Pharmaceuticals

I attended a talk today on pharmaceutical companies and their practice of using marketing money to get medical types to prescribe their drugs. It was given by a nurse at work who has major issues with this sort of thing. The gist of the talk was that these companies are irresponsible and underhanded in their practices and spend billions of dollars shmoozing prescribers in an effort to get their sales up. The point was that we're being fleeced by these drup reps and their post-it notes and sponsored educational dinners and tickets to conferences in exotic places, and that we shouldn't stand for it because it's insulting and demeaning.

There was a bit of a gap in the logic for me, and I wonder if I'm just missing something. I mean, we as nurses and health professionals are trained to evaluate the quality of any source of information we encounter. Because there is a pharmaceutical company's logo on a fancy, shiny diagram of prostate cancer doesn't necessarily mean, to me, that I should exclude it from my practice out of hand. I can't yet see the conflict if there is no mention of that company's particular drug on the material. We, as professionals, know that there are at least three drugs which do the same thing as Viagra. This nurse's argument is that docs are more likely to prescribe Viagra because it is such a household word, due directly to brand recognition from the advertising, like my diagram.

Anyway, I think my point is that I am sufficiently educated to make the choice which is right for the patient, regardless of the butt-kissing from the drug reps. I acknowledge the influence. But there are some competing factors to consider.

First, the pharmaceutical companies have a responsibility to their shareholders, moreso, some would argue, than to the Greater Good. So they have a right to do what they want to flog their wares. Having said that, sleazy tactics should be recognized for what they are, and practitioners should be sufficently educated to make reasoably unbiased decisions, with the Good of the Patient in mind.

Second, I think that the problem lies not in the bribery, but the irresponsible way in which the pharmaceutical companies spend their money. If there was less money in advertising, maybe the prohibitively expensive drugs would be more economically feasible. Of course the bottom lines may suffer, but the Greater Good would benefit (naive, I know). Trickling the benefit down to the patient means that if a $20,000 drug suddenly costs Health Canada only $10,000, then they may expand indications for use so more people could use it. It would never happen, but the point is that it could. Maybe it ought to.

Thirdly, my institution cannot (or will not) afford to provide pens for its nurses, so why would we ever expect them to provide shiny, pretty diagrams of prostate cancer for us to use? The money is simply not available. And whether we like it or not, the diagrams are useful.

Finally, the drugs benefit the patients, whether we like the company's practices or not. And if they want to enter an $11 billion pissing contest with each other, fine. I maintain that health professionals should be able to evaluate educational material and make an unbiased decision, but even if the reps are influencing prescribing practices, does it really matter, if the treatment is successful? That was more or less a rhetorical question, because I am not sure of the answer. I'll keep thinking about it.

I guess find the issue more with the economics of it all than any kind of general bad-taste-in-the-mouth from the mugs and pens printed with drug labels. I have no particular objection to a moratorium on pharmaceutical sponsorship/gifting, but I think a major component of the problem was not mentioned.

Or, maybe I am naive, and idealistic, and think I can resist all attempts to influence me. Well, I never have been offered sponsorship to a conference in the Carribean... maybe my cognitive dissonance would be more difficult to resolve if the stakes were higher than free lunch.

Well, this was a bit of a stream-of-consciousness thing, because the point of this talk was to make us aware of the subtle and not-so-subtle influences of the drug companies. It was certainly successful in that way. I'm just not convinced yet that the practice, in general, is a horrible thing.

Conferences

We had Parent-Student-Teacher conferences tonight, preceded by report cards yesterday.

Our kids are smart and well-behaved.

Huh. You could have fooled me. Well, at least the well-behaved part.

Actually, I'm mostly kidding. They've been pretty good these days, both of them. And their teachers concur.

Aimee's report card was glowing. Her teacher said she was reading well above grade level and she is often paired up with older kids for classroom activities. Her spelling and math were outstanding, too. Nothing on the report card showed she was anything but at or above grade 2 level. I asked her teacher if there was anything we needed to work on, and she had a tough time coming up with anything.

Jack, too, had a great report. His strongest area seems to be math but he is certainly making strides in reading too. His teacher said he was respectful and attentive and enthusiastic. She told us that when there is a substitute teacher, she always tells them they can go to Jack for information. That's what I like about him. His uninhibited willingness to keep people informed of every conceivable situation.

I was a little worried about Jack's class. He tells us, daily, about a particular kid who is sent out of the classroom for failing to respect the rules and the teacher. This happens frequently, like several times a day. He has been suspended, already, at least once. From kindergarten. I would be mortified, as a parent, if we even got so much as a letter sent home about behaviour, let alone a suspension. Either this kid is a completely uncontrollable sociopathic monster, or his parents are not concerned enough with his behaviour to discipline him. I can't imagine. The teacher, in a blatant breach of confidentiality, but in response to several fairly leading, open-ended questions from me, told us that this kid picked up a chair and threatened her with it the other day (I must confess to fishing a little, but she probably shouldn't have told us that). Thank goodness Jack hasn't been sucked over to the Dark Side by this kid - obviously the consequences do not make the behaviour appealing enough for him to chance it. I worried that there was a chance that Jack could go the other way - he certainly needs to work on respect at home - but apparently he has it mastered at school, and that's a darn good start.

