Doing your own research (13 Viewers)

[Terminalxylem]

Just in our lifetimes doctors have pushed dietary guidelines and foods that turned out not to be beneficial, and in some cases, like trans fats, were actively harmful. Antibiotics were handed out like candy and now we’re dealing with resistance. Then came the over-prescription of opioids and we all know how that turned out. So the idea that doctors now have it all figured out, especially when it comes to medications being aggressively marketed for profit, feels unrealistic. Sure, the person who refuses a vaccine because of something they read on Facebook is probably super frustrating. But a healthy dose of skepticism (even “research") doesn’t seem like the worst thing in the world. Sometimes it’s just a patient trying to stay informed in a system that doesn’t always earn blind trust.

I don't think I've ever disagreed with a Nipsey post in 25 years here but this is crazy to me. You're penalizing science for doing science. Of course dietary guidelines and recommendations change over time as we learn more, are better able to analyze data, and become more informed about the human body. That's literally how science is supposed to work.

I don't understand the logic in attempting to override scientific consensus and advice from your doctor who literally spent 7 years becoming an expert because of a Facebook post or a podcast from a comedian. In almost every scenario, you are better off taking the advice from your physician rather than contradicting her/his advice because you "did your own research".

Think of it as placing bets. You walk into a casino and a team of MIT mathematicians offer you blackjack advice. When is it ever smart to say, "nah, my ex-wife's uncle once hit on 19 and got a 2, so that's my strategy". Even if you hit and get a 2, it was a stupid bet.

That’s a weird post to quote if you want to pick a nit. Opioids and antibiotics are two areas where it’s no longer debatable whether or not the medical-industrial complex has behaved appropriately.

Medical industrial complex <> most doctors.

Interesting

Equally interesting that people wanna lump them all together.

 

[Joe Bryant]

Just in our lifetimes doctors have pushed dietary guidelines and foods that turned out not to be beneficial, and in some cases, like trans fats, were actively harmful. Antibiotics were handed out like candy and now we’re dealing with resistance. Then came the over-prescription of opioids and we all know how that turned out. So the idea that doctors now have it all figured out, especially when it comes to medications being aggressively marketed for profit, feels unrealistic. Sure, the person who refuses a vaccine because of something they read on Facebook is probably super frustrating. But a healthy dose of skepticism (even “research") doesn’t seem like the worst thing in the world. Sometimes it’s just a patient trying to stay informed in a system that doesn’t always earn blind trust.

I don't think I've ever disagreed with a Nipsey post in 25 years here but this is crazy to me. You're penalizing science for doing science. Of course dietary guidelines and recommendations change over time as we learn more, are better able to analyze data, and become more informed about the human body. That's literally how science is supposed to work.

I don't understand the logic in attempting to override scientific consensus and advice from your doctor who literally spent 7 years becoming an expert because of a Facebook post or a podcast from a comedian. In almost every scenario, you are better off taking the advice from your physician rather than contradicting her/his advice because you "did your own research".

Think of it as placing bets. You walk into a casino and a team of MIT mathematicians offer you blackjack advice. When is it ever smart to say, "nah, my ex-wife's uncle once hit on 19 and got a 2, so that's my strategy". Even if you hit and get a 2, it was a stupid bet.

That’s a weird post to quote if you want to pick a nit. Opioids and antibiotics are two areas where it’s no longer debatable whether or not the medical-industrial complex has behaved appropriately.

Medical industrial complex <> most doctors.

Interesting

Equally interesting that people wanna lump them all together.

Seems much more interesting though on how much some want to disassociate themselves from the complex. It’s understandable.

 

[gianmarco]

Just in our lifetimes doctors have pushed dietary guidelines and foods that turned out not to be beneficial, and in some cases, like trans fats, were actively harmful. Antibiotics were handed out like candy and now we’re dealing with resistance. Then came the over-prescription of opioids and we all know how that turned out. So the idea that doctors now have it all figured out, especially when it comes to medications being aggressively marketed for profit, feels unrealistic. Sure, the person who refuses a vaccine because of something they read on Facebook is probably super frustrating. But a healthy dose of skepticism (even “research") doesn’t seem like the worst thing in the world. Sometimes it’s just a patient trying to stay informed in a system that doesn’t always earn blind trust.

I don't think I've ever disagreed with a Nipsey post in 25 years here but this is crazy to me. You're penalizing science for doing science. Of course dietary guidelines and recommendations change over time as we learn more, are better able to analyze data, and become more informed about the human body. That's literally how science is supposed to work.

I don't understand the logic in attempting to override scientific consensus and advice from your doctor who literally spent 7 years becoming an expert because of a Facebook post or a podcast from a comedian. In almost every scenario, you are better off taking the advice from your physician rather than contradicting her/his advice because you "did your own research".

Think of it as placing bets. You walk into a casino and a team of MIT mathematicians offer you blackjack advice. When is it ever smart to say, "nah, my ex-wife's uncle once hit on 19 and got a 2, so that's my strategy". Even if you hit and get a 2, it was a stupid bet.

That’s a weird post to quote if you want to pick a nit. Opioids and antibiotics are two areas where it’s no longer debatable whether or not the medical-industrial complex has behaved appropriately.

Medical industrial complex <> most doctors.

Interesting

Equally interesting that people wanna lump them all together.

Seems much more interesting though on how much some want to disassociate themselves from the complex. It’s understandable.

The VAST majority want nothing to do with "the complex". Insurance companies, hospital business groups, and administrators mostly detract from patient care. They add time, dictate/limit care, expect more production for less while maximizing revenue.

It's NOT what most doctors are looking for. Patient encounters are shorter to try and see more patients, insurance companies tie up resources, deny care, and limit reimbursement, and hospital administrators care more about satisfaction scores and turning over beds that have nothing to do with quality care.

It's why many are leaving in droves. And fewer are going into medicine.

Despite your tone in this thread, most physicians care about their patients and their health and aren't changing what they do because of financial reasons. It's the other players that have taken over that have caused this financial battle.

 

[The Longtime Lurker]

The Oxycontin addictions and lawsuits against Purdue Pharma are a great example of the doctors not being able to get it right because they were fed junk data from Purdue. That's not that the "industry" got it wrong. It's that dis/misinformation was fed everyone. I would hope that we can all see that as an example of the "exception". Its true that this kind of stuff can happen (nothing is perfect), but it is not really evidence of what Term or myself are talking about. And its certainly not evidence of where "did my own research" would have helped in any way. Everyone was working off the same published data (which was altered).

This may have been true at some early to middle stage. But to pretend that right up until “the end” pill doctors didn’t know opioids were addictive is total ********. There was absolutely a point in time where it became patently obvious — and yet pill/ kept being prescribed (by what percentage of doctors? You tell me.) to patients.

Longtime Lurker is spot on — if the excuse is “we were fed faulty data” then how can we trust that ALL the data isn’t faulty?

What percentage of doctors prescribed opioids for secondary gain, realizing their addictive potential?

My guess? 1%, or less. My wife, a physician, thinks < 10%.

What percentage of people in your field of work are unscrupulous?

To make sure I understand, you’re saying 99% of physicians that were prescribing opioids didn’t realize their addictive potential?

No, I'm not saying that at all.

I'm saying 99% physicians prescribed them for the benefit of their patients, based on available data and policy, after weighing the benefits and risks, including addictive potential. I suspect less than 1% of docs were prescribing opioids for secondary gain, as one might see working at a "pill mill", for example.

Now did the 99% fully realize what would result from prescribing practices? I doubt it. But they were prescribing in good faith, at the time.

I struggle with this unless there's something I'm missing. A super strong opioid, heroin like intoxication potential and the alarm bells weren't going off? How could this possibly end well? I just find it hard to wrap my head around everyone thinking they discovered a free lunch painkiller. If we were talking 1910 sure, but in the 21st century how is it possible for doctors to not question if this was a proper recommendation? Was morphine considered a more dangerous option at the time, or were all painkillers prescribed at the same rates?

 

[Joe Bryant]

Despite your tone in this thread, most physicians care about their patients and their health and aren't changing what they do because of financial reasons. It's the other players that have taken over that have caused this financial battle.

