Medical education in the days of Big Pharma 30. October 2010 William Davis (43) I received this detailed email from an unexpected source: a 3rd-year medical student.In her email, Theresa describes her frustrations in what she is witnessing for the first time, proceeding through her training and getting exposed to the realities of medical life. Medical training, particularly clinical training from the 3rd and 4th years of medical school, onwards through internship, residency, and fellowship training, consists largely of bullying, "pimping" (meaning rapid-fire grilling of questions at trainees), and sleep deprivation. It is an extended hazing period meant to demoralize and inculcate the trainee into following the lead of superiors. Buck the system and you're . . . out. Imagine you've just sunk $190,000 and 8 years of college into getting to your internship. You are not going to chance being thrown out on principle. So you just swallow your pride, go along with the game, and echo all the answers they want you to repeat. While Theresa laments the sad state of modern American pharmaceutical- and procedure-obsessed medicine, she provides me with hope that some young people training to practice medicine today will carve out their own paths, not the one laid for them by the pharmaceutical industry, nor fall for the temptation of higher-paying procedural specialties like orthopedics and cardiology. I am impressed with her ability to see this so early in her career. Dr. Davis,I am a 3rd year medical student at ________ University. I came across your blog today, and I'm very glad I did. I appreciate the value of your time, so I want to be as succinct as possible while still getting across what I'm really thinking and feeling:From what I gathered exploring your blog for a while this afternoon, the wellness strategies you incorporate into your practice are some of the exact things I want to do with my future patients. Personally, I strongly believe in staying healthy by eating right, staying active, etc. For instance, I don't eat grains or much in the way of starches and sugars. So I love the fact that you are helping your patients make these powerful and foundational changes in their lives.As I'm sure was your experience, a full appreciation of nutrition and lifestyle as a first-line health strategy is not something that was taught to me in medical school. I came to school with this deep conviction already in my heart and mind, and now, on my 3rd year rotations, I am still conflicted and at a loss as to how I'm going to be able to practice medicine the way I want to, which is to incorporate these all-important principles into the care of my patients.What I've come to understand about the medical field today is that the information that exists is primarily subsidized by the pharmaceutical industry, and dictated to medical professionals as "evidence-based" treatment guidelines and recommendations by organizations with sincere and official sounding names like American Heart Association and American Cancer Society. Add to that the pressure of potential malpractice litigation and the complexities of the insurance reimbursement game, and it seems to me like what you get is a bunch of diagnostic and medication management algorithms that any half-trained monkey could follow. In his sleep. Which I guess would be alright if at least they weren't algorithms based on misguided, self-serving, profit-seeking Big Pharma, Food Inc, insurance conglomerates, and agri-politics (I think I just made that word up.) A lot of well-intentioned physicians are just parroting the party line, as their patients dutifully and gratefully chomp down their statins and diabetes drugs and blood pressure pills. And I'm sorry, but "diabetes education" programs with curriculum put together by drug companies? How is that even legal? Massive corporations raking in massive profits that are dependent on uncontrolled blood sugars telling people how to best control their blood sugars?!Anyway, forgive my rant. What I'm getting at is this: How can I practice medicine, with the freedom to educate/coach/treat my patients with diet and lifestyle changes to mitigate/reverse their chronic health conditions? Without feeling like I automatically have to first and foremost prescribe the litany of drugs dictated by "evidence-based" guidelines? Without excessive fear of litigation or loss of credibility among my peers? Without having to lie through my teeth to my patients, and tell them that eating low-fat and heart-healthy whole grains is the best way (implication also being the only scientifically proven way) to control their diabetes, lower their cholesterol, etc, etc, etc?I want my patients to have the full benefit of honest nutrition and lifestyle information, and medications and surgery as necessary. I'm afraid that there isn't room for this kind of holistic emphasis in the medical profession today. Are there residencies that include this kind of training or at least respect these "unconventional" philosophies? Are there clinics or practice groups that would allow me to practice with this emphasis, or is there a bias against docs who do not necessarily conform to the party position? Will I have no other option but to go it alone under the auspices of my own shingle? How do you handle these kinds of issues in your professional life?Sincerely,Theresa M. A ray of hope! Perhaps Theresa is just the first among many more medical students who refuse to submit to the brainwashing practices of the pharmaceutical industry, the same mind manipulation that has hopelessly turned most of my colleagues into their unwitting puppets. I'll be interested in watching how Theresa's experience unfolds. I've asked her to keep us informed every so often.