"Side Effects"

I attended a free screening of the independent film, "Side Effects," last night (www.sideeffectsthemovie.com). It was written and directed by a women who worked as a pharmeceutical representitive for about ten years. The film is based on her experiences during that decade, with 'documentary' style interviews of physicians spliced in throughout the work. After the viewing, the director answered questions fielded by the audience. The movie was amazingly well made, considering the budget of under $200,000, and the issues it addressed as well as the issues that surfaced during the subsequent questioning were both enlightening and frightening. Here are a few things I picked up:

*Information released from drug research is largely influenced by what will best market the drug, and often studies that may discredit or expose dangers of the drug are thrown out based on trivial 'flaws' in the study's procedures, patient group, etc. The illustration from the film was with a fictional drug, Vivexx, which had shown to cause significant liver damage in confidential studies. These studies were thrown out of the acceptable literature of the company based on a minute inconsistency in procedure by the researching physician.

*Branding. As I took notes during the film, I realized that the pad of paper I was using was advertising one drug, and the pen I wrot with was advertisement for another. Like the fast food industry and young children, I suppose it is a clever tactic of the drug companies are attempting to win my loyalties early while I'm still in medical student. The film illustrated that pens, paper, and sponsored office lunches are just touching the surface of the drug paraphernalia made avaliable to both the physicians and aspiring pharmeceutical reps. There has since been laws regulating the extent of gifts, but in the past, drug companies have flown physicians on exotic vacations and provided luxury automobiles in exchange for pushing their drugs.

*Pharmeceutical companies research the prescribing trends of doctors and cater their sales pitch toward these habits. This may seem at first like a reasonable tactic, but I wonder if it breaches doctor-patient confidentiality. If they know what is prescribed, do they also know to whom? If so, i would consider this both legally and ethically questionable.

*The writer/director also shared that she does not envy physicians at this time. Not only do they have to put up with the antics and rhetoric of pharmeceutical reps, but they also have to consider the demands/desires of their patients, which are heavily influenced by the marketing of the drug industry. Add that onto the headache of insurance issues, HMO demands, and larger and larger patient loads, it greatly jeopardizes a physicians ability to care and cure.

Like violence, I believe that caving into corporate manipulation/advertising is due to a lack of imagination, (often resulting from a lack of options.) I hope that in time I bump into like-minded individuals who are willing to sacrifice and spend the energy and resources required to first imagine then create a better way of both being consumers and physicians.

Two borrowed thoughts: for those under the fist of oppression, be it a great storm or violent injustice

Christ would not be Redeemer
if he had not concerned himself with giving food to the crowds that were hungry,
if he had not given light to the eyes of the blind,
if he had not felt sorrow for the forsaken crowds that had no one to love them, no one to help them.
Christianity cares about human development, about the political and social aspects of life.
Redemption would not be complete if it did not consider these aspects,
of the Christ who chose in fact to be an example
of one oppressed under a powerful empire
and under a ruling class of his own people
that savaged his reputation and honor
and left him on a cross.

People of our time,
anguished about so many problems,
deprived of hope,
seeking paradise on this earth:
Seek it not here,
seek it in Christ arisen.
Let us find in him relief for our affliction,
for our worries,
for our anguish,
and in him let us place our hope

both written March 26, 1978 by Oscar Romero.

Music Tag, Anyone?

I was 'tagged' by a fellow blogger (Amanda Peterson of PUMP Church in Portland, OR... good stuff) to post my current top ten songs, thus, in no particular order...

This World - Derek Webb
It's Alright, Ma (I'm Only Bleeding) - Bob Dylan
Swallowed in the Sea - Coldplay
We Are All Lepers Here - Psalters
Love and Peace or Else - U2
Beautiful Disaster - 311
Every Grain of Sand - Derek Webb
Nightingale - Saves the Day
Fix You - Coldplay
Lover - Derek Webb

Feel free to share your own tunes...

OMM

Every Tuesday afternoon for about 3 hours, my classmates and I attend our Osteopathic Manipulative Medicine course, or OMM. This course, along with a more wholistic philosophy, gives us a set of skills that set osteopathic physicians apart from our allopathic counterparts. The goal of this set of skills is to help the body reach its homeostatic position, and thereby, alleviate symptoms that occur from a 'Somatic Dysfunction,' or an impaired or altered function of a certain part of the body.

This brief description may persuade you to believe that this is a sophisticated skill performed by trained, intellectual professionals, and I'm sure, in about 2 years, this will be true; however, I assure you, at this point, it is anything but that. For the most part, we stand, sit, or lie around half naked (guys in short, gals in sports bra and shorts) feeling quite sheepish and hopelessly unskilled as we try to mimic the instructor as she/he demonstrates each new technique. It's quite a scene: about 20 exam tables lined up, one of us playing doctor, one patient, limbs going this way and that, the instructor and TA's going from table to table.

So far, we have learned to assess various soft tissue and locate important skeletal components, called landmarks. Yesterday's session was a session in which we really got to 'know' our classmates as we found landmarks, namely the landmarks of the pelvis. As much as we all tried to remain as professional and mature as possible, its just a bit embarrassing and ultimately funny to palpate (examine by touch) the symphysis pubis and inferior lateral angles (I'll let the inquiring-mind look those up) of someone with whom you were casually talking about the new Coldplay album 10 minutes before. We all kind of grin and bear the days when our personal space is 'breached' in the name of our medical careers, and I'm very thankful for our teaching assistants (second year students, who are ultimately our 'real' teachers) when they are able to share an experience that they've had in a clinic, where knowing how to do these things that feel so foolish actually relieved a patient. (Just so you know, if you're experiencing lower back pain, it could originate from the posterior pelvis.)

All in all, OMM has been very challenging because it is a skill where the fingers do just as much 'thinking' as the brain. My fingers are currently amatuers, but I truly hope that I become proficient in this skill.

a Luddite concedes...

If you've kept up with the events my life over the last 5 years, then you are either someone who changed my diapers as a child, or you are the friend that took the initiative to keep communication lines open. I confess, with a bit of shame, that I stink at long distance communication. And, I believe, this has more do with my loathing of the telephone than anything else. It requires that the participants simultaneously be avaliable, usually accomplished by labor-intensive planning or dumb luck, and it is void of the communication nuances of body language and facial expression. That said, in order to overcome the former complaint since overcoming the latter is a bit expensive and time consuming (ie, travelling to the locale of the other participant), I am starting a blog!! My next lecture on the "Urea Cycle and Ammonia Catabolism" (which is basically the process of our bodies getting rid of anything we don't need that we get from our diet, for example ammonia resulting from the break down of proteins) starts in 5 minutes, so this will conclude my first entry; however, I do plan to post regularly (at least twice a week) and look forward to your comments.