24 ms·

Opioid makers made payments to one in 12 U.S. doctors

270 points by metheus 9y ago

oleg123 9y ago
bribes - or payments?
- diogenescynic 9y ago
  In America it's all the same. Or you can call it 'lobbying' if you really want to dress it up.
  - deelowe 9y ago
    Doctor's aren't public officials. So no, you wouldn't call it that.
    - alexandercrohde 9y ago
      Doctors have taken an oath and have a public responsibility. They are liable for bad medical behavior (particularly if deliberate) [malpractice]. So let's not quibble over semantics.
      - dragonwriter 9y ago
        > They are liable for bad medical behavior (particularly if deliberate) Malpractice is in many senses a reduced standard of negligence liability compared to that faced by the general public, since it turns on established professional practice in the field not objective reasonableness in the circumstances.
      - outside1234 9y ago
        Believe it or not, this grew out of the threat of lawsuits if they DIDN'T prescribe opioids because they were ignoring the "5th vital sign" (pain). The real culprits here are the corporations - they should be liable for paying for the treatment of the folks addicted to the drugs they pushed.
        alexandercrohde 9y ago
        Well if the root is the corporation, I think civil suits have proven ineffective at preventing such abuses. I wonder if the answer may be criminal suits and a greater emphasis on whistleblowing. Most people I know would rat out their company's immoral/illegal behavior for a million dollars.
        smackingly 9y ago
        5th vital sign is urine output :) What is actually driving this is that income (and other hospital measures) is tied to patient satisfaction. Don't want to lose 30k/year because I didn't give the patient what they want. I'm an inpatient physician (ICU), so I never prescribe chronic opioids, but I am pretty liberal with them in the hospital. And no, I've never received a Panera lunch for the privilege of hearing about OxyContin. It's an extremely complex and difficult problem. I think doctors are taking too much of the blame. Maybe we should simply ban the use of chronic opioids for non-cancer pain (or other similar etiologies). When I was a resident, I made all my patients sign an agreement that I would not prescribe chronic opioids unless they had metastatic cancer, were otherwise in a hospice facility, or I made a special exception. Don't sign? Then you find another doctor. I realize that will evoke some strong emotions from some of you, but you don't see the everyday begging from patients for more opioids when they obviously don't need them. Some people with legit use-cases will suffer under such a scheme. And that could drive up the use of heroin. There's no easy solution to this problem.
        DanBC 9y ago
        > 5th vital sign is urine output :) US doctors began prescribing many more opioids after a campaign by the VA describing pain as the 5th vital sign. Doctors began having to ask people about pain, which meant they had to treat that pain. The VA also said that opioids are not addictive when used to treat pain. They're not so addictive when used to treat acute pain, but they're more addictive when used to treat chronic pain. Very many more people got opioids to treat chronic pain because of this campaign. https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital_Sign_Toolkit.pdf https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/ > It's an extremely complex and difficult problem. I think doctors are taking too much of the blame. A lot of americans get opioids from doctors. https://www.cdc.gov/drugoverdose/data/prescribing.html https://www.cdc.gov/drugoverdose/data/prescribing.html > An estimated 1 out of 5 patients with non-cancer pain or pain-related diagnoses are prescribed opioids in office-based settings > However, primary care providers account for about half of opioid pain relievers dispensed. Some states have between 93 and 143 opioid prescriptions per 100 people!!
elipsey 9y ago
Reminds me of what Rostand said about murder: "Kill one man, and you are a murderer. Kill millions of men, and you are a conqueror. Kill them all, and you are a god." Sell one oxycontin and you're drug dealer; sell a million and you're a C level.
- bostik 9y ago
  That can be generalised. Petty thieves break the law. Mafiosos skirt and avoid the law. The real kingpins write the law.
  - stephengillie 9y ago
    Smart criminals don't commit crimes; they change the laws and then act freely.
  - deleted 9y ago
    [deleted]
- esterly 9y ago
  Agreed. When a C level is profiting it is hard to change course. The onion nails it http://www.theonion.com/article/sweating-shaking-pharmaceutical-ceo-says-he-can-st-55704 http://www.theonion.com/article/sweating-shaking-pharmaceuti...
- erdewit 9y ago
  31 billion$ earned on the sale of oxycontin... https://en.wikipedia.org/wiki/Oxycodone#History https://en.wikipedia.org/wiki/Oxycodone#History
  - refurb 9y ago
    Lipitor was over $150B through it's lifecycle.
- deleted 9y ago
  [deleted]
lr4444lr 9y ago
Maybe it's because Americans just have this cognitive dissonance that their trusted doctor could be any less than 100% conscientious about their health, but we need to plainly face the fact that if members of the press were able to write exposés about drug makers' fudging the data about the addictiveness and effectiveness of their products, that doctors with their medical training and responsibility over actual people's lives should have proceeded with more caution and not written scripts mindlessly to get rid of every tiny pain patients had just because they kept asking for something. It's just unconscionable. EDIT: this survey was also very damning: http://www.chicagotribune.com/news/local/breaking/ct-prescription-painkiller-overuse-met-20160324-story.html http://www.chicagotribune.com/news/local/breaking/ct-prescri...
- zjaffee 9y ago
  Your ignoring the fact that up until recently, pain was considered to be the fifth vital sign and was just as important to treat as things like a fever. Medicine as a field is largely about removing discomfort, as many medical conditions could be relatively debilitating. Think how many times taking an ibuprofen/acetaminophen just made it possible for you to go on with your day, rather than needing to lay in bed in agony. For people with chronic pain, or those coming out of surgery, perceived recovery time can be a big thing for people. Additionally, the article didn't address the fact that it could very well be that doctors were being paid off to prescribe a particular brand of opioid rather than just opioids in general, something that is relatively common when there are a large number of drugs that can equally help treat a given ailment.
