You can click this link:
http://actnow-phr.org/campaign/support_pepfar

And forward the action to friends and colleagues here:
http://actnow-phr.org/campaign/support_pepfar/forward

Clearly, in the USA, DtoC advertising is a big part of Pharma companies marketing strategy. I would be very surprised if there were not regulations in place governing the content of such adverts. In the UK there are adverts for medicines, however to my mind these are usually only over the counter medications e.g. simple analgesics which patients do not need to visit a doctor to be issued a prescription. Another way that patients may demand a particular therapeutic is in the case of new drugs e.g. the monoclonal antibody Herceptin for breast cancer a few years ago, where patients in certain areas were given the drug and patients living elsewhere were denied the drug-a so called ‘postcode lottery’. This created a lot of media attention and patient groups and charities put pressure on hospital authorities to allow the drug to be used in those denied it. The National Institute of Clinical Excellence (NICE) was created to take an analytical approach by estimating the additional benefit in relation to the additional cost of treatment with new technologies. It then produces national guidelines which has helped remove this ‘post code lottery’.

Dear Tom, I am a new member of the Lancet Student and have just finished reading your article on the relationship between the pharmaceutical industry, doctors and patients. I thought the subject matter was very interesting and thoroughly researched. The point where you mention direct-to-consumer advertising in the United States particularly caught my attention. I live in the US and have been exposed to TV commercials for drug companies for at least the past ten years. When this market campaign first began commercials were vague and ambiguous; one for Claritin/antihistamine initially just showed outdoor scenes, hot air ballooning etc. without ever stating the drug’s target for treatment. Now the trend has evolved into commercials that are more explicit with a voice over providing an exhaustive laundry list of all possible side effects from the drug being advertising. In particular drug commercials now seem to attempt to create patient pro-activeness as each spot usually closes with the phrase “talk to your doctor”. Ads often list symptoms of a disorder, asking the viewer if they share these symptoms. Next it is suggested to the viewer that they may have this disorder but there is hope in the drug that is being advertised. I personally can’t picture coming in for a doctor’s appointment, telling the physician that I think I may have a certain disease or disorder and then requesting a specific brand of prescription medicine by name. Honestly, the pharmaceutical advertising campaign in the US has always confused me and while I can’t see its effectiveness it is absolutely continuing. I don’t see patients becoming more well informed of their drug treatment options because there are no comparisons or statistical information offered in the advertisements to promote educated consumers. The only result I can see is an increasing sense of hypochondria or perhaps if the patient is prescribed a drug with a name brand that they recognize some blanketed feeling of security in the quality of the drug due to the association through TV advertising. So it wasn’t clear to me from the article if you felt direct to consumer advertising in the United States was a positive as far as eliminating the influence of the drug companies with their motive for commercial profit. Do you think direct to consumer advertising would improve the situation in the UK? I would say that consumers are definitely more aware of the name brands of drugs and their associated illnesses but absolutely without complete understanding of the different options or even the diseases/disorders the advertising drugs purportedly treat. I would be interested to know your thoughts on this and if you think a modified consumer education program would be effective. Again, to my mind, the issue is the bias caused by whomever will profit from the advertising, in this case again, the drug companies; providing limited information to their own benefit.
Thanks for the article, Katie

Dear Katie, I have not had much exposure to ‘direct to consumer’ advertising and as such did not really expand on my comment. I mentioned DtoC advertising simply to compare the amount of information patients have across the Atlantic, from here. I understand that it could be perceived that I believe this form of advertising is a good thing. However, I had not thought in great detail about the disadvantages of this and concentrated on the problems associated with intense marketing towards the medical profession. Your points are very interesting, and I believe DtoC advertising is going too far the other way! With regards to a modified consumer education program, I believe if patients are driven to find out about their illness and treatment options they will use the Internet to satisfy their curiosity so see no real benefit of such a program. This is just my opinion! Tom

Here in the US, the American Medical Student Association held a full day of programming around the topic as part of its Annual Convention, held in Houston, TX.

Read on to hear some of the highlights.

The event was coordinated by the
Medical Alliance to Stop Global Warming
(for more information on this group, please contact Liza Goldman Huertas leg32@omega.med.yale.edu)

**Voices from the Grassroots: Working for Health and Environmental Justice**
————————————————————
AMSA’s first Environmental Health Institute
co-sponsored by Teleosis Institute
Wednesday, March 12, 2008

Med students learned how to:
*respond to health consequences of climate change and fight global warming*
*promote healthy urban planning and sustainable food*
*help make workplaces safe*
*promote well-being of low-income communities and communities of color*
*address toxic threats to child development*
*prevent cancer*
*use the knowledge and voice of the medical community to support
social justice*
*green our healthcare*

… and much more!

The keynote speakers included Jill Stein, MD, Jerome Ringo. Juan Parras.

