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Opioid makers made payments to one in 12 U.S. doctors
11–20 of 105 posts
Re: Opioid makers made payments to one in 12 U.S. doctors
#12This 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?
Re: Opioid makers made payments to one in 12 U.S. doctors
#13Earlier quoted context omitted.
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.
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.
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.
Re: Opioid makers made payments to one in 12 U.S. doctors
#14Earlier quoted context omitted.
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.
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…
> 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...
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
> 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!!
Re: Opioid makers made payments to one in 12 U.S. doctors
#15This 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?
They would not be providing lunch if it did not work. Advertising demonstrates how easy people are swayed by subconscious connections.
Re: Opioid makers made payments to one in 12 U.S. doctors
#16Earlier quoted context omitted.
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.
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…
I was given strong Opioids (Hydromorphone etc) for less than 3 weeks after major surgery. They clearly worked, but even that much exposure IMO was not worth the risk as I very quickly started to get cravings.
Even without getting high, freedom from pain is a ridiculously powerful motivator. And because they have such strong peaks and valleys you make a very strong association with those pills.
Re: Opioid makers made payments to one in 12 U.S. doctors
#17This 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?
They would not be providing lunch if it did not work. Advertising demonstrates how easy people are swayed by subconscious connections.
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.
Re: Opioid makers made payments to one in 12 U.S. doctors
#18This 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?
They could eliminate the suspicion by not buying lunch.
A relative of mine was a pharma salesman. She had a database with the lunch preferences for every doctor on her circuit, and bought several lunches a day.
Re: Opioid makers made payments to one in 12 U.S. doctors
#19Earlier quoted context omitted.
They would not be providing lunch if it did not work. Advertising demonstrates how easy people are swayed by subconscious connections.
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.
Free lunches, pens, merchandise, cruises...all of these tactics work and have proven ROI for the drug manufacturers. They've known for years that they're worthwhile investments. It's not really the doctor's fault, it's just reality until there's stricter regulation.
Re: Opioid makers made payments to one in 12 U.S. doctors
#20Earlier quoted context omitted.
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…
> 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…
Yeah it was kind of an inside joke, as urine output is really important in critically ill patients and I have to constantly remind my residents and nurses of that.
As for the VA's campaign: yes, I remember it. And it's why we have those emoji scorecards all over the hospital. Which doctors never use. My subjective opinion is that we still vastly under-treat pain in the acute-care setting.
And I could talk all day long about how stupid the VA health system is.