  - lr4444lr 9y ago
    I think you're raising an interesting point, but I disagree with your example - what pain that is so bad its sufferer needs "to lay in bed in agony" can be relieved by ibuprofen, acetaminophen, or any other OTC pain reliever? The Great Binge[0] ended long ago - perhaps for the wrong reasons, but ended nonetheless, until recently when legal opioid prescriptions spiked. This is about doctors putting their patients at risk in the process of treating them for routine problems which did not result in opioid addiction rates as recently as 25 years ago, and certainly were not prescribed with any other side benefit as far as I've heard. [0]https://en.wikipedia.org/wiki/The_Great_Binge https://en.wikipedia.org/wiki/The_Great_Binge
lootsauce 9y ago
I have two relatives that died from prescription opioid addiction and abuse and I don't think a few payments here and there is what motivates doctors to prescribe these drugs at a higher rate. Maybe it does maybe not. The fact is they are powerful drugs that can stop pain AND they make LOTS of money so they get pushed as the best option. The thing that is in question in a doctors mind is, can I say this is the best option. Thats what the face-time with reps, meals, conferences etc are doing, giving the MD a perception that this is best practice. It's the professional cover to prescribe what everyone knows is a highly addictive and dangerous narcotic. If the same kind of money were spent on informing, reminding and reminding again, face-time with addiction prevention advocates, conferences on the opioid epidemic, payments for speaking on alternatives to opioids for pain treatment, giving doctors the facts about these drugs, the addiction and death rates, the impact on families and communities of the inevitable proportion of people who will become addicted and of those who will die, it will be much much harder to say this is a best practice. But even then doctors are pushed hard to deal with as many patients as possible. A quick answer that deals with the immediate problem is what the patient wants and its all the doc has time and support from the system to give. This situation lends itself to the potential for those who truly benefit, the makers of these drugs, to take advantage of the situation and push drugs they know will make people addicted leading to higher use and profits. Lost lives and destroyed families be damned.
vkou 9y ago
Not related to payments, but related to opioids: My father broke his thumb a few weeks ago, while operating a woodchipper. After getting a cast, he went to see a specialist, who recommended that K-wires be surgically installed - small metal rods that go into his thumb, until it heals, at which point they will be pulled out. He got local anesthetic, got the wires installed, and got sent home. Because he lives in Canada, they gave him nothing for the pain. Two days later, the pain died down, and he's now waiting for the bones to heal. In America, I can't imagine that doctor would get many positive reviews from his patients, for not prescribing painkillers. Market forces would push him towards over-prescribing... And statistically, some of his patients will become addicted.
- rayuela 9y ago
  What? You've responded to a rigorous research paper with a completely baseless guess of what America might be like...
- mnm1 9y ago
  Sounds like a shitty doctor. It takes longer than two days on weak opiates to get addicted and the doctor knows that.
gayprogrammer 9y ago
>> Q: What connection might there be between drug-maker payments to physicians and the current opioid use epidemic? The article is pure speculation. They did not correlate the payments made to doctors with the prescriptions those doctors made, nor even more broadly with national prescription rates. This article just makes the implied assumption that doctors push pills onto patients. I don't discount that at one time doctors may have been incentivized to play it fast and loose with pain pills, but those days are LONG gone now. I would like to see research on the population in terms of predisposition to addiction and susceptibility to chemical dependence.
ddebernardy 9y ago
Is this really news? John Oliver ran a piece on the topic and the industry's many other dubious practices over 2 years ago, and I'm quite sure he wasn't the first to try to raise awareness. https://www.youtube.com/watch?v=YQZ2UeOTO3I https://www.youtube.com/watch?v=YQZ2UeOTO3I
- tylersmith 9y ago
  Not everyone watches John Oliver. Lots of things you and I know would be news to a lot people and many things they know would be news to us.
  - ddebernardy 9y ago
    Of course, but like you and I those in his team don't have a single source of information, and as Oliver quips in said video, you know you have a problem when your marketing practices are notorious enough to make it into TV series.
liveoneggs 9y ago
check your doctor: https://openpaymentsdata.cms.gov/ https://openpaymentsdata.cms.gov/
- api_or_ipa 9y ago
  This really should be more widely known. TIL my doctor got a meal + beverages worth $130. Seems reasonable compared to the national average of over $3k.
  - tylersmith 9y ago
    When I was younger I was prescribed Paxil and strongly encouraged to stick with it despite horrible side effects. Brain shocks, hateful feelings, and definitely horrible depression to name a few of the non-personal ones. I still have them occasionally 6 years later. I eventually ran away from my old life, moved across the country, and eventually stopped the Paxil and eventually got better but not after burning a ton of bridges. After this site came out I found the doctor had been given nearly $30k from Glaxo Smith Kline over a few years.
- jws 9y ago
  My doctor had 16 payments in 2016. Mostly in the $10-$13 range for food and drink. Looks like a rep paying for lunch at the medical center cafeteria. Sounds a lot like "ok, I want to hear about your product, but I'm not giving up billable hours for it, so talk at lunch". I'm not sure how doctors think, but there is no meal you can buy me that would make me go hear about your product if I didn't want to hear about your product.
