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posted by martyb on Sunday June 04 2017, @03:49PM   Printer-friendly
from the content-and-context dept.

Researchers have found that a one paragraph letter to the New England Journal of Medicine in 1980 was "uncritically cited as evidence that addiction was rare with long-term opioid therapy" [emphasis in original retained]:

Canadian researchers have traced the origins of the opioid crisis to one letter published almost 40 years ago.

The letter, which said opioids were not addictive, was published in the New England Journal of Medicine (NEJM) in 1980.

Dr David Juurlink says the journal's prestige helped fuel the misguided belief that opioids were safe.

His research found that the letter was cited more than 600 times, usually to argue that opioids were not addictive.

On Wednesday, the NEJM published Dr Juurlink's rebuttal to the 1980 letter, along with his team's analysis of the number of times the letter was cited by other researchers.

The two names to blame? Dr. Hershel Jick and his assistant Jane Porter. Dr. Jick did not anticipate the misuse of his short letter:

Jick still works at Boston University School of Medicine. He told the Associated Press this week that he is "essentially mortified that that letter to the editor was used as an excuse to do what these drug companies did."

"They used this letter to spread the word that these drugs were not very addictive," he said. Jick noted that he testified as a government witness in a lawsuit some years ago concerning the marketing of pain drugs.

A 1980 Letter on the Risk of Opioid Addiction (DOI: 10.1056/NEJMc1700150) (DX)

Addiction Rare in Patients Treated with Narcotics (DOI: 10.1056/NEJM198001103020221) (DX)


Original Submission

Related Stories

Purdue Pharma to Cut Sales Force, Stop Marketing Opioids to Doctors 46 comments

Pain Pill Giant Purdue to Stop Promotion of Opioids to Doctors

Pain-pill giant Purdue Pharma LP will stop promoting its opioid drugs to doctors, a retreat after years of criticism that the company's aggressive sales efforts helped lay the foundation of the U.S. addiction crisis.

The company told employees this week that it would cut its sales force by more than half, to 200 workers. It plans to send a letter Monday to doctors saying that its salespeople will no longer come to their clinics to talk about the company's pain products.

"We have restructured and significantly reduced our commercial operation and will no longer be promoting opioids to prescribers," the company said in a statement. Instead, any questions doctors have will be directed to the Stamford, Connecticut-based company's medical affairs department.

OxyContin, approved in 1995, is the closely held company's biggest-selling drug, though sales of the pain pill have declined in recent years amid competition from generics. It generated $1.8 billion in 2017, down from $2.8 billion five years earlier, according to data compiled by Symphony Health Solutions. It also sells the painkiller Hysingla.

Oxycodone.

Also at Reuters, USA Today, The Verge, and CNN.

Previously: City of Everett, Washington Sues OxyContin Maker Purdue Pharma
OxyContin's 12-Hour Problem
South Carolina Sues OxyContin Maker Purdue

Related: Opioid Crisis Partly Blamed on a 1980 Letter to the New England Journal of Medicine
President Trump Declares the Opioid Crisis a National Emergency
Study Finds Stark Increase in Opioid-Related Admissions, Deaths in Nation's ICUs
CVS Limits Opioid Prescriptions
Congress Reacts to Reports that a 2016 Law Hindered DEA's Ability to go after Opioid Distributors
Opioid Crisis Official; Insys Therapeutics Billionaire Founder Charged; Walgreens Stocks Narcan


Original Submission

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  • (Score: 2, Interesting) by Anonymous Coward on Sunday June 04 2017, @03:59PM (3 children)

    by Anonymous Coward on Sunday June 04 2017, @03:59PM (#520245)

    In conclusion, we found that a five-sentence letter published in the Journal in 1980 was heavily and uncritically cited as evidence that addiction was rare with long-term opioid therapy.

    When I did medical research I would find stuff like this all the time. Sometimes a paper would cite an earlier one that just speculated something in the intro/discussion, then another paper would cite that one until the speculation became something "everyone knows". Other times they would cite a paper claiming it included an experiment when it simply didn't. Other times the original paper would claim to have checked something (eg no correlation between x and y) but if you extract the data from the charts and analyze yourself you see a very huge one. AFAIK that drug is still in clinical trials. Watch out.