Interesting. I was especially clear to state some of the best people I know are part of the medical complex. Including my best friend. Not sure what “tone” you mean there but I’ve been consistent and honest. It does appear I’ve struck a nerve with some which is to be expected with vested interests.

 

[Mister CIA]

The Oxycontin addictions and lawsuits against Purdue Pharma are a great example of the doctors not being able to get it right because they were fed junk data from Purdue. That's not that the "industry" got it wrong. It's that dis/misinformation was fed everyone. I would hope that we can all see that as an example of the "exception". Its true that this kind of stuff can happen (nothing is perfect), but it is not really evidence of what Term or myself are talking about. And its certainly not evidence of where "did my own research" would have helped in any way. Everyone was working off the same published data (which was altered).

This may have been true at some early to middle stage. But to pretend that right up until “the end” pill doctors didn’t know opioids were addictive is total ********. There was absolutely a point in time where it became patently obvious — and yet pill/ kept being prescribed (by what percentage of doctors? You tell me.) to patients.

Longtime Lurker is spot on — if the excuse is “we were fed faulty data” then how can we trust that ALL the data isn’t faulty?

But those free lunches at the doctor's office were pretty sweet.

Pharma Spending on Doctors Is Correlated With Opioid Deaths​

A new study shows that doctors wrote more prescriptions, and more people overdosed on opioids, in counties where drug companies spent more money.

Pharma Spending on Doctors Is Correlated With Opioid Deaths

A new study shows that doctors wrote more prescriptions, and more people overdosed on opioids, in counties where drug companies spent more money.

www.wired.com

This is not representing today. The article cites a study of the 2013-2015 timeframe. Things have changed drastically with opioid prescribing since 2015, as detailed in the thread linked earlier. IMO this is irresponsible posting. If you want to post on this subject, you should do the diligence to find current data to cite.

A microcosm of the overall theme.

 

[Terminalxylem]

Just in our lifetimes doctors have pushed dietary guidelines and foods that turned out not to be beneficial, and in some cases, like trans fats, were actively harmful. Antibiotics were handed out like candy and now we’re dealing with resistance. Then came the over-prescription of opioids and we all know how that turned out. So the idea that doctors now have it all figured out, especially when it comes to medications being aggressively marketed for profit, feels unrealistic. Sure, the person who refuses a vaccine because of something they read on Facebook is probably super frustrating. But a healthy dose of skepticism (even “research") doesn’t seem like the worst thing in the world. Sometimes it’s just a patient trying to stay informed in a system that doesn’t always earn blind trust.

I don't think I've ever disagreed with a Nipsey post in 25 years here but this is crazy to me. You're penalizing science for doing science. Of course dietary guidelines and recommendations change over time as we learn more, are better able to analyze data, and become more informed about the human body. That's literally how science is supposed to work.

I don't understand the logic in attempting to override scientific consensus and advice from your doctor who literally spent 7 years becoming an expert because of a Facebook post or a podcast from a comedian. In almost every scenario, you are better off taking the advice from your physician rather than contradicting her/his advice because you "did your own research".

Think of it as placing bets. You walk into a casino and a team of MIT mathematicians offer you blackjack advice. When is it ever smart to say, "nah, my ex-wife's uncle once hit on 19 and got a 2, so that's my strategy". Even if you hit and get a 2, it was a stupid bet.

That’s a weird post to quote if you want to pick a nit. Opioids and antibiotics are two areas where it’s no longer debatable whether or not the medical-industrial complex has behaved appropriately.

Medical industrial complex <> most doctors.

Interesting

Equally interesting that people wanna lump them all together.

Seems much more interesting though on how much some want to disassociate themselves from the complex. It’s understandable.

Indeed.

I'd say my views align with most doctors, who don't want to be employed, beholden to corporate whim. There's near universal contempt for insurers/hospital admin/billing/coding/utilization management/etc., and a love/hate relationship with Pharma.

Docs mostly want the autonomy to help patients. And before anyone jumps down my throat, they believe they should be paid well.

Unfortunately, short of concierge medicine (which I find ethically dicey), private practitioners are a dying breed.

 

[Joe Bryant]

The Oxycontin addictions and lawsuits against Purdue Pharma are a great example of the doctors not being able to get it right because they were fed junk data from Purdue. That's not that the "industry" got it wrong. It's that dis/misinformation was fed everyone. I would hope that we can all see that as an example of the "exception". Its true that this kind of stuff can happen (nothing is perfect), but it is not really evidence of what Term or myself are talking about. And its certainly not evidence of where "did my own research" would have helped in any way. Everyone was working off the same published data (which was altered).

This may have been true at some early to middle stage. But to pretend that right up until “the end” pill doctors didn’t know opioids were addictive is total ********. There was absolutely a point in time where it became patently obvious — and yet pill/ kept being prescribed (by what percentage of doctors? You tell me.) to patients.

Longtime Lurker is spot on — if the excuse is “we were fed faulty data” then how can we trust that ALL the data isn’t faulty?

But those free lunches at the doctor's office were pretty sweet.

Pharma Spending on Doctors Is Correlated With Opioid Deaths​

A new study shows that doctors wrote more prescriptions, and more people overdosed on opioids, in counties where drug companies spent more money.

Pharma Spending on Doctors Is Correlated With Opioid Deaths

A new study shows that doctors wrote more prescriptions, and more people overdosed on opioids, in counties where drug companies spent more money.

www.wired.com

This is not representing today. The article cites a study of the 2013-2015 timeframe. Things have changed drastically with opioid prescribing since 2015, as detailed in the thread linked earlier. IMO this is irresponsible posting. If you want to post on this subject, you should do the diligence to find current data to cite.

A microcosm of the overall theme.

How so exactly? We’ve talked about a lot of interesting things.

 

[Mister CIA]

The Oxycontin addictions and lawsuits against Purdue Pharma are a great example of the doctors not being able to get it right because they were fed junk data from Purdue. That's not that the "industry" got it wrong. It's that dis/misinformation was fed everyone. I would hope that we can all see that as an example of the "exception". Its true that this kind of stuff can happen (nothing is perfect), but it is not really evidence of what Term or myself are talking about. And its certainly not evidence of where "did my own research" would have helped in any way. Everyone was working off the same published data (which was altered).

This may have been true at some early to middle stage. But to pretend that right up until “the end” pill doctors didn’t know opioids were addictive is total ********. There was absolutely a point in time where it became patently obvious — and yet pill/ kept being prescribed (by what percentage of doctors? You tell me.) to patients.

Longtime Lurker is spot on — if the excuse is “we were fed faulty data” then how can we trust that ALL the data isn’t faulty?

But those free lunches at the doctor's office were pretty sweet.

Pharma Spending on Doctors Is Correlated With Opioid Deaths​

A new study shows that doctors wrote more prescriptions, and more people overdosed on opioids, in counties where drug companies spent more money.

Pharma Spending on Doctors Is Correlated With Opioid Deaths

A new study shows that doctors wrote more prescriptions, and more people overdosed on opioids, in counties where drug companies spent more money.

www.wired.com

This is not representing today. The article cites a study of the 2013-2015 timeframe. Things have changed drastically with opioid prescribing since 2015, as detailed in the thread linked earlier. IMO this is irresponsible posting. If you want to post on this subject, you should do the diligence to find current data to cite.

A microcosm of the overall theme.

How so exactly? We’ve talked about a lot of interesting things.

Until we don't.

 

[Joe Bryant]

The Oxycontin addictions and lawsuits against Purdue Pharma are a great example of the doctors not being able to get it right because they were fed junk data from Purdue. That's not that the "industry" got it wrong. It's that dis/misinformation was fed everyone. I would hope that we can all see that as an example of the "exception". Its true that this kind of stuff can happen (nothing is perfect), but it is not really evidence of what Term or myself are talking about. And its certainly not evidence of where "did my own research" would have helped in any way. Everyone was working off the same published data (which was altered).

This may have been true at some early to middle stage. But to pretend that right up until “the end” pill doctors didn’t know opioids were addictive is total ********. There was absolutely a point in time where it became patently obvious — and yet pill/ kept being prescribed (by what percentage of doctors? You tell me.) to patients.