- CyberDildonics 9y ago
  The mean is $3,000 USD while the median is only $160. Some doctors must be getting a windfall.
refurb 9y ago
This should be kept in context. Let's say the manufacturer presented new data at a conference. During that presentation they provided lunch and refreshments. Everyone of those doctors that attended will now show up in the CMS database. Do we think that a $15 lunch is going to influence a physician to over-prescribe a drug?
- tylersmith 9y ago
  Why not? When my wife worked at an insurance agency they always refered people to mechanics/etc that stopped by and gave them candy every few months. Not all doctors handle their profession with the respect and care we'd like.
- rasz 9y ago
  Except you organize that conference in Hawaii, all expenses paid.
- Retric 9y ago
  They would not be providing lunch if it did not work. Advertising demonstrates how easy people are swayed by subconscious connections.
  - smackingly 9y ago
    Yeah, but I'm not sure how much of an effect it has on the quantity of opioids prescribed. Drug lunches probably influenced which drug I prescribe (for some reason Norco was the most popular oral opioid in our hospital, maybe because it only has 2 syllables). Though I've never attended an opioid lunch.
    - tylersmith 9y ago
      Norco is common because it's a mild opioid that is able to treat the majority of "intermediate" pains. If your pain can be treated with ibuprofen you don't need urgent care. If it can't then Norco is the lightest alternative most likely to help.
    - 9y ago
11thEarlOfMar 9y ago
I don't like the 'pigs at the trough' image of this type of report. There are almost certainly pigs, but there is much more to resolving it than just revoking some licenses or throwing some people in jail. Standard practice in business of all types is to take clients out for a meal to talk business. Usually, the meal setting enables a different type of legitimate, sober interaction. Many types of business are conducted this way. Some companies have policies that limit the value of what a salesperson can share with a client, for example, Applied Materials limits the value of any type of entertainment by a vendor to $100. This is good corporate policy to inhibit undue influence by vendors. But it is not 'a payment'. Likewise, it is pretty easy to see that pharma would want a Dr. who is prescribing their medication and has a positive story to tell to speak at one of their seminars. The Dr. might say that his time is worth $x, and the Pharma needs to cover his travel expenses, and then he'd consent to presenting. In this case, any fees paid would be considered payment. The question is, how much is being paid and does that payment present undue influence. Many doctors are independent contractors and can choose to do this type of activity without a policy to override or limit the value of it. On the other hand, state medical boards which license physicians should have policies that limit all medical and pharmaceutical companies in how they can influence physicians.
- tiggybear 9y ago
  I think that is ridiculous. Learning about new medicine is continuing education for physicians. It is their job. Having a third party paying them or even just offering dinner to them so they can do their jobs is a huge conflict of interest. Further, they are getting a completely biased education on these new drugs in addition to being "taught" by pharma reps who often do not even have a BS in life sciences...so they are very limited in being able to relay nuanced medical information.
  - bionoid 9y ago
    > Having a third party paying them or even just offering dinner to them so they can do their jobs is a huge conflict of interest. Not directly related, but my sister studied to become an audiologist some 15 years ago (in Norway). I was absolutely stunned at the corporate sponsorship - full on weekend trips with a nice hotel room and paid drinks and fun activities (plus a conference). Not once, but many times during the studies, for all students, sponsored by different companies (I'm not sure if they were competing companies, but you'd think so..) There must be a lot of money in hearing aid for that to make financial sense.. Is/was this type of sponsorship common for students in other areas, medical or elsewhere?
robmiller 9y ago
There is an irony here that the US invaded Afghanistan, the world's largest opium exporter[1]. [1] https://en.wikipedia.org/wiki/Opium_production_in_Afghanistan https://en.wikipedia.org/wiki/Opium_production_in_Afghanista...
- Theodores 9y ago
  ...and those drugs go North towards the former Soviet Union. This is chemical warfare by other means. When our Russian friends cannot afford the heroin any more they make 'Krokodil': https://en.wikipedia.org/wiki/Desomorphine https://en.wikipedia.org/wiki/Desomorphine Whatever you do, don't do image or video searches on this 'flesh eating drug'!!! This product came about in part due to codeine being as available as aspirin (no prescription needed) and a crackdown on heroin by the teetotal Putin. In the USA and places like Australia 'crystal meth'/'ice' took hold in same-but-different circumstances. When you look at the UN report on opium cultivation in Afghanistan for 2002 you see why there was such an important need to bomb the country - those evil Taliban ('students') had wiped out this important (to the Americans) industry. Thankfully with the British protecting the poppy fields the trade has been restored and we are back to business as usual.
ransom1538 9y ago
Feel free to browse doctors' opioid counts here. I was able to match them to their actual profiles. Take into account their field, but, even with that the numbers are ridiculous. If you are in "Family Practice" and prescribe opioids 9167 times per year you probably have a very sore hand. https://www.opendoctor.io/opioid/highest/ https://www.opendoctor.io/opioid/highest/
- microcolonel 9y ago
  > If you are in "Family Practice" and prescribe opioids 9167 times per year you probably have a very sore hand. Though Bruce D. Mackey works at a Family practice, he specializes in Pediatric Occupational Therapy[0] (pediatrics broadly covering patients up to 21 years of age). It's fairly common for a Family Practice to have some specialty staff, and some such clinics have very large patient throughput. I used to be registered to one which specialized in sports medicine, others specialize in things like dietary/lifestyle intervention. [0]: https://www.opendoctor.io/bruce-d-mackey-otr-1146468 https://www.opendoctor.io/bruce-d-mackey-otr-1146468
