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David Nierenberg, M.D.: Pharm stand
By Jennifer Durgin
There are two sure ways to get pharmacologist David Nierenberg, M.D., fired up: take notes with a drug-company pen or mention DMEDS, the Dartmouth Medical Encounter Documentation System. The former rouses his ire, the latter his enthusiasm.
On this particular day, he's teaching pharmacology to second-year medical students. As the students suggest possible drug treatments for two fictional patients, he pushes them to think through their answers step by step—from considering the symptoms and physiological mechanisms of each condition to evaluating which drugs to prescribe.
The class "is supposed to be about pharm, but you can't really think about drugs until you've thought through the pathophysiology," explains Nierenberg, who is also senior associate dean for medical education. He is conversational with the students, sometimes humorous, but never condescending and always precise. It's clearly a good approach: he's been awarded the Medical School's Clinical Science Teaching Award twice, in 1986 and in 2000.
After class, a few students linger to talk with him. As one asks a question, Nierenberg reaches across the table to examine the contents of her purple pencil case. "You're not going to make me angry with any drug-company pens in there?" he asks. His mock glare is softened by his unruffled voice and quick grin. "No," she laughs. A fellow student had already warned her about Nierenberg's disdain for the way many pharmaceuticals are marketed to physicians.
"Good. Because I go into anaphylactic shock when I see drug-company pens," he says, feigning shortness of breath. Nierenberg is creative in the way he conveys his strong opinions about pharmaceutical marketing. For example, he has a "dirty-pen swap," offering students a chance to turn in the free, often fancy, pens they get at drug company-sponsored luncheons and lectures for a "clean" pen.
"This is all voluntary and educational. I've never confiscated," contends Nierenberg. Is it true that he's broken some students' pens? He explodes with laughter. "Wow, that myth has grown."
But the dirty-pen swap is sometimes a tough sell. "See," he explains, "the drug companies hand out $7 or $8 pens" that are colorful, thick, and comfortable in one's hand. His are skinny, bright-orange, 39c knock-offs that say "DHMC Clinical Pharmacology Rx: Prescribe the BEST drug!"
The message has great significance for Nierenberg. Teaching medical students how to prescribe the best medicines for their patients is what got him interested in course design and educational administration. But his interest in medicine goes back even further, to when he was a kid and observed the work of his family internist. "That looks like a nice combination of service and science," he remembers thinking. By the time he was 15, he had taken all the science courses that his high school in Chappaqua, N.Y., offered. So, in 1965, he enrolled in Phillips Academy, a boarding school in Andover, Mass. He then carried his passion for science to Harvard, where he earned a degree in biochemistry in 1971.
He planned to go on to medical school but wanted a break from academic rigor. So he headed to Oxford on a Harvard
fellowship to work in a research lab. "Research has a very different tempo and feel than taking four or five courses every term," says Nierenberg.
In 1972, he returned to Harvard for medical school. After completing his M.D., he did an internal medicine residency at Boston's Beth Israel Hospital and a clinical pharmacology fellowship at the University of California at San Francisco (UCSF). When the head of clinical pharmacology at UCSF became chair of medicine at Stanford, he asked Nierenberg to be his chief medical resident. In 1981, Stanford tried to entice Nierenberg to stay on by offering him either of two positions—one that would be 90% research and 10% clinical and another 90% clinical and 10% teaching.
But Nierenberg had other ideas. "What I really wanted," he says, "was to spend about a third of my time teaching, about a third of my time as a physician, and about a third of my time doing research." He and his wife also wanted to move back to New England. One night, they wondered if Dartmouth might be the right place. They'd always enjoyed visiting New Hampshire on long weekends and vacations. The very next day, out of the blue, Nierenberg got a letter from DMS. "It was literally the next day!" he says, still awed by the timing.
DMS needed someone with his kind of training to set up a division of clinical pharmacology, teach a new fourth-year pharmacology course, and do whatever else that person wanted. Nierenberg accepted. To his surprise, what he enjoyed most was teaching and designing courses. "Between 1981 and 1991, we developed the most intensive, best, required clinical pharmacology course, almost certainly, of any medical school," he boasts.
In 1995, then-Dean Andrew Wallace, M.D., appointed Nierenberg to the newly created role of associate dean for medical education. Ever since, Nierenberg has been helping DMS move to the forefront of medical education. Under his leadership, the school has reduced
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Jennifer Durgin is Dartmouth Medicine magazine's senior writer.