Thursday, July 13, 2006

The American Medical Student Association: consistency after all?

I have occasionally blogged about the inconsistency between AMSA’s Pharmfree campaign (supposedly standing for scientific integrity and evidence based medicine) and their enthusiastic promotion of alternative medicine with its numerous unproven health claims.

One of my posts drew a comment from ba who said “As for integrative medicine, AMSA is not doing enough. The medical schools are still in way too deep with the pharma$ to have credible integrative health programs. So far the integrative medicine programs sound more like mere window dressing and decoys.” That suggests a common thread in the AMSA’s seemingly contradictory positions: the notion that Big Pharma is leading a medical-industrial conspiracy to suppress research in (and the integration of) alternative methods.

Could these positions be part of a broad political agenda? Go to the AMSA’s main page and search such hot button issues as reproductive rights, universal health care and, last but not least, malpractice. Extensive material is posted concerning these issues. After perusing their articles on malpractice I gather they are not in favor of damage caps, think the liability crisis is exaggerated and seek other solutions to rising premiums such as reforming the insurance industry, reducing medical errors and disciplining bad doctors.

Medical students and faculty should be aware that while AMSA purports to be concerned with medical professionalism it is very much a political activist group. At 60,000 members it is the largest medical student organization. Medical students are being groomed to transform the culture of the profession, and in a way that should concern us.

I agree with commenter ba on one point. The integrative medicine programs in most medical schools are not credible. The remedy for this credibility gap is not to decrease reliance on “pharma$”. Instead medical schools need to dispense with magical thinking and be appropriately critical of pseudoscience.


Anonymous said...

I will be entering medical school this fall. After reading several of your blog posts on AMSA, I have decided not to join. Not even for the free Netters.

Robert W Donnell said...

A free Netters! That must be one heck of a lure. Incoming med students tend to be vulnerable, a little frightened and cash strapped. With gross anatomy right around the corner that's a powerful incentive. Sounds like a bribe to me. That's ironic considering all their moral preening about refusing gifts from drug companies. Are they up front with incoming students about who they really are? I'd like to know more. If you'd be more comfortable contact me via email.

Anonymous said...

As the National Pharm Free Coordinator for AMSA, I speak for our members on this issue. AMSA members believe in providing the highest quality care through evidence-based medicine. As such, and through our pharm-free campaign, we hope to educate future and current physicians about the problems that the status quo presents, in terms of the relationship between our profession and the pharmaceutical industry. This relationship has professional, ethical and practical consequences that affect not only the public trust in our profession, but the pocket books of all those to whom we prescribe. All physicians should be aware of these consequences. Those who deny that pharmaceutical companies significantly alter our prescribing practices, even against the evidence base, and do so at the expense of our patients, are a shrinking minority. Medical schools, residency programs and Academic Medical Centers, those to whom we as a profession turn to lead the way in evidence-based practice, are moving further and further in the direction of limiting access to pharmaceutical reps. AMSA is playing an active role in this process.

There is no inconsistency in AMSA's support of research into Complementary and Alternative Medications. Many of our most commonly used medication are derived from natural compounds. To cut off exploration of natural remedies, especially those, like acupuncture, saw palmetto, black cohash, that have proven clinical efficacy in certain scenarios, is akin to halting exploration of renewable resources in favor of trying to find more ways to suck oil out of shale.

Medicine has its roots in a tradition of healing. Healing is about a relationship, as much as any pharmacopia. If we refuse to meet the patients where they stand - correctly suspicious of an industry that, with a history of good works, wastes its energy on disease mongering and creation of "me-too" drugs, and willing to try natural products with potentially fewer side effects - than we will continue to lose these patients.

Thank you for your interest in AMSA. I do hope "anonymous" reconsiders his decision not to join. AMSA members are activists who dedicate much of their little free time to making medicine better, not just for physicians, but for patients. I am always humbled to be in the presence of such intelligent, well meaning individuals.
justin sanders

Robert W Donnell said...

I agree partially and can meet you half way on your concerns about industry promotion. Certainly we should not rely on industry promotional materials for information. I agree that medical school faculty and residency program directors have a legitimate concern about what trainees are exposed to, and in may need to limit exposure to drug reps.

The inconsistency is that if your'e going to be critical of drug company promotions (as well you should) then why not be appropriately critical of alternative medicine? To be Pharmfree and not Altfree creates a credibility gap.

I appreciate your response and will consider a follow up blog post acknowledging your points.