Wednesday, November 11, 2015

"Bags of Stuff": ACEP 2015

You may have heard about changes in the marketing practices of pharmaceutical companies.  It’s now considered unethical for companies to offer, or for physicians to accept, gifts from manufacturers of drugs and medical devices.  The theory here, of course, is that physicians who get stuff from these corporations are more prone to use those drugs or devices regardless of efficacy or cost, driving up health care expenditures without necessarily benefiting anyone but the purveyors of fine pills and nostrums.

In all faith, I cannot say that I’ve never been influenced by a drug company.  I’ve written before in the pages about how, on a small scale, I still know the dose of a currently obscure antibiotic because during my internship a salesman for this drug brought my fellows and I donuts every single day for a year.  And in the heyday of pharmaceutical marketing, when I had become an attending physician in the early 1990’s, I went to Boston for a weekend on someone else’s to learn about clotbuster therapy for heart attacks.  (Yes, the other person’s money was the company that made the drug.)

Personally, I miss those days.  Not because I think I was corrupted by the process, but because in an era where the practice of medicine and respect for physicians has been knocked so far off it’s pedestal that we’re like the shattered bust in the end credits of Peabody and Sherman, it would be nice to be flattered once again.  So yes, I’d like to be influenced by the drug companies. I would happily take their money to support research.  I would beg to be one of those players known as a “drug whore,” doctors who get shipped to meetings both at home and abroad to present lectures on important topics such as Reversing Anticoagulants and then get to say things like, “There are three agents out there.  I’m going to talk a lot about one, very little about a second, and none about a third,” and then claim to be an impartial evaluator of the literature.  Bring it on.

However, the simple fact is that emergency physicians are relatively insulated from that sort of marketing.  The reason is basic economics.  We don’t do anything particularly profitable.  With some rare exceptions, what we do is pretty basic.  We don’t use expensive antibiotics or symptomatic medications, especially as much of our clientele couldn’t afford them if we did.  Because we have short clinical attention spans, we don’t prescribe high-cost, long-term maintenance medications.  Even most of the IV medications we use have been around for long time, and while there are some medical devices we use they’re rarely the innovative, costly, single-use, high-volume supplies used by our colleagues.  It’s not that we can’t use them; it’s that we don’t need to in order to be the Great Triage Officer of Life and Death.  So there’s very little money in pushing expensive blood pressure medications or coronary artery stents to us.  We simply just don’t use them.

That doesn't mean we don't get "marketed."  There are some pharmaceutical and medical device companies who bring their wares to display. But it's mostly from physician recruiters, individual physician groups looking to by pass the recruiters' fees, and locums agencies trying to find part-time docs to go to places that nobody can recruit for.  There are risk management groups, billing firms, places that outsource documentation, scheduling, and practice management.  All of them say the same thing and use the same words, most of which end in "-ize" (optimize, maximize, incetivize), which is Latin for “make the galley slaves work.”  So how do you stand out among the competition?  The answer, of course, is the trinket.

Here's my disclaimer.  Trinket acquisition is one of my primary drivers for attending medical meetings.  The education tends to be spotty unless you happen to know a particular speaker is really good. I'm not a networker.  Most of the receptions are way too crowded, and most "open bars" really aren't.  But I am totally enamored with the scavenger hunt through the exhibit hall, to see what I can pick up and then leave in a large tote bag for whatever housecleaner enters my hotel room after I'm long gone.

Like any game, however, you have to know the rules to play:

  1. You may take only take one of each item from any one exhibitor.
  2. As long as you don't have to talk, you may feign interest in anything.
  3. If you are required to talk, you may not lie.  For instance, you may not say you don't want to practice in dusty East Texas because you're afraid the cat's allergies will start to act up.  ("But it’s not like that! We have hills and trees! Watch our video!" exclaims the lovely Miss Longview 2012.) You may, however, invoke fixed personal characteristics as an excuse, as when dealing with recruiters for hospitals in the oil-rich sheikdoms of the Middle East ("I'm not sure my people do so well there.")
  4. If you don't know what something is, you have to ask so you can accurately record it.

