[Plura-list] How Big Pharma bribed docs to overprescribe opioids

[Cory Doctorow]

Read today's issue online at: https://pluralistic.net/2022/05/17/dollars-for-docs/

Today's links

* How Big Pharma bribed docs to overprescribe opioids: Analysis from UCSF's "Opioid Industry Documents" repository.

* Hey look at this: Delights to delectate.

* This day in history: 2002, 2007, 2012, 2017, 2021

* Colophon: Recent publications, upcoming/recent appearances, current writing projects, current reading

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🥷 How Big Pharma bribed docs to overprescribe opioids

I have complex chronic pain, and I've seen a lot of specialists. One of them prescribed long-term opioids for me. I dodged a bullet there, I think. Here's a little story about how hard it is to know whether to trust your doctor when you have a pain condition.

One day, I was in a neurologist's office here in Burbank, waiting for a nerve timing study. I picked up the neurology journal on the waiting-room table and thumbed through it. The lead study was an article about how opioid addiction risks had been overstated and doctors didn't have to worry about it. It cited the infamous "Jick letter," a five-sentence letter to the editor at the *NEJM*, which pharma companies turned into the foundation of a tower of junk addiction science that collapsed and led to 800,000 fatal overdoses, and counting.

https://www.theatlantic.com/health/archive/2017/06/nejm-letter-opioids/528840/

I knew that this was a bad sign, so I turned to the journal's colophon and learned that it was not a journal at all. It was an advertorial from a pharma giant - one with a profitable line in opioids - that was disguised as a peer-reviewed journal. It looked like a journal, but it wasn't. It was targeted at doctors - like my doctor.

I put the journal down, just as a well-made-up, confident woman strode into the waiting room with a tray of Starbucks Frappuccinos and toaster-sandwiches, which she handed to the receptionist, who shared them out across the back-office staff. They clearly all knew each other well, and the food was a prelude to a merry chat about the doctor, her prescribing habits, and the practice overall. That woman was a pharma rep, from a different company to the one that published the fake journal.

I discussed all this with my doctor when I got into the examination room and she sighed and said she didn't know what to do. She relied on the pharma companies for continuing education and technical updates on medication for her patients, and her staff were only getting the same perks that every medical office staff in the building were getting.

It didn't inspire confidence.

Over the past 15 years, the origins and scope of the opioid epidemic have come into focus, and we've learned that this was no accident. Pharma companies - led by Purdue Pharma, makers of Oxycontin, owned by the secretive billionaire Sackler family, who once threatened to sue me for criticizing them - deliberately created the epidemic and made fortunes by doing so.

The plot to addict people to opioids had a lot of moving parts. One arm of it targeted pharmaceutical distributors. McKinsey was brought in to help with this, and they proposed that pharma companies could pay bonuses to distributors based on the number of overdoses in their sales territories:

https://www.nytimes.com/2021/02/03/business/mckinsey-opioids-settlement.html

But the key battleground of the opioid crisis was right there, in my doctor's office, and in thousands of offices just like it. Pharma companies bribed office staff with Starbucks calorie-bombs, and then they bribed docs. They paid docs vast sums of money to give "speeches" at conferences, or paid to fly them and their families to those conferences at swanky tropical resorts. They paid them to do "research," or paid them to "consult." These were tissue-thin pretexts for transferring vast sums - sometimes millions - to the doctors most willing to overprescribe their products.

12 years ago, Propublica stood up Dollars for Docs, a searchable database of cash transfers from pharma companies to MDs. The reason a nonprofit newsroom had to step in to provide this critical information to patients? The US government abdicated that responsibility.

https://projects.propublica.org/docdollars/

Finally, in 2019, the US Centers for Medicare and Medicaid Services stepped up and launched the more comprehensive and up-to-date "Open Payments" service. Go check whether your doc is on the take!

https://openpaymentsdata.cms.gov/

But these databases offer an incomplete picture of the opioid wars; the only offer a glimpse into one aspect of the outcomes of pharma bribes: how much money changed hands. The *Washington Post* did yeoman service fleshing out that picture, cross-referencing the list of top bribe recipients with the list of top opioid prescribers:

https://www.washingtonpost.com/investigations/interactive/2022/mallinckrodt-documents-doctors-sales/

Still, we were only seeing the outputs, not the inputs, so we only had a partial picture of the depravity and callousness of the pharma industry execs who masterminded this plot. That changed earlier this year, when a court settlement with some pharma giants led to the release of 1.4 million internal docs:

https://www.industrydocuments.ucsf.edu/opioids/

Now, Propublica offers the first findings from that trove, with Charles Ornstein laying out the internal deliberations and schemes at opioid peddlers, leaving no doubt that the hundreds of thousands of deaths they caused, and the millions of lives they destroyed, were no accident:

https://www.propublica.org/article/pharmaceuticals-pay-doctors-drugs

Take this chart from Covidien, tracking whether Las Vegas doctors were hitting their prescription targets for the highly addictive opioid Exalgo. An accompanying email from a Covidien rep excitedly recounts using small bribes to turn doctors' office staff into eager cheerleaders for opioids:

https://www.industrydocuments.ucsf.edu/docs/#id=qngf0253

Covidien's reps followed a script, and they fed back on its efficacy to the company so it could be constantly refined to enable the company to recruit more footsoldiers in its battle to increase opioid use.

