Opioid makers made payments to one in 12 U.S. doctors • Hacker News Board

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

#31

Post by vkou » Fri, Aug 18, 2017, 9:01 PM UTC

Not related to payments, but related to opioids:

My father broke his thumb a few weeks ago, while operating a woodchipper. After getting a cast, he went to see a specialist, who recommended that K-wires be surgically installed - small metal rods that go into his thumb, until it heals, at which point they will be pulled out.

He got local anesthetic, got the wires installed, and got sent home. Because he lives in Canada, they gave him nothing for the pain. Two days later, the pain died down, and he's now waiting for the bones to heal.

In America, I can't imagine that doctor would get many positive reviews from his patients, for not prescribing painkillers. Market forces would push him towards over-prescribing... And statistically, some of his patients will become addicted.

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

#32

Post by rayuela » Fri, Aug 18, 2017, 9:19 PM UTC

vkou wrote: post #31

Not related to payments, but related to opioids: My father broke his thumb a few weeks ago, while operating a woodchipper. After getting a cast, he went to see a specialist, who recommended that K-wires be surgically installed - small metal rods that go into his thumb, until it heals, at which point they will be pulled out. He got local anesthetic, got the wires installed, and got sent home. Because he lives in Canad…

What? You've responded to a rigorous research paper with a completely baseless guess of what America might be like...

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

#33

Post by zjaffee » Fri, Aug 18, 2017, 9:21 PM UTC

lr4444lr wrote: post #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 peopl…

Your ignoring the fact that up until recently, pain was considered to be the fifth vital sign and was just as important to treat as things like a fever.

Medicine as a field is largely about removing discomfort, as many medical conditions could be relatively debilitating. Think how many times taking an ibuprofen/acetaminophen just made it possible for you to go on with your day, rather than needing to lay in bed in agony. For people with chronic pain, or those coming out of surgery, perceived recovery time can be a big thing for people.

Additionally, the article didn't address the fact that it could very well be that doctors were being paid off to prescribe a particular brand of opioid rather than just opioids in general, something that is relatively common when there are a large number of drugs that can equally help treat a given ailment.

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

#34

Post by api_or_ipa » Fri, Aug 18, 2017, 9:31 PM UTC

liveoneggs wrote: post #11

check your doctor: https://openpaymentsdata.cms.gov/

This really should be more widely known. TIL my doctor got a meal + beverages worth $130. Seems reasonable compared to the national average of over $3k.

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

#35

Post by lr4444lr » Fri, Aug 18, 2017, 9:35 PM UTC

zjaffee wrote: post #33

lr4444lr wrote: post #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 peopl…

Your ignoring the fact that up until recently, pain was considered to be the fifth vital sign and was just as important to treat as things like a fever. Medicine as a field is largely about removing discomfort, as many medical conditions could be relatively debilitating. Think how many times taking an ibuprofen/acetaminophen just made it possible for you to go on with your day, rather than needing to lay in bed in ag…

I think you're raising an interesting point, but I disagree with your example - what pain that is so bad its sufferer needs "to lay in bed in agony" can be relieved by ibuprofen, acetaminophen, or any other OTC pain reliever? The Great Binge[0] ended long ago - perhaps for the wrong reasons, but ended nonetheless, until recently when legal opioid prescriptions spiked.

This is about doctors putting their patients at risk in the process of treating them for routine problems which did not result in opioid addiction rates as recently as 25 years ago, and certainly were not prescribed with any other side benefit as far as I've heard.

[0]https://en.wikipedia.org/wiki/The_Great_Binge

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

#36

Post by slededit » Fri, Aug 18, 2017, 9:43 PM UTC

rdtsc wrote: post #24

refurb wrote: 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 wr…

Getting lunch from your employer isn't the same and doesn't cause a conflict of interest. Its not about the lunch but rather who the lunch is coming from.

If you worked for google and Uber was buying your lunches then there would be a conflict of interest.

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

#37

Post by mnm1 » Fri, Aug 18, 2017, 9:51 PM UTC

lr4444lr wrote: post #35

zjaffee wrote: post #33

Earlier quoted context omitted.

Your ignoring the fact that up until recently, pain was considered to be the fifth vital sign and was just as important to treat as things like a fever. Medicine as a field is largely about removing discomfort, as many medical conditions could be relatively debilitating. Think how many times taking an ibuprofen/acetaminophen just made it possible for you to go on with your day, rather than needing to lay in bed in ag…

I think you're raising an interesting point, but I disagree with your example - what pain that is so bad its sufferer needs "to lay in bed in agony" can be relieved by ibuprofen, acetaminophen, or any other OTC pain reliever? The Great Binge[0] ended long ago - perhaps for the wrong reasons, but ended nonetheless, until recently when legal opioid prescriptions spiked. This is about doctors putting their patients at r…

Headaches can easily be that bad and relieved with ibuprofen. Otherwise yeah, it's lay in bed and try to sleep and hope they don't last into the next day.

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

#38

Post by mnm1 » Fri, Aug 18, 2017, 9:55 PM UTC

vkou wrote: post #31

Not related to payments, but related to opioids: My father broke his thumb a few weeks ago, while operating a woodchipper. After getting a cast, he went to see a specialist, who recommended that K-wires be surgically installed - small metal rods that go into his thumb, until it heals, at which point they will be pulled out. He got local anesthetic, got the wires installed, and got sent home. Because he lives in Canad…

Sounds like a shitty doctor. It takes longer than two days on weak opiates to get addicted and the doctor knows that.

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

#39

Post by tylersmith » Fri, Aug 18, 2017, 9:55 PM UTC

api_or_ipa wrote: post #34

liveoneggs wrote: post #11

check your doctor: https://openpaymentsdata.cms.gov/

This really should be more widely known. TIL my doctor got a meal + beverages worth $130. Seems reasonable compared to the national average of over $3k.

When I was younger I was prescribed Paxil and strongly encouraged to stick with it despite horrible side effects. Brain shocks, hateful feelings, and definitely horrible depression to name a few of the non-personal ones. I still have them occasionally 6 years later. I eventually ran away from my old life, moved across the country, and eventually stopped the Paxil and eventually got better but not after burning a ton of bridges. After this site came out I found the doctor had been given nearly $30k from Glaxo Smith Kline over a few years.

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

#40

Post by tylersmith » Fri, Aug 18, 2017, 10:00 PM UTC

refurb wrote: 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?

Why not? When my wife worked at an insurance agency they always refered people to mechanics/etc that stopped by and gave them candy every few months. Not all doctors handle their profession with the respect and care we'd like.