Infiltrating Medical School and Continuing Education

Once my husband found one of those funny videos that is called “Viral” because of the way it spreads across the internet like wildfire.  This one was an episode of a 1950s game show.

Like many shows of the era, it had a sponsor’s name and logo prominently displayed in every camera shot – the backdrop of the set where the panel sat and I think even the desk fronts of the panelists.  The sponsor was Raleigh cigarettes.

The show had made the rounds of the video sites because it was so hilariously biased.  The simple quiz format always yielded the same answer –

“What is the capital of North Carolina?”

“What British nobleman spread his coat over a puddle so Queen Elizabeth wouldn’t get her shoes muddy?”

You didn’t have to be very sharp to quickly realize you could get every question correct without even listening to it!  I’m wondering how long the show lasted – after all, how many questions can you make up that are answered with “Raleigh?”

The bias was so blatant that it was hilarious.  In fact, the panelists started looking embarrassed very quickly (which made the show even funnier).  I don’t remember exactly, but I wouldn’t be surprised if the winner got a lifetime supply of cigarettes.

Sure – it can be funny when there is such obvious bias.  But in some instances, it can be dangerous.  Take the situation with the relationship of the pharmaceutical industry and the practice of medicine, for example.

Generally in French medical school, there were no textbooks.  Oh sure, there was some recommended reading, but everyone knew and professors explicitly said that all exam questions — and in most courses, the final exam– was mostly always the only grade of the semester or even year. I tried to ask people why it was like this.  One of the younger surgeons told me it was a “gauchiste” (leftist, or socialist) idea, that if people had to buy textbooks, then the rich could buy more, and they would be somehow “favored.”

Sometimes, the medical students would actually pick the best note-taker and convince that person — even pay that person — to take great notes, which would be reproduced and generally sold for a not-excessive fee so that other students could have access. These “professional notes,” I learned from the other students, were often “sabotaged,” and contained false material.

In my third year, I got something that was identified as a privately published textbook.  It read like the class notes, which I had been told usually did not change for several years.  On the cover of that — amazing to me — was the logo of the drug company Sandoz.

Years later, when I saw more and more Sandoz products in the United States, I remembered that book had been a precious gift.  I don’t think it directly affected prescription practices for me, for there simply were not as many choices in psychiatric medication as there are now.

At that time, Sandoz, like most drug companies who operated in France, waited until after the first year examination to distribute their notes, as if to make sure that the people on whom they spent money were really going to make it through and be doctors.

The wash-out rate was high in France, where medical school was competitive.  First year was open to anyone interested, but an exam at the end of the year chose only a relative few to continue on to second year.

In my own university at the time I attended, only one in six students got to stay. Needless to say, I worked my then-sizable tushie off to make sure I did not return to my family in the USA in disgrace.

Sandoz was also at the forefront of the few pharmaceutical companies who bought students lunches.  And they were even more generous with residents. It is hard to exaggerate the poverty of a French medical student and or resident at that time.  It was possible to get some nursing type jobs from the third year on, but there never seemed to be time enough to make a working wage. For the first two years, I had a stipend from my folks, and earned a little bit from tips made as a cafe waitress.

Obviously I – as did many students — developed a lot of warm, fuzzy feelings for Sandoz and other such generous companies.  Later, when I could start to make clinical decisions, these companies banked on our gratitude turning into reliance upon their products as a preference for treatment.

More of these textbooks and other types of largesse came throughout my educational experience, and I will admit to warm fuzzy feelings for the company that gave us lunches, sometimes as good as the big guys, in a country where the main meal is taken during the day.

Today, there is more awareness of how pharmaceutical manufacturers influence the practice of medicine at all levels.  The thought that the industry might be influencing students is not usually concentrated on as much as other areas, but if you think about it, it is a brilliant and key concept.

You will also notice — in the linked article – mention of “indirect” influences, like industry-sponsored research, that are passed on by faculty.  I expect those existed during my education. I simply know nothing about them.

Surprise, surprise — Doctors just love to do studies.  I can’t believe that two people looked at those “continuing medical education” industry-sponsored pieces that doctors do to keep up their licenses and found that there was a bias on the part of the sponsoring pharmaceutical company.

If you don’t know what I mean, to be able to renew our licenses every few years, we must complete a set number of hours of continuing education.  Some hours can be earned by traveling to conferences and symposia – which can run into expense.  Others can be earned by paying for mail-order type read-and-complete-questionnaire situations.  Or – you can do an article and quiz sponsored by a drug company.  But don’t be surprised if an article telling you how to diagnose and treat break-through mania in a bipolar patient is presented to you by the very people that make the medicine used in this type of treatment.

Yes, the biases are that obvious.  Sure, this flies in the face of the non-bias stuff from the folks who accredit these exercises in allegedly-learning about your profession. Some are actually printed in medical journals who accept paid advertising from the same companies. They generally give you a questionnaire at the end and actually ask if there is any bias. I said yes, once, many years ago, and got a long series of pain in the neck emails which induced me to stop noticing this as quickly as possible.

In this great information age, I do a bunch of my continuing education online, because I can get proof of them, in case anyone wants to audit my online activities.  Yes, I am “learning,” and have chosen to do it at free sites.  I don’t usually enjoy gossip, but in this case I enjoy this.  I can almost always guess who the sponsor is from the title. Is anybody really surprised that nobody has blown the whistle on this before?  Me, I do them, but I have long assumed my real learning will happen elsewhere.