- Clubber 9y ago
  Also, consider that doctors must re-subscribe them every month or so. I think federal law requires the patients to have an office visit every 3 months. It's probably shorter now. I dare say if someone went to the doctor's office and said they were hooked on pain killers and would like to be subscribed a step down prescription, they would be denied and told to tough it out, out of fear of DEA retribution. That's one of the problems with government in healthcare.
potus_putin 9y ago
A lot of doctors get paid to treat cancer. Obviously it is a conspiracy and the treatment of cancer must be banned. Eschew chemotherapy. Turmeric poultices with single plantation Zen chai will fix your personal glioblastoma.
CodeWriter23 9y ago
If it walks like a marketing program and quacks like a marketing program, guess what...
zeep 9y ago
And they tell them that their patients suffer from "pseudo-addiction" and should get more of the drugs...
ams6110 9y ago
"the average payment to physicians was $15, the top 1 percent of physicians reported receiving more than $2,600 annually in payments" Neither is enough to sway most physicians IMO. This seems to me like trying to stir up a scandal where there really isn't one. I did hear on the radio today that 90% of prescription opiates are sold in USA and Canada, with the bulk of that being the USA. Other countries treat pain more holistically.
- gvd 9y ago
  When I was living in Europe and had my wisdom-tooth removed I only got a local anesthetic so I wouldn't feel the cutting. Recently I heard a friend of mine (here in the US) say she was given vicodin afterwards. To me that's just insane. Sure I was a little uncomfortable for half a day but I'm not going to take bloody opioids because of that. It might also be the case that people just don't ask for it as easily as in the US (I mean, it's much more common to hear Americas place food orders with a bunch of custom stuff, Europeans usually just order what's on the menu).
  - icelancer 9y ago
    I didn't get any pain pills after wisdom teeth. I had local anesthetic and nitrous oxide gas to ease me, but not enough to sedate me (and obviously, no IV). Some people are given pain pills because their teeth are impacted and the doctors have to break bones; the surgery is far more painful in the recovery stage than if it goes normally. Even still, a common theme amongst my friends who got vicodin after the surgery was them not taking the pills, or only taking a single dose the day after to manage the pain.
    - gvd 9y ago
      I'm not saying this happens everywhere, but there are plenty of odd cases where medication is given way to easy. They should create some central registry to monitor these prescriptions.
- kartan 9y ago
  > Neither is enough to sway most physicians IMO. It is not just a bribe. Companies spend a few dollars on advertisment per person to get more customers. When you can spend $2,600 on one doctor for advertisment purposes, you can do a lot to get their attention.
jasonkostempski 9y ago
Are there any rules that if a doctor has such a deal, it must be clearly expressed to the patient verbally and in writing? I think that would help not only deter doctors for making the deal at risk of being viewed as untrustworthy but also help people who blindly trust their doctor to maybe think twice before accepting their solution. I don't think there's a fix for the patients that just want the drug, and as long as they're informed, consenting adults, it should be their prerogative.
esm 9y ago
Payments may affect prescribing, but I think that system factors count for more than many people realize. By way of an example, imagine the following case, which is reasonably common at the outpatient medicine office I am rotating through: A 46 yo M with diabetes, hypertension, a 30 pack year smoking history, and low back pain that has been treated with oxycodone ever since a failed back operation 1.5 years ago presents to your office for routine follow-up. It's 10am, the hospital allots 15 minutes for routine appointments, and your next patient is in the waiting room. You are his physician -- what do you prioritize? Smoking, diabetes, and hypertension are a perfect storm for a heart attack in the next 10 years, so how much time do you want to spend optimizing antihypertensive meds and glucose control? You could talk to him about quitting smoking, which is pretty high-yield since it would lower his cardiovascular and cancer risk. On the other hand, he doesn't seem particularly motivated to quit right now. You would like to see him exercise more and eat better, since his blood sugars are not too bad yet, and you might be able to spare him daily insulin injections. But, his back pain is so bad that walking is difficult and exercise is out of the question. Tylenol and ibuprofen only "take the edge off". Oxycodone is the one thing that seems to really help. He asks you to refill his prescription, especially because "the pain is so bad at night, I can't sleep without it". His quality-of-life is already poor, and it would become miserable if you took away his opioid script without providing some other form of pain control. You believe that he might benefit from physical therapy and time. He is willing to try PT, but he is adamant that he will not be able to "do all of the stretches and stuff" without taking oxycodone beforehand. You now have 7 minutes to come up with a plan he agrees on (you're there to help him, after all), put in your orders, and read up on the next patient. How do you want to allocate your time? What if you suggest cutting down on his oxycodone regimen and he pushes back? I don't know if there is a good answer. But these situations happen all the time, and someone has to make a decision. Most doctors are normal people. The different backgrounds, personalities, willingness to engage in confrontation or teaching, and varying degrees of concern for public health vs. individual patient needs, etc. lead to a variety of approaches. In the end, I think that pharma payments have a marginal effect on most doctors who have families, bosses, insurance constraints, a full waiting room, and are faced with the patient above.
- RhysU 9y ago
  Car mechanics tell you that you need a new transmission when you need a new transmission.

