Med students and drug reps

The NY Times today published an article reporting that the AAMC has proposed a ban on drug reps offering free merchandise on all of the nation's medical school campuses. This issue has been discussed for some time by many groups, and I have to say I support it. It's definitely a complex issue, though.

Our medical school is not particularly well funded. Some of the departments are notoriously poor, like infectious disease, where the physicians are paid very poorly for what they do (that's generalizable to all ID physicians across the country, by the way). On ID, we would have free lunches funded by drug companies multiple times per week, and at the beginning of each, the drug rep would talk to us about the indications for this antibiotic or that antifungal. Useful information? Sure, especially if you actually write prescriptions. But the only way to get that information? Hardly. If the FDA just approved a drug for a new indication, you can get that news from the FDA, or from The Medical Letter, a non-profit newsletter that compiles the same information but accepts no advertising or drug company sponsorships. Does free food sway you into preferentially using a particular drug? Hard to say -- especially if you were getting free food from the maker of every drug in a particular class.

On psychiatry, we have a drug rep lunch every Wednesday. During our orientation to the clinic, our head preceptor asked if either of us were anti-drug company. I sort of raised my hand, and he told us about the Wednesday lunches but assured us that we were not expected to attend, and that no one would care if we didn't. Well, let's put it this way: it's hard to turn down free food. So I take it, but I usually take it back to my own office to eat while browsing the internet. So I'm just taking advantage of THEM, right? If the food wasn't there, I wouldn't miss it, but it is there, so...

In all honesty, I find the drug rep talks really annoying. It's very obvious that they're sales people, and I don't like it.

When I become the one in charge, I won't invite drug reps in to provide the office with coffee and pastries or lunches. And the only drug pens I take are the ones that don't have a drug name on them (OK, I have one for Gardasil, but I worked on that sh*t and I'm pretty proud of it!). Besides, I really love my Pilot G-2s, and no other pen really compares.

Other medical students aren't so happy. "How will I eat?" is the #1 protest. I understand that food is a priority for all med students, but don't you think it sounds silly to keep drug reps solely for their food-providing abilities? I mean, I still have to fend for myself four days a week when it comes to lunch; will one more day really cause so much harm? Even if you think you're not swayed by sales pitches, the studies show that you are; and even if those studies are wrong, patients say that they don't like the idea of physicians being influenced by drug companies. I think this is a good thing, and I'm interested to see how it unfolds.

It's been a while

There's plenty to tell, but no time to tell it. Here are some bullets to get some of these thoughts out of my head:

• Eric came this weekend for photographer meetings. We met with 3 photographers on Friday and Saturday, and I met with an additional 2 others earlier this month that luckily turned into non-contenders early on (so I wouldn't have to schedule more meetings with Eric this weekend). We think we have a winner, but we just have a couple final questions to get answered before we send our deposit in.
• We saw Avenue Q on Friday night, and it was HILARIOUS. Definitely go see it. We had nosebleed tickets (hard to turn down $17 tickets, though!), and I thought it would be OK since we had binoculars... but we couldn't find the binoculars! It ended up all right, though. Be warned, though: despite being a musical performed by puppets, it is NOT Sesame Street-rated. There were many people in the audience who had no idea to expect the cursing, raunchy humor, and... puppet blow jobs. Avenue Q was the only show we saw this year; I missed Sweeney Todd in February, unfortunately. Next season brings Wicked and Spring Awakening (among others), both of which I want to try to see. I love Broadway! And of course, yesterday I found the binoculars.
• Eric took the cats back east with him last night. They're staying with Eric's mom for a while, because from the end of May to the end of September I will not be in Louisville. When Eric left, I had the cats to keep me company, but now I have no one, sniff sniff. Good thing things will be getting busy for me soon!
• Medical marijuana patients face transplant hurdles. I've never smoked marijuana, but I mostly buy into the idea that it's the least problematic of any drug, alcohol included. I got trapped last week when a patient asked me why she shouldn't smoke it, and I honestly couldn't tell her. Thank goodness for attendings to fall back on. It sucks that it keeps people from getting transplants.
• I have at least 6 weeks' worth of clean laundry in piles around the apartment. They've been clean and piled for so long that they've almost become dirty again. A lot of them are cold-weather clothes, and since it got warm I've been able to just keep pulling new things from the closet, and there really hasn't been a reason to put them away. Except that they're taking over the entire place.
• I have two new roommates lined up! An incoming surgery intern is staying for the year, starting in early June. He's never going to be here, since the UofL surgery internship -- well, frankly, it sucks. But it's OK for me, because he will hardly ever be here but will be paying half the rent! And from June to September a visiting fourth-year med student from Germany will be staying here as well. It all works out well, because that's when I'll be gone in rural Kentucky and Philadelphia, so the two of them will be covering my rent completely for 4 months! Score!

Earthquake

I never thought I'd experience one in my lifetime; it just never occurred to me. After all, I've never even visited California.

So at 5:37 this morning, when I was shaken in my bed so hard that I sat straight up and tried to figure out what was going on while rubbing the sleep from my eyes, "earthquake" was the last thing on my mind.

