PHRMA U – THE HIDDEN CURRICULUM

John Giordano, Doctor of Humane Letters, MAC, CAP

PHRMA U – THE HIDDEN CURRICULUM

A group of Harvard Medical Students – who are fed up with the lack of comprehensive coursework on opioid addiction and its treatment – have elected to educate themselves. The group who identify themselves as ‘White Coats for Recovery,’ present their mission statement on their Facebook page; “We represent the changing of face of medicine, one that addresses addiction with compassionate action, not with judgment or dismissal. To take a stand against stigma and to give our patients and community members a fighting chance at recovery, we are buying and carrying naloxone, a drug that saves lives by reversing opioid overdoses.” One of the organizers who helped initiate the training sessions, John Weems, a fourth-year medical student, said: “What kind of a doctor would I be if I didn’t know how to do this?”

How positively refreshing and it gets better!

There is a large group of healthcare students, “Student Coalition on Addiction,” from Boston University, Harvard University, Tufts University, and University of Massachusetts who are advocates for residents at risk for substance use disorders, including those disadvantaged by homelessness, poverty, racism, and other systemic forces. You can view their website at www.ma-sca.org/

I can’t help but to get excited and encouraged when I see our young future physicians put into clear focus the reality that has plagued us for the last twenty-years. Perhaps it’s a generational thing, but these students get it.
Katrina Ciraldo, a recent Boston University Medical School graduate, has a personal connection to the disease. Her best friend from childhood died of a heroin overdose when she was in her first year of medical school. “She had all of these interactions with the health care system before she died. There were missed opportunities. We could do so much better.” Katrina mentioned the multiple track marks on her friend’s arms – certainly a red flag indicating addiction – that seemed to go unnoticed by medical professionals.

I give a lot of credit to these students who had to rise above and challenge the norms. But I become concerned when, according to Ciraldo, “the doctors who are teaching us medicine have not gotten this education.” This just begs the question what is being taught about addiction and its treatment at our finest universities? If the professors lack the education, than who is teaching our best and brightest? If schools like Boston University and Harvard lack comprehensive coursework on addiction and its treatment, who is teaching it?

Rolvix Patterson, a student at Tufts University School of Medicine, stated that “At the beginning of every lecture that we have when we have a guest lecturer, they always have a slide that says, ‘These are my conflicts of interest.’” Believe it or not this is an improvement. In the past pharmaceutical representatives often made presentations to med students without identifying their business ties to the industry.

While in med school at the University of Toronto in 2004, Doctor Navindra Persaud attended a week-long course on how to treat patients suffering from chronic pain. He felt as though something was missing from the presentation. In his estimation the negative effects of opioids such as deaths, overdoses, and addiction were strongly downplayed while ‘positive’ research that supported prescribing opioids for chronic pain was played up. He stated that he and his peers left the lecture with an “incomplete and partially inaccurate” picture of how to treat patients. It was later found out that the lecturer had been previously paid to speak about pain management on behalf of Purdue Pharma LP, the makers of OxyContin.

Just how much influence does the Pharmaceutical Industry have on our future healthcare professionals has been the source of great controversy and a heated debate going on for quite some time. As early as 1961, Dr. Charles May, editor of the AMA journal Pediatrics and serving on the AMA Council on Drugs, wrote in his article Selling Drugs by Educating Physicians” that the “independence of physicians is … threatened by … drug manufacturers … [that] promote their products by assuming an aggressive role in the education of doctors.”

In the April 2016 issue of in-Training Magazine – the agora of
the medical student community – was an article titled, “The Pharmaceutical Industry’s Role in U.S. Medical Education.” In it the authors, Rijul Kshirsagar and Priscilla Vu – both medical student at the University of California, Irvine School of Medicine – point out that “Medical students are subjected to a barrage of advertising that inevitably leads to a physician-industry connection that can be harmful to our health care system. Medical students’ exposure to pharmaceutical marketing begins early, growing in frequency throughout their training. Students receive gifts such as free meals, textbooks, pocket texts, small trinkets and even drug samples. Forty to one-hundred percent of medical students report exposure to the pharmaceutical industry, with clinical students being more likely than preclinical students to report exposure. The number
of students recalling over 20 exposures to marketing rose from 33.3 percent to nearly 72 percent as students entered their clinical training. Pharmaceutical companies, recognizing the formative nature of the clinical years of medical education, seek to form relationships with medical students’ years before they are ready to independently practice medicine.”

While Rijul Kshirsagar and Priscilla Vu paint a vivid picture of how the Pharmaceutical industry attempts to influence young future medical professionals’ decision making, a few researchers took it to the next level.

Kirsten E. Austad MD (Harvard Lab fellow at the time of publishing); Aaron Kesselheim, Research Associate, Department of Health Policy and Management Harvard; And Jerome “Jerry” Lewis Avorn, M.D., Professor of Medicine at Harvard Medical School and Chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital conducted a systematic review report according to PRISMA guidelines to determine the frequency and nature of medical students’ exposure to the drug industry, as well as students’ attitudes concerning pharmaceutical policy issues. In their paper titled ‘Medical Students’ Exposure to and Attitudes about the Pharmaceutical Industry: A Systematic Review’ published in the peer-reviewed journal PLoS (May 2011), they concluded that; “undergraduate medical education provides substantial contact with pharmaceutical marketing, and the extent of such contact is associated with positive attitudes about marketing and skepticism about negative implications of these interactions. These results support future research into the association between exposure and attitudes, as well as any modifiable factors that contribute to attitudinal changes during medical education.

Rijul Kshirsagar and Priscilla Vu echoed a similar observation in their article stating that; “In losing their ability to detect bias and analyze pharmaceutical marketing statements objectively, medical students hinder their future ability to practice evidence-based medicine.”

There is no question that a relationship between Academics and the Pharmaceutical Industry is essential to our current and future wellbeing. What is debatable – and seems to be fluid – is where the line is between a healthy relationship and unethical practices. That line seems to me as being more like a snaking river than the closest distance between two points. With all of this being said I have to ask; with the mountains of scientific evidence at our fingertips, why on God’s green earth are the professors at – of all places – Harvard not educated in the safe prescribing of opioids as their med students claim?! Moreover, why didn’t Dr. Jeffrey Flier, Dean of the Faculty of Medicine at Harvard University, knowing that America is in a full blown opiate/opioid epidemic, institute a comprehensive addiction and its treatment coursework in the school he oversees? How many people have to die before there is any meaningful change on our campuses?

Michael Botticelli, head of the White House Office of National Drug Control Policy, in a recent interview said that “The nation has seen ‘no huge change in prescribing behavior’ around addictive opioid painkillers. Botticelli continued; “there is little to no education within medical education curriculums around addiction and safe prescribing.” In addition, our drug Czar revealed that the number of people who die of overdoses in each state is closely linked to how widely doctors are prescribing opioids.

But don’t despair; there is hope on the horizon. Dr. Joji Suzuki, a Harvard psychiatrist said the current generation of med students shows much more interest in learning about addiction than did their predecessors who are now setting the curriculum. Change is coming!

John Giordano DHL, MAC is a counselor, President and Founder of the National Institute for Holistic Addiction Studies and Chaplain of the North Miami Police Department. For the latest development in cutting-edge treatment check out his website: www.holisticaddictioninfo.com