270 points by metheus 9y ago

oleg123 9y ago

bribes - or payments?

diogenescynic 9y ago
In America it's all the same. Or you can call it 'lobbying' if you really want to dress it up.
- deelowe 9y ago
  Doctor's aren't public officials. So no, you wouldn't call it that.
  - alexandercrohde 9y ago
    Doctors have taken an oath and have a public responsibility. They are liable for bad medical behavior (particularly if deliberate) [malpractice]. So let's not quibble over semantics.
    - dragonwriter 9y ago
      > They are liable for bad medical behavior (particularly if deliberate) Malpractice is in many senses a reduced standard of negligence liability compared to that faced by the general public, since it turns on established professional practice in the field not objective reasonableness in the circumstances.
    - outside1234 9y ago
      Believe it or not, this grew out of the threat of lawsuits if they DIDN'T prescribe opioids because they were ignoring the "5th vital sign" (pain). The real culprits here are the corporations - they should be liable for paying for the treatment of the folks addicted to the drugs they pushed.
      - alexandercrohde 9y ago
        Well if the root is the corporation, I think civil suits have proven ineffective at preventing such abuses. I wonder if the answer may be criminal suits and a greater emphasis on whistleblowing. Most people I know would rat out their company's immoral/illegal behavior for a million dollars.
      - smackingly 9y ago
        5th vital sign is urine output :) What is actually driving this is that income (and other hospital measures) is tied to patient satisfaction. Don't want to lose 30k/year because I didn't give the patient what they want. I'm an inpatient physician (ICU), so I never prescribe chronic opioids, but I am pretty liberal with them in the hospital. And no, I've never received a Panera lunch for the privilege of hearing about OxyContin. It's an extremely complex and difficult problem. I think doctors are taking too much of the blame. Maybe we should simply ban the use of chronic opioids for non-cancer pain (or other similar etiologies). When I was a resident, I made all my patients sign an agreement that I would not prescribe chronic opioids unless they had metastatic cancer, were otherwise in a hospice facility, or I made a special exception. Don't sign? Then you find another doctor. I realize that will evoke some strong emotions from some of you, but you don't see the everyday begging from patients for more opioids when they obviously don't need them. Some people with legit use-cases will suffer under such a scheme. And that could drive up the use of heroin. There's no easy solution to this problem.
        DanBC 9y ago
        > 5th vital sign is urine output :) US doctors began prescribing many more opioids after a campaign by the VA describing pain as the 5th vital sign. Doctors began having to ask people about pain, which meant they had to treat that pain. The VA also said that opioids are not addictive when used to treat pain. They're not so addictive when used to treat acute pain, but they're more addictive when used to treat chronic pain. Very many more people got opioids to treat chronic pain because of this campaign. https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital_Sign_Toolkit.pdf https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/ > It's an extremely complex and difficult problem. I think doctors are taking too much of the blame. A lot of americans get opioids from doctors. https://www.cdc.gov/drugoverdose/data/prescribing.html https://www.cdc.gov/drugoverdose/data/prescribing.html > An estimated 1 out of 5 patients with non-cancer pain or pain-related diagnoses are prescribed opioids in office-based settings > However, primary care providers account for about half of opioid pain relievers dispensed. Some states have between 93 and 143 opioid prescriptions per 100 people!!

elipsey 9y ago

Reminds me of what Rostand said about murder: "Kill one man, and you are a murderer. Kill millions of men, and you are a conqueror. Kill them all, and you are a god." Sell one oxycontin and you're drug dealer; sell a million and you're a C level.

bostik 9y ago
That can be generalised. Petty thieves break the law. Mafiosos skirt and avoid the law. The real kingpins write the law.
- stephengillie 9y ago
  Smart criminals don't commit crimes; they change the laws and then act freely.
- deleted 9y ago
  [deleted]
esterly 9y ago
Agreed. When a C level is profiting it is hard to change course. The onion nails it http://www.theonion.com/article/sweating-shaking-pharmaceutical-ceo-says-he-can-st-55704 http://www.theonion.com/article/sweating-shaking-pharmaceuti...
erdewit 9y ago
31 billion$ earned on the sale of oxycontin... https://en.wikipedia.org/wiki/Oxycodone#History https://en.wikipedia.org/wiki/Oxycodone#History
- refurb 9y ago
  Lipitor was over $150B through it's lifecycle.
deleted 9y ago
[deleted]

lr4444lr 9y ago

Maybe it's because Americans just have this cognitive dissonance that their trusted doctor could be any less than 100% conscientious about their health, but we need to plainly face the fact that if members of the press were able to write exposés about drug makers' fudging the data about the addictiveness and effectiveness of their products, that doctors with their medical training and responsibility over actual people's lives should have proceeded with more caution and not written scripts mindlessly to get rid of every tiny pain patients had just because they kept asking for something. It's just unconscionable. EDIT: this survey was also very damning: http://www.chicagotribune.com/news/local/breaking/ct-prescription-painkiller-overuse-met-20160324-story.html http://www.chicagotribune.com/news/local/breaking/ct-prescri...