Longtime Lurker is spot on — if the excuse is “we were fed faulty data” then how can we trust that ALL the data isn’t faulty?

What percentage of doctors prescribed opioids for secondary gain, realizing their addictive potential?

My guess? 1%, or less. My wife, a physician, thinks < 10%.

What percentage of people in your field of work are unscrupulous?

To make sure I understand, you’re saying 99% of physicians that were prescribing opioids didn’t realize their addictive potential?

No, I'm not saying that at all.

I'm saying 99% physicians prescribed them for the benefit of their patients, based on available data and policy, after weighing the benefits and risks, including addictive potential. I suspect less than 1% of docs were prescribing opioids for secondary gain, as one might see working at a "pill mill", for example.

Now did the 99% fully realize what would result from prescribing practices? I doubt it. But they were prescribing in good faith, at the time.

I struggle with this unless there's something I'm missing. A super strong opioid, heroin like intoxication potential and the alarm bells weren't going off? How could this possibly end well? I just find it hard to wrap my head around everyone thinking they discovered a free lunch painkiller. If we were talking 1910 sure, but in the 21st century how is it possible for doctors to not question if this was a proper recommendation? Was morphine considered a more dangerous option at the time, or were all painkillers prescribed at the same rates?

But the research…

 

[Joe Bryant]

The Oxycontin addictions and lawsuits against Purdue Pharma are a great example of the doctors not being able to get it right because they were fed junk data from Purdue. That's not that the "industry" got it wrong. It's that dis/misinformation was fed everyone. I would hope that we can all see that as an example of the "exception". Its true that this kind of stuff can happen (nothing is perfect), but it is not really evidence of what Term or myself are talking about. And its certainly not evidence of where "did my own research" would have helped in any way. Everyone was working off the same published data (which was altered).

This may have been true at some early to middle stage. But to pretend that right up until “the end” pill doctors didn’t know opioids were addictive is total ********. There was absolutely a point in time where it became patently obvious — and yet pill/ kept being prescribed (by what percentage of doctors? You tell me.) to patients.

Longtime Lurker is spot on — if the excuse is “we were fed faulty data” then how can we trust that ALL the data isn’t faulty?

But those free lunches at the doctor's office were pretty sweet.

Pharma Spending on Doctors Is Correlated With Opioid Deaths​

A new study shows that doctors wrote more prescriptions, and more people overdosed on opioids, in counties where drug companies spent more money.

Pharma Spending on Doctors Is Correlated With Opioid Deaths

A new study shows that doctors wrote more prescriptions, and more people overdosed on opioids, in counties where drug companies spent more money.

www.wired.com

This is not representing today. The article cites a study of the 2013-2015 timeframe. Things have changed drastically with opioid prescribing since 2015, as detailed in the thread linked earlier. IMO this is irresponsible posting. If you want to post on this subject, you should do the diligence to find current data to cite.

A microcosm of the overall theme.

How so exactly? We’ve talked about a lot of interesting things.

Until we don't.

Sorry. Again I don’t understand the snips. Can you elaborate on what you mean?

I think this has been a remarkable thread.

 

[hagmania]

From my standpoint, the physicians have the leverage in their relationship with the “medical industrial complex.”

Entities like my company need their practice. They come to us for many different reasons - convenience in bookkeeping and regulatory reporting as an example. We bend over backwards for hospitalists.

As to the topic at hand, a doctor is like a police detective. They’re going to follow best practices and investigate the evidence and systematically, rationally diagnose you, oftentimes by proving the negative. That’s one reason you can get three different opinions from three different doctors - they each may have set out to disprove in a different order.

You can get lucky and “crack the case” ahead of them sometimes. In the end, I wager it is highly likely they would have arrived at the same answer as the lucky patient.

The scientific method of healthcare delivery is a system that should, over time, arrive at the best outcomes for the most people. It hurts when you are the outlier because our health is just about all we got. I understand the desire to take research into one’s own hand. In my opinion, the goal of research should be to open your own mind to what the doctor is telling you and allow you to ask good questions that help you make an informed decision with your doctor - not to go in with a diagnosis.

 

[The Longtime Lurker]

The Oxycontin addictions and lawsuits against Purdue Pharma are a great example of the doctors not being able to get it right because they were fed junk data from Purdue. That's not that the "industry" got it wrong. It's that dis/misinformation was fed everyone. I would hope that we can all see that as an example of the "exception". Its true that this kind of stuff can happen (nothing is perfect), but it is not really evidence of what Term or myself are talking about. And its certainly not evidence of where "did my own research" would have helped in any way. Everyone was working off the same published data (which was altered).

This may have been true at some early to middle stage. But to pretend that right up until “the end” pill doctors didn’t know opioids were addictive is total ********. There was absolutely a point in time where it became patently obvious — and yet pill/ kept being prescribed (by what percentage of doctors? You tell me.) to patients.

Longtime Lurker is spot on — if the excuse is “we were fed faulty data” then how can we trust that ALL the data isn’t faulty?

You guys are reading a lot into my comment. I'm not pretending anything. So let me be clear. WIth this specific incident, the damage was done well before the frauds were exposed as such. And the pills continue to be prescribed today. What I said is 100% true. Prior to data being exposed as fraudulent it would have been virtually impossible for someone "doing their own research" to look at that data and come to a different conclusion than the doctors. It wasn't until other studies were performed and data analyzed that they could prove otherwise. And it's wonderful that doctors and researchers were observing some odd patterns to even think about digging into it to verify. When they did, Purdue was exposed.

That's not ok. Why weren't those part of the initial testing? Thank God there's doctors willing to challenge the status quo indeed.

Stories like this are a huge black eye. Nobody should wonder why people would want to be a little skeptical and take a look at all the options.

This may not be your local PCP intentionally misleading anyone, but nobody can wonder why trust isn't easy to come by and the stakes are pretty high when it's your life in someone else's hands.

 

[Joe Bryant]

The Oxycontin addictions and lawsuits against Purdue Pharma are a great example of the doctors not being able to get it right because they were fed junk data from Purdue. That's not that the "industry" got it wrong. It's that dis/misinformation was fed everyone. I would hope that we can all see that as an example of the "exception". Its true that this kind of stuff can happen (nothing is perfect), but it is not really evidence of what Term or myself are talking about. And its certainly not evidence of where "did my own research" would have helped in any way. Everyone was working off the same published data (which was altered).

This may have been true at some early to middle stage. But to pretend that right up until “the end” pill doctors didn’t know opioids were addictive is total ********. There was absolutely a point in time where it became patently obvious — and yet pill/ kept being prescribed (by what percentage of doctors? You tell me.) to patients.

Longtime Lurker is spot on — if the excuse is “we were fed faulty data” then how can we trust that ALL the data isn’t faulty?

You guys are reading a lot into my comment. I'm not pretending anything. So let me be clear. WIth this specific incident, the damage was done well before the frauds were exposed as such. And the pills continue to be prescribed today. What I said is 100% true. Prior to data being exposed as fraudulent it would have been virtually impossible for someone "doing their own research" to look at that data and come to a different conclusion than the doctors. It wasn't until other studies were performed and data analyzed that they could prove otherwise. And it's wonderful that doctors and researchers were observing some odd patterns to even think about digging into it to verify. When they did, Purdue was exposed.

That's not ok. Why weren't those part of the initial testing? Thank God there's doctors willing to challenge the status quo indeed.

Stories like this are a huge black eye. Nobody should wonder why people would want to be a little skeptical and take a look at all the options.

This may not be your local PCP intentionally misleading anyone, but nobody can wonder why trust isn't easy to come by and the stakes are pretty high when it's your life in someone else's hands.

You just don’t get it.

It does kind of suck I guess that a lot of people died.

But apparently “That's how it works “

 

[Terminalxylem]

The Oxycontin addictions and lawsuits against Purdue Pharma are a great example of the doctors not being able to get it right because they were fed junk data from Purdue. That's not that the "industry" got it wrong. It's that dis/misinformation was fed everyone. I would hope that we can all see that as an example of the "exception". Its true that this kind of stuff can happen (nothing is perfect), but it is not really evidence of what Term or myself are talking about. And its certainly not evidence of where "did my own research" would have helped in any way. Everyone was working off the same published data (which was altered).