The gym teacher, though, that was in interesting conversation. I usually just make a vague comment and let the teachers respond. This time, I said something like "He's a wild man" as Jack took off across the gym at full speed. The gym teacher, contrary at first to what the classroom teacher said, told us, "Yeah, I was a little worried at first, he's pretty wild." He knew Jack from daycare/being Aimee's brother. Hmmm, I thought. What is that supposed to mean? That he was a screaming brat? "But he's really well controlled in the gym. He's a leader." The leader bit relieved me a bit, because I worried we'd cheated him by keeping him back a year, due to the January birthday. I guess not. Maybe the extra year of age does give him a maturity advantage. Then we looked at Aimee, who was spread-eagled half way up the climbing wall. He said, "I was worried about her too, at first. She's so small, I was afraid she would be too fragile, too precious. Small kid, small voice. But she really gets in there and participates. She's doing great."

So, a relief, but not unexpected. Both kids are smart, sociable, and respectful away from home. What more could a parent want? Couldn't ask for a better report, especially whent he teachers can't even tell us what we should work on. I guess we should keep doing what we're doing. Whatever it is. Maybe if I figure it out, I'll write a book.

Uninspired

I have been so uninspired lately for writing but my friend just pointed out that a true writer never needs to be inspired to write - they just write. So I will tell you about the bus today.

My Monday started out pretty shaky. I forgot my Palm Pilot and my lab coat, after reminding myself out loud to remember them. Then, on the way to work, I missed my bus by seconds. I was literally steps from the bus stop and the driver didn't see me and he just kept on going. So I whined, and pulled out my book and started reading, and suddenly, there was another bus. Then, all of a sudden, I was downtown, and it took about 15 minutes (it usually takes 30). I figured out that I managed to get on a new Super Express bus that only stops at half the stops. It was pretty quick. Very exciting. It only started running today.

Then on the way home, the same thing happened. I got off one bus, ran for the next one, the usual one, and it took off without me. So I pulled out my book and got on the Super Express when it arrived. I was home maybe a little quicker than usual, but it was just kind of nice to not stop at every single block. Fewer people on it, too. Less crowded, less chance of having to actually talk to someone.

I hope I get the Super Express tomorrow.

Isn't it sad that the highlight of my day was an exctitng new bus route? Oh, wait, maybe not - a doctor did take me out for lunch today. Good Vietnamese food. Yummy.

Ok, there is my token piece of writing tonight. I promise to redouble my efforts to write more often. I warn you, though... it may be as lame as this. You asked for it.

Whatnot

So I was invited to this thing tonight, this direct sales thing that my next-door neighbour was hosting. It was a company that claims to sell chemical-less cleaning products. The woman who presented obviously knew her products, and was quite articulate. She was persuasive enough to convince me to buy a stupidly expensive dish cloth on the promise that this will end all need for soap, detergent, products and elbow grease forever, all with a 60 day money-back guarantee. At one point, she was flogging this miracle towel, which she claimed could dry off two adults. "At the same time?" I asked with mock incredulity. It was my personal comedic triumph - never have I thought and acted so quickly, or got such a loud laugh. I think I stole her thunder. I blame the home-made plonk, consumed nearly to excess. Anyway, this woman's chief fault was her excessive use of the word 'whatnot'. I'm thinking this product could launch the space shuttle, if the qualities implicit in the 'whatnot' were half true. So we'll see... I'm hoping that the whatnot will clean the house for me.

I admire these consultants. Direct sales is a tough job and I know I couldn't do it. I am not a salesperson. I think you have to have too much bullshit in you to do it well, an we all know I have no bullshit. I could change 15 adult diapers, but ask me to convince someone that they couldn't live without my product? Well I can't even convince my own husband of that. But seriously, those who love it do it well, those who don't, well, it's a job. That they will do for a short time, with much dread, little enthusiasm, and an early retirement. With a lot of leftover product and debt. My best friend (whose birthday is today) was saying she was looking for a home-based business she could start. But, she said, it had to be a product that she really believed in. I suggested the sex toy one. She could really get into that. I haven't heard from her since. Either she loved my suggestion or she hated it.

A cute kid story, full of whatnot, before I hit the hay - Aimee, Jack and I were chatting the other night and the talk turned to bad words. Aimee told me, "Paige said a bad word". Paige is 3.

"Oh, which word is that?" I asked.

"I can't say it out loud, it's too bad", said Aimee.

"What does it start with?" I asked

"F", she said.

"Oh," I said. "Tell me what it is. I promise you won't get in trouble. I just want to know if you know it," I told her.

"I can't," she said. "It's too bad, I can't say it out loud," said Aimee. Thank goodness, I thought.

"Whisper it. I promise I won't get mad".

She hesitated, then approached my ear. "Fuck," she said, in barely a whisper. Oh, I thought. So she does know it. Darn.