zjaffee 9y ago
Your ignoring the fact that up until recently, pain was considered to be the fifth vital sign and was just as important to treat as things like a fever. Medicine as a field is largely about removing discomfort, as many medical conditions could be relatively debilitating. Think how many times taking an ibuprofen/acetaminophen just made it possible for you to go on with your day, rather than needing to lay in bed in agony. For people with chronic pain, or those coming out of surgery, perceived recovery time can be a big thing for people. Additionally, the article didn't address the fact that it could very well be that doctors were being paid off to prescribe a particular brand of opioid rather than just opioids in general, something that is relatively common when there are a large number of drugs that can equally help treat a given ailment.
- lr4444lr 9y ago
  I think you're raising an interesting point, but I disagree with your example - what pain that is so bad its sufferer needs "to lay in bed in agony" can be relieved by ibuprofen, acetaminophen, or any other OTC pain reliever? The Great Binge[0] ended long ago - perhaps for the wrong reasons, but ended nonetheless, until recently when legal opioid prescriptions spiked. This is about doctors putting their patients at risk in the process of treating them for routine problems which did not result in opioid addiction rates as recently as 25 years ago, and certainly were not prescribed with any other side benefit as far as I've heard. [0]https://en.wikipedia.org/wiki/The_Great_Binge https://en.wikipedia.org/wiki/The_Great_Binge

lootsauce 9y ago

I have two relatives that died from prescription opioid addiction and abuse and I don't think a few payments here and there is what motivates doctors to prescribe these drugs at a higher rate. Maybe it does maybe not. The fact is they are powerful drugs that can stop pain AND they make LOTS of money so they get pushed as the best option. The thing that is in question in a doctors mind is, can I say this is the best option. Thats what the face-time with reps, meals, conferences etc are doing, giving the MD a perception that this is best practice. It's the professional cover to prescribe what everyone knows is a highly addictive and dangerous narcotic. If the same kind of money were spent on informing, reminding and reminding again, face-time with addiction prevention advocates, conferences on the opioid epidemic, payments for speaking on alternatives to opioids for pain treatment, giving doctors the facts about these drugs, the addiction and death rates, the impact on families and communities of the inevitable proportion of people who will become addicted and of those who will die, it will be much much harder to say this is a best practice. But even then doctors are pushed hard to deal with as many patients as possible. A quick answer that deals with the immediate problem is what the patient wants and its all the doc has time and support from the system to give. This situation lends itself to the potential for those who truly benefit, the makers of these drugs, to take advantage of the situation and push drugs they know will make people addicted leading to higher use and profits. Lost lives and destroyed families be damned.

vkou 9y ago

Not related to payments, but related to opioids: My father broke his thumb a few weeks ago, while operating a woodchipper. After getting a cast, he went to see a specialist, who recommended that K-wires be surgically installed - small metal rods that go into his thumb, until it heals, at which point they will be pulled out. He got local anesthetic, got the wires installed, and got sent home. Because he lives in Canada, they gave him nothing for the pain. Two days later, the pain died down, and he's now waiting for the bones to heal. In America, I can't imagine that doctor would get many positive reviews from his patients, for not prescribing painkillers. Market forces would push him towards over-prescribing... And statistically, some of his patients will become addicted.

rayuela 9y ago
What? You've responded to a rigorous research paper with a completely baseless guess of what America might be like...
mnm1 9y ago
Sounds like a shitty doctor. It takes longer than two days on weak opiates to get addicted and the doctor knows that.

gayprogrammer 9y ago

>> Q: What connection might there be between drug-maker payments to physicians and the current opioid use epidemic? The article is pure speculation. They did not correlate the payments made to doctors with the prescriptions those doctors made, nor even more broadly with national prescription rates. This article just makes the implied assumption that doctors push pills onto patients. I don't discount that at one time doctors may have been incentivized to play it fast and loose with pain pills, but those days are LONG gone now. I would like to see research on the population in terms of predisposition to addiction and susceptibility to chemical dependence.

ddebernardy 9y ago

Is this really news? John Oliver ran a piece on the topic and the industry's many other dubious practices over 2 years ago, and I'm quite sure he wasn't the first to try to raise awareness. https://www.youtube.com/watch?v=YQZ2UeOTO3I https://www.youtube.com/watch?v=YQZ2UeOTO3I

tylersmith 9y ago
Not everyone watches John Oliver. Lots of things you and I know would be news to a lot people and many things they know would be news to us.
- ddebernardy 9y ago
  Of course, but like you and I those in his team don't have a single source of information, and as Oliver quips in said video, you know you have a problem when your marketing practices are notorious enough to make it into TV series.

liveoneggs 9y ago

check your doctor: https://openpaymentsdata.cms.gov/ https://openpaymentsdata.cms.gov/

api_or_ipa 9y ago
This really should be more widely known. TIL my doctor got a meal + beverages worth $130. Seems reasonable compared to the national average of over $3k.
- tylersmith 9y ago
  When I was younger I was prescribed Paxil and strongly encouraged to stick with it despite horrible side effects. Brain shocks, hateful feelings, and definitely horrible depression to name a few of the non-personal ones. I still have them occasionally 6 years later. I eventually ran away from my old life, moved across the country, and eventually stopped the Paxil and eventually got better but not after burning a ton of bridges. After this site came out I found the doctor had been given nearly $30k from Glaxo Smith Kline over a few years.
jws 9y ago
My doctor had 16 payments in 2016. Mostly in the $10-$13 range for food and drink. Looks like a rep paying for lunch at the medical center cafeteria. Sounds a lot like "ok, I want to hear about your product, but I'm not giving up billable hours for it, so talk at lunch". I'm not sure how doctors think, but there is no meal you can buy me that would make me go hear about your product if I didn't want to hear about your product.
CyberDildonics 9y ago
The mean is $3,000 USD while the median is only $160. Some doctors must be getting a windfall.

