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.
In opposition to what you think, doctors are highly egoistical individuals and absolutely do not cover for one another.
The tendency I observed when competency was questioned was to not punish in any way that had strong ramifications. They might badmouth them, but the desire to strip of their license or award large punitive damages isn't there because they are worried about it happening to them, real or imagined.
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.
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.
Pill mill doctors are a different story and they are prosecuted for it.
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-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...
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
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.
Yes, but pharmaceutical companies cannot market the drug for non-approved uses or discuss off-label use when promoting or selling the drug. That is illegal.
That illegal activity is exactly what the courts determined Purdue did - bribery, fraudulent marketing, and more. The issue is that Purdue broke the law (and that their sentences for breaking the law were way too light).
There are lots of FDA-approved drugs that are highly inappropriate for most patients. One of the reasons we tolerate the professional status of physicians is because of their purported expertise in prescribing these drugs safely. If they don't know the function and habit-forming potential of opioids, one might well question that expertise. They aren't regulated in any sense by FDA, and they can't blame FDA for their ignorance.
The drug being talked about was given a new time-release formulation which was described as less addictive.
The drug company spent a lot of time and money distorting the image around addictiveness.
Here's a list of things Purdue did: https://www.feinberg.northwestern.edu/sites/ipham/conference...
Given that the same opioids are approved in the US and Netherlands, with the same warnings and information, why do you think the outcomes are so different between countries?
People need to realize that medical school isn't some all-knowing institution where everything knowable about human physiology is imparted unto students.
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.
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.
I am merely pointing out that the idea that medical doctors being unaware of a basic correlation between opioids and addiction, one which has progressed from one medicine to another over the decades, seems ... disingenuous? Preciously naive? Remember, I am replying to "If the companies are lying about safety, how are the doctors supposed to know?"
Here, I think the doctors are supposed to know in the case of opioids because this is an ongoing historical trend. A random new class of medicine? No, they will probably trust the safety sheet, as well they should. The umpteenth opioid? I would be viewing with a gimlet eye anything saying "Nah, no addictive potential."
You would probably not do this because you have a historical association with pesticides turning out to be rather broader in impact than was originally let on. You understand that history.
I only suggest that this historical wariness sounds completely reasonable for opioids, whereas a brand new drug class has no history associated with it.
Does your understanding of the companies history outweigh your experience of the formats history?
And I would still not add that pesticide to my drinking water. So I will ask ... would you?
It's a dumb hypothetical though, as my point has repeatedly been that doctors have far too many areas to be concerned about to selectively decide that this one pain killer needs more investigation before I prescribe it regularly.
And pharma companies are one of many sources of information about drugs. Doctors aren’t forced to only listen to them.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/#__sec2...
Any doctor with a basic understanding of pharmacology, and basic bedside manner, should have known something was up 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.
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.
This is my point - the claims were BS. A number of doctors should have been raising a number of red flags, because their knowledge contradicted those claims, as did patient evidence right in front of their very eyes.
I'm obviously not saying they should ignore or distrust all clinical data, but if they see such massive discrepancies then they should be speaking up.
Purdue committed fraud, but they never made claims that were so outrageous that they would be prima facie false. (If that had been the case, Oxycontin would never have been approved in the first place). The problem wasn't that the claims were outrageously impossible; it's that the claims were wrong, and Purdue either falsified or misrepresented clinical data in order to convince doctors that Oxycontin was safer than it actually was.
> Patient evidence right in front of their eyes
Encouraging people to rely overly on anecdotal observations is incredibly dangerous, especially when most doctors who prescribe opioids don't prescribe them in such numbers that these issues would be readily visible to them in the first place.
Yes, there were a small number of doctors who did aggressively overprescribe and misprescribe Oxycontin. That was the result of a direct and explicit campaign by Purdue to identify and enable those doctors. Some of those doctors were prosecuted and/or did lose their licenses, but those doctors still only amounted to a small part of the opioid crisis.
> I'm obviously not saying they should ignore or distrust all clinical data, but if they see such massive discrepancies then they should be speaking up.
Most doctors weren't seeing massive discrepancies. We know the discrepancies exist now because there were lawsuits and prosecutions which revealed the specific fraudulent behavior that Purdue and others were engaged in. But without the benefit of hindsight, these issues simply weren't reasonably visible to a typical doctor - they were only visible at large scale to Purdue, who went out of their way to mislead everyone else about it.
Furthermore, opioids shouldn't even be used as first line after wisdom teeth removal - across Europe you'd be sent home and told to take paracetamol or ibuprofen, because those medications generally work very well for inflammation-type pain.
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.
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....
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.
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.
Because of the...money? There is/was plenty for everyone.
https://lowninstitute.org/industry-payments-to-doctors-opioi...
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.
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.
Well, if I had to make an educated guess, they really did cross their fingers and nobody seems to be investigating/enforcing otherwise and they're getting away with it - because I'm telling you, first hand... it's happening, quite frequently, at least on the West Coast.
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
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.
[1] https://floridadailypost.com/florida-pill-mills-gateway-opio...