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> 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

> 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.
    - vanderZwan 6y ago
      That does change the interpretation of your earlier statement quite a lot, thank you for clarifying. Together with Scoundreller's observation it does seem that there are a number of systemic issues working together in the US to create this problem. And one of these seems to be how doctors prescribe medication.
- wil421 6y ago
  Before a doctor gets a new drug it should’ve been approved by a government agency and gone through trails. The company selling it trains doctors on its use and side affects. The problem is the company was lying and telling half truths. Not only that they pushed use cases where something as strong as Oxy was not needed. Pill mill doctors are a different story and they are prosecuted for it.
  - TheOtherHobbes 6y ago
    Pharma distributors used various shady techniques - originally pioneered by Purdue - to persuade doctors to push the drug. https://www.wbur.org/commonhealth/2020/01/12/opioid-kickback-scheme-boston-bribery-trial-epidemic https://www.wbur.org/commonhealth/2020/01/12/opioid-kickback... And while some jail time happened - for some of the distributors - the sentences were relatively light. https://www.npr.org/2020/01/23/798973304/pharmaceutical-executive-john-kapoor-sentenced-to-66-months-in-prison-in-opioid https://www.npr.org/2020/01/23/798973304/pharmaceutical-exec... Purdue kept a database of doctors willing to prescribe their products "for pain relief" and have now switched sides to push a drug that treats opioid addiction under a new marketing campaign and a new industry front. https://www.genesisrecovery.com/who-caused-the-opioid-crisis/ https://www.genesisrecovery.com/who-caused-the-opioid-crisis...
- vanderZwan 6y ago
  This is (well, was) a new drug. Doctors cannot have learned about a drug in medical school when that drug did not exist when they were studying. My parents are retired Dutch GPs who also ran a small pharmacy[0], so I know a little about how this works, at least in the Netherlands (I admit that this is a pretty big caveat, because (aside from the obvious biases that this introduces) the opioid crisis doesn't exist here - it seems to be a US-only thing. On the other hand, that only gives me more reason to suspect that the problem is systemic, not something to be blamed on individual doctors). Every year doctors (or any other medical professional as well) have to attend a mandatory amount of lessons to update their knowledge of recent developments in their medical field. In my parents case this also was true for pharmaceutical knowledge. This is where they learn about new medications and their usage. So yeah, they do in fact learn which drug is supposedly safe to prescribe under which circumstances. But you know what is required for all of that to work? An authoritative source of trustworthy information on drug use. Doctors only start prescribing a drug after it has been approved by the relevant governmental bodies for their usage. So if OxyContin got through the FDA, and was marked as safe for the usage it was advertised for, then I do not understand why you suggest that it's the fault of doctors that they prescribed it in those cases. Sure, there might have been some stories going around that this drug might not be quite as safe as claimed, but keep in mind that at any given moment hundreds of quack medicine scaremongering stories are making the rounds. When given a choice between believing those, or the official body that is supposed to verify which drugs are safe or not, doctors will usually pick the latter, and in most cases rightly so. [0] in the Netherlands this is relatively common in small countryside villages that are too small to sustain a pharmacist, who typically needs at least 5000 clients to be sustainable
  - Scoundreller 6y ago
    > Doctors only start prescribing a drug after it has been approved by the relevant governmental bodies for their usage. So if OxyContin got through the FDA, and was marked as safe for the usage it was advertised for, then I do not understand why you suggest that it's the fault of doctors that they prescribed it in those cases. The caveat is that once a drug is approved for XYZ, doctors can, and do, prescribe it for anything else in their judgement. Oxycontin wasn’t approved for chronic non-cancer pain, because it’s a poor choice for that, but that’s where the recurring revenue is and somehow accounted for most of its usage. Short-term post-operative pain and cancer pain just isn’t that big of a market.
- Dirlewanger 6y ago
  >They are supposed to have learned about it in medical school. People need to realize that medical school isn't some all-knowing institution where everything knowable about human physiology is imparted unto students.
at_a_remove 6y ago
I think a casual understanding of history has numerous examples of opioids that were prescribed as being safe, and that people then got addicted to, and then we all moved on to the next one. Heroin was one, after all. I find it hard to imagine too many doctors who are unaware of the history. How they have chosen to view that history (psychiatry's triumphant "this time we got it right!" or perhaps simply shrinking away from the issue) is what informs their decisions. Is it an opioid? Then it is probably addictive for some people. I know that there is some experimentation involving kappa opioid receptors, trying to essentially neutralize any euphoria or uplift with the k-receptor's dysphoria "bummer," but until that has been ironed out, they're habit-forming for many. Not all, but many.
- boomboomsubban 6y ago
  Asking doctors to decide which research they should and should not trust based on their understanding of history seems like a more dangerous situation.
  - at_a_remove 6y ago
    I dunno, "The history of all opioids we have ever encountered has always been associated with addiction" is not a particularly difficult concept to grasp, nor can I see it taking an inordinate amount of time to cram into their education.
    - gknoy 6y ago
      A huge part of most doctors' jobs is balancing the risk of bad things with the benefits of procedures, medications, etc. One of the main reasons we have doctors is so that we can trust their educated judgment. For example, mine noted that guidance had changed on when we should test for some cancers (not as early), because the risk of false positive is higher than the risk of actually having the cancer. In the case of opioids, doctors know they are addictive. They also unfortunately happen to be _extremely effective_ (for most people) at treating severe pains, and have to balance the benefits of pain relief (both in terms of patient happiness and the healing process) versus the risk of harm. I've definitely seen a shift in doctors' prescribing habits in the past fifteen years, in favor of starting with Ibuprofen or other NSAIDs, with the option to ask for a stronger prescription if pain is too much.
refurb 6y ago
Lying about safety? These are opioids which have been around for more than 100 years. And pharma companies are one of many sources of information about drugs. Doctors aren’t forced to only listen to them.
- xsmasher 6y ago
  Purdue specifically claimed that oxy was safer; that it had a smaller chance of addiction. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/#__sec2title https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/#__sec2...
GordonS 6y ago
Consider OxyContin, which the makers claimed worked for 12 hours. 2 things should be red flags here: firstly, I haven't seen an extended release formulation of anything that would work over that period; I'm not even sure if it's physically possible given the human digestion system. Secondly, the many, many patients who complained that it only worked for 6-8 hours. Any doctor with a basic understanding of pharmacology, and basic bedside manner, should have known something was up there.
- TAForObvReasons 6y ago
  "doctors should have known the manufacturers' claims were bogus" is shifting the blame. The real blame should be focused on the manufacturers making false claims in the first place.
  - GordonS 6y ago
    It wasn't my intention to shift the blame - clearly the manufacturers should be strung up for making the false claims they did. Absolutely no argument there. My point is though, that doctors shouldn't blindly trust whatever a manufacturer tells them, if the evidence right in front of their eyes says different.
    - chimeracoder 6y ago
      > My point is though, that doctors shouldn't blindly trust whatever a manufacturer tells them, if the evidence right in front of their eyes says different. Just to be clear, you're advocating doctors eschewing published clinical data (including data from published trials and the FDA approval) on the basis of nonrandomized anecdotal data? The issue here is that the manufacturers committed fraud - falsifying and/or misrepresenting clinical data. The courts confirmed this, finding them guilty of fraud, bribery, and more. Unlike courts, a doctor is in no better position to such sophisticated identify fraud at that scale than a patient is. The pharmaceutical companies and manufacturers absolutely should be held accountable for that, but doctors by and large are not to blame for the fraud committed by pharmaceutical companies.