refurb 9y ago

This should be kept in context. Let's say the manufacturer presented new data at a conference. During that presentation they provided lunch and refreshments. Everyone of those doctors that attended will now show up in the CMS database. Do we think that a $15 lunch is going to influence a physician to over-prescribe a drug?

tylersmith 9y ago
Why not? When my wife worked at an insurance agency they always refered people to mechanics/etc that stopped by and gave them candy every few months. Not all doctors handle their profession with the respect and care we'd like.
rasz 9y ago
Except you organize that conference in Hawaii, all expenses paid.
Retric 9y ago
They would not be providing lunch if it did not work. Advertising demonstrates how easy people are swayed by subconscious connections.
- smackingly 9y ago
  Yeah, but I'm not sure how much of an effect it has on the quantity of opioids prescribed. Drug lunches probably influenced which drug I prescribe (for some reason Norco was the most popular oral opioid in our hospital, maybe because it only has 2 syllables). Though I've never attended an opioid lunch.
  - tylersmith 9y ago
    Norco is common because it's a mild opioid that is able to treat the majority of "intermediate" pains. If your pain can be treated with ibuprofen you don't need urgent care. If it can't then Norco is the lightest alternative most likely to help.
  - 9y ago

11thEarlOfMar 9y ago

I don't like the 'pigs at the trough' image of this type of report. There are almost certainly pigs, but there is much more to resolving it than just revoking some licenses or throwing some people in jail. Standard practice in business of all types is to take clients out for a meal to talk business. Usually, the meal setting enables a different type of legitimate, sober interaction. Many types of business are conducted this way. Some companies have policies that limit the value of what a salesperson can share with a client, for example, Applied Materials limits the value of any type of entertainment by a vendor to $100. This is good corporate policy to inhibit undue influence by vendors. But it is not 'a payment'. Likewise, it is pretty easy to see that pharma would want a Dr. who is prescribing their medication and has a positive story to tell to speak at one of their seminars. The Dr. might say that his time is worth $x, and the Pharma needs to cover his travel expenses, and then he'd consent to presenting. In this case, any fees paid would be considered payment. The question is, how much is being paid and does that payment present undue influence. Many doctors are independent contractors and can choose to do this type of activity without a policy to override or limit the value of it. On the other hand, state medical boards which license physicians should have policies that limit all medical and pharmaceutical companies in how they can influence physicians.

tiggybear 9y ago
I think that is ridiculous. Learning about new medicine is continuing education for physicians. It is their job. Having a third party paying them or even just offering dinner to them so they can do their jobs is a huge conflict of interest. Further, they are getting a completely biased education on these new drugs in addition to being "taught" by pharma reps who often do not even have a BS in life sciences...so they are very limited in being able to relay nuanced medical information.
- bionoid 9y ago
  > Having a third party paying them or even just offering dinner to them so they can do their jobs is a huge conflict of interest. Not directly related, but my sister studied to become an audiologist some 15 years ago (in Norway). I was absolutely stunned at the corporate sponsorship - full on weekend trips with a nice hotel room and paid drinks and fun activities (plus a conference). Not once, but many times during the studies, for all students, sponsored by different companies (I'm not sure if they were competing companies, but you'd think so..) There must be a lot of money in hearing aid for that to make financial sense.. Is/was this type of sponsorship common for students in other areas, medical or elsewhere?

robmiller 9y ago

There is an irony here that the US invaded Afghanistan, the world's largest opium exporter[1]. [1] https://en.wikipedia.org/wiki/Opium_production_in_Afghanistan https://en.wikipedia.org/wiki/Opium_production_in_Afghanista...

Theodores 9y ago
...and those drugs go North towards the former Soviet Union. This is chemical warfare by other means. When our Russian friends cannot afford the heroin any more they make 'Krokodil': https://en.wikipedia.org/wiki/Desomorphine https://en.wikipedia.org/wiki/Desomorphine Whatever you do, don't do image or video searches on this 'flesh eating drug'!!! This product came about in part due to codeine being as available as aspirin (no prescription needed) and a crackdown on heroin by the teetotal Putin. In the USA and places like Australia 'crystal meth'/'ice' took hold in same-but-different circumstances. When you look at the UN report on opium cultivation in Afghanistan for 2002 you see why there was such an important need to bomb the country - those evil Taliban ('students') had wiped out this important (to the Americans) industry. Thankfully with the British protecting the poppy fields the trade has been restored and we are back to business as usual.

ransom1538 9y ago

Feel free to browse doctors' opioid counts here. I was able to match them to their actual profiles. Take into account their field, but, even with that the numbers are ridiculous. If you are in "Family Practice" and prescribe opioids 9167 times per year you probably have a very sore hand. https://www.opendoctor.io/opioid/highest/ https://www.opendoctor.io/opioid/highest/

microcolonel 9y ago
> If you are in "Family Practice" and prescribe opioids 9167 times per year you probably have a very sore hand. Though Bruce D. Mackey works at a Family practice, he specializes in Pediatric Occupational Therapy[0] (pediatrics broadly covering patients up to 21 years of age). It's fairly common for a Family Practice to have some specialty staff, and some such clinics have very large patient throughput. I used to be registered to one which specialized in sports medicine, others specialize in things like dietary/lifestyle intervention. [0]: https://www.opendoctor.io/bruce-d-mackey-otr-1146468 https://www.opendoctor.io/bruce-d-mackey-otr-1146468
Clubber 9y ago
Also, consider that doctors must re-subscribe them every month or so. I think federal law requires the patients to have an office visit every 3 months. It's probably shorter now. I dare say if someone went to the doctor's office and said they were hooked on pain killers and would like to be subscribed a step down prescription, they would be denied and told to tough it out, out of fear of DEA retribution. That's one of the problems with government in healthcare.