    • (Score: 3, Informative) by Anonymous Coward on Sunday June 04 2017, @05:34PM (1 child)

      by Anonymous Coward on Sunday June 04 2017, @05:34PM (#520285)

      When I did medical research I would find stuff like this all the time.

      Its not just medical research. Everyone here ought to be familiar with the waterfall model of software engineering.
      Well its origin was a 1970 paper [obsglobal.com] that used it as a simplistic process for the purposes of demonstrating the flaws of simplistic engineering processes. But people didn't pay attention to the thesis of the paper, they just uncritically cited it to legitimize a very flawed but very simple engineering process. That snowballed and pretty soon it became accepted as an industry standard.

      We all stand on the shoulders of those who came before us. It is impossible for anyone to know more than a tiny fraction of the knowledge out there. But it is also important not to be intellectually lazy. Finding a balance is hard, go too far in one direction and you become a lemming jumping off a cliff, go to far in the other direction and you sit there constantly re-inventing the wheel but never using it to go forward.

      • (Score: 2) by goodie on Monday June 05 2017, @03:14PM

        by goodie (1877) on Monday June 05 2017, @03:14PM (#520778) Journal

        Interesting comparison with the waterfall model. What I love about this one is that Royce never advocated for the kind of rigid, linear process that "agile" claims it is. And his paper has a section called "involve the customer". Anyway, it's become a stereotype for better or worse.

    • (Score: 2) by FatPhil on Monday June 05 2017, @10:19PM

      by FatPhil (863) <pc-soylentNO@SPAMasdf.fi> on Monday June 05 2017, @10:19PM (#521011) Homepage
      What I don't understand is that when an old family friend was on his last legs, back in the late 70s, I remember hearing my parents discussing the problems with the opioids that were being prescribed. In particular, I remember the discussions touching upon the adddictive nature of the drugs. (And the follow-up of "well, it's not going to fuck him up for long".) Why was medicine in the UK so different from medicine in the US?
      --
      The "free" in #freearistarchus is the "free" in "free jazz"
  • (Score: 1, Interesting) by Anonymous Coward on Sunday June 04 2017, @04:35PM (2 children)

    by Anonymous Coward on Sunday June 04 2017, @04:35PM (#520255)

    Can't we just blame this on moral decline, lazy bums and the erosion of family values like usual.

    Oh wait, it's white Republicans dying? White Trump voters? OK let's cut all their healthcare lol. At least Republicans will get to taste their own dog food that they've been putting on the menu for the last 30 years.

    • (Score: 0) by Anonymous Coward on Sunday June 04 2017, @04:47PM

      by Anonymous Coward on Sunday June 04 2017, @04:47PM (#520262)

      We've eaten the dogfood. Now we're eating the dogs. My best advice, keep your ugly sister home!

    • (Score: 1, Funny) by Anonymous Coward on Sunday June 04 2017, @06:19PM

      by Anonymous Coward on Sunday June 04 2017, @06:19PM (#520305)

      You have to be more specific than that. Opioids being addictive is something new--they weren't before because doctors are never wrong, and this new addictiveness is caused by millennials, political correctness, and marijuana. Mostly millennials and marijuana. Marijuana itself makes opioids addictive. I'm sure Mr. Sessions would never lie to us about that. Of course, we wouldn't have millennials and marijuana without political correctness. So there you have it.

  • (Score: 2) by Runaway1956 on Sunday June 04 2017, @04:46PM (2 children)

    by Runaway1956 (2926) Subscriber Badge on Sunday June 04 2017, @04:46PM (#520261) Journal

    The letter seems to cover it's bases fairly well. First, the professional environment when the letter was written tended to discourage the prescription of potentially addictive drugs. Not ban them, nothing like that, it just discouraged any unnecessary prescriptions. Bearing that in mind, the letter goes on to stipulate that properly monitored patients, in hospital, seldom developed addictions.

