31–40 of 96 posts
I hope I never have to take this stuff. Watching how dependent my mom has become on this has been painful to watch.
Can somebody give some context on the root cause of the problem - the chronic pain epidemic in US. What caused it, why it is more than in other parts of the world and why so many painkillers? Is it cultural?
The patent for OxyContin was predicated on the claim that each dose lasted longer than older poducts. When that didn't work they raised the dose instead of shortening dosing intervals, which caused a reward/withdrawal cycle in patients.
Doctors should be more skeptical of pharma companies' marketing claims, right? Who believes everything they read? There's probably a case to be made that the FDA should have been more involved, too. The data on how fast OC released its drug would have been available to the FDA, if not doctors.
Which is it? I honestly don't think the FDA is culpable in this. They're there to ensure that the manufacturer is meeting a minimum standard of proof, and if the manufacturer is falsifying that proof and ignoring clinical feedback then the manufacturer is solely responsible and needs to be held accountable. But to say that the FDA isn't doing its job here isn't particularly accurate, because they're doing their best to apply the law and ensure that the claims being made are accurate.
Sensible doctors do not believe drug company marketing.
I get large amounts of ad-junk from drug companies that ends up unread in the bin. I refuse to meet with drug company representatives. I smile politely at them if I bump into them in the corridor and suggest that they leave their ad-junk with my secretary. My staff then file their ad-junk in the trash bin.
On Friday, I had a drug company representative attempt to tell me ( he was hanging around my coffee area ) about the joys of Targin, a fixed-dose combination of oxycodone and naloxone. I gently shook him off, and directed him to my secretary.
Drug company representatives are usually decent human beings with lives and families. However they are poorly educated, poorly informed salesmen and women with sales targets to meet and product managers to keep happy. Even worse, they and the drug company have no accountability if a patient dies because of their recommendations. If avoidable death supervenes or if there are non-lethal complications or even just therapeutic failure, I am accountable.
Instead of relying on marketing, I rely on information from good, well performed randomised controlled studies published in reputable peer reviewed journals ( I like the NEJM ) and on meta-analyses of these. I view the results of these through a filter of scepticism, cynicism, pragmatism and a modicum of hope.
Many of my colleagues do likewise. I trust that you do the same in your respective vocations. Regrettably, there is a bell curve. I am sure that the drug companies find enough gullible prescribers out in the wild for their purposes.
I'm sure this is an easy question to answer, but it was bugging me during the whole article. What's preventing a pill that releases a dose immediately and one after 6 hours? Or something like a diabetic pump that dispenses medication continuously? Surely such systems have the potential to be safer and more effective for patients?
> What's preventing a pill that releases a dose immediately and one after 6 hours? Being plopped into a bath of hydrochloric acid makes this a little tricky, I am led to understand. > Or something like a diabetic pump that dispenses medication continuously? And this led me down a brief Google walk for what these are, and...huh, that's a really good question...
IV pain management often includes a button the patient can push (that releases a dose and sets a timer for the next dose). Or at least it used to, I don't know if it is still done.
Can somebody give some context on the root cause of the problem - the chronic pain epidemic in US. What caused it, why it is more than in other parts of the world and why so many painkillers? Is it cultural?
>What caused it, why it is more than in other parts of the world and why so many painkillers? >Is it cultural? That's actually a really common misconception on HN. The United States ranks 27th among countries which abuse opiates, [1] behind many first-world countries like the UK, Italy, Spain, Switzerland, Ireland, and Russia, to name a few. What's the cause? A lot of HNers like to pin it on unemployment and low-wage…
Can somebody give some context on the root cause of the problem - the chronic pain epidemic in US. What caused it, why it is more than in other parts of the world and why so many painkillers? Is it cultural?
Seems to me it comes down to competence and ethics of individual doctors, as well as to preferences and susceptability of individual patients, of course.
We are not experiencing quite the epidemic proportions of the US, presumably owing to a different structure of health services, and probably a higher general level of scepticism towards medical authority, but the mechanisms and the potential are clearly in place.
Can somebody give some context on the root cause of the problem - the chronic pain epidemic in US. What caused it, why it is more than in other parts of the world and why so many painkillers? Is it cultural?
Something I've noticed: in the US people generally have an aversion to being even mildly uncomfortable. And, it's culturally acceptable to be on medication so people take it for basically any inconvenience. Sweating a little? Crank the AC. Small headache? take a pill. Bad day? Have a drink. Workout left muscles sore? Another pill. Sprained ankle? Obviously you need pain medication! It's easy to see how there is a low…
Can somebody give some context on the root cause of the problem - the chronic pain epidemic in US. What caused it, why it is more than in other parts of the world and why so many painkillers? Is it cultural?
People take painkillers because they can't afford surgery. Say you have a messed up disk in your spine. Surgery is tens of thousands of dollars. Getting a prescription for opioids from a primary care physician is a bit cheaper. You don't see doctors in europe routinely prescribing hard pain killers because they try to fix the problem instead. Healthcare in america is set up in such a way that hospitals just bill what…
There are situations where risks from surgery are potentially worse than the (yes, possibly misinformed) side effects of painkillers.
Is there any data on this? Anecdotally, I know a few people who are either living with pain or taking medication because surgery is too risky.
Doctors should be more skeptical of pharma companies' marketing claims, right? Who believes everything they read? There's probably a case to be made that the FDA should have been more involved, too. The data on how fast OC released its drug would have been available to the FDA, if not doctors.
Every time one of these articles comes out, people say that the FDA should have been more involved. Every time we hear about some new drug that Europe, India, or China has that is still being cleared in the US, people say that the FDA needs to step back and let pharma companies innovate. Which is it? I honestly don't think the FDA is culpable in this. They're there to ensure that the manufacturer is meeting a minimum…
Like what if some of the requirements for new drugs are arbitrary (slowing approval) and the standard of proof for novel release mechanisms is too low?