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I never understand why doctors are not blamed for prescribing these. Are doctors not supposed to be responsible for prescriptions? If they are not, should we st

I never understand why doctors are not blamed for prescribing these. Are doctors not supposed to be responsible for prescriptions? If they are not, should we stop allowing them to prescribe? Why don’t doctors unions throw out members who would claim to have been hoodwinked by pharmaceutical companies?

thefounder 6y ago
>> Why don’t doctors unions throw out members who would claim to have been hoodwinked by pharmaceutical companies? Because of the...money? There is/was plenty for everyone.
- pradn 6y ago
  Do doctors get paid more for prescribing one brand of medication vs another?
  - x86_64Ubuntu 6y ago
    I think there are rules against payment but as we all know, there are ways around rules when it concerns money. Looks like there is a correlation between doctors being buttered up, and them prescribing opiods. https://lowninstitute.org/industry-payments-to-doctors-opioids-are-the-tip-of-the-iceberg/ https://lowninstitute.org/industry-payments-to-doctors-opioi...
  - mannykannot 6y ago
    the pharmacutical companies have developed many ways of rewarding doctors for being compliant, such as by being paid 'consultants' presenting at conferences in exotic locations. For everyday practitioners, social primping (wining, dining, rounds of golf in prestigious locations and/or company) works as well as for just about everyone.
  - Zaak 6y ago
    https://www.healthline.com/health-news/is-your-doctor-getting-paid-to-prescribe-painkillers-for-you https://www.healthline.com/health-news/is-your-doctor-gettin...
  - sacred_numbers 6y ago
    Not typically in money, but in gifts, lunches, and attention paid by young, attractive pharmaceutical sales people. For opioids, specifically, there is also the factor that doctors prescribing opioids will have higher customer satisfaction in the short term because opioids are better than almost anything for pain relief. Higher customer satisfaction (not necessarily the same as better patient outcomes) usually means more recommendations and more money. If some of your patients get addicted it just means they'll come in more frequently for more prescriptions. Plus, they can't actually be addicted, since your sales rep with a bachelor's in biology said that Oxycontin is not addictive.
    - R0b0t1 6y ago
      Saying Oxycontin isn't addictive is false but from talking to doctors they tend to not consider it addiction if you are receiving the medication for an actively treated issue.
    - refurb 6y ago
      Gifts from pharma hasn’t been true for a couple decades. They don’t even give pens now. Sure they can get a free lunch, but it’s usually brought to their office and it’s fast food. Customer satisfaction is relevant, but only because hospitals have put so much emphasis on it. But regardless, nobody can get these drugs without a doctor writing a script, so there is plenty of blame to go around.
      - s5300 6y ago
        Huh. I'd love to know where you're getting that idea from. Through a strange series of events (extreme sports hobbies) I became friends with a group of doctors, none of them participating in anything very special or that could be seen as a career height. Most really just starting out after the hell that is med school. They spoke of pretty regular outreach of gifts from pharma. Mainly in the form of fancy retreats (like to Hawaii - note, we were based in SoCal at the time) with pretty extravagant dinners and fancy boating stuff. These were, according to them, always filled with the brim with others like them to the point it got to be quite frankly boring, annoying, and a nuisance. No matter how hard they tried to ignore the unsolicited outreach, it wouldn't stop coming. Just some anecdata tho.
blendergeek 6y ago
> Why don’t doctors unions throw out members who would claim to have been hoodwinked by pharmaceutical companies? If the companies are lying about safety, how are the doctors supposed to know? The only ones with the data necessary to know the dangers of these drugs are the manufacturers and the manufacturers were lying and covering up the dangers.
- vanderZwan 6y ago
  Exactly, there is a chain of trust involved, and when that trust is broken it makes sense to first look as far up the chain as possible. Holding doctors responsible for their actions only starts making sense once we are talking about doctors who keep prescribing this long after the risks have become known, which I am sure has happened too. But it's not the root problem.
- songshu 6y ago
  They are supposed to have learned about it in medical school. If not, that's fine, maybe doctors shouldn't be allowed to prescribe and maybe only pharmacists should be allowed. My point is that it's a very valuable professional quality and we should put the responsibility where the quality is.
  - treefish 6y ago
    Doctors who were prescribing medicine at the time that OxyContin hit the market were not in medical school, they had graduated already. If pharma lies about safety there is no way for a doctor to know unless they conduct their own study, which would require lots of extra time and massive funding. Pharmacists didn't know that the safety data was fudged either. Everyone got their oxycontin from a pharmacist after a doctor prescribed it, so having a pharmacist be the only one allowed to prescribe it wouldn't have changed anything.
    - songshu 6y ago
      Sorry, I meant that they should have learned about drug safety in medical school, not that they should have learned about this specific drug.
JMTQp8lwXL 6y ago
Why blame doctors when the makers of OxyContin told Congress for years that it was safe and non-addictive. It's a systemic issue with various actors/stakeholders whom all are partially to blame in various capacities.
- songshu 6y ago
  Yes, I do blame law makers and manufacturers too.
- spaetzleesser 6y ago
  Both should be blamed. There were plenty of doctors who noticed that the OxyContin promises didn’t work out but they kept prescribing anyway.
  - iorrus 6y ago
    While doctors do share some blame, they were actively targetted by Purdue with brochures, slick salesmen etc.How is was allowed is the real issue for me.
- LanceH 6y ago
  Congress chooses which experts it listens to. Too often it chooses those "experts" based on notoriety and the conclusion they hope to reach. Now they are "shocked" to find out they people they've been accepting money from were leading them astray -- not that they knew where that money was ever coming from.
DanBC 6y ago
Some doctors are blamed for over-prescribing, which is why some doctors were jailed and some doctors struck off. That doesn't take away from the fact that the manufacturers led a campaign to deliberately mislead people for years about the addictiveness and efficacy of opioid medication to treat pain.