Jill Stein is a physician and health advocate who is nationally known for her work to protect children from toxic exposures. Dr. Stein was a candidate for Governor of Massachusetts in 2002. Jerome Ringo has been called “the most interesting environmental leader in the United
States right now,” by The Nation magazine, and he is among Ebony magazine’s most influential African-Americans of 2006.

Juan Parras, founder of Texas Environmental Justice Advocacy
Services (TEJAS) will take us on an Environmental Justice tour of Houston! TEJAS focuses on environmental issues in the Houston Ship Channel neighborhood, a predominantly Latino and low-income community. To learn more about Juan Parras, go to http://www.cleanhouston.org/heros/parras.htm.

The day ended with action plans: for a medical student
environmental health leadership initiative, for AMSA, for our schools and hospitals, and for our profession.

Well consider this then, If we dont stop the Genocide thats happening inside China to the peaceful Falun Gong who are having their organs forcibly taken from them resulting in obvious death to sell to the lucrative international transplant industry then we are no better than accomplices to this human rights disaster.

Hitler committed similar atrocities to the Jewish people and no one paid any attention then either and the Olympics went ahead and now we know the result.

Never Again is Happening Again.

Crimes Against Humanity and the Olympics cannot Co-exist

Please read the independent reports from 2 very distinguished Gentlemen in Canada at
http://organharvestinvestigation.net/

Shame and name the Ccp .A boycott will work to save lives. Directly use their own human rights abuses not Darfur and Sudan because most Chinese have no idea what Chinas involvement is in Darfur or Burma. Remember they have complete control over all Chinese media.

This is not to say that these organizations or American physicians as whole do not recognize the value of disaster medicine. On the contrary, ACEP has an active disaster medicine section, and there are a number of fellowships in disaster medicine in the U.S. ACEP and other groups are working together to develop a disaster subspecialty board that would be recognized by ABMS.

I agree with Dr. Ramirez that “the disaster medicine community internationally must move beyond national boundaries, professional politics and territorialism [sic] to work cooperatively.” However, without the support of the house of medicine in the U.S., it is premature to hail a new specialty.

Marlow Macht
Candidate for MD-MPH in 2008
Tulane University
New Orleans, Louisiana, USA

“The results of randomized controlled trials conducted in low-, middle-, and high-income countries provide no assurance that DOT compared with self administration of treatment has any quantitatively important effect on cure or treatment completion in people receiving treatment for tuberculosis”

While I think it may be useful for some patients or in some clinical settings, the WHO protocol for universal DOT therapy may be wasting badly needed resources. Any thoughts on this?

Josh

In the UK there is a big drinking culture amongst medical students. I wondered what attitudes towards alcohol like amongst med students in other countries? Is it setting a bad example, or should we be allowed to do what we want in our free time?
Interesting that the WHO doesn’t employ smokers - should it take teh same stand on heavy alcohol consumption?

The reason I know this is that we’ve actually (Dalhousie University, Halifax, Canada) just established our chapter here, and I am aware that there is some tremendous progress being made by one particular Canadian university– the University of British Columbia. In fact, I will be meeting with the Technology Transfer Officer for UBC next week, to discuss the enormous success that the UBC chapter of UAEM has had in getting tangible policy changes at the university research level.

The reason I bring that up, is to simply say that; when we, as medical students (or any students for that matter) organize ourselves, we really can affect change. That potential (to bring about significant changes)coupled with the understanding that one of our responsibilities as physicians is to advocate for others, underscores a key point: That while we may only be in the training phase of our careers, and not quite ‘professionals’, simply being aware of issues like these and being open to discussing and engaging the issues with our peers, you may actually have done more than you think.

Amit.

As for the PharmFree pledge, my view is that it’s a good thing to do. If we are so hesitant to give up the gifts/free lunches, then we must be more dependent on these perks than we thought, and perhaps these marketing efforts affect us more than we think as well. As you alluded to in your post, pharma companies can track exactly how physicians prescribe by buying access to databases sold by the AMA and data collection companies. Thus, the corporations can see precisely how prescribing changes after a lunch with one of their drug reps, after an all-expenses-paid, pharma-funded conference, or after dropping off a box of free samples of their newest, most-expensive drug (with the skimpiest track record for safety). The companies calculate their rate of return on these investments, and we know it must be quite handsome because the industry continues to increase their expenditures on this kind of marketing.

However, while the pledge is a fine thing to do for individuals, it’s not how we will ultimately achieve institutional and cultural change. For that, we need to bring these concerns to those who have the power to change institutional policy — our deans, for example, or the heads of clinical departments. Students can have a surprisingly powerful voice on this issue. At the University of Connecticut, for example, a comprehensive conflict of interest policy is now going into effect because one medical student approached his dean and asked how his school could receive such a low grade on the AMSA Scorecard and what could be done about it. Other medical students can have a similar impact.