Record it, you say?  But of course.  Getting the stuff is only half the fun.  Then you get to take it back to the hotel to sort through it, and catalog in detail what you've obtained.  (This is best done while eating room service spaghetti and watching Los Reales in Game 1.)  Then you compare it to your previous catalogs to get a sense of how medicine has really changed.  It's a faster, quicker, and much more accurate way to look at medical progress than any old textbook or lecture.  

With this as background, I'm pleased to report to you my gleanings from the 2015 Scientific Assembly of the American College of Emergency Physicians in Boston.  Here we go:

Eight plastic boxes of band-aid strips.  Each box contains five band-aids.  I have never really thought about how many band-aids I use, so I don't know if this is enough for a week or a lifetime supply.  I have resolved to monitor my band-aid use in the future as part of my own personal Customer-Focused and Culture-Changing Continuing Quality Improvement project. (I've been looking for an excuse to work all the hot administrative buzzwords into a sentence.  Bingo.)

One golf towel.  I think it's a golf towel, because it has a little grommet in it and some kind of clip. I don't play golf.  But if I did, I'm not sure what message it sends that I'm wiping grime onto your product's name.

One ice scraper.  This is from some very nice recruiters for a hospital system in Southern Illinois. I actually suggested to the Cream Of Collinsvile that if you're wanting people to move there, reminding folks that they're going to have to chip snow and ice from their car may not be the best pitch.  In retrospect, though, I think maybe they got it right, because the other selling point would be "We're really close to East St. Louis."

A full-size selfie stick.  Here’s the story.  Last month the Dental Empress and I went on a Mediterranean Cruise.  As we wandered the streets of the Old World, we learned that the Official Street Vendor Product of the European Union is the selfie stick.  So at lunch one day outside the Colleseum we fell into a discussion with a British couple sitting next to us and a Spansih foursome sitting one table over.  The latter group had been drawn into negotiations with a street vendor (who, I’m fairly certain, was not a native of the Tiber River Valley) over the cost of a selfie stick.  The initial asking price was ten euros.  Then it went down to seven, at which point the Brits noted that they had bought their selfie stick in Venice for only three euros, in a fine example of free market economics.  The final price was four euros, or a little over five bucks, accounting for the difference in the cost of living between the capital and provinces.

(The British couple, while great company at lunch, were truly a mismatched pair.  He was a young, very quiet IT professional, while she was an older, extroverted marketer and outdoors enthusiast.  They were describing how their first vacations together were disasters until they hit on the solution to spend their holidays someplace where neither of them will be particularly happy.  Which is why they’ve spent two weeks in each of the last three years at a hermetically sealed beach resort in Egypt.  Which plan, as of this writing, probably needs to be rethought.)

Thirteen different sizes and shapes of tote bags, of which I'm planning on keeping two.  One is from Long Island Jewish Medical Center.  It's really of very high quality, with zippers and a shoulder strap and quite subtle advertising for a give away item.  It's also of sturdy fabric, which you probably need while using the bag as a weapon to fight off the thugs which this boy from Flyover Country is convinced lurks behind every corner of the New York Tri-State Metropolitan Area. And yes, I cognitively know that at Long Island Jewish Medical Center I'm more likely to encounter an elderly matron selling raffle tickets for Hadassah, but they scare me, too.  The other bag I'm keeping is an insulated lunch bag forma healthcare management company, because helping  me carry my lunch is about the only thing a healthcare management company will ever do for me.

Two refrigerator magnets, one of which gives me the warning signs of atrial fibrillation, which might be helpful on those days my heart skips a beat when I find those forgotten "science experiments" in the back of my refrigerator. The other says, "Dammit  Jim, I'm a Doctor, Not a Data Entry Clerk, " which is silly because everyone knows the Data Entry Clerk is Yeoman Rand.

