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The Gifted Program

'Tis the season when emergency departments overflow with gourmet cookie baskets, industrial-size tubs of popcorn in three flavors and all other manner of gifts from hospital-supply companies, pharmaceutical firms and other vendors. But even this largesse is only a small portion of the year-round gift programs maintained by many vendors.

There has been a lot of talk in the medical literature regarding the influence of gift-giving by pharmaceutical and technical sales representatives on a physician's clinical practice. The cover story in a recent issue of Emergency Medicine News noted that even residents in elite academic emergency medicine teaching programs are not immune to this influence. Faculty at Washington University in St. Louis tracked the prescribing habits of EM residents before and after "drug reps" spoke to the young physicians. On average, outpatient prescriptions for the featured agents doubled, and use within the ED increased by one-third.

I should note that pharmaceutical representatives do not come to the ED empty-handed. The truly effective ones are usually toting bags of food. In the life of the medical resident or, for that matter, the EMT or paramedic free and accessible food is not to be taken lightly. I will confess that I still fight the urge to use a certain antibiotic because of a salesman who always had a large box of hot glazed donuts available at 6:30 a.m.

Unfortunately, there's no reason to suspect that EMS folks, despite their best intentions, are any different. After all, we're only human. (Note to someone, anyone: I think there's a study here crying out to be done.)

As your loyal correspondent in all things emergent, I felt it was incumbent upon me to demonstrate to you my total incorruptibility. The Annual Scientific Assembly of the American College of Emergency Physicians would be the site of temptation, my Tree of Knowledge with an enticing blonde seductively caressing the trunk and an Aesculapian serpent lounging in the leaves.

Therefore, I am pleased to list those things I received from drug companies, billing companies, software companies, recruiting firms and technology corporations that will definitely not influence my choices:

One garish Mardi Gras necklace strung with gold, purple and green plastic beads interspersed with crowns that say "Mardi Gras." (Apparently there are so many other occasions where you might wear this that its use needs to be clarified.)

A bag of peanuts from a billing company. I am unsure of whether this means I currently work for peanuts or if I truly will be when they're in charge.

A combination pen and laser pointer, which I managed to break within four minutes while trying to figure out how to get three button batteries in through the top. (Turns out you can't do it. Oops.)

Two four-pronged angular things, which are supposedly back massagers. I put one on the floor, watched it closely, and saw nothing. Later someone told me that I was supposed to have someone move it over my back. (This total obliviousness to common sense is not a new thing for me. I'm the same person who took nearly a decade to figure out why the Village People were so hot on the Navy and the YMCA.)

Twelve boxes of fake Resperidol mints. As you may know, Resperidol is a relatively new antipsychotic. The candies are non-active tablets designed to show you how easily the medication dissolves in the mouth and that it can be used emergently in an oral form. I took a large number of boxes because I foresee the day when I'll just start popping them during a meeting and watch what others do.

Four types of refrigerator magnets with clips, each emblazoned with a pharmaceutical name. These will be useful in hanging up my son's pictures from school, especially if I want to associate his art with prescription drugs.

Two plastic "twisty" puzzles that, if aligned properly, spell out, "Find litigation puzzling?" (You can also make those letters spell "Plutonian digit fizzling," and a lot of other things I'm sure I'll get e-mail about.)

A thing that looks like two 3.5-inch floppy discs stuck together, but when you move the metal slide that covers the media, a soft brush emerges from the side.

One miniature radio-controlled car.

Squishy toys to include one Valentine-type red heart, one anatomic heart with painted arteries and veins, one white golf ball, one rainbow-hued brain, an orange fish keychain and two further squishy brains that will stick when hurled against the wall.

One plastic baseball on a lanyard that opens (with difficulty ... I must have fought with this for a half hour before I realized I could crack it open by flinging it on the floor) to reveal Band-Aids, an alcohol wipe, and a folded 4x6 flyer entitled "FIRST AID."

A plastic ruler with an etched concentric circle LSD flashback magnifying glass in the center.

A toy that is genuinely hard to describe. The top looks like a yellow hard plastic ball with two pink cylinders coming off the sides, and when you wave it back and forth it makes a strange squeaky sound. The handle acts as a container of soapy solution, and the stopper is a bubble wand. I have no idea what it does, other than I'm sure it will be incredibly annoying in the hands of my son.

One clip-on koala to remind me of the 2004 International Conference on Emergency Medicine. This is to be held in Cairns, Australia, where my good friend Dr. Peter Periera is the ED boss at Cairns Base Hospital. He also hasn't called in ages, so I'm thinking I'll punish him unmercifully by not staying in his house that overlooks the Pacific and by not having cocktails on his cliffside porch. That'll show him.

