A prescription for change

By Eric Quiñones

Princeton NJ -- As a pharmaceutical salesman, Michael Oldani rarely thought about what happened after he convinced a physician client to prescribe his company's drugs. He would simply move on to the next deal, one step closer to making his quota.

After nine years, under wearisome pressure to increase sales and at odds with his employer, Oldani left his job to move full time into academia. As he forges a new career as an anthropologist at Princeton, however, the pharmaceutical industry remains a core element of Oldani's professional life.

  Michael Oldani
Oldani completed a master's in anthropology at the University of Wisconsin-Milwaukee in 1998 while still working as a pharmaceutical salesman and is now a doctoral candidate at Princeton, where he has examined sales practices in the drug industry and their effects on the medical community. His paper "Thick Prescriptions," which describes "the three-way gift cycle occurring in the medical marketplace between reps, doctors and patients," last year shared the Society of Medical Anthropology's annual award for best paper by a graduate student.

While continuing to incorporate his personal and scholarly knowledge of the drug business, Oldani is expanding his research. He is conducting fieldwork for his dissertation in Winnipeg, Manitoba, on the diagnosis and pharmaceutical treatment of fetal alcohol syndrome (FAS) and attention deficit hyperactivity disorder (ADHD) within the area's aboriginal community. Oldani won a U.S.-Canada Fulbright award to fund his research.

"The first part of my life in the pharmaceutical world was all about getting the drug written as a prescription. All I was concerned with for a couple of years at Princeton was the activity behind generating prescriptions. Now I'm looking at what happens once those prescriptions are in circulation," he said.

Oldani, a native of Kenosha, Wis., initially developed the project after conversations with members of his wife's family in Winnipeg, including a member of the Cree Nation who cares for foster children. "I said I was interested in pharmaceuticals and she said, 'A lot of our kids are on Ritalin, and we're not sure why.' That made me curious," Oldani recalled.

Through a grant from Princeton's Council on Regional Studies, he did some preliminary research in Winnipeg and found that Ritalin -- best known for treating ADHD -- was being prescribed frequently to aboriginal children for treatment of FAS. While the two conditions share many of the same characteristics and Ritalin is often prescribed to treat behavioral problems associated with both, FAS carries a much greater stigma, Oldani said.

His early findings raised questions about whether aboriginal children in Winnipeg's public schools were being improperly labeled with FAS because of widespread alcohol abuse in the area's reservations.

"A counselor or a principal may say, 'We think your child may have FAS. He needs to go to a doctor and be put on Ritalin before he can come back to school.' This is a phenomenon with young kids today who have behavioral problems in schools," Oldani said. "What I'm interested in now is how these categories are being racialized. Do the white kids get ADHD, but aboriginal kids without recognizable physical features of FAS still get that diagnosis? It's a really hard diagnosis to shake."

Oldani returned to Winnipeg last September to pursue his fieldwork, which he will complete in December. "It's taken a long time to get to the point where people trust me and understand the project. Some of the families I've met have been really generous about opening up about their experiences with these children and the medical establishment and schools," he said.

In addition to building relationships with families, Oldani noted, "the hardest part has been educating doctors about what I want to do as a medical anthropologist, to allow me to observe their clinical practices. A lot of physicians aren't used to being scrutinized that way." After several months, he recently was granted approval from the University of Manitoba's health research ethics board to observe the interactions of pediatricians and psychiatrists with parents or caregivers of children diagnosed with FAS or ADHD.

His experience in the pharmaceutical industry will help Oldani meet the anthropologist's challenge of understanding the intricate relationships between the various elements involved in his research, said his adviser, Professor Lawrence Rosen. "Certainly this background can contribute to the maturity of a scholar, as well as to the legitimacy of what they have to say," Rosen said. "Michael is not out to do a journalistic critique or exposé, but a study of how each of the actors imagines the others in their mutual encounters."

Oldani believes that many of the skills he honed as a salesman continue to benefit his current work. "As a rep you had to build trust and a rapport. Those types of things are very important as an anthropologist, but it's a completely different context," he said. "You did those things in the industry because the bottom line was you wanted to generate prescriptions -- that's the number-one goal."

Oldani remains in touch with people in the business for his research and harbors mixed feelings about an industry that benefits millions of people but ultimately is driven by profit motives. Oldani said his own departure from his previous employer, which he prefers not to identify, stemmed largely from pressure put on reps to push certain pharmaceuticals "off-label," meaning for uses that may be beneficial but are not approved by the Food and Drug Administration.

"These companies exist within their own ethical paradox," he said. "They make great products for the most part, but I think the drive is so intense for increasing share price that they play with that gray area."



April 28, 2003
Vol. 92, No. 25
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Page one
Shelton tells both sides of story in barrier-breaking research
The price of prejudice: Interactions with minorities can sap mental capacity of highly biased people
A prescription for change

Students explore creativity through collaboration
Tilghman co-chairs new state economic development commission
Lacrosse teammates a triple threat since middle school

Weiss was an award-winning poet, editor and literary critic

Calendar of events
Nassau Notes
By the numbers:

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Editor: Ruth Stevens
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Staff writers: Jennifer Greenstein Altmann, Steven Schultz
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