spaetzleesser 6y ago
Most organizations are not good at throwing out members that do bad things. Usually they are set up to be defensive no matter what. Looked at police unions who protect bad cops, judges (there was something on Reuter’s about judge misconduct) and doctors (it takes forever and many injured people to get bad surgeons banned). It would be grwat these organizations had higher standards for their members but they don’t.
quickthrowman 6y ago
Because medical boards are staffed with doctors who let other doctors off the hook. Doctors are held to account about as well as police (in the US), i.e. not at all.
chongli 6y ago
I never understand why doctors are not blamed for prescribing these Because doctors are human beings and in particular they’re people who are motivated by the desire to alleviate suffering. When faced with patients who repeatedly return to their office, complaining of severe pain, what can they do? There are no miracle painkillers. We have anti-inflammatories for minor aches and pains. We have opioids for severe, temporary pain (such as recovery from surgery and end-of-life care). We do not have a painkiller suitable for chronic pain. Purdue pharma offered doctors a way out. The institutional structure of healthcare, into which doctors and pharma companies fit, permits diffusion of responsibility [1]. Doctors escape blame because the determination of the safety and efficacy of medication is outside their area of responsibility. [1] https://en.wikipedia.org/wiki/Diffusion_of_responsibility https://en.wikipedia.org/wiki/Diffusion_of_responsibility
bitxbit 6y ago
Not that it makes this situation any better but the entire pharma marketing landscape was FAR worse in 90s and 00s.
bagacrap 6y ago
they should be. One of my parents was a primary care physician. When I was growing up she had on-call duties once a month, and fielded lots of after-hours requests for opioid prescriptions or renewals. These were patients of other doctors at her clinic calling in. She always told them that she wouldn't prescribe those drugs over the phone and they'd need to go into urgent care because she was aware of the abuse and addictive potential. This happened in the mid 90s.
throwaway5752 6y ago
1. Physicians in the US don't have a union. Some conservatives call the AMA a physicians' union, and while it shares some union functions it simply is not one. Physicians are licensed to practice by individual states. 2. Physicians are responsible for writing prescriptions, pharmacists dispense them, and patients self-administer in most cases. The opioid epidemic was caused by failures at each of these levels, not just when writing the rx. 3. Physicians are routinely prosecuted, lose their licenses, and go to jail for this: https://www.deadiversion.usdoj.gov/crim_admin_actions/index.html https://www.deadiversion.usdoj.gov/crim_admin_actions/index.... Your lack of information on the topic is not the same as a systemic problem. Please do a bit more due diligence before making claims like this.
rrrrrrrrrrrryan 6y ago
It's because doctors and hospitals are increasingly evaluated based on patient satisfaction instead of patient outcomes. It's why you'll walk into a medical plaza lobby that looks like a 4-star hotel, with fountains and art on the wall, and why the doctor will write you a prescription for an absurd dose of narcotics after surgery. After you've been cut open, it's normal to be in some pain for a while, but if the doctor drugs you into such a daze that you feel nothing, you'll rate him or her more highly. Even if 9/10 people end up being fine and stop taking the drug when they're supposed to, 1/10 people have a new addition. This is bizarre the end-result of the privatization of our medical system. We're just one step away from rating doctors with stars like Uber, where they offer you drugs instead of a free water bottle when you walk in.
- nojito 6y ago
  The field isn’t called patient satisfaction anymore. It’s called patient experience and it is pretty much ubiquitous to ensuring high quality patient care.
- wmeredith 6y ago
  HealthGrades.com and RateMDs.com is already a thing.
  - R0b0t1 6y ago
    I see these as a consequence to having no real way to remove bad doctors through the legal system. They all protect each other. There's some idiots looking for narcotics, but that isn't all of it.
    - rscho 6y ago
      The more you'll sue doctors, the more MDs will practice defensive medicine and you'll end up with shit quality overly invasive care. The way to go is to sue the institutions, but not the practitioners themselves. Then the institution punishes the doc if warranted. In opposition to what you think, doctors are highly egoistical individuals and absolutely do not cover for one another.
eagsalazar2 6y ago
Doctors as a group are not that dissimilar to police unions in that their primary function is to actually shield doctors from responsibility or accountability. Both are extremely hostile to criticism of any kind. This focus on their own outcomes results in zero virtuous feedback and being dysfunctional and failing to serve their customers consistently, with frequent gross failures.
caycep 6y ago
Of note, in california, every opiate rx is very rigidly traced in the CURES database. I'm sure there's some complicated technical way around it, but it's not a willy-nilly rx system, at least in CA. In general, the rule of thumb is if you need opiates, more that a simple vicodin or tramadol, we refer you to a pain management specialist.
- ipnon 6y ago
  In Florida, opioid prescriptions were recently as easy to get as a medical marijuana card in California before full legalization.[1] The drugs could then be smuggled by car to states with restrictive prescription tracing. The smugglers had legal protection because the prescription was in their name. [1] https://floridadailypost.com/florida-pill-mills-gateway-opioid-crisis/ https://floridadailypost.com/florida-pill-mills-gateway-opio...
Florin_Andrei 6y ago
Shifting the blame to the doctors is/was one of the major strategies pursued by influencers working for the Sacklers. You're simply playing their game here (either knowingly or unknowingly).
sevensor 6y ago
Doctors? Let's talk about bankers, accountants, and real estate agents. They must get paid a lot of money to turn off the part of the brain that's screaming about how dishonest this whole chain of transactions is, how much it looks like a pack of guilty people trying to put their ill-gotten wealth out of harm's way.
Nasrudith 6y ago
Because doctors are supposed to provide it to people in pain who approved it and it would rapidly turn arbitrary and Kafkaesque if they started punishing doctors for doing their job while obligating them to do so at the same time. If you punish a surgeon for having a patient die good luck ensuring access to surgeons.