A calculator that is also an international clock, with built-in buttons to push for the time in different cities of the world. (I could've used this last week the day I arose and wondered what time it was in Karachi. Now I know.)

One box of paper-thin soap flakes, which look exactly like those mint films that you peel off and pop into your mouth. I don't know about you, but the mint films taste like ... well, small pieces of edible plastic, which is what I think they are. I have yet to taste the soap flakes, but see great promise for subtle language discipline ("Great joke, Bob. Never knew it rhymed with duck. Have a mint?").

Two sample bottles of New Blue Raspberry Children's Advil Suspension. Being the kind of father who feels strongly that I can't fake liking medicine in front of my son unless I know what I'm lying about, I actually drank the stuff. For something therapeutic, it wasn't bad. Couldn't drink it every day, however, unless it had a chaser. Kind of reminded me of the Star Trek episode where McCoy ("Jim, I'm an underpaid actor, not a doctor") concocted an antidote to some dreaded intergalactic plague. The ever-enterprising Mr. Scott ("She canna take any more. She's gonna blow!") asked if it made a good mix with scotch. McCoy, ever the empiricist, replied, "I don't know, but it should." Whereupon, with a nod toward the health of the crew, Scotty grabbed the serum and brogued, "I'll let you know."

One diaphragm cover for my stethoscope. This is presumably to ensure that it can't get pregnant, no matter how much it loves the other stethoscope.

One combination sewing and grooming kit, which I will need to place in my checked baggage because it contains two needles and a nail clipper ("I vill clip you if you do not take ze plane to Zurich, I svear I vill!").

The Deadly Dates Calendar for 2004, which presents a year's worth of interesting moments in the history of toxicology. For instance, it turns out that my birthday is also the day in 1809 that Anna Maria Scholeben Zwanzinger, Austria's premier poisoner, was legally lavaged from society.

(In fairness, I should note that I left the "Deadly Dates" booth in disgrace. As I picked up the calendar, I asked if the title was a reflection of anyone's social life. Much hostility ensued. And speaking of ways to lose free items, I was watching a demonstration of a rather clever device called the Katz extractor. It's designed to help get foreign bodies out of ears and noses. It looked like a sample was within reach when I blurted out, "Well, what if it's not a cat that's stuck? I mean, what if it's a mouse or a lizard or something?" The frowns of the passers-by encouraged my hasty retreat.)

Five boxes of assorted mints in tins; five straps and lanyards with clips on the end; two beach balls; two golf balls, one red and one white; one coin purse; two light-up yo-yos; two balsa wood airplanes; one pocket planner; four penlights; one loaded Band-Aid dispenser; five cloth bags of variant shape and size; a blue backpack; a red coffee mug; a plastic travel mug; two bottles of antibacterial hand wash; a bottle of water branded as an anticoagulant; two basic first aid kits; one bouncy plastic ball that lights up when it hits the floor; one fold-up pocket Frisbee; one miniature FM radio with ear buds; one lint remover; one three-color highlighter with a clear barrel filled with sparkles; a package of golf tees; a pocket ruler; one datalink phone modem cord for travel (something useful ... be still, my fluttering heart); two small bottles of Tabasco sauce; two CD cases (one cheap clear plastic and one genuine faux naugahyde); three small packages of Kleenex; one dual-bladed letter opener; two heavy-duty carbineer key rings; a trio of Chapstick balms; a Rand McNally pocket road atlas; one floppy plastic bottle top gripper; a rolling tape measure; two bottles of antibacterial gel; one travel alarm clock with a base that opens into a calculator; a beer can cooler (no mixed messages there); a doorknob hanger that lists the positive and negative symptoms of schizophrenia on opposite sides; one pair of really good trauma shears; 10 stick-on wounds; and lots, and lots and lots of candy.

So given this embarrassment of riches (and mind you, this is just what I could carry on the first day of the meeting), how can you trust me? How can I verify my purity of thought and my integrity of action? How do you know that when I discuss EMS products and services, I am more than a shill for those companies that vie for your business?

The answer is simple. I have no idea who gave me any of these things. I walked by a booth and peered in. Before I had a clue what product was featured, things were being proferred to me and dropped in my bag. It's kind of like an overwhelming Christmas, where you get so many gifts that the wrapping paper and cards are hopelessly confused, and your great aunt on your second cousin's side has no idea why she is getting a thank-you note for a Mixmaster. And you should also know that I was able to demonstrate my independence from the marketing bonanza by categorically refusing to attend any of the 6 a.m. breakfast symposia, preferring the breakfast company of a beautiful and witty woman to that of "respected thought leaders" (which I think is the new term for "a guy from out of town with a box of slides").

Influenced by drug reps? Not me.

Now where's that radio controlled car?


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