Pharmed Out: An Interview with Dr. Adriane Fugh-Berman

In June, I will be returning to Washington for the annual Pharmed Out conference, a project located at Georgetown University Medical Center.  It is one of my favorite events of the year, in part because of the wide array of academics, journalists, and activists who attend, but mainly because of its extraordinarily committed, outspoken director, Dr. Adriane Fugh-Berman, and her merry band of student volunteers.  Adriane agreed to an interview by email.  Part 1 appears below.  I will post Part 2 next week.

Would it be fair to say that your project was funded by a felony?

Yes, we were funded by the Attorney General Consumer and Prescriber Grant program, a novel and never-to-be-repeated program that resulted from a settlement between Pfizer and all 50 states and the District of Columbia.  We promised so much that before we got the grant, the grant administrators asked us to cut down what we promised to do.  We refused — and in the end, we exceeded what we promised.

Just by chance, we had begun our project by shooting an interview of Shahram Ahari — a former drug rep for Eli Lilly who is now a medical student — talking about how he had sold Zyprexa.  That was just days before the story broke in The New York Times about how Lilly hid data about adverse effects.  Jim Ridgeway, the investigative reporter and filmmaker we worked with, realized that what we had was newsworthy and insisted that we release a quickly edited video clip. We didn’t even have a phone line yet, let alone a Web site. So we released the video on YouTube, crediting the not-yet-existing PharmedOut, with Georgetown’s media office as the contact number.  It received a lot of media attention.  The video “Zyprexa Drug Rep” has been viewed more than 150,000 times.

Since then, we’ve done novel research on, for example, promotional tone in medical journal articles, and how marketing messages are inserted into CME. We created the first educational module that has convinced physicians that they are personally affected by promotion. And we’ve had groundbreaking conferences, the third of which will be held at Georgetown on June 14-15. It’s called “Missing the Target: When Practitioners Harm More Than Heal,” and will cover the potential adverse effects of marketing drugs and medical devices.

How did you get started as an activist?

I came out of women’s health advocacy work, and we were fighting medicalization of childbirth, menopause, and menstruation, so I feel I always had that bent. Being a reformer suits my crabby nature.

I come from a family of utterly fearless women.  I’m the most cautious, but apparently still less afraid than most.  My parents were both anti-Vietnam war activists.  My mother was very active with Women’s Strike for Peace, and met with Vietnamese women in Djakarta. My brother was president of SDS [Students for a Democratic Society] at Rutgers.  I think I learned to walk at demonstrations.

I got involved in feminism, women’s health, worked at Planned Parenthood as a teen, then a reproductive health  clinic as a counselor and medical assistant. I would sometimes ask docs to treat women who couldn’t afford care.  I decided it would be easier to become a doc then beg docs to help people.   Anyone who hasn’t been through medical training romanticizes medicine; med school and internship were so tough in unexpected ways.

I know exactly what you mean, but maybe you should explain. 

Med school was anti-intellectual and inhumane.  First there was the vast quantity of mind-numbing rote memorization of largely irrelevant material in the basic-science years, followed by the clinical years, in which we learned tradition, myth, and ritual. The overwhelming amount of material in the preclinical years makes students pine for shortcuts.  No wonder they’re ripe for the simplistic, definitive messaging of drug reps later. Third year was one long hazing ritual; then in fourth year we were accepted into the fold.  And in gratitude, we would accept and perpetuate the whole dehumanizing training system.

Questions were punished.  Empathy for patients was discouraged.  I was horrified that there seemed to be no connection between medicine and public health, and only a tenuous connection between medicine and science.  (Whenever docs are caught out doing something nonscientific, they say, medicine is an art, not a science.)  And only lip service was paid to the concept of patient autonomy, or making medical decisions in the context of a patient’s own life and values.

So when they removed your soul in medical school, did it hurt?  I was under the impression that soul extraction was a pretty simple procedure, but to be honest, I found it excruciatingly painful. 

Yeah, they need to work on the informed consent for that procedure.

I think all of us found ourselves doing things or thinking things we would not have imagined being capable of. Being deprived of sleep, food, and the company of loved ones is terrible for the soul. I remember reading an account of a hungry, exhausted intern who  wolfed down the dinner of a patient who had just died. No physician would be proud of that, but we would all understand it. We need to change the training system. Physicians-in-training who are treated compassionately will treat their patients with compassion. Medical training is changing, but not fast enough.

This post first appeared on the Chronicle of Higher Education Brainstorm blog.