This may have been true at some early to middle stage. But to pretend that right up until “the end” pill doctors didn’t know opioids were addictive is total ********. There was absolutely a point in time where it became patently obvious — and yet pill/ kept being prescribed (by what percentage of doctors? You tell me.) to patients.

Longtime Lurker is spot on — if the excuse is “we were fed faulty data” then how can we trust that ALL the data isn’t faulty?

What percentage of doctors prescribed opioids for secondary gain, realizing their addictive potential?

My guess? 1%, or less. My wife, a physician, thinks < 10%.

What percentage of people in your field of work are unscrupulous?

To make sure I understand, you’re saying 99% of physicians that were prescribing opioids didn’t realize their addictive potential?

No, I'm not saying that at all.

I'm saying 99% physicians prescribed them for the benefit of their patients, based on available data and policy, after weighing the benefits and risks, including addictive potential. I suspect less than 1% of docs were prescribing opioids for secondary gain, as one might see working at a "pill mill", for example.

Now did the 99% fully realize what would result from prescribing practices? I doubt it. But they were prescribing in good faith, at the time.

I struggle with this unless there's something I'm missing. A super strong opioid, heroin like intoxication potential and the alarm bells weren't going off? How could this possibly end well? I just find it hard to wrap my head around everyone thinking they discovered a free lunch painkiller. If we were talking 1910 sure, but in the 21st century how is it possible for doctors to not question if this was a proper recommendation? Was morphine considered a more dangerous option at the time, or were all painkillers prescribed at the same rates?

When you're in pain, your body processes opioids differently.

Example:. I broke my leg skiing. I was in complete agony, nearly delirious from "10 out of 10" pain. But I'd only taken opioids once before in my life, a single Tylenol with codeine, after a root canal. As a teetotalling, substance-free 19 year old, I was totally thrown for a loop, and slept for nearly two days.

Fast forward a couple decades: After a jarring toboggan ride down the mountain, I was offered 4 mg intravenous morphine. Despite shivering from excruciating pain, I asked to cut the dose in half. After all, that dose was roughly 2-4 the strength of the codeine, and would act much more quickly through an IV.

Well, that didn't cut it. In short order, I received 10 mg morphine, 50 mcg fentanyl, and 5 mg of Versed, a benzodiazepine.

Normally, that amount of meds would kill me, but in my condition, I handled it well. Pain was controlled, and I was able to have coherent discussions with the emergency physician, anesthesiologist, orthopedist, and my wife. I made the informed decision to have surgery, without the benefit of outside "research".

As a side note, I didn't feel any euphoria/"high". Don't think I'm wired that way.

Anyway, my point is, context matters. All those meds are appropriate in those with legitimate, severe pain.

 

[hagmania]

Regarding the opinions shared in this thread, I lean way more to the Term/gianmarco side of the spectrum than the Joe B/Nipsey side… with the exception of the opinion that most physicians are losers.

#TeamNurse

 

[Joe Bryant]

As a side note, I didn't feel any euphoria/"high". Don't think I'm wired that way.

I can see that. “I know my own body" and "everybody's different" and all that.

 

[Terminalxylem]

As a side note, I didn't feel any euphoria/"high". Don't think I'm wired that way.

I can see that. “I know my own body" and "everybody's different" and all that.

Tactfully, I didn't it frame it quite that way. But I could tell the ER physician thought he knew better.

As it turns out, he did.

 

[gianmarco]

The Oxycontin addictions and lawsuits against Purdue Pharma are a great example of the doctors not being able to get it right because they were fed junk data from Purdue. That's not that the "industry" got it wrong. It's that dis/misinformation was fed everyone. I would hope that we can all see that as an example of the "exception". Its true that this kind of stuff can happen (nothing is perfect), but it is not really evidence of what Term or myself are talking about. And its certainly not evidence of where "did my own research" would have helped in any way. Everyone was working off the same published data (which was altered).

This may have been true at some early to middle stage. But to pretend that right up until “the end” pill doctors didn’t know opioids were addictive is total ********. There was absolutely a point in time where it became patently obvious — and yet pill/ kept being prescribed (by what percentage of doctors? You tell me.) to patients.

Longtime Lurker is spot on — if the excuse is “we were fed faulty data” then how can we trust that ALL the data isn’t faulty?

You guys are reading a lot into my comment. I'm not pretending anything. So let me be clear. WIth this specific incident, the damage was done well before the frauds were exposed as such. And the pills continue to be prescribed today. What I said is 100% true. Prior to data being exposed as fraudulent it would have been virtually impossible for someone "doing their own research" to look at that data and come to a different conclusion than the doctors. It wasn't until other studies were performed and data analyzed that they could prove otherwise. And it's wonderful that doctors and researchers were observing some odd patterns to even think about digging into it to verify. When they did, Purdue was exposed.

That's not ok. Why weren't those part of the initial testing? Thank God there's doctors willing to challenge the status quo indeed.

Stories like this are a huge black eye. Nobody should wonder why people would want to be a little skeptical and take a look at all the options.

This may not be your local PCP intentionally misleading anyone, but nobody can wonder why trust isn't easy to come by and the stakes are pretty high when it's your life in someone else's hands.

You just don’t get it.

It does kind of suck I guess that a lot of people died.

But apparently “That's how it works “

Yeah, once again, I doubt this kind of tone/snark/sarcasm/whatever you want to call it would be tolerated by others usually.

And to your previous "tone" question, no idea why you're being passive aggressive about being called out on it. You've been quite disparaging of physicians, continually lumping them in with this "medical complex" despite being told by more than one poster that's not the reality of it, accusing physicians in general of being financially motivated and lacking some magical altruism when that's exactly what most adhere to.

Frankly, it's insulting and I would expect you to be better than that.

I'm out.

 

[Nipsey]

I made the informed decision to have surgery, without the benefit of outside "research".
.

You're a doctor. And was it really a decision?

 

[Terminalxylem]

I made the informed decision to have surgery, without the benefit of outside "research".
.

You're a doctor. And was it really a decision?

Of course. I was out-of-state, could have delayed until I went home, or managed non-operatively (cast).

 

[Terminalxylem]

The Oxycontin addictions and lawsuits against Purdue Pharma are a great example of the doctors not being able to get it right because they were fed junk data from Purdue. That's not that the "industry" got it wrong. It's that dis/misinformation was fed everyone. I would hope that we can all see that as an example of the "exception". Its true that this kind of stuff can happen (nothing is perfect), but it is not really evidence of what Term or myself are talking about. And its certainly not evidence of where "did my own research" would have helped in any way. Everyone was working off the same published data (which was altered).

This may have been true at some early to middle stage. But to pretend that right up until “the end” pill doctors didn’t know opioids were addictive is total ********. There was absolutely a point in time where it became patently obvious — and yet pill/ kept being prescribed (by what percentage of doctors? You tell me.) to patients.

Longtime Lurker is spot on — if the excuse is “we were fed faulty data” then how can we trust that ALL the data isn’t faulty?

You guys are reading a lot into my comment. I'm not pretending anything. So let me be clear. WIth this specific incident, the damage was done well before the frauds were exposed as such. And the pills continue to be prescribed today. What I said is 100% true. Prior to data being exposed as fraudulent it would have been virtually impossible for someone "doing their own research" to look at that data and come to a different conclusion than the doctors. It wasn't until other studies were performed and data analyzed that they could prove otherwise. And it's wonderful that doctors and researchers were observing some odd patterns to even think about digging into it to verify. When they did, Purdue was exposed.

That's not ok. Why weren't those part of the initial testing? Thank God there's doctors willing to challenge the status quo indeed.

Stories like this are a huge black eye. Nobody should wonder why people would want to be a little skeptical and take a look at all the options.

This may not be your local PCP intentionally misleading anyone, but nobody can wonder why trust isn't easy to come by and the stakes are pretty high when it's your life in someone else's hands.

You just don’t get it.

It does kind of suck I guess that a lot of people died.

