I'm Your Pusherman...

I was floating around the office of my LPP (Longitudinal Preceptorship Program) as I normally do--feeling and looking perhaps a bit awkward, not sure where exactly to stand in the narrow hallway, sporting my emblem of medical knowledge, the stethoscope and entertaining thoughts of what was in store for the afternoon in this pediatric practice. Gracefully, skillfully, she swooped me into conversation: Angela, making the hallway even narrower and impassable, introduced herself and proceeded to corner me into a conversation about current ADHD treatments and diagnosis. She was from J & J (that's Johnson & Johnson if you're outside of the biz). Perhaps the snicker that grew in the corners of my lips made it obvious to her that I was not listening to a word she said but instead churning over statistics about drug reps and their devious game. There is a really interesting report on the rules and tactics of this game here. Below are a few of the most interesting points:

• The rep categorizes the doctor based on 8 categories and tailors their tactics based on that categorization; this is a finely tuned science.
• Despite the self control that we all want to believe we have over our influences, those little samples that pharmaceutical reps distribute so freely actually affect the decisions that doctors make (otherwise, they wouldn't give 'em out!)
• As much training as physicians have in behavior change, the psychology of habituation, and the mind's interpretation of everyday events, drug reps are able to give doctors a taste of their own medicine. The gift giving works, the relationship building makes money, and, perhaps tritely, everyone is human--most of all physicians themselves.
  

As I was cycling through the information that I had heard about pharmaceutical sales watching Angela's lips move, I was reminded of a song by Curtis Mayfield and thought that this well-dressed, well-groomed woman was nothing more than a pusherman:

"...I'm your doctor, when in need
want some coke, have some weed
you know me, I'm your friend
your main boy, thick and thin
I'm your pusherman,
I'm your pusherman."

John Wood

The same issue that has come up for me in the past surfaced today. It is the problem only of the rich, the privileged, those to whom everything has been given and who began life already with more potential simply because of the income level of their parents; perhaps the social version of genetic, Darwinian, advantage. Dr. Michael Hirsh, the highly decorated, highly respected Chief of Pediatric Surgery spoke to our class about "Why He Entered the Field of Public Health". His story, what he called--after the Sioux tradition--a "sacred bundle", began with John Wood. John Wood was an impressive character by Hirsh's description. A musician, pediatrician-turned-surgeon, and a longtime Columbia man, he was Hirsh's colleague, friend, mentor. John was shot in the chest while working outside of Columbia's hospital in the Upper East side and Hirsh was the physician on call (ironically, a favor he was doing for Wood). He described the 26 bus loads of people that were shuttled to Princeton for the funeral and the feelings of rage that followed the initial shock.

This was Hirsh's foray into injury prevention, a staple to his professional career and clearly, to his personal accomplishments.

The story was captivating and heartfelt, although I couldn't help but think about what my "injury prevention" is, who or what my "John Wood" is and in recognizing that I don't believe that I have found either of those yet, how and when I would discover such a personal connection to a larger world issue. I find myself often stuck between problems of grand magnitude and greatest importance, not knowing which to invest myself in. I do not have a family member afflicted with HIV/AIDS; I never witnessed a shooting; I don't feel the pangs of emotion when I think of heart disease, disaster preparedness, environmental health, infectious diseases, the list goes on interminably. The point is that while I see the the intellectual and conceptual direness to each and all of these global issues, I feel no emotional attachment to them.

Am I empty, am I simply not examining my past hard enough, or should I simply continue to wait?