thefounder 6y ago

>> Why don’t doctors unions throw out members who would claim to have been hoodwinked by pharmaceutical companies? Because of the...money? There is/was plenty for everyone.

pradn 6y ago
Do doctors get paid more for prescribing one brand of medication vs another?
- x86_64Ubuntu 6y ago
  I think there are rules against payment but as we all know, there are ways around rules when it concerns money. Looks like there is a correlation between doctors being buttered up, and them prescribing opiods. https://lowninstitute.org/industry-payments-to-doctors-opioids-are-the-tip-of-the-iceberg/ https://lowninstitute.org/industry-payments-to-doctors-opioi...
- mannykannot 6y ago
  the pharmacutical companies have developed many ways of rewarding doctors for being compliant, such as by being paid 'consultants' presenting at conferences in exotic locations. For everyday practitioners, social primping (wining, dining, rounds of golf in prestigious locations and/or company) works as well as for just about everyone.
- Zaak 6y ago
  https://www.healthline.com/health-news/is-your-doctor-getting-paid-to-prescribe-painkillers-for-you https://www.healthline.com/health-news/is-your-doctor-gettin...
- sacred_numbers 6y ago
  Not typically in money, but in gifts, lunches, and attention paid by young, attractive pharmaceutical sales people. For opioids, specifically, there is also the factor that doctors prescribing opioids will have higher customer satisfaction in the short term because opioids are better than almost anything for pain relief. Higher customer satisfaction (not necessarily the same as better patient outcomes) usually means more recommendations and more money. If some of your patients get addicted it just means they'll come in more frequently for more prescriptions. Plus, they can't actually be addicted, since your sales rep with a bachelor's in biology said that Oxycontin is not addictive.
  - R0b0t1 6y ago
    Saying Oxycontin isn't addictive is false but from talking to doctors they tend to not consider it addiction if you are receiving the medication for an actively treated issue.
  - refurb 6y ago
    Gifts from pharma hasn’t been true for a couple decades. They don’t even give pens now. Sure they can get a free lunch, but it’s usually brought to their office and it’s fast food. Customer satisfaction is relevant, but only because hospitals have put so much emphasis on it. But regardless, nobody can get these drugs without a doctor writing a script, so there is plenty of blame to go around.
    - s5300 6y ago
      Huh. I'd love to know where you're getting that idea from. Through a strange series of events (extreme sports hobbies) I became friends with a group of doctors, none of them participating in anything very special or that could be seen as a career height. Most really just starting out after the hell that is med school. They spoke of pretty regular outreach of gifts from pharma. Mainly in the form of fancy retreats (like to Hawaii - note, we were based in SoCal at the time) with pretty extravagant dinners and fancy boating stuff. These were, according to them, always filled with the brim with others like them to the point it got to be quite frankly boring, annoying, and a nuisance. No matter how hard they tried to ignore the unsolicited outreach, it wouldn't stop coming. Just some anecdata tho.