But apparently “That's how it works “

Yeah, once again, I doubt this kind of tone/snark/sarcasm/whatever you want to call it would be tolerated by others usually.

And to your previous "tone" question, no idea why you're being passive aggressive about being called out on it. You've been quite disparaging of physicians, continually lumping them in with this "medical complex" despite being told by more than one poster that's not the reality of it, accusing physicians in general of being financially motivated and lacking some magical altruism when that's exactly what most adhere to.

Frankly, it's insulting and I would expect you to be better than that.

I'm out.

Yeah, it's really out of character. I hope all is well, and I, too, will move on, with a reposting;

How do we stop talking past each other, and what should we do instead?​

In today’s health landscape, doing your own research is unavoidable. But too often, it leads to people navigating complex and at times conflicting information without the tools to make sense of it. Rejecting expertise is not helpful; mocking people for doing their own research is not helpful either. Here’s how we can do a better job meeting in the middle:

1. Recognize the value of experience. No generation before has had the information-sorting task that we have, and it’s hard. Experts play a critical role in helping people navigate the noise. A bias against expertise will derail the quest for unbiased information.
2. Don’t demand trust because you’re an expert. On the flip side, experts should realize that “trust me I’m an expert” doesn’t work well anymore. Expertise matters, but building trust is often more about how we treat people than the letters after our names.
3. Offer knowledge, don’t push it. For those who want more autonomy in their health decisions, offering knowledge is helpful, but telling them what to do is not. For this audience, it’s more helpful to provide information (“the benefits of the MMR vaccine outweigh the risks, here’s why”), without telling them how to use it (“you need to vaccinate your child.”)
4. Acknowledge uncertainty in the data. When the data aren’t straightforward, we must embrace nuance—acknowledge what we do and don’t know instead of giving overly simple answers.
5. Don’t gatekeep, do explain. Telling people not to read research studies because it’s “too complicated” won’t stop them, but it will alienate them. Instead, invite people to understand the data: “here’s why that study was flawed” is a whole lot better than “stop trying to read papers you don’t understand.”

 

[The Longtime Lurker]

The Oxycontin addictions and lawsuits against Purdue Pharma are a great example of the doctors not being able to get it right because they were fed junk data from Purdue. That's not that the "industry" got it wrong. It's that dis/misinformation was fed everyone. I would hope that we can all see that as an example of the "exception". Its true that this kind of stuff can happen (nothing is perfect), but it is not really evidence of what Term or myself are talking about. And its certainly not evidence of where "did my own research" would have helped in any way. Everyone was working off the same published data (which was altered).

This may have been true at some early to middle stage. But to pretend that right up until “the end” pill doctors didn’t know opioids were addictive is total ********. There was absolutely a point in time where it became patently obvious — and yet pill/ kept being prescribed (by what percentage of doctors? You tell me.) to patients.

Longtime Lurker is spot on — if the excuse is “we were fed faulty data” then how can we trust that ALL the data isn’t faulty?

What percentage of doctors prescribed opioids for secondary gain, realizing their addictive potential?

My guess? 1%, or less. My wife, a physician, thinks < 10%.

What percentage of people in your field of work are unscrupulous?

To make sure I understand, you’re saying 99% of physicians that were prescribing opioids didn’t realize their addictive potential?

No, I'm not saying that at all.

I'm saying 99% physicians prescribed them for the benefit of their patients, based on available data and policy, after weighing the benefits and risks, including addictive potential. I suspect less than 1% of docs were prescribing opioids for secondary gain, as one might see working at a "pill mill", for example.

Now did the 99% fully realize what would result from prescribing practices? I doubt it. But they were prescribing in good faith, at the time.

I struggle with this unless there's something I'm missing. A super strong opioid, heroin like intoxication potential and the alarm bells weren't going off? How could this possibly end well? I just find it hard to wrap my head around everyone thinking they discovered a free lunch painkiller. If we were talking 1910 sure, but in the 21st century how is it possible for doctors to not question if this was a proper recommendation? Was morphine considered a more dangerous option at the time, or were all painkillers prescribed at the same rates?

When you're in pain, your body processes opioids differently.

Example:. I broke my leg skiing. I was in complete agony, nearly delirious from "10 out of 10" pain. But I'd only taken opioids once before in my life, a single Tylenol with codeine, after a root canal. As a teetotalling, substance-free 19 year old, I was totally thrown for a loop, and slept for nearly two days.

Fast forward a couple decades: After a jarring toboggan ride down the mountain, I was offered 4 mg intravenous morphine. Despite shivering from excruciating pain, I asked to cut the dose in half. After all, that dose was roughly 2-4 the strength of the codeine, and would act much more quickly through an IV.

Well, that didn't cut it. In short order, I received 10 mg morphine, 50 mcg fentanyl, and 5 mg of Versed, a benzodiazepine.

Normally, that amount of meds would kill me, but in my condition, I handled it well. Pain was controlled, and I was able to have coherent discussions with the emergency physician, anesthesiologist, orthopedist, and my wife. I made the informed decision to have surgery, without the benefit of outside "research".

As a side note, I didn't feel any euphoria/"high". Don't think I'm wired that way.

Anyway, my point is, context matters. All those meds are appropriate in those with legitimate, severe pain.

Ok, that's a fair point for prescribing for extreme pain, but then i have to wonder where the problem was that caused the fraud? Prescribing for lesser pain? Saying it worked as well as morphine with less risk? Pardon my ignorance if this is common knowledge. Something still feels fishy to me.

This may be heading down a different path than the threads intent. I just have a hard time not seeing this as a failure throughout the medical community.

 

[Joe Bryant]

The Oxycontin addictions and lawsuits against Purdue Pharma are a great example of the doctors not being able to get it right because they were fed junk data from Purdue. That's not that the "industry" got it wrong. It's that dis/misinformation was fed everyone. I would hope that we can all see that as an example of the "exception". Its true that this kind of stuff can happen (nothing is perfect), but it is not really evidence of what Term or myself are talking about. And its certainly not evidence of where "did my own research" would have helped in any way. Everyone was working off the same published data (which was altered).

This may have been true at some early to middle stage. But to pretend that right up until “the end” pill doctors didn’t know opioids were addictive is total ********. There was absolutely a point in time where it became patently obvious — and yet pill/ kept being prescribed (by what percentage of doctors? You tell me.) to patients.

Longtime Lurker is spot on — if the excuse is “we were fed faulty data” then how can we trust that ALL the data isn’t faulty?

You guys are reading a lot into my comment. I'm not pretending anything. So let me be clear. WIth this specific incident, the damage was done well before the frauds were exposed as such. And the pills continue to be prescribed today. What I said is 100% true. Prior to data being exposed as fraudulent it would have been virtually impossible for someone "doing their own research" to look at that data and come to a different conclusion than the doctors. It wasn't until other studies were performed and data analyzed that they could prove otherwise. And it's wonderful that doctors and researchers were observing some odd patterns to even think about digging into it to verify. When they did, Purdue was exposed.

That's not ok. Why weren't those part of the initial testing? Thank God there's doctors willing to challenge the status quo indeed.

Stories like this are a huge black eye. Nobody should wonder why people would want to be a little skeptical and take a look at all the options.

This may not be your local PCP intentionally misleading anyone, but nobody can wonder why trust isn't easy to come by and the stakes are pretty high when it's your life in someone else's hands.

You just don’t get it.

It does kind of suck I guess that a lot of people died.

But apparently “That's how it works “

Yeah, once again, I doubt this kind of tone/snark/sarcasm/whatever you want to call it would be tolerated by others usually.

And to your previous "tone" question, no idea why you're being passive aggressive about being called out on it. You've been quite disparaging of physicians, continually lumping them in with this "medical complex" despite being told by more than one poster that's not the reality of it, accusing physicians in general of being financially motivated and lacking some magical altruism when that's exactly what most adhere to.

Frankly, it's insulting and I would expect you to be better than that.

I'm out.

Sorry to hear my opinion of including physicians as part of the industrial medical complex offends you. That’s not passive aggressive or posting better. And certainly not being called out. That’s my opinion and my viewpoint.

