7 ms·

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 s

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.

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.