blendergeek 6y ago

> Why don’t doctors unions throw out members who would claim to have been hoodwinked by pharmaceutical companies? If the companies are lying about safety, how are the doctors supposed to know? The only ones with the data necessary to know the dangers of these drugs are the manufacturers and the manufacturers were lying and covering up the dangers.

vanderZwan 6y ago
Exactly, there is a chain of trust involved, and when that trust is broken it makes sense to first look as far up the chain as possible. Holding doctors responsible for their actions only starts making sense once we are talking about doctors who keep prescribing this long after the risks have become known, which I am sure has happened too. But it's not the root problem.
songshu 6y ago
They are supposed to have learned about it in medical school. If not, that's fine, maybe doctors shouldn't be allowed to prescribe and maybe only pharmacists should be allowed. My point is that it's a very valuable professional quality and we should put the responsibility where the quality is.
- treefish 6y ago
  Doctors who were prescribing medicine at the time that OxyContin hit the market were not in medical school, they had graduated already. If pharma lies about safety there is no way for a doctor to know unless they conduct their own study, which would require lots of extra time and massive funding. Pharmacists didn't know that the safety data was fudged either. Everyone got their oxycontin from a pharmacist after a doctor prescribed it, so having a pharmacist be the only one allowed to prescribe it wouldn't have changed anything.
  - songshu 6y ago
    Sorry, I meant that they should have learned about drug safety in medical school, not that they should have learned about this specific drug.

JMTQp8lwXL 6y ago

Why blame doctors when the makers of OxyContin told Congress for years that it was safe and non-addictive. It's a systemic issue with various actors/stakeholders whom all are partially to blame in various capacities.

songshu 6y ago
Yes, I do blame law makers and manufacturers too.
spaetzleesser 6y ago
Both should be blamed. There were plenty of doctors who noticed that the OxyContin promises didn’t work out but they kept prescribing anyway.
- iorrus 6y ago
  While doctors do share some blame, they were actively targetted by Purdue with brochures, slick salesmen etc.How is was allowed is the real issue for me.
LanceH 6y ago
Congress chooses which experts it listens to. Too often it chooses those "experts" based on notoriety and the conclusion they hope to reach. Now they are "shocked" to find out they people they've been accepting money from were leading them astray -- not that they knew where that money was ever coming from.

DanBC 6y ago

Some doctors are blamed for over-prescribing, which is why some doctors were jailed and some doctors struck off. That doesn't take away from the fact that the manufacturers led a campaign to deliberately mislead people for years about the addictiveness and efficacy of opioid medication to treat pain.

spaetzleesser 6y ago

Most organizations are not good at throwing out members that do bad things. Usually they are set up to be defensive no matter what. Looked at police unions who protect bad cops, judges (there was something on Reuter’s about judge misconduct) and doctors (it takes forever and many injured people to get bad surgeons banned). It would be grwat these organizations had higher standards for their members but they don’t.

quickthrowman 6y ago

Because medical boards are staffed with doctors who let other doctors off the hook. Doctors are held to account about as well as police (in the US), i.e. not at all.

chongli 6y ago

I never understand why doctors are not blamed for prescribing these Because doctors are human beings and in particular they’re people who are motivated by the desire to alleviate suffering. When faced with patients who repeatedly return to their office, complaining of severe pain, what can they do? There are no miracle painkillers. We have anti-inflammatories for minor aches and pains. We have opioids for severe, temporary pain (such as recovery from surgery and end-of-life care). We do not have a painkiller suitable for chronic pain. Purdue pharma offered doctors a way out. The institutional structure of healthcare, into which doctors and pharma companies fit, permits diffusion of responsibility [1]. Doctors escape blame because the determination of the safety and efficacy of medication is outside their area of responsibility. [1] https://en.wikipedia.org/wiki/Diffusion_of_responsibility https://en.wikipedia.org/wiki/Diffusion_of_responsibility

bitxbit 6y ago

Not that it makes this situation any better but the entire pharma marketing landscape was FAR worse in 90s and 00s.