 

[dickey moe]

Just in our lifetimes doctors have pushed dietary guidelines and foods that turned out not to be beneficial, and in some cases, like trans fats, were actively harmful. Antibiotics were handed out like candy and now we’re dealing with resistance. Then came the over-prescription of opioids and we all know how that turned out. So the idea that doctors now have it all figured out, especially when it comes to medications being aggressively marketed for profit, feels unrealistic. Sure, the person who refuses a vaccine because of something they read on Facebook is probably super frustrating. But a healthy dose of skepticism (even “research") doesn’t seem like the worst thing in the world. Sometimes it’s just a patient trying to stay informed in a system that doesn’t always earn blind trust.

I don't think I've ever disagreed with a Nipsey post in 25 years here but this is crazy to me. You're penalizing science for doing science. Of course dietary guidelines and recommendations change over time as we learn more, are better able to analyze data, and become more informed about the human body. That's literally how science is supposed to work.

I don't understand the logic in attempting to override scientific consensus and advice from your doctor who literally spent 7 years becoming an expert because of a Facebook post or a podcast from a comedian. In almost every scenario, you are better off taking the advice from your physician rather than contradicting her/his advice because you "did your own research".

Think of it as placing bets. You walk into a casino and a team of MIT mathematicians offer you blackjack advice. When is it ever smart to say, "nah, my ex-wife's uncle once hit on 19 and got a 2, so that's my strategy". Even if you hit and get a 2, it was a stupid bet.

That’s a weird post to quote if you want to pick a nit. Opioids and antibiotics are two areas where it’s no longer debatable whether or not the medical-industrial complex has behaved appropriately.

Medical industrial complex <> most doctors.

Interesting

Equally interesting that people wanna lump them all together.

Seems much more interesting though on how much some want to disassociate themselves from the complex. It’s understandable.

Indeed.

I'd say my views align with most doctors, who don't want to be employed, beholden to corporate whim. There's near universal contempt for insurers/hospital admin/billing/coding/utilization management/etc., and a love/hate relationship with Pharma.

Docs mostly want the autonomy to help patients. And before anyone jumps down my throat, they believe they should be paid well.

Unfortunately, short of concierge medicine (which I find ethically dicey), private practitioners are a dying breed.

My physician is converting to concierge service next month. He has a wellness philosophy and he's told me he hates dealing with the insurance companies. Why do you consider it ethically dicey? Also, what would be a resonanable annual fee for concierge service, in your opinion?

 

[Joe Bryant]

As a side note, I didn't feel any euphoria/"high". Don't think I'm wired that way.

I can see that. “I know my own body" and "everybody's different" and all that.

Tactfully, I didn't it frame it quite that way. But I could tell the ER physician thought he knew better.

As it turns out, he did.

The ER doctor was concerned with the euphoria/high?

My comment was about you not feeling you “were wired that way.”

 

[Nipsey]

Regarding the opinions shared in this thread, I lean way more to the Term/gianmarco side of the spectrum than the Joe B/Nipsey side… with the exception of the opinion that most physicians are losers.

#TeamNurse

What bothered me was the admitted bias against patients simply for mentioning they did their own research (or for any reason) which does not seem professional or supportive of quality patient care. Dr. T also said he supports shared decision making which to me kind of contradicts his earlier point but whatever. If I'm being honest I'm probably a little biased myself having seen the way a family member with a serious illness was treated by a doctor when she looked into treatment options on her own. There were a couple of times where she was met with impatience and dismissal, which added to all of the crap and stress she was already dealing with.

 

[Caveman33]

I'm one of those problematic patients who like to do their own research. Just last year a cardiologist prescribed me Spironolactone. As to the potential downsides, she mentioned that it could cause my potassium levels to get too high. She didn't mention that it would block my testosterone and potentially cause irreversible breast tissue growth. I'm in my 30s. There are other drugs to treat heart failure. Why would an educated doctor prescribe me Spiro? Luckily, I did my own research before blindly taking her prescription. She had started me with a blood pressure medication. My blood pressure is usually 125/70. Even with the lowest dose, it became 95/55. Suddenly I was having frequent heart palpitations, my resting heart rate would sometimes double and I became overwhelmed by weakness throughout my body. No consideration for my age, the unique characteristics about my situation, etc. She was basically using a generic checklist to make prescriptions. And this was just supposed to be the start. She said I'd have to take these drugs for the rest of my life.

I've had bad digestion/gut issues for many years. I've developed theories and ways to mitigate the problem. When I went to a doctor about it, he listened for a few minutes and then said you have IBD, here is a prescription. "But you haven't done any testing? What makes you think this drug would be good for me?" I asked. "I always start with that one," He said, "If it doesn't work, we'll try a different one." Lol. Who needs a medical degree to practice medicine like that? Treat the patients like lab rats. See what result the drug has and then give them another one. Who cares if they suffer? It's not the doctor's body or their life.

 

[CGRdrJoe]

The Oxycontin addictions and lawsuits against Purdue Pharma are a great example of the doctors not being able to get it right because they were fed junk data from Purdue. That's not that the "industry" got it wrong. It's that dis/misinformation was fed everyone. I would hope that we can all see that as an example of the "exception". Its true that this kind of stuff can happen (nothing is perfect), but it is not really evidence of what Term or myself are talking about. And its certainly not evidence of where "did my own research" would have helped in any way. Everyone was working off the same published data (which was altered).

This may have been true at some early to middle stage. But to pretend that right up until “the end” pill doctors didn’t know opioids were addictive is total ********. There was absolutely a point in time where it became patently obvious — and yet pill/ kept being prescribed (by what percentage of doctors? You tell me.) to patients.

Longtime Lurker is spot on — if the excuse is “we were fed faulty data” then how can we trust that ALL the data isn’t faulty?

You guys are reading a lot into my comment. I'm not pretending anything. So let me be clear. WIth this specific incident, the damage was done well before the frauds were exposed as such. And the pills continue to be prescribed today. What I said is 100% true. Prior to data being exposed as fraudulent it would have been virtually impossible for someone "doing their own research" to look at that data and come to a different conclusion than the doctors. It wasn't until other studies were performed and data analyzed that they could prove otherwise. And it's wonderful that doctors and researchers were observing some odd patterns to even think about digging into it to verify. When they did, Purdue was exposed.

That's not ok. Why weren't those part of the initial testing? Thank God there's doctors willing to challenge the status quo indeed.

Stories like this are a huge black eye. Nobody should wonder why people would want to be a little skeptical and take a look at all the options.

This may not be your local PCP intentionally misleading anyone, but nobody can wonder why trust isn't easy to come by and the stakes are pretty high when it's your life in someone else's hands.

You just don’t get it.

It does kind of suck I guess that a lot of people died.

But apparently “That's how it works “

Yeah, once again, I doubt this kind of tone/snark/sarcasm/whatever you want to call it would be tolerated by others usually.

And to your previous "tone" question, no idea why you're being passive aggressive about being called out on it. You've been quite disparaging of physicians, continually lumping them in with this "medical complex" despite being told by more than one poster that's not the reality of it, accusing physicians in general of being financially motivated and lacking some magical altruism when that's exactly what most adhere to.

Frankly, it's insulting and I would expect you to be better than that.

I'm out.

truth, it’s his board and he always keeps his twitter right wing **** here and then deletes everything else on this board away. it’s wild

 

[Scoresman]

At the end of the day, we need to acknowledge all doctors are not equal. There are good doctors and poor doctors. Finding the right one is important and can be a long difficult process.

This is at the heart of my earlier comment. I've had the misfortune of having a bad doctor. One that lost my trust and caused me to question their motivation for even being a doctor.

Since then I've found a much better doctor that is more than willing to discuss treatments, treatment alternatives, and accept patient input. It's refreshing. For the record in almost every instance i defer to their expertise, but will push for non pharmaceutical methods if possible or PT vs surgery.

Medicine isn't one size fits all and when i felt lumped into the same category as a patient not willing to work at their health like i am and told refusing pills in lieu of dietary intervention was wrong I "researched" a new doctor.

Eta. There was much more to this particular doctor than haggling over medication. Just an easy example of a conflict over treatment.

Although their communication was poor, it’s entirely possible your initial doctor wasn’t wrong.