One round plastic pizza cutter.

Six 2 GB flash drives.

Four of those things that you plug into your car's cigarette lighter, into which you then put a USB cable, and then plug into your phone to charge it more slowly then you burn power listening to Spotify.  I don't actually know what they're officially called.  Car charger sounds wrong because you're not actually charging your car, and you need some other pieces like a USB cord to charge anything else.  I do know you can usually find them in plastic buckets for $3.99 near the check-out of the Quik Trip, which means they're probably made in China for less then a nickel apiece, which lets me know just how much those who peddle these promos think of me

Eleven different sizes and shapes of bottles of hand sanitzer, all of which could pass by the TSA as they are all less than three ounces in volume.

Four buttons that say "I love night shifts;" a further button modeling the Flag of Emergistan (a buzzard on a field of red, green, and blue); and a badge from a company called Blue Jay Consulting that says "Be Happy" that I picked up just so I could look at it and say, "Not so much.  Go Royals."

("Emergistan," the Land of Emergency Room, is the creation of Edwin Leap, MD.  He's an excellent writer, and has the gift for finding positives in the chaotic void.  From a literary standpoint, he's the good child you want to live next door, while I'm that distant relative you have to invite for the holidays, and why you serve Thanksgiving dinner at 10 AM so you can move him more quickly out of the house.  Catch up with Dr. Leap at

A plastic slinky.

Ten plastic foam squishy toys, incldung three ambulances, one gold key that won't fit anything, three balls, a blue and gray fish, a yellow van with the VA logo, a rhino., and a football.  

Two toothbrushes, one in a fold-up plastic travel case.  One box of floss shaped like a tooth.  A bicuspid, if you must know.

A rubber duck with a stethoscope and that head thing that doctors are supposed to wear that I've never actually seen a doctor wear.

A faux leather mini football that seems tough enough for actual play. In contrasting this to the squishy football, the good one is from a company in Texas.  Which makes snese, because people in the south take football seriously.  The promotional football is not a toy.  It's a lifestyle.

9 diferent collapsible coozies, two of which are bottle-shaped.  There was also one rigid cylinder shaped coozie which was used to great effect as I put a brown glass bottle of cream soda (yet another giveaway) inside it, totally covering up the label of the latter and giving the impression that I was swilling my way through the exhibit impression which, truth be told, I did nothing to correct.

16 different computer screen wipes.  Most are simply wisps  of cloth, but one looks like a soft furry green sea urhcin, or perhaps an inverted Scrubbing Bubble.

Seven containers of chapstick.  Four tubes, three plastic balls.

Three stuffed animals. The two bears wearing promotional tee-shirts show great promise as dog toys.  The Snoopy dressed in World War I Flying Ace gear is mine.

Eight plastic sleeves that I couldn't figure out until it was explained to me that you're supposed to stick them to the back of your cellphone so you can put your driver's license and your credit card in there so you can keep them all together and eliminate the need for a purse or wallet when you go out.  it also means that when you lose  your phone, you can suffer identity theft and have your credit ruined as well. I was also told that once you stick it on, it's nearly impossible to get off. I can't use them myself, because I already have an "I Was Brave" sticker featuring Thomas the Tank Engine on the back of my phone from when I got my flu shot last year and didn't pass out. (I've got a thing about needles.) 

Seven small notebooks, including one from a US-Saudi joint venture with Arabic script on the cover which will go down beautifully with the TSA. Out of this assortemnt, I'll be keeping a small red one that look like Chairman Mao's.  I plan to paste fortune cookie papers into it and quote them frequently in a cryptic yet knowing way.

One small travel package of Kleenex.  Why only one, you ask? Because there's no crying in ER.

Three letter openers with covered blades, because death by an unsheathed letter opener is just silly.  

Seven different lanyards with clips for ID badges, so you have seven different ways to declare your corporate allegiance. (Disclaimer:  My ID badge lanyard at work is form Princess Cruises.)