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.
  - vanderZwan 6y ago
    That does change the interpretation of your earlier statement quite a lot, thank you for clarifying. Together with Scoundreller's observation it does seem that there are a number of systemic issues working together in the US to create this problem. And one of these seems to be how doctors prescribe medication.
wil421 6y ago
Before a doctor gets a new drug it should’ve been approved by a government agency and gone through trails. The company selling it trains doctors on its use and side affects. The problem is the company was lying and telling half truths. Not only that they pushed use cases where something as strong as Oxy was not needed. Pill mill doctors are a different story and they are prosecuted for it.
- TheOtherHobbes 6y ago
  Pharma distributors used various shady techniques - originally pioneered by Purdue - to persuade doctors to push the drug. https://www.wbur.org/commonhealth/2020/01/12/opioid-kickback-scheme-boston-bribery-trial-epidemic https://www.wbur.org/commonhealth/2020/01/12/opioid-kickback... And while some jail time happened - for some of the distributors - the sentences were relatively light. https://www.npr.org/2020/01/23/798973304/pharmaceutical-executive-john-kapoor-sentenced-to-66-months-in-prison-in-opioid https://www.npr.org/2020/01/23/798973304/pharmaceutical-exec... Purdue kept a database of doctors willing to prescribe their products "for pain relief" and have now switched sides to push a drug that treats opioid addiction under a new marketing campaign and a new industry front. https://www.genesisrecovery.com/who-caused-the-opioid-crisis/ https://www.genesisrecovery.com/who-caused-the-opioid-crisis...
vanderZwan 6y ago
This is (well, was) a new drug. Doctors cannot have learned about a drug in medical school when that drug did not exist when they were studying. My parents are retired Dutch GPs who also ran a small pharmacy[0], so I know a little about how this works, at least in the Netherlands (I admit that this is a pretty big caveat, because (aside from the obvious biases that this introduces) the opioid crisis doesn't exist here - it seems to be a US-only thing. On the other hand, that only gives me more reason to suspect that the problem is systemic, not something to be blamed on individual doctors). Every year doctors (or any other medical professional as well) have to attend a mandatory amount of lessons to update their knowledge of recent developments in their medical field. In my parents case this also was true for pharmaceutical knowledge. This is where they learn about new medications and their usage. So yeah, they do in fact learn which drug is supposedly safe to prescribe under which circumstances. But you know what is required for all of that to work? An authoritative source of trustworthy information on drug use. Doctors only start prescribing a drug after it has been approved by the relevant governmental bodies for their usage. So if OxyContin got through the FDA, and was marked as safe for the usage it was advertised for, then I do not understand why you suggest that it's the fault of doctors that they prescribed it in those cases. Sure, there might have been some stories going around that this drug might not be quite as safe as claimed, but keep in mind that at any given moment hundreds of quack medicine scaremongering stories are making the rounds. When given a choice between believing those, or the official body that is supposed to verify which drugs are safe or not, doctors will usually pick the latter, and in most cases rightly so. [0] in the Netherlands this is relatively common in small countryside villages that are too small to sustain a pharmacist, who typically needs at least 5000 clients to be sustainable
- Scoundreller 6y ago
  > Doctors only start prescribing a drug after it has been approved by the relevant governmental bodies for their usage. So if OxyContin got through the FDA, and was marked as safe for the usage it was advertised for, then I do not understand why you suggest that it's the fault of doctors that they prescribed it in those cases. The caveat is that once a drug is approved for XYZ, doctors can, and do, prescribe it for anything else in their judgement. Oxycontin wasn’t approved for chronic non-cancer pain, because it’s a poor choice for that, but that’s where the recurring revenue is and somehow accounted for most of its usage. Short-term post-operative pain and cancer pain just isn’t that big of a market.
Dirlewanger 6y ago
>They are supposed to have learned about it in medical school. People need to realize that medical school isn't some all-knowing institution where everything knowable about human physiology is imparted unto students.

