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Research Article

Medical Students' Exposure to and Attitudes about the Pharmaceutical Industry: A Systematic Review

  • Kirsten E. Austad,

    Affiliations: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America, Edmond J. Safra Center for Ethics at Harvard University, Cambridge, Massachusetts, United States of America

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  • Jerry Avorn,

    Affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America

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  • Aaron S. Kesselheim mail

    akesselheim@partners.org

    Affiliations: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America, Edmond J. Safra Center for Ethics at Harvard University, Cambridge, Massachusetts, United States of America

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  • Published: May 24, 2011
  • DOI: 10.1371/journal.pmed.1001037

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The hidden curriculum

Posted by james46 on 09 Jun 2011 at 00:33 GMT

The article’s focus on those in the earliest stages of medical education is laudable. The dramatic advertising success story of this industry begins on the first day of medical school. Students, by name, are precisely targeted and groomed as future prescribing agents. They are not yet aware that their individual prescribing habits will be monitored; that their unique prescribing histories will be bought as a tool for directed promotion; nor do they yet know that certain students are destined for future availability as commercial shills (1). I noted the first-day barrage of attitude-managing gifts and invitations in 1968 at Western Reserve School of Medicine. I was pleased that fellow students in two class years mounted a minor rebellion against this practice. I circulated a critique of the pharmaceutical industry's economics and advertising habits, based, among other sources, on the Kefauver Committee's findings. Nonetheless, shortly the powerful "hidden curriculum" of attitudes and habits of residents, faculty, and private practitioners took a severe toll on any residual critical skills students may have had.
The pharmaceutical industry has ably developed its image as a co-profession, even as it transformed the logic and integrity of medicine and its journals. In the Hobbesian business world, this oligopolistic enterprise must generally be regarded as a success. However, its very success required serious failure for us as physicians. We have allowed commercial needs to distort our research agendas and our prescribing menus. This represents an unending betrayal of our patients and the public, and is a deep embarrassment to medicine's professional values. The betrayal starts in medical school, and not even a brave attempt by medical students (2) to shame the institutions can change the powerful economic facts on the ground. Not much, in fact, has changed since 1968-- just a few reluctant adaptations in style and sophistication to dodge some public criticism. Harriet Washington's analysis in the June 2011 American Scholar provides a discouraging dose of reality for those who think none of this matters (3).


1. http://www.bmj.com/conten...
2. http://www.amsascorecard....
3. http://www.theamericansch...

No competing interests declared.