bagacrap 6y ago

they should be. One of my parents was a primary care physician. When I was growing up she had on-call duties once a month, and fielded lots of after-hours requests for opioid prescriptions or renewals. These were patients of other doctors at her clinic calling in. She always told them that she wouldn't prescribe those drugs over the phone and they'd need to go into urgent care because she was aware of the abuse and addictive potential. This happened in the mid 90s.

throwaway5752 6y ago

1. Physicians in the US don't have a union. Some conservatives call the AMA a physicians' union, and while it shares some union functions it simply is not one. Physicians are licensed to practice by individual states. 2. Physicians are responsible for writing prescriptions, pharmacists dispense them, and patients self-administer in most cases. The opioid epidemic was caused by failures at each of these levels, not just when writing the rx. 3. Physicians are routinely prosecuted, lose their licenses, and go to jail for this: https://www.deadiversion.usdoj.gov/crim_admin_actions/index.html https://www.deadiversion.usdoj.gov/crim_admin_actions/index.... Your lack of information on the topic is not the same as a systemic problem. Please do a bit more due diligence before making claims like this.

rrrrrrrrrrrryan 6y ago

It's because doctors and hospitals are increasingly evaluated based on patient satisfaction instead of patient outcomes. It's why you'll walk into a medical plaza lobby that looks like a 4-star hotel, with fountains and art on the wall, and why the doctor will write you a prescription for an absurd dose of narcotics after surgery. After you've been cut open, it's normal to be in some pain for a while, but if the doctor drugs you into such a daze that you feel nothing, you'll rate him or her more highly. Even if 9/10 people end up being fine and stop taking the drug when they're supposed to, 1/10 people have a new addition. This is bizarre the end-result of the privatization of our medical system. We're just one step away from rating doctors with stars like Uber, where they offer you drugs instead of a free water bottle when you walk in.

nojito 6y ago
The field isn’t called patient satisfaction anymore. It’s called patient experience and it is pretty much ubiquitous to ensuring high quality patient care.
wmeredith 6y ago
HealthGrades.com and RateMDs.com is already a thing.
- R0b0t1 6y ago
  I see these as a consequence to having no real way to remove bad doctors through the legal system. They all protect each other. There's some idiots looking for narcotics, but that isn't all of it.
  - rscho 6y ago
    The more you'll sue doctors, the more MDs will practice defensive medicine and you'll end up with shit quality overly invasive care. The way to go is to sue the institutions, but not the practitioners themselves. Then the institution punishes the doc if warranted. In opposition to what you think, doctors are highly egoistical individuals and absolutely do not cover for one another.

eagsalazar2 6y ago

Doctors as a group are not that dissimilar to police unions in that their primary function is to actually shield doctors from responsibility or accountability. Both are extremely hostile to criticism of any kind. This focus on their own outcomes results in zero virtuous feedback and being dysfunctional and failing to serve their customers consistently, with frequent gross failures.

caycep 6y ago

Of note, in california, every opiate rx is very rigidly traced in the CURES database. I'm sure there's some complicated technical way around it, but it's not a willy-nilly rx system, at least in CA. In general, the rule of thumb is if you need opiates, more that a simple vicodin or tramadol, we refer you to a pain management specialist.

ipnon 6y ago
In Florida, opioid prescriptions were recently as easy to get as a medical marijuana card in California before full legalization.[1] The drugs could then be smuggled by car to states with restrictive prescription tracing. The smugglers had legal protection because the prescription was in their name. [1] https://floridadailypost.com/florida-pill-mills-gateway-opioid-crisis/ https://floridadailypost.com/florida-pill-mills-gateway-opio...

Florin_Andrei 6y ago

Shifting the blame to the doctors is/was one of the major strategies pursued by influencers working for the Sacklers. You're simply playing their game here (either knowingly or unknowingly).

sevensor 6y ago

Doctors? Let's talk about bankers, accountants, and real estate agents. They must get paid a lot of money to turn off the part of the brain that's screaming about how dishonest this whole chain of transactions is, how much it looks like a pack of guilty people trying to put their ill-gotten wealth out of harm's way.

Nasrudith 6y ago

Because doctors are supposed to provide it to people in pain who approved it and it would rapidly turn arbitrary and Kafkaesque if they started punishing doctors for doing their job while obligating them to do so at the same time. If you punish a surgeon for having a patient die good luck ensuring access to surgeons.