Diet and exercise typically lower LDL (“bad” cholesterol) 10-20%, and compliance is usually poor. Guidelines account for this, and suggest immediate medication, plus lifestyle modification, if LDL is sky high. What is sky high? 190+, or lower, if coupled with other vascular risk factors.

There should have been more shared decision making in that process, and tolerance for your trial of lifestyle modification. That was your doctor’s failure.

You also should know, “optimal” LDL hasn’t been well defined, as every 40 point drop associated with roughly 20% cardiovascular risk reduction, all the way down to 45 mg/dL - I’m guessing yours isn’t that low. For this reason, some physicians think HMG reductase inhibitors (aka “statins”) should be nearly universally prescribed.

I think my doctor agrees. Best primary physician I've ever had. He says almost everyone should be on a statin. I'm on 80mg and my LDL was 70ish last test.

I wonder if they have made them "better" over the years. I remember when I was previously on a statin, I had bad liver side effects, but not that I'm in such a high dose, my liver is just fine.

 

[DA RAIDERS]

The Oxycontin addictions and lawsuits against Purdue Pharma are a great example of the doctors not being able to get it right because they were fed junk data from Purdue. That's not that the "industry" got it wrong. It's that dis/misinformation was fed everyone. I would hope that we can all see that as an example of the "exception". Its true that this kind of stuff can happen (nothing is perfect), but it is not really evidence of what Term or myself are talking about. And its certainly not evidence of where "did my own research" would have helped in any way. Everyone was working off the same published data (which was altered).

This may have been true at some early to middle stage. But to pretend that right up until “the end” pill doctors didn’t know opioids were addictive is total ********. There was absolutely a point in time where it became patently obvious — and yet pill/ kept being prescribed (by what percentage of doctors? You tell me.) to patients.

Longtime Lurker is spot on — if the excuse is “we were fed faulty data” then how can we trust that ALL the data isn’t faulty?

But those free lunches at the doctor's office were pretty sweet.

Pharma Spending on Doctors Is Correlated With Opioid Deaths​

A new study shows that doctors wrote more prescriptions, and more people overdosed on opioids, in counties where drug companies spent more money.

Pharma Spending on Doctors Is Correlated With Opioid Deaths

A new study shows that doctors wrote more prescriptions, and more people overdosed on opioids, in counties where drug companies spent more money.

www.wired.com

I can speak to this. Before the rules/laws changed, “pharmaceuticals” were our best customers. Absolute bread and butter. 3-5 parties a week with a spend at 10-50k for 30-100 people. Reps would buy cases of wine at full retail and give them away. I had one rep that would come 3 times a year. He’d have a hot shot dr. The best presenter best wine. Lobster. Whatever they wanted. he’d spend upwards of 75k.

 

[fatness]

I can speak to this. Before the rules/laws changed, “pharmaceuticals” were our best customers.

When did the rules/laws change? Thanks.

 

[Tau837]

The Oxycontin addictions and lawsuits against Purdue Pharma are a great example of the doctors not being able to get it right because they were fed junk data from Purdue. That's not that the "industry" got it wrong. It's that dis/misinformation was fed everyone. I would hope that we can all see that as an example of the "exception". Its true that this kind of stuff can happen (nothing is perfect), but it is not really evidence of what Term or myself are talking about. And its certainly not evidence of where "did my own research" would have helped in any way. Everyone was working off the same published data (which was altered).

This may have been true at some early to middle stage. But to pretend that right up until “the end” pill doctors didn’t know opioids were addictive is total ********. There was absolutely a point in time where it became patently obvious — and yet pill/ kept being prescribed (by what percentage of doctors? You tell me.) to patients.

Longtime Lurker is spot on — if the excuse is “we were fed faulty data” then how can we trust that ALL the data isn’t faulty?

What percentage of doctors prescribed opioids for secondary gain, realizing their addictive potential?

My guess? 1%, or less. My wife, a physician, thinks < 10%.

What percentage of people in your field of work are unscrupulous?

To make sure I understand, you’re saying 99% of physicians that were prescribing opioids didn’t realize their addictive potential?

Are you aware of the difference between dependence and addiction? Are you aware of the actual rate of addiction from prescription opioids that has been shown through many studies? What do you think that addiction rate is? Given that prescribing opioids is always going to carry non-zero risk, where do you think the line is on balancing that risk in an acceptable manner with treating pain?

ETA: I'm truly very sorry you apparently lost your brother to addiction, but you are not coming across as being particularly well informed about his subject you are commenting on. @Terminalxylem linked another thread earlier in which i personally posted 80+ articles on this general subject of opioids. It's an informative read.

 

[BassNBrew]

The Oxycontin addictions and lawsuits against Purdue Pharma are a great example of the doctors not being able to get it right because they were fed junk data from Purdue. That's not that the "industry" got it wrong. It's that dis/misinformation was fed everyone. I would hope that we can all see that as an example of the "exception". Its true that this kind of stuff can happen (nothing is perfect), but it is not really evidence of what Term or myself are talking about. And its certainly not evidence of where "did my own research" would have helped in any way. Everyone was working off the same published data (which was altered).

This may have been true at some early to middle stage. But to pretend that right up until “the end” pill doctors didn’t know opioids were addictive is total ********. There was absolutely a point in time where it became patently obvious — and yet pill/ kept being prescribed (by what percentage of doctors? You tell me.) to patients.

Longtime Lurker is spot on — if the excuse is “we were fed faulty data” then how can we trust that ALL the data isn’t faulty?

You guys are reading a lot into my comment. I'm not pretending anything. So let me be clear. WIth this specific incident, the damage was done well before the frauds were exposed as such. And the pills continue to be prescribed today. What I said is 100% true. Prior to data being exposed as fraudulent it would have been virtually impossible for someone "doing their own research" to look at that data and come to a different conclusion than the doctors. It wasn't until other studies were performed and data analyzed that they could prove otherwise. And it's wonderful that doctors and researchers were observing some odd patterns to even think about digging into it to verify. When they did, Purdue was exposed.

That's not ok. Why weren't those part of the initial testing? Thank God there's doctors willing to challenge the status quo indeed.

Stories like this are a huge black eye. Nobody should wonder why people would want to be a little skeptical and take a look at all the options.

This may not be your local PCP intentionally misleading anyone, but nobody can wonder why trust isn't easy to come by and the stakes are pretty high when it's your life in someone else's hands.

You just don’t get it.

It does kind of suck I guess that a lot of people died.

But apparently “That's how it works “

Yeah, once again, I doubt this kind of tone/snark/sarcasm/whatever you want to call it would be tolerated by others usually.

And to your previous "tone" question, no idea why you're being passive aggressive about being called out on it. You've been quite disparaging of physicians, continually lumping them in with this "medical complex" despite being told by more than one poster that's not the reality of it, accusing physicians in general of being financially motivated and lacking some magical altruism when that's exactly what most adhere to.

Frankly, it's insulting and I would expect you to be better than that.

I'm out.

truth, it’s his board and he always keeps his twitter right wing **** here and then deletes everything else on this board away. it’s wild

Wow my notebook is bad. I thought Joe leaned left.

 

[DA RAIDERS]

Admittedly, I usually cringe when people address their medical care in this manner. "Doing my own research" is on the short list of trigger phrases which bias me against a patient, along with "I know my own body" and "everybody's different", as these statements usually precede noncompliance with the suggested plan.

Are you honest with your patients and disclose to them you hold this bias against them?

That feels like a super important thing for the patient to know.

I try to keep an open mind in these situations. I’m honest with them, but no, I don’t typically find a need to disclose potential biases - it’s incumbent on me to recognize and avoid them.

Interesting. You were clear here to say it was a bias. Not a potential bias.

"Doing my own research" is on the short list of trigger phrases which bias me against a patient, along with "I know my own body" and "everybody's different", as these statements usually precede noncompliance with the suggested plan.

My bad.

I should have said: may bias me against a patient.

Seemed clear to me.

You’re referring to the ivermectin, no measles, no polio type of thinkers. Those that just dismiss science and think they know better than not only you, but years and years of proven research.