Covidien was eventually flogged off to med-tech monopolist (and notorious tax-evader) Medtronic, and the opioid business was spun out into a company called Mallinckrodt - which eventually paid a $1.75b settlement for its opioid tactics (the company refused to admit any guilt).

https://www.mallinckrodt.com/about/news-and-media/news-detail/?id=26491

The company also paid $260m to settle claims related to its program of paying kickbacks to doctors who prescribed its H.P. Acthar Gel, an expensive alternative to cheaper drugs, whose efficacy is, at best, dubious:

https://www.propublica.org/article/the-obscure-drug-with-a-growing-medicare-tab

The new document trove will continue to reveal the corrupting influence of pharma companies who view their fines as merely part of the cost of doing business, and who continue to operate and generate dividends for their shareholders and bonuses for their executives.

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🥷 Hey look at this

* Life Among the Econ https://ibiblio.org/philecon/life-econ-crop.pdf (h/t John Naughton)

* Software Freedom Conservancy hands Vizio its ass https://sfconservancy.org/news/2022/may/16/vizio-remand-win/

* What is the Software Freedom Conservancy? https://sfconservancy.org/news/2022/may/12/introduction/

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🥷 This day in history

#20yrsago Kottke on ETCON https://web.archive.org/web/20020603082103/http://www.kottke.org/02/05/index.html

#15yrsago Image-search isn’t a copyright violation (Perfect 10)https://web.archive.org/web/20070519084149/https://www.eff.org/deeplinks/archives/005259.php

#15yrsago Rudy Rucker, Terry Bisson and me reading/talking in SF https://ia802708.us.archive.org/26/items/SFinSF_Cory_Doctorow_and_Rudy_Rucker/SFinSF_1_Cory_Doctorow_256.mp3

#15yrsago HD-DVD re-cracked six days *before* it is patched https://www.engadget.com/2007-05-17-newest-aacs-circumvented-the-matrix-trilogy-set-free.html

#10yrsago Private-equity driven dentists accused of “dentally abusing” poor kids on Medicaid with painful, unnecessary procedures https://www.bloomberg.com/news/articles/2012-05-17/dental-abuse-seen-driven-by-private-equity-investments

#10yrsago People of Burning Man [NSFW] https://memex.craphound.com/2012/05/17/people-of-burning-man-nsfw/

#10yrsago Canada’s warrantless surveillance bill is, improbably, dead https://web.archive.org/web/20120516120311/https://www.theglobeandmail.com/news/politics/john-ibbitson/how-the-toews-sponsored-internet-surveillance-bill-quietly-died/article2432916/

#10yrsago London cops want to suck your phone dry in an instant https://web.archive.org/web/20121025162138/http://www.computerworlduk.com/news/public-sector/3357807/met-police-uses-quick-mobile-data-extraction-system-against-suspects/

#5yrsago The new Apple campus has a 100,000 sqft gym and no daycare https://qz.com/984785/apples-new-5-billion-apple-park-campus-has-a-100000-square-foot-gym-and-no-daycare-aapl/

#5yrsago Mocking the $2,145 “couture Ikea bag” with awesome Ikea bag hacks https://food52.com/blog/19685-how-to-repurpose-your-bright-blue-ikea-bag

#5yrsago Airline lobby group claims a laptop ban would cost $1B https://consumerist.com/2017/05/17/airline-industry-says-expanding-ban-on-laptops-would-cost-travelers-1-billion/

#5yrsago Chelsea Manning is a free woman https://theintercept.com/2017/05/17/chelsea-manning-is-a-free-woman-her-heroism-has-expanded-beyond-her-initial-whistle-blowing/

#1yrago The Public Interest Internet: Reviving pre-enclosure glory https://pluralistic.net/2021/05/17/disgracenote/#enclosure

#1yrago Paygo, false consciousness and the IRS: Why we can't have nice things https://pluralistic.net/2021/05/17/disgracenote/#false-consciousness

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🥷 Colophon

Today's top sources:

Currently writing:

* Some Men Rob You With a Fountain Pen, a Martin Hench noir thriller novel about the prison-tech industry. Yesterday's progress: 539 words (4937 words total)

* The Internet Con: How to Seize the Means of Computation, a nonfiction book about interoperability for Verso 1038 words (1644 words total)

* Picks and Shovels, a Martin Hench noir thriller about the heroic era of the PC. Yesterday's progress: 508 words (92849 words total) - ON PAUSE

* A Little Brother short story about DIY insulin PLANNING

* Vigilant, Little Brother short story about remote invigilation. FIRST DRAFT COMPLETE, WAITING FOR EXPERT REVIEW

* Moral Hazard, a short story for MIT Tech Review's 12 Tomorrows. FIRST DRAFT COMPLETE, ACCEPTED FOR PUBLICATION

* Spill, a Little Brother short story about pipeline protests. FINAL DRAFT COMPLETE

* A post-GND utopian novel, "The Lost Cause."  FINISHED

* A cyberpunk noir thriller novel, "Red Team Blues."  FINISHED

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