potus_putin 9y ago

A lot of doctors get paid to treat cancer. Obviously it is a conspiracy and the treatment of cancer must be banned. Eschew chemotherapy. Turmeric poultices with single plantation Zen chai will fix your personal glioblastoma.

CodeWriter23 9y ago

If it walks like a marketing program and quacks like a marketing program, guess what...

zeep 9y ago

And they tell them that their patients suffer from "pseudo-addiction" and should get more of the drugs...

ams6110 9y ago

"the average payment to physicians was $15, the top 1 percent of physicians reported receiving more than $2,600 annually in payments" Neither is enough to sway most physicians IMO. This seems to me like trying to stir up a scandal where there really isn't one. I did hear on the radio today that 90% of prescription opiates are sold in USA and Canada, with the bulk of that being the USA. Other countries treat pain more holistically.

gvd 9y ago
When I was living in Europe and had my wisdom-tooth removed I only got a local anesthetic so I wouldn't feel the cutting. Recently I heard a friend of mine (here in the US) say she was given vicodin afterwards. To me that's just insane. Sure I was a little uncomfortable for half a day but I'm not going to take bloody opioids because of that. It might also be the case that people just don't ask for it as easily as in the US (I mean, it's much more common to hear Americas place food orders with a bunch of custom stuff, Europeans usually just order what's on the menu).
- icelancer 9y ago
  I didn't get any pain pills after wisdom teeth. I had local anesthetic and nitrous oxide gas to ease me, but not enough to sedate me (and obviously, no IV). Some people are given pain pills because their teeth are impacted and the doctors have to break bones; the surgery is far more painful in the recovery stage than if it goes normally. Even still, a common theme amongst my friends who got vicodin after the surgery was them not taking the pills, or only taking a single dose the day after to manage the pain.
  - gvd 9y ago
    I'm not saying this happens everywhere, but there are plenty of odd cases where medication is given way to easy. They should create some central registry to monitor these prescriptions.
kartan 9y ago
> Neither is enough to sway most physicians IMO. It is not just a bribe. Companies spend a few dollars on advertisment per person to get more customers. When you can spend $2,600 on one doctor for advertisment purposes, you can do a lot to get their attention.

jasonkostempski 9y ago

Are there any rules that if a doctor has such a deal, it must be clearly expressed to the patient verbally and in writing? I think that would help not only deter doctors for making the deal at risk of being viewed as untrustworthy but also help people who blindly trust their doctor to maybe think twice before accepting their solution. I don't think there's a fix for the patients that just want the drug, and as long as they're informed, consenting adults, it should be their prerogative.

esm 9y ago

Payments may affect prescribing, but I think that system factors count for more than many people realize. By way of an example, imagine the following case, which is reasonably common at the outpatient medicine office I am rotating through: A 46 yo M with diabetes, hypertension, a 30 pack year smoking history, and low back pain that has been treated with oxycodone ever since a failed back operation 1.5 years ago presents to your office for routine follow-up. It's 10am, the hospital allots 15 minutes for routine appointments, and your next patient is in the waiting room. You are his physician -- what do you prioritize? Smoking, diabetes, and hypertension are a perfect storm for a heart attack in the next 10 years, so how much time do you want to spend optimizing antihypertensive meds and glucose control? You could talk to him about quitting smoking, which is pretty high-yield since it would lower his cardiovascular and cancer risk. On the other hand, he doesn't seem particularly motivated to quit right now. You would like to see him exercise more and eat better, since his blood sugars are not too bad yet, and you might be able to spare him daily insulin injections. But, his back pain is so bad that walking is difficult and exercise is out of the question. Tylenol and ibuprofen only "take the edge off". Oxycodone is the one thing that seems to really help. He asks you to refill his prescription, especially because "the pain is so bad at night, I can't sleep without it". His quality-of-life is already poor, and it would become miserable if you took away his opioid script without providing some other form of pain control. You believe that he might benefit from physical therapy and time. He is willing to try PT, but he is adamant that he will not be able to "do all of the stretches and stuff" without taking oxycodone beforehand. You now have 7 minutes to come up with a plan he agrees on (you're there to help him, after all), put in your orders, and read up on the next patient. How do you want to allocate your time? What if you suggest cutting down on his oxycodone regimen and he pushes back? I don't know if there is a good answer. But these situations happen all the time, and someone has to make a decision. Most doctors are normal people. The different backgrounds, personalities, willingness to engage in confrontation or teaching, and varying degrees of concern for public health vs. individual patient needs, etc. lead to a variety of approaches. In the end, I think that pharma payments have a marginal effect on most doctors who have families, bosses, insurance constraints, a full waiting room, and are faced with the patient above.

RhysU 9y ago
Car mechanics tell you that you need a new transmission when you need a new transmission.