood loss', all of which are very practically, clinically useful... stuff that is always good to get exposed to multiple times if you ever want to actually remember it. Don't kid yourself -medicine itself is a brain-washing process, that's how we eventually come to remember so much stuff, only because we get exposed and re-exposed to variants of the same information enough times first theoretically and then in a clinical context, then get examined and re-examined on it... this is the reality of continuous education in medicine, especially early on! See at the end of the day, we all know Tylenol, Valium, Prozac, Pedialyte, Diabeta, Metformin, Micardis... trade names, trade names, trade names. How much do you think you'd be affected by going to a talk where there's a plug for Prozac? And what if you went to a talk about psychoactive drugs and that's where you got an 'aside' refresher on the use of chlorpromazine for intractable hiccups? Aren't you more likely to remember that than skimming past it in a 1000-page volume about all the antipsychotic drugs?

So you know, maybe ideally, we just need doctors to give lectures to other doctors without Big Pharma sponsorship... but what doctor do you know who can afford the time or lack of payment (especially in Quebec, let's be serious) to give the lecture, and how many less people would attend if there was no free food (free food, whether it is a lobster tail or McDonald's will always attract more people, no matter what the context and that is the cold, hard truth). Anyway. I know. This is a big bag of sweet and sour grapes, with a few rotten ones, no doubt. And I'm kind of tired of exploring the various arguments for and against all this.

But yes, for now, I'll say I felt guilty tonight, but did that guilt come from a real ethical place or from exposure to a lot of extreme opinions on both sides and the 'type' of person I want to associate myself with or emulate? Probably from both. Tricky (you can roll your eyes now because this is getting a bit too "meta" -I won't judge you for it). And I understand the whole ethical quandry. But I am also just putting it all into perspective -there are pros and cons and ignoring either is rather dangerous. Okay. Enough about that for now.

Changing topics, for the second half of my pediatrics rotation, I am currently "en régions" (i.e. other regions of Quebec, generally more remote / "rural", like some people here actually drink well-water and their kids get Giardia from it... I refuse to specify location / hospital details in a blog because my vagueries in these matters helps protect confidentiality and also maintains some anonymity of events, people, places, etc...) Today was Day 3 and I am liking it better everyday (I expected that I would, so of course, I was greatly disappointed with how I felt after Days 1 and 2... but let's be serious, I have hated the first few days of any rotation so far because that is when you're at your moron-est and then it gets better). For example, my first day was super depressing and I hated pediatrics that day; you would have too, and this classic moment is why:

I walk into this room of viral plague (well, not really, but it feels like it). I have to see this kid with runny eyes and nose, hacking away, while intermittently sucking intensely on this blue terry-cloth (or as I like to say, “towel-material”) teddy bear. I go to examine him, talk sweetly and lovingly and all that jazz (don’t worry, I was sincere at the time, and I am being sincere now too). What does he do? He “offers” me his sopping-wet, soaked-up-with-drool-and-infectious-secretions toy, and by “offer”, I mean thrusts it enthusiastically into my cowl-neck, bare arm and face. I, of course, thanked him for it (“Is this a present for me? Thank you!” Yes. This is exactly what I said. Verbatim. What else was I supposed to say –“hey, Terrible 2, stop contaminating me and coughing in my eye!”).

Yes, I realize that I am becoming a doctor and have thus conceded to spending the rest of my professional life in a cesspool of germs. But this kind of special treatment is very particular to pediatrics okay. I don't mind getting blood splattered all over me in a delivery or a surgery -that shit just happens sometimes. But this is just poor parenting and there is no medical or personal gain whatsoever in me getting yucked-up here -there is no benefit to this relative 'cost'. Anyway, I am not the callous physician nobody wants to have. I felt bad for the kid and wanted him to get better and mustered up all the maternal love I could to cope with the yuck factor (and successfully at the time, might I add), but honestly the only kid who's saliva I won't mind having all over my face will be my own, one day in the future. I have decided that I don't actually mind pediatrics... but that's exactly how I feel about it -I don't mind it. I don't love it either.

Now NICU (which is part of pediatrics) I loved. I mean they're too small and frail and sick and helpless to do anything, poor things (it's my favourite part of wards, even here). How can you not love them and want to sell bits of your own soul to save their lives if it was possible? Really, I could physically examine and write about those little bodies, and little hearts and open fontanelles and grasp reflexes all day long forever. But towel-material goopy wetness just for the sake of it? For now, I'll say no thanks to that.