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opinion | Nathaniel P. Morris

Learning the difference between medicine and the medical industry

Medical students learn only generic names, but hospitals speak in brands

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Last month, I was standing in an intensive care unit, wearing my white coat and trying to look like I knew what I was doing. My third year of medical school had just begun. It was my first day on a clinical rotation, my first time actually taking care of patients. My assigned team had started morning rounds, discussing the patients on the unit and making decisions about their care. While the dialogue bounced among residents, nurses, and attending physicians, I struggled to keep up with the conversation.

“Increase his Levophed dose.”

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“She’s got a St. Jude’s. Is Lovenox the best choice?”

“Throw some Kerlix on his leg.”

I had expected a difficult transition to the hospital. Still, my team seemed to be speaking a foreign language. Why hadn’t I ever heard of any of these terms? Had I fallen behind at some point or studied the wrong things?

When I looked up the words, I discovered that I wasn’t as lost as I had thought — I just knew this jargon in a different way. It was my first day in the hospital, and I realized I hadn’t learned medical brand names.

In the weeks since, I’ve seen many different aspects of medicine and brand names factor into these experiences every day. I’m constantly expanding my industry vocabulary. Prescription drugs. Surgical instruments. Prosthetic devices. There are even special brands of tape. Whenever I enter the hospital, I’m learning the trademarks, logos, and company names of products that, directly or indirectly, contribute to patient care.

These brands were noticeably absent during my previous two years in the classroom. And having to relearn the language of medicine during my rotations has been frustrating. Yet there are strong arguments for separating the medical industry and medical education. Industry ties among faculty can distort teaching preferences, and it’s important to protect medical students’ learning from these types of outside influences. Removing corporate nomenclature from the curriculum may prevent future doctors from developing biases early in their training.

But can medical schools truly teach the practice of medicine when they present a censored version of health care as it exists today? The innovations of drug companies and medical device manufacturers advance the modern management of disease and create new possibilities for patient care. Whether we’d like to admit it or not, these products shape the manner in which medical professionals work and converse with one another in clinical settings.

Harvard Medical School, among others, has publicly struggled with these issues during recent years. In 2009, Harvard medical students made national headlines after protesting industry influences in the classroom and prompting the administration to implement new policies for faculty disclosures, in addition to other changes.

Despite such reforms, these tensions have not gone away. For example, last November, a professor gave a lecture on asthma to my class. At the front of the auditorium, she picked up a labeled medication and declared, “I am not endorsing anything, any of these medications. Two years ago, I had the names on here and people complained. And then, last year, I took the names off, and then people complained.”

Her dilemma sums up the tightrope that medical educators must walk on a daily basis.

So while not knowing brand names has been challenging in the hospital, I understand the quandaries that academic institutions face. Both the presence and the absence of industry content in curricula can create problems when educating future physicians. Medical schools must awkwardly straddle this divide between removing corporate influences from teaching and providing a practical education.

But medical students can still learn about industry in productive ways, even without exposure to advertisements or brand names. To prepare budding doctors for their careers, medical schools should teach their students frameworks for understanding the corporate realities of health care.

Every medical student should learn about the regulations that govern relationships between companies and health care providers. Classes should cover the approval processes for pharmaceutical drugs and medical devices. Medical schools need to facilitate discussion about conflicts of interest and other biases that affect clinical decision-making. And all physicians-in-training should graduate with a basic grasp of medical industry trends, as well as pertinent health care legislation.

During the first half of medical school, my classmates and I had opportunities to study some of these topics. But now we’ve left campus for the clinics and hospitals. We’ll have to grapple with these issues for as long as we treat patients.

Getting down brand names is just an orientation.

Nathaniel P. Morris is a student at Harvard Medical School.
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