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posted by martyb on Tuesday March 20 2018, @12:43PM   Printer-friendly
from the speechless dept.

CNN Exclusive: The more opioids doctors prescribe, the more money they make (archive)

The data:

The CNN/Harvard analysis looked at 2014 and 2015, during which time more than 811,000 doctors wrote prescriptions to Medicare patients. Of those, nearly half wrote at least one prescription for opioids.

Fifty-four percent of those doctors -- more than 200,000 physicians -- received a payment from pharmaceutical companies that make opioids.

Among doctors in the top 25th percentile of opioid prescribers by volume, 72% received payments. Among those in the top fifth percentile, 84% received payments. Among the very biggest prescribers -- those in the top 10th of 1% -- 95% received payments.

On average, doctors whose opioid prescription volume ranked among the top 5% nationally received twice as much money from the opioid manufacturers, compared with doctors whose prescription volume was in the median. Doctors in the top 1% of opioid prescribers received on average four times as much money as the typical doctor. Doctors in the top 10th of 1%, on average, received nine times more money than the typical doctor. [...]

Some studies have looked at whether the amount of money a doctor receives makes a difference. Studies by researchers at Yale University, the George Washington University Milken Institute of Public Health and Harvard Medical School have all found that the more money physicians are paid by pharmaceutical companies, the more likely they are to prescribe certain drugs.

The story:

Angela Cantone says she wishes she had known that opioid manufacturers were paying her doctor hundreds of thousands of dollars; it might have prompted her to question his judgment.

She says Dr. Aathirayen Thiyagarajah, a pain specialist in Greenville, South Carolina, prescribed her an opioid called Subsys for abdominal pain from Crohn's disease for nearly 2½ years, from March 2013 through July 2015.

Subsys is an ultrapowerful form of fentanyl, which is 50 to 100 times more potent than morphine, according to the US Centers for Disease Control and Prevention.

"He said it would do wonders for me, and it was really simple and easy. You just spray it in your mouth," Cantone said.

She says Subsys helped her pain, but it left her in "a zombie-like" state. She couldn't be left alone with her three young children, two of whom have autism and other special needs.

"I blacked out all the time. I'd find myself on the kitchen floor or the front lawn," she said.

She says that if she missed even one day of the drug, she had uncontrollable diarrhea and vomiting.

She said she brought her concerns to Thiyagarajah, but he assured her it couldn't be the Subsys that was causing her health problems.

"I trusted him. I trusted my doctor as you trust the police officer that's directing traffic when the light is out," she said.

She says that when she eventually asked Thiyagarajah to switch her to a non-opioid medication, he became belligerent.

"He said it was Subsys or nothing," she said.

Cantone would later learn that from August 2013 through December 2016, the company that makes Subsys paid Thiyagarajah more than $200,000, according to Open Payments, the federal government database that tracks payments from pharmaceutical companies to doctors.
CNN compared the $190,000 he received from 2014 to 2015 with other prescribers nationwide in the same medical specialty and found that he received magnitudes [50 times] more than the average for his peers.

Nearly all of the payments were for fees for speaking, training, education and consulting.

Dr. Aathirayen Thiyagarajah wrote nearly twice as many opioid prescriptions per patient annually compared to his colleagues

The rebuttal:

Dr. Patrice Harris, a spokeswoman for the American Medical Association, said that the CNN and Harvard data raised "fair questions" but that such analyses show only an association between payments and prescribing habits and don't prove that one causes the other.

It's "not a cause and effect relationship," said Harris, chairwoman of the association's opioid task force, adding that more research should be done on the relationship between payments and prescriptions.

"[We] strongly oppose inappropriate, unethical interactions between physicians and industry," she added. "But we know that not all interactions are unethical or inappropriate."  Harris added that relationships between doctors and industry are ethical and appropriate if they "can help drive innovation in patient care and provide significant resources for professional medical education that ultimately benefits patients."


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  • (Score: 4, Insightful) by insanumingenium on Tuesday March 20 2018, @04:09PM (2 children)

    by insanumingenium (4824) on Tuesday March 20 2018, @04:09PM (#655443) Journal
    I would love to see decriminalization, but that isn't the issue here. These aren't illegal drugs, these people aren't taking these drugs because they want them per se. These people are taking these drugs because the person they made responsible for their well being suggested it, and here is the crucial bit, according to the article the doctors that suggest it the most are getting paid the most by the manufacturers.

    Now perhaps there is some missing information, perhaps all these high paid pushers are all treating client bases which actually need more drugs. I would welcome data from both sides.

    But if the situation is as is suggested, that people are being prescribed in excess of need primarily for the financial benefit of their doctors, then we have a serious problem.

    I do things under doctors orders that I wouldn't do otherwise, most obviously take drugs, if the doctor had anything but my well being in mind when he made those recommendations that would be a terrible breach of trust.

    Also, I hope you are never close to any addicts, that would make it very hard for you to deny the very real costs of addiction.
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  • (Score: 2) by aiwarrior on Tuesday March 20 2018, @06:26PM

    by aiwarrior (1812) on Tuesday March 20 2018, @06:26PM (#655540) Journal

    > I do things under doctors orders that I wouldn't do otherwise

    This! Modern medicine requires a huge amount of training and knowledge so I assume that if this person says I should take this, then that is what is best. Maybe people don't realize, but most doctors can do what would be rape, if committed by any other person. I would never submit to a prostate examine by any other living being than a doctor. This is the amount of trust people put.

    Poor America. Good luck

  • (Score: 2) by NotSanguine on Tuesday March 20 2018, @07:09PM

    Now perhaps there is some missing information, perhaps all these high paid pushers are all treating client bases which actually need more drugs. I would welcome data from both sides.

    One of the things I noted from TFA which isn't included in TFS is that while the data on moneys paid to physicians is from the CMS database [cms.gov] which (or at least it's supposed to) covers all physicians in the US, the prescribing data comes only from *Medicare* recipients.

    While there certainly are a lot of folks on Medicare (anyone over 65), there are many, many more who have private insurance or Medicaid.

    Given that older people have chronic pain issues more often than younger people, it stands to reason that physicians would prescribe more painkillers to older folks.

    One of the confusing things about TFA is why someone with young children (who was interviewed for the story) would be a part of the dataset used for the study. My guess is that she wasn't. Since her doctor was one of the most highly paid by big pharma, and that same physician (based on the Medicare data) prescribes opioids more than other physicians, it seems reasonable to expect that he would do so for non-Medicare patients as well.

    But that's just inference, not data. We don't have any good studies on opioid prescribing nationally, in part, because while many states require reporting of such prescriptions, not all of them do, and the data that is reported isn't uniform or normalized between state programs.

    What's more, that while correlation between volume of opioid prescriptions and "consulting/speaking fees" appears to be statistically significant, correlation does not explicitly mean causation.

    This is complicated by the fact that many physicians play a dual role as educators (especially since physicians are *required* to have continuing education throughout their careers) and who better to educate others than those with significant experience in a particular specialty.

    All that said, based on the strong correlations, the whole thing stinks of unsavory activities by big pharma and the physicians who receive hundreds of thousands of dollars.

    Perhaps a solution might be to require the AMA to host and cover *all* costs for continuing education for its members and preclude big pharma (even if they contribute to the AMA's continuing education funds) from paying physicians directly.

    There are several physicians in my family and I will ask their opinions (none of them specialize in "pain management" and none of them -- yes, I checked -- get large sums from big pharma) as to how they think these issues should be handled.

    --
    No, no, you're not thinking; you're just being logical. --Niels Bohr