    Maybe Jick "contributed" to some small degree to today's crisis. Maybe Jick should have emphasized the limitations of his stufy. Maybe Jick was less than 100% responsible. But, Jick didn't twist the pharmaceutical company's arms to wage a sales campaign, pushing the drugs.

    Someone is looking for a scapegoat is all I see here. We had a related discussion recently, which exposed Big Pharma's culpability in this. https://soylentnews.org/comments.pl?noupdate=1&sid=19639&page=1&cid=513377 [soylentnews.org]

    --
    ︻╦══╤─
    • (Score: 0) by Anonymous Coward on Sunday June 04 2017, @05:49PM

      by Anonymous Coward on Sunday June 04 2017, @05:49PM (#520294)

      Can't trust scientists. that's the take home message. Contradictions, retractions, arguments over many decades. Shh, there there, be calm. It's time to let the Leader lead. That's why Jeff Sessions will be introducing draconian punishment for all drug offenses. And mandatory minimums because you can't trust judges either.

    • (Score: 0) by Anonymous Coward on Sunday June 04 2017, @09:36PM

      by Anonymous Coward on Sunday June 04 2017, @09:36PM (#520373)

      Maybe Jick "contributed" to some small degree to today's crisis. Maybe Jick should have emphasized the limitations of his stufy. Maybe Jick was less than 100% responsible.

      Or, maybe not. Really hard to judge, when Runaway opines on opiates.

  • (Score: 2) by VLM on Sunday June 04 2017, @05:11PM (1 child)

    by VLM (445) Subscriber Badge on Sunday June 04 2017, @05:11PM (#520272)

    I read both letters, the original and the response, and they're apples and oranges comparisons.

    The most striking observation is the original letter specified patients in the hospital. So, setting a broken leg or surgery or cancer hospice care.

    Whereas the response letter specifically defines the problem as outpatient long term use.

    I think its very likely both letters do not conflict and are simultanously true.

    It sounds extremely realistic that giving a terminally ill hospice patient an injection in their last week of life or giving a little kid an injection while their broken leg is set into a cast will not result in long term addiction. While at the same time sending someone home with a bottle or two of pills and medical instructions that they are not medically cleared to do anything but get high and watch daytime TV is probably going to turn them into a raging addict.

    Just look at the setting alone; one scenario associates getting high with dying, broken bones, car accident, burn unit, not really positive stuff. The other associates getting high with partying at home and watching TV. Hmm. Getting high in the burn unit after the fire accident or getting high watching anime at home, I wonder which makes more addicts LOL.

    • (Score: 1, Informative) by Anonymous Coward on Sunday June 04 2017, @11:31PM

      by Anonymous Coward on Sunday June 04 2017, @11:31PM (#520441)

      Along with this has been the development (and/or commercialization) of very high potency opiates. The latest stuff from big pharma is orders of magnitude more potent than heroin (a patent medicine ~100 years ago) and morphine.

  • (Score: 0) by Anonymous Coward on Sunday June 04 2017, @05:34PM (2 children)

    by Anonymous Coward on Sunday June 04 2017, @05:34PM (#520286)

    Conventional medical wisdom also seems to say that amphetamines are not addictive when prescribed by a doctor.

    • (Score: 0) by Anonymous Coward on Sunday June 04 2017, @06:16PM (1 child)

      by Anonymous Coward on Sunday June 04 2017, @06:16PM (#520303)

      Source?

      • (Score: 0) by Anonymous Coward on Monday June 05 2017, @07:15AM

        by Anonymous Coward on Monday June 05 2017, @07:15AM (#520609)

        Whoosh... look it up, it's very reliable.

  • (Score: 0) by Anonymous Coward on Sunday June 04 2017, @07:04PM

    by Anonymous Coward on Sunday June 04 2017, @07:04PM (#520320)

    Those darn opioids! They're so bad for you that rather than see you abuse them (as we define the word), we'll kill you for your own good.

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