Doctors already taking heat for selling out their prescription pads for financial gain may want to brace themselves for new anger from patients, regulators, and lawmakers over two sets of data detailing unsavory links between MDs’ payments from Big Pharma and their opioid drug prescribing.
CNN, Harvard University, and CareDash.com — a site that says it seeks to serve low- to middle-income patients with reliable health care information — have examined national prescribing data, finding links between Big Pharma pay and doctors’ ordering of prescription painkillers central to a nationwide epidemic of abuse.
CNN, with Harvard, reported its findings:
[O]pioid manufacturers are paying physicians huge sums of money — and the more opioids a doctor prescribes, the more money he or she makes. In 2014 and 2015, opioid manufacturers paid hundreds of doctors across the country six-figure sums for speaking, consulting and other services. Thousands of other doctors were paid over $25,000 during that time. Physicians who prescribed particularly large amounts of the drugs were the most likely to get paid.
CareDash reported its top-line findings this way:
[We] found that physicians who accepted a payment from a pharmaceutical company manufacturer related to a specific opioid drug were 14.5 times more likely to prescribe that drug over a similar alternative. The larger study results also found that physicians receiving at least one industry payment from a pharmaceutical company for any specific brand-name drug were five times more likely to prescribe that drug over alternatives, including lower cost generic drugs.
Dr. Andrew Kolodny, a senior scientist at the Institute for Behavioral Health at the Heller School for Social Policy and Management at Brandeis University, where he is co-director of the Opioid Policy Research Collaborative, said of the CNN-Harvard results: “It smells like doctors being bribed to sell narcotics, and that’s very disturbing.”
Aaron S. Kesselheim, a doctor, lawyer, associate professor of medicine at Harvard Medical School/Brigham and Women’s Hospital, and a leading global expert on bioethics, pharmaceutical law, and regulatory policies, reviewed the CareDash study and results, saying: “This study reaffirms the potential influence pharmaceutical companies have on physician prescribing practices, which can lead to possible risks for patients.”
To be clear, doctors, legally and ethically, can accept payment from drug makers and others for speaking, consulting, and providing other purported medical services. Practitioners who take such payments defend them, arguing they’re providing valuable information and advice to colleagues to improve medicine.
But as the sums for such activities rise for individual doctors, the corrosive funding can raise conflict of interest issues: Are doctors looking out for their patients first, or for themselves, Big Pharma, and lucrative payments? Lest anyone think that question’s outlandish, consider how upside-down the opioid crisis has gotten: Hospitals now are reporting that due to painkillers’ abuse, they’re now challenged to get powerful medications needed for patients with significant, bona fide pain, including from cancer and burns.
In my practice, I see the harms that patients suffer while seeking medical services, and the wreckage that can be inflicted on their lives by dangerous drugs, including risky and addictive opioids. Overdoses of these drugs, the powerful synthetic painkiller fentanyl, and illicit street heroin have become the leading killer of Americans younger than 50. In 2016 alone, opioids killed more than 64,000 Americans, and we need to know not only how we got into the crisis but ways we can get out.
A vital step, of course, would be for doctors, hospitals, and insurers to step up, accept what they have done wrong, and make corrections — including recognizing Big Pharma’s pernicious sway in promoting opioids with purported benefits that now are proving untrue. Yes, some specialists are getting paid to help doctors improve the management of their patients’ pain, including by educating them about the benefits of foregoing opioids for equally effective, long-term, and less risky therapies and medications, some of them over the counter.
But for their patients’ sake, and for their own professional respect, doctors need to see that Big Pharma — including its back-slapping, ubiquitous drug sales staffers, armed with swag and free lunches — likely have at their central interest big drug profits and not MDs or good medical practice. (And, no, Big Pharma can’t race back into the public’s good graces by pulling a 180 and helping to fund ads to fight opioid abuse).
With the president advocating extreme, perhaps provocative punishment — the death penalty — for those involved in worsening the opioid crisis, doctors and Big Pharma execs might want to mind their P’s and Q’s more scrupulously, especially with the Trump Administration’s propensity to pursue law enforcement rather than medical responses to deal with drug abuse. Indeed, federal prosecutors indicted five New York doctors, some with fancy hospital affiliations in Manhattan, in what officials have asserted is a fentanyl-prescribing kickback scheme. Authorities also have suggested they are, if anything, widening their probe of physicians’ opioid prescribing.