Two large plastic squeeze bottles, two medium-sized rigid plastic cups with built-in straws, one travel cup, and one "shaker" from a vendor in Hawaii that i was told is to be used to mix up protein shakes and the like, but that I will keep becuase I thnk it would be somehow fitting to make tropical drinks for sitting poolside in a cup sponsored by the Aloha State.

Six large magnetic clips you put on your refrigerator to hang up your children's drawings.  Only one of them is big enough to use as a chip clip.  My son is way past the refrigerator art gallery stage of life.  So you can guess which one I'm keeping.

(Shameless promo:  The kid doesn't draw, but he does write.  Check out his blog at

Lots of candy.  And lots of little plastic packages of mints that I might maybe someday use as placebos. But when I do, I'll give them a fancy name, like Obecalp.

A sewing kit, which will prove to be of no use to me as I can sew a screaming kid, but cannot fathom things like what buttons are or how they got there.

Eleven small flashlight, presumably for looking at small things.

One tee-shirt that says, "This is Your Brain on ICD-10."  (Okay, you had to be there.)

Two yo-yos, which may also be used as bolos to hunt small game in a survival setting.

One collapsible travel cup.

Three miniature harmonicas on key chains.

Two plastic wishbones.

One squishy blue rubber ring and one similarly textured clear rubber ball filled with lots of smaller pink, green, blue, and yellow balls. Both of these blink incessantly when squeezed.  

One retractable tape measure.

Two sets of fake teeth that you can put between your lips.  When you blow into a small mouthpiece, a small fan creates a whirring sound.

Three gel packs that I can freeze or heat as needed to provide pain relief when my Dilaudid runs out.

Badge ribbons.  If you've been to large meetings lately, you will have noticed that the recent trend is for attendees to stratify themselves through the ribbons they attach to their name badge, things that say "Director" or "Board Member" or "Donor" and the like.  (I think these are the convention equivalents of fifty-five year old men who drive fire-red sports cars, the rainbow of markings on the amorous mandrill, and male peacock feathers.  An evolutionary biologist would have a field day sorting out this competition for status, not to mention the fertile females.  Or maybe it's a more innocent behavior, sort of like a certain Labradoodle I know named Goldie Goldstein who will fling her 70 pounds of dog at your head, landing with a resounding thud , eyes open, mouth agape, tongue lolling, drooling everywhere, as her saliva-punctuated way of proclaiming, "Pay attention to me!"). In response to this trend, there were several vendors giving out additional ribbons with some less important mesages, including "Troublemaker," "I Run With Scissors," "I Read Your E-mail," and of course "My Ribbon is Better than Your Ribbon."  I got a buch of those last ones.  Two went on my badge so the fertile females would look at me more than those one-ribbon guys.

A small lapel pin of the Canadian flag.

A 3.7 ml bottle of tabasco sauce, whch I look forward to using in its entirity on one medium sized tiger shrimp.

116 assorted pens, all fairly nondescript with the exception of one shaped like a femur and another that has  wobbly jack-in-the-box head with strands of blue yarn hair on the top.  84 write with black ink, the remainder blue.

A rubber device that looks like a plastic pocket protector with an attached  megaphone.  What you do is slip this over the end of your iPhone 5 and apparently an opening on the inside of the pocket is right over the speaker, which then transmits the sound through the megaphone to the world at large.  Which is probably a great thing, if you have an iPhone 5 and have a background in cheerleading.  The Dental Empress is a former cheerleader (all four years, cheering football and basketball, not wrestling...I understand that's important in Cheer World) so I know what a "Herky" is, and I'm currently enamored with the "Cheerleader" by OMI but that's as  close as I get.  Plus, I went right from an iPhone 4 to a 6 because the same cheerleader told me the 5 was awful, though in retrospect it probably just needed a megaphone.  And yes, on this one I had to ask.

That's just the trinkets.  I did actually look at some products as well. More on that later.  Now, If only I could find a pen...