Am I REALLY swaying back and forth while sitting completely still?
What IS that noise that seems to be coming from the building?
The window next to me is open, is there a breeze making the closet door in front of me swing?

By the time it occurred to me that I might be experiencing an earthquake, thought that I maybe should go stand in a doorway or something (?), and decided that even if this was an earthquake, it didn't feel that bad, it was pretty much over. There was another tremble, but the whole thing took less than a minute.

I decided that yes, I WAS being shaken back and forth (east-west), the noise was the building itself rocking in its foundation, and the curtains were perfectly still, so it wasn't a breeze making the door swing on its hinges. I remember looking up at the ceiling and getting the sensation that the swaying was much worse up there than down on the bed. (I can only imagine what the swaying must have felt like up on the 7th floor!)

The cats were walking around looking confused, which is exactly how I felt, too. I still didn't know what had happened, but it was over. I thought about turning on the TV, but for some reason I didn't think that was going to be useful. I sort of thought (it was 5:37 am, remember, and I had been sound asleep so my logic was very fuzzy) that if there had been some sort of natural disaster like an earthquake, that the tornado alarms would be going off. It just made sense.

So I called Eric, apologized for waking him up, and asked, "How would I know if an earthquake just happened?" I contemplated calling 911, but I knew that was irresponsible. Eventually I tried to go back to sleep, but tossed and turned until I heard fire trucks in the distance. Somehow that calmed me. It must have been a real disaster if the fire trucks are responding. I'm not crazy. Other people felt it, too...

An hour later, Eric called me back to confirm that the 5.2-magnitude earthquake had happened about 150 miles west of Louisville, in southern Illinois. Poor guy, he had stayed up and didn't go back to sleep until after he told me that. In the meantime, I had been sound asleep and dreaming about earthquakes.

And of course, it was all over the local news this morning. A cornice fell off the roof of a building a few blocks away, and it's apparently a big deal. No one was hurt, though, which is good.

Meanwhile, life goes on. I guess I can check "earthquake" off my list of things to experience before I die.

Schedule coming together

I'll be in Whitesburg, KY, for my rural family medicine rotation May 26 - June 20 to finish out my third year. I have no idea what to expect with regards to the rurality of it or the medicine I'm going to see, but it's less than 2 hours from Eric's sister and her family, so at least I will be able to visit someone.

Then I get one week off between third and fourth year.
Then, if my Drexel rotation comes through, I'll get another week off to sync up with Drexel's academic calendar.

Hopefully I'll be at Drexel July 7 - August 1 for an Ob/Gyn rotation.

I'm definitely going to be at UPenn August 4 - 29 for an Ob/Gyn rotation in Uro-gynecology, which should be fun.

Then I'll have three weeks off to re-sync up with the UofL academic calendar, so I'll take that time to study for Step 2 before I start back at UofL September 22 with a third Ob/Gyn rotation in a row. Whew.

Speaking of Step 2, I just want to take this moment to rail against the NBME. I guess I can understand $480 to take a computer-based test. There's all sorts of security that goes into it, and I'm sure it costs money to develop those test questions. I guess. But I also registered for Step 2 CS, which is a clinical skills exam in which you do interviews with standardized patients in one of 5 cities across the entire country. The official goal is to make sure all graduating medical students can interact with patients at some baseline level and know how to do a proper physical exam and patient interview. But the word on the street is that the test is very easy and it is essentially to make sure that all incoming interns can speak English proficiently (you know, because of all the foreign medical grads that do U.S. residencies). Either way, I don't really care, because it costs $1,025 to take! WTF!!!!! My financial aid for the school year is quickly dwindling, and July (and my next disbursement) is still a long way away.

Recent thoughts

It's been a busy-in-a-good-way couple of weeks, but that doesn't mean there haven't been post tidbits brewing in my head...

*Totally awesome bachelorette party in Pittsburgh last weekend (two weekends ago now, sheesh!). It included a hunky guy taking off his shirt and flexing for us and waaay too much alcohol for not much money. What more could you ask for?
*Jenny McCarthy said she cured her son's autism with a gluten-free diet. Sorry, hon, that's called celiac disease, not autism.
*Got back in the pool yesterday, and went again today. It's been far too long, and it feels great. Except for the fact that my good old left hand numbness is back, my shoulders are tense again, and now my knee hurts, too. Why on earth must we peak at 18? I've got 5 days to lose at least 2-3 pounds to fit into this stupid bridesmaid dress comfortably on Saturday, so it will be gym gym gym every day this week :(
*The weather is gorgeous now, in the mid-70s yesterday and today, it smells like spring, and I smell like chlorine. I wish every day was like this.
*Took the cats to the park yesterday. That probably deserves its own post, since there are pictures involved.
*I've finished a week of psychiatry, and I see so much depression, anxiety, and bipolar it's not even funny. The true crazy people, the schizos and the off-their-meds bipolars, don't come to the office, but I see some of them, too. That probably deserves its own post as well.
*If I had a porch, I'd go sit on it and watch the sun set while sipping a glass of wine. Instead, I've got the window open and I'm going to sit on the (large) window sill.