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Opioid makers made payments to one in 12 U.S. doctors

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21–30 of 105 posts

Re: Opioid makers made payments to one in 12 U.S. doctors

#21
I don't like the 'pigs at the trough' image of this type of report. There are almost certainly pigs, but there is much more to resolving it than just revoking some licenses or throwing some people in jail.

Standard practice in business of all types is to take clients out for a meal to talk business. Usually, the meal setting enables a different type of legitimate, sober interaction. Many types of business are conducted this way. Some companies have policies that limit the value of what a salesperson can share with a client, for example, Applied Materials limits the value of any type of entertainment by a vendor to $100. This is good corporate policy to inhibit undue influence by vendors.

But it is not 'a payment'.

Likewise, it is pretty easy to see that pharma would want a Dr. who is prescribing their medication and has a positive story to tell to speak at one of their seminars. The Dr. might say that his time is worth $x, and the Pharma needs to cover his travel expenses, and then he'd consent to presenting. In this case, any fees paid would be considered payment. The question is, how much is being paid and does that payment present undue influence. Many doctors are independent contractors and can choose to do this type of activity without a policy to override or limit the value of it. On the other hand, state medical boards which license physicians should have policies that limit all medical and pharmaceutical companies in how they can influence physicians.

Re: Opioid makers made payments to one in 12 U.S. doctors

#22
post #12

This 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?

I honestly think it makes a difference. People don't necessarily think about the monetary value of something. It's like paying for employees' lunches every day. At $10 each the cost is 5104= $200/month. I am pretty sure they will be more excited about free lunch than $200/month more.

Re: Opioid makers made payments to one in 12 U.S. doctors

#23
post #5

Reminds me of what Rostand said about murder: "Kill one man, and you are a murderer. Kill millions of men, and you are a conqueror. Kill them all, and you are a god." Sell one oxycontin and you're drug dealer; sell a million and you're a C level.

31 billion$ earned on the sale of oxycontin...

https://en.wikipedia.org/wiki/Oxycodone#History

Re: Opioid makers made payments to one in 12 U.S. doctors

#24
post #12

This 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?

Sure free lunch has always been seen as a perk even for the supposedly rational and logical people like programmers (being slightly sarcastic there). I've heard of people going for a lower paying jobs and citing free lunch as deciding factor.

Moreover there are other ways to influence doctors. In some states they have to pass certifications or exams for continued education. Pharma companies would pay the companies writing the tests to insert names of their drugs in there.

There are speaking fees and other such things. Eventually the law catches up but by then they find a new loophole.

Re: Opioid makers made payments to one in 12 U.S. doctors

#25

I don't like the 'pigs at the trough' image of this type of report. There are almost certainly pigs, but there is much more to resolving it than just revoking some licenses or throwing some people in jail. Standard practice in business of all types is to take clients out for a meal to talk business. Usually, the meal setting enables a different type of legitimate, sober interaction. Many types of business are conduct…

[deleted]

Re: Opioid makers made payments to one in 12 U.S. doctors

#26

I don't like the 'pigs at the trough' image of this type of report. There are almost certainly pigs, but there is much more to resolving it than just revoking some licenses or throwing some people in jail. Standard practice in business of all types is to take clients out for a meal to talk business. Usually, the meal setting enables a different type of legitimate, sober interaction. Many types of business are conduct…

I think that is ridiculous.

Learning about new medicine is continuing education for physicians. It is their job. Having a third party paying them or even just offering dinner to them so they can do their jobs is a huge conflict of interest.

Further, they are getting a completely biased education on these new drugs in addition to being "taught" by pharma reps who often do not even have a BS in life sciences...so they are very limited in being able to relay nuanced medical information.

Re: Opioid makers made payments to one in 12 U.S. doctors

#27
Maybe it's because Americans just have this cognitive dissonance that their trusted doctor could be any less than 100% conscientious about their health, but we need to plainly face the fact that if members of the press were able to write exposés about drug makers' fudging the data about the addictiveness and effectiveness of their products, that doctors with their medical training and responsibility over actual people's lives should have proceeded with more caution and not written scripts mindlessly to get rid of every tiny pain patients had just because they kept asking for something. It's just unconscionable.

EDIT: this survey was also very damning: http://www.chicagotribune.com/news/local/breaking/ct-prescri...

Re: Opioid makers made payments to one in 12 U.S. doctors

#28
I have two relatives that died from prescription opioid addiction and abuse and I don't think a few payments here and there is what motivates doctors to prescribe these drugs at a higher rate. Maybe it does maybe not. The fact is they are powerful drugs that can stop pain AND they make LOTS of money so they get pushed as the best option.

The thing that is in question in a doctors mind is, can I say this is the best option. Thats what the face-time with reps, meals, conferences etc are doing, giving the MD a perception that this is best practice. It's the professional cover to prescribe what everyone knows is a highly addictive and dangerous narcotic.

If the same kind of money were spent on informing, reminding and reminding again, face-time with addiction prevention advocates, conferences on the opioid epidemic, payments for speaking on alternatives to opioids for pain treatment, giving doctors the facts about these drugs, the addiction and death rates, the impact on families and communities of the inevitable proportion of people who will become addicted and of those who will die, it will be much much harder to say this is a best practice.

But even then doctors are pushed hard to deal with as many patients as possible. A quick answer that deals with the immediate problem is what the patient wants and its all the doc has time and support from the system to give. This situation lends itself to the potential for those who truly benefit, the makers of these drugs, to take advantage of the situation and push drugs they know will make people addicted leading to higher use and profits. Lost lives and destroyed families be damned.

Re: Opioid makers made payments to one in 12 U.S. doctors

#29
post #16

Earlier 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…

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.

I was given a 30 day supply of oxy-something when I had my wisdom teeth removed. I needed 0 of the pills.

Re: Opioid makers made payments to one in 12 U.S. doctors

#30
post #5

Reminds me of what Rostand said about murder: "Kill one man, and you are a murderer. Kill millions of men, and you are a conqueror. Kill them all, and you are a god." Sell one oxycontin and you're drug dealer; sell a million and you're a C level.

That can be generalised.

Petty thieves break the law. Mafiosos skirt and avoid the law. The real kingpins write the law.

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