at_a_remove 6y ago

I think a casual understanding of history has numerous examples of opioids that were prescribed as being safe, and that people then got addicted to, and then we all moved on to the next one. Heroin was one, after all. I find it hard to imagine too many doctors who are unaware of the history. How they have chosen to view that history (psychiatry's triumphant "this time we got it right!" or perhaps simply shrinking away from the issue) is what informs their decisions. Is it an opioid? Then it is probably addictive for some people. I know that there is some experimentation involving kappa opioid receptors, trying to essentially neutralize any euphoria or uplift with the k-receptor's dysphoria "bummer," but until that has been ironed out, they're habit-forming for many. Not all, but many.

boomboomsubban 6y ago
Asking doctors to decide which research they should and should not trust based on their understanding of history seems like a more dangerous situation.
- at_a_remove 6y ago
  I dunno, "The history of all opioids we have ever encountered has always been associated with addiction" is not a particularly difficult concept to grasp, nor can I see it taking an inordinate amount of time to cram into their education.
  - gknoy 6y ago
    A huge part of most doctors' jobs is balancing the risk of bad things with the benefits of procedures, medications, etc. One of the main reasons we have doctors is so that we can trust their educated judgment. For example, mine noted that guidance had changed on when we should test for some cancers (not as early), because the risk of false positive is higher than the risk of actually having the cancer. In the case of opioids, doctors know they are addictive. They also unfortunately happen to be _extremely effective_ (for most people) at treating severe pains, and have to balance the benefits of pain relief (both in terms of patient happiness and the healing process) versus the risk of harm. I've definitely seen a shift in doctors' prescribing habits in the past fifteen years, in favor of starting with Ibuprofen or other NSAIDs, with the option to ask for a stronger prescription if pain is too much.

refurb 6y ago

Lying about safety? These are opioids which have been around for more than 100 years. And pharma companies are one of many sources of information about drugs. Doctors aren’t forced to only listen to them.

xsmasher 6y ago
Purdue specifically claimed that oxy was safer; that it had a smaller chance of addiction. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/#__sec2title https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/#__sec2...

GordonS 6y ago

Consider OxyContin, which the makers claimed worked for 12 hours. 2 things should be red flags here: firstly, I haven't seen an extended release formulation of anything that would work over that period; I'm not even sure if it's physically possible given the human digestion system. Secondly, the many, many patients who complained that it only worked for 6-8 hours. Any doctor with a basic understanding of pharmacology, and basic bedside manner, should have known something was up there.

TAForObvReasons 6y ago
"doctors should have known the manufacturers' claims were bogus" is shifting the blame. The real blame should be focused on the manufacturers making false claims in the first place.
- GordonS 6y ago
  It wasn't my intention to shift the blame - clearly the manufacturers should be strung up for making the false claims they did. Absolutely no argument there. My point is though, that doctors shouldn't blindly trust whatever a manufacturer tells them, if the evidence right in front of their eyes says different.
  - chimeracoder 6y ago
    > My point is though, that doctors shouldn't blindly trust whatever a manufacturer tells them, if the evidence right in front of their eyes says different. Just to be clear, you're advocating doctors eschewing published clinical data (including data from published trials and the FDA approval) on the basis of nonrandomized anecdotal data? The issue here is that the manufacturers committed fraud - falsifying and/or misrepresenting clinical data. The courts confirmed this, finding them guilty of fraud, bribery, and more. Unlike courts, a doctor is in no better position to such sophisticated identify fraud at that scale than a patient is. The pharmaceutical companies and manufacturers absolutely should be held accountable for that, but doctors by and large are not to blame for the fraud committed by pharmaceutical companies.