"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.