"Hmmm...yes, that's it. But you know never ever to say it out loud, right?" I said.

"I know, Mom", she said, rolling her eyes. "Eaton in my class says that word. He says the other bad word, too."

"Which one?" I asked with significant trepidation.

"The 'a' word. It's like 'as', but with another 's'," she said.

Yet another example of how our reach just doesn't go as far as her friends' anymore. I just hope we can still influence good choices - like not to use the 'f' word in public. Or the 'a' word. Anyway, I can take solace in the knowledge that she is still at least somewhat innocent, only slightly corrupted. I hope it lasts.

Work

Work this week was not so much fun. I was out of the comfort zone of my usual assignment and working with the surgical oncology clinic. The good part is that I now no longer detest all surgeons (now it's just plastic surgeons I despise). The bad part is that anyone who is supposed to have surgery next week will be lucky to get it, unless the insane number of forms and papers I had to complete ever finds their rightful mailboxes.

I am also being yanked out of my assignment to take on more of the "resource" role in the title Clinical Resource Nurse (whereas now I am more "Clinical" than "Resource"). In theory, it means I will arrange staffing for the clinic, and organize and provide orientation for new nurses, and sit on a bunch of committess which are supposed to give me the impression I might be able to help make positive changes around the institution. In practice, it means I will be the SuperFloat nurse, who gets to work in a clinic whenever a nurse calls in sick, and will never get to do my own work (whatever that is). Well, it's a term position that I have until August '06, at which time I can go back to my own little corner of the clinic and do the work I feel most comfortable doing, if I want.

The other bummer thing about this week has been the morale around the building. No one seems happy and I know of about 3 nurses actively looking for new jobs because of it. I am just getting so sick of hearing people bitch and whine about how awful the job is. The worst part is that you can't even expect that they should be coming up with any suggestions for improving the place because the place is so top-heavy with management that it will take, literally, months to get the smallest change institutionalized. It's a Dilbert world and incredibly frustrating. I have come up with a few suggestions - which will go nowhere. The why-bother mentality is very tempting.

I am seriously thinking of more education, sooner than later. The problem there is what to take. I could do a Master's in Nursing, or in Education (ick), or a Nurse Practitioner degree. I am also interested in a Bioethics degree, which may pave the way for some cushy government appointment, which is really what I'm after (because a smallish bureaucracy like mine isn't frustrating enough). Who knows. All I know is that the deadlines are all coming up, so I'd better get off the pot if I want to start in September.

Well, I think I've killed enough time... my eyelids are heavy. We went out for a nice dinner tonight with friends, and I'm getting my hair cut tomorrow, and my sister is redecorating the bathroom. So exciting things are afoot around home, if not at work. Keep you posted.

Jostens

Jostens Canada

To whom it may concern:

We were extremely disappointed with the quality of our children’s’ school portraits this year. One child was not even centered in the photo and the other had a silly look on her face. Our disappointment is compounded by a number of factors related directly to your corporate policies and practices.

Your current practice is to charge families up front for their pictures, with no chance to preview or choose a pose and no chance for retakes unless there is some “quality defect” present. This puts us out nearly $100 (minimal compared to other families’ investments, I am certain) until you are able to provide us with a refund. In effect, we are lending you our money, on the chance that your work will be of sufficient quality for us to keep and display, which it obviously was not. Should this practice continue, we will be reticent to order portraits next year. This is a major disappointment; as I am sure you are aware, the annual school portrait is a tradition in many families, and treasured by most. Unfortunately, this year, we will be using another company to provide us with this service, because, despite the convenience of your product, the quality has proved to be abysmal.

Furthermore, we are now required to pay the postage to have the pictures returned to you. In this stead, I am requesting that you add the cost of the postage to your refund, as the problem is entirely yours, and should not be borne by your customers.

I look forward to your prompt attention to the matter of our refund and respectfully request that this letter be forwarded to your customer service managers so that these concerns regarding your corporate policies can be registered appropriately.

Sincerely disillusioned,
[Name withheld to protect the irritated]

Vocabulary

We overheard a conversation between Jack and Aimee this morning when we were at the Y. He was trying to convince her to play in the gym with him.

Jack says,"Aimee do you want to go play basketball with me? I'm really good".

"Ok," Aimee replies.

Jack hustling along behind her says, "Do you want to know how I got so good at it?"

"Ok, how?" says Aimee indifferently, shrugging.

Jack replies, with gusto, "Perseverance."

Good to know "stupid idiot" isn't the only impressive language he has learned in his five short years.

Books

I referred you to The Kite Runner recently - well, I have decided to share my opinions on the books I read, so I have started a separate blog, Books I Have Read Lately.

I finished another good read just the other day, and I'm sure my loyal fans will want to know about it. So check out my latest opinion.

Sorry, but that's it for tonight... I'm still sick and I have no energy to be creative. I'll post Hallowe'en photos of the kids as soon as T send me some. They were cute - had a great time. Too much junk, though, although now we have ammunition to get them to do what we want...