AMSA has put together a step-by-step guide on how to approach one’s dean about this, including a couple of high-yield articles for students to read and a template cover letter to the dean. This can be found on pages 4-6 of the PharmFree Toolkit, which was just released here:

http://www.amsa.org/prof/PharmFreeActionToolkit.pdf

The pressure to institute such policies is building, and now is a critical moment when medical students can actually tip the balances simply by raising the issue.

I personally view taxation as paying for yourself- My share of street lighting; my share of garbage collection, my share of policing. My ambulance if I should need one and my hospital care for when the ambulance drops me off. My state pension should I take it and my share of public sector employees acting on my behalf.

I don’t see it as my contribution to society or replacing charity be that in the form of time or money. Maybe a lot of people do though.

The Lancet Student is giving an opportunity for medical students like us to spread our arms in the international grounds and also as a platform to improve our skills in blogging & reviewing.

Thank You Lancet and thank you xenoMED from where I actually got linked to Lancet.

AMSA has really come a long way and its contribution to the welfare and benefit of students genuinely deserves much appreciation from deep down the heart.

xenoMED on the other hand, even in its short span of existence has gained much popularity among the medicos not only in Nepal but across the whole world. More than 15,000 registered users – the figure says it all. With a large group of medical professionals, xenoMED has established itself as a site of the medics, for the medics and by the medics. “Share and be shared” as the motto goes!

Going through this blog I felt - xenoMED, AMSA and now this student lancet are just perfect examples how we should use the blooming information technology for our benefit and how we can easily get our message across the globe with the help of few clicks. How different things would have been without these technologies? I just wonder.

I enjoy student lancet very much and i wish it a very good luck.

Dragging medical students from the first semester, enlighting them and attracting them for research & publication, journal clubs and continued medical education (CME) has also become a fundamental prospective of this site.

A lot to begin, a lot to be done.
Thanks to Xenomed.com

HOSPICE Nepal (http://www.hospicenepal.org.np/) is an non-political, non-profit organization was started in year 2000 with a team of dedicated nurses just to take care of terminally ill patients.

Hope World Hospice and Palliative Care Day ma achieve its goals.

But you didn’t talk much about “global health forum and looks at research challenges for health in developing countries”.

However, I went to its homepage
http://www.globalforumhealth.org

and this link
http://www.globalforumhealth.org/announcements/07/young%20voices%202007.php

and learnt more about it.

MP3 files took long time to get downloaded and I almost lost my patience although its broad band. Most of the developing countries are still using dial up internet connection.

Have you thought of making MP3 as less painful as possible.

Prof Dr Madan Koirala of the Central Department of Environment Science under the Tribhuvan University said though Nepal contributes 0.025 per cent of the total greenhouse gas emission, it is highly vulnerable to the hazards of climate change.

“The government should focus on the clean energy mechanism to minimise greenhouse emission,” he said, calling on the world community to accord top priority to emission control measures.

Read full article
http://www.xenomed.com/forums/general-talks/84830-global-warming-posing-threat-glacial-lakes-nepal.html

Now, let me go through all the links and poscast, would be interesting.

But I am amzed to see only two of you are working for TLS might be because its in beta phase.

All the best,

But I am amzed to only two of you are working for TLS might be because its in beta phase.

What are you planning for TLS?

I’m glad to see you starting The Lancet Student. I was wondering where you would be after leaving studentBMJ.

Wishing you all the best for the great success of The Lancet Student.

Perhaps the right to health becomes an even broader and more important topic where medical schools begin to address global health as well as national health.

Should strategies to address the problem of child soldiers be aiming just to remove child soldiers from these situations, or should they be more holistic, aiming more at the root of the problem? Maybe Aoife is suggesting that we have to accept that many conflicts won’t be solved for many years/ever, so we have to deal as best we can with the situation?

In addition, there are some great interviews with him available online. I find these two particually interesting: http://www.netscape.com/viewstory/2006/09/20/interview-with-dr-steven-miles/?url=http%3A%2F%2Fwww.uruknet.de%2F%3Fp%3Dm26766%26hd%3D0%26size%3D1%26l%3Dt&frame=true

http://www.thiemeworks.com/write/archives/steven_miles_interview.htm

It sounds like you are all having an amazing experience in Kent at the moment. Its such an important thing, not just for medical students to get to learn so much about global health issues, but also to meet other medics from around the world, make friends and be able to think together about how, as medical students, we can really do something to deal with all of the injustice out there. As a medic not able to attend the conference (but still massively interested!), it would be great if you guys could let all of the rest of us out there know whats going on, what you think the biggest issues being discussed and if there are any ideas for student action circulating, or that you have just come up with.

Enjoy the rest of the week,

Rach