As you know, I’m dealing with a strange(to me) medical problem. I’ve done my “research” as it’s been really frustrating dealing with it especially since the 1st round of treatment didn’t work. But you, 3 GPs and two specialists all were in agreement with my best treatment options. You did nix drinking bleach though.

 

[DA RAIDERS]

Glad to hear you’ve had that experience. So have I — sometimes. Other times (like above)? Not as much.

What were you trying to convey with your counter example?

That I've had many interactions with doctors in the last several years and that, with varying amounts of effort on my part, communication was achieved without one party talking down to another. I'd estimate that there were 40 visits or so. You had listed 1 example of things going badly with a doctor for you and I felt like some more examples would be informative.

The last doctor who talked down to me and would not listen to me was a referral from my PCP, so I went back to the PCP and complained. He no longer gets referrals from that PCP.

When I was in the ER last month I saw the attending infectious disease Dr. very blunt. Very clear. Very informative. My nurse didn’t like her and told me so after she left. I had another nurse say she difficult to talk to. I’ve had 3 tele doc visits with her that could not have been better. She’s still blunt, clear and informative. But she listens to me and knows her stuff. And I had plenty of questions. Good drs are amazing.

I went to 3 cardiologists before choosing the one that would burn the inside of my heart. Intelligent due diligence and research is part of being you own advocate. And as @gianmarco said, you don’t have to do what the dr says.

 

[DA RAIDERS]

If I hire an engineer for a project, I'm not researching it myself and checking his work.

You're a different type of person. I check everything. But that's probably the engineer in me.

And I've caught and saved a lot of mistakes. The latest being a wndow order mistake. No way I was going to replace all our windows myself, but, had I not checked the order when the windows arrived we would have had the wrong type in two windows. Good thing I didn't just leave it to the window experts.

Window experts.. my window experts brought the wrong windows as well. They were also drinking modelos after lunch. I knew the owner. Gave him a call. He lost his ****. And then he came and did the work himself.

 

[DA RAIDERS]

I can speak to this. Before the rules/laws changed, “pharmaceuticals” were our best customers.

When did the rules/laws change? Thanks.

It started changing 2008 and was more widespread by 2013

 

[Joe Bryant]

The Oxycontin addictions and lawsuits against Purdue Pharma are a great example of the doctors not being able to get it right because they were fed junk data from Purdue. That's not that the "industry" got it wrong. It's that dis/misinformation was fed everyone. I would hope that we can all see that as an example of the "exception". Its true that this kind of stuff can happen (nothing is perfect), but it is not really evidence of what Term or myself are talking about. And its certainly not evidence of where "did my own research" would have helped in any way. Everyone was working off the same published data (which was altered).

This may have been true at some early to middle stage. But to pretend that right up until “the end” pill doctors didn’t know opioids were addictive is total ********. There was absolutely a point in time where it became patently obvious — and yet pill/ kept being prescribed (by what percentage of doctors? You tell me.) to patients.

Longtime Lurker is spot on — if the excuse is “we were fed faulty data” then how can we trust that ALL the data isn’t faulty?

What percentage of doctors prescribed opioids for secondary gain, realizing their addictive potential?

My guess? 1%, or less. My wife, a physician, thinks < 10%.

What percentage of people in your field of work are unscrupulous?

To make sure I understand, you’re saying 99% of physicians that were prescribing opioids didn’t realize their addictive potential?

Are you aware of the difference between dependence and addiction? Are you aware of the actual rate of addiction from prescription opioids that has been shown through many studies? What do you think that addiction rate is? Given that prescribing opioids is always going to carry non-zero risk, where do you think the line is on balancing that risk in an acceptable manner with treating pain?

ETA: I'm truly very sorry you apparently lost your brother to addiction, but you are not coming across as being particularly well informed about his subject you are commenting on. @Terminalxylem linked another thread earlier in which i personally posted 80+ articles on this general subject of opioids. It's an informative read.

Thanks for the condolences.

I definitely am no expert on ny of this. And not sure what specifically you’re referring to as not being informed. The quote you responded to above was me asking a question to make sure I understood what the poster was saying.

 

[Joe Bryant]

The Oxycontin addictions and lawsuits against Purdue Pharma are a great example of the doctors not being able to get it right because they were fed junk data from Purdue. That's not that the "industry" got it wrong. It's that dis/misinformation was fed everyone. I would hope that we can all see that as an example of the "exception". Its true that this kind of stuff can happen (nothing is perfect), but it is not really evidence of what Term or myself are talking about. And its certainly not evidence of where "did my own research" would have helped in any way. Everyone was working off the same published data (which was altered).

This may have been true at some early to middle stage. But to pretend that right up until “the end” pill doctors didn’t know opioids were addictive is total ********. There was absolutely a point in time where it became patently obvious — and yet pill/ kept being prescribed (by what percentage of doctors? You tell me.) to patients.

Longtime Lurker is spot on — if the excuse is “we were fed faulty data” then how can we trust that ALL the data isn’t faulty?

You guys are reading a lot into my comment. I'm not pretending anything. So let me be clear. WIth this specific incident, the damage was done well before the frauds were exposed as such. And the pills continue to be prescribed today. What I said is 100% true. Prior to data being exposed as fraudulent it would have been virtually impossible for someone "doing their own research" to look at that data and come to a different conclusion than the doctors. It wasn't until other studies were performed and data analyzed that they could prove otherwise. And it's wonderful that doctors and researchers were observing some odd patterns to even think about digging into it to verify. When they did, Purdue was exposed.

That's not ok. Why weren't those part of the initial testing? Thank God there's doctors willing to challenge the status quo indeed.

Stories like this are a huge black eye. Nobody should wonder why people would want to be a little skeptical and take a look at all the options.

This may not be your local PCP intentionally misleading anyone, but nobody can wonder why trust isn't easy to come by and the stakes are pretty high when it's your life in someone else's hands.

You just don’t get it.

It does kind of suck I guess that a lot of people died.

But apparently “That's how it works “

Yeah, once again, I doubt this kind of tone/snark/sarcasm/whatever you want to call it would be tolerated by others usually.

And to your previous "tone" question, no idea why you're being passive aggressive about being called out on it. You've been quite disparaging of physicians, continually lumping them in with this "medical complex" despite being told by more than one poster that's not the reality of it, accusing physicians in general of being financially motivated and lacking some magical altruism when that's exactly what most adhere to.

Frankly, it's insulting and I would expect you to be better than that.

I'm out.

truth, it’s his board and he always keeps his twitter right wing **** here and then deletes everything else on this board away. it’s wild

Sorry to hear you think that. Or that we “delete everything else on this board away.”

We do delete political content, and have for a long time. Not sure what “right wing” posting you think is here.

Questioning authority and the medical industrial complex is not political in my opinion.

Wait until @Nipsey finds out he’s a Right Winger

 

[Joe Bryant]

And someone tell

The Oxycontin addictions and lawsuits against Purdue Pharma are a great example of the doctors not being able to get it right because they were fed junk data from Purdue. That's not that the "industry" got it wrong. It's that dis/misinformation was fed everyone. I would hope that we can all see that as an example of the "exception". Its true that this kind of stuff can happen (nothing is perfect), but it is not really evidence of what Term or myself are talking about. And its certainly not evidence of where "did my own research" would have helped in any way. Everyone was working off the same published data (which was altered).

This may have been true at some early to middle stage. But to pretend that right up until “the end” pill doctors didn’t know opioids were addictive is total ********. There was absolutely a point in time where it became patently obvious — and yet pill/ kept being prescribed (by what percentage of doctors? You tell me.) to patients.

Longtime Lurker is spot on — if the excuse is “we were fed faulty data” then how can we trust that ALL the data isn’t faulty?

You guys are reading a lot into my comment. I'm not pretending anything. So let me be clear. WIth this specific incident, the damage was done well before the frauds were exposed as such. And the pills continue to be prescribed today. What I said is 100% true. Prior to data being exposed as fraudulent it would have been virtually impossible for someone "doing their own research" to look at that data and come to a different conclusion than the doctors. It wasn't until other studies were performed and data analyzed that they could prove otherwise. And it's wonderful that doctors and researchers were observing some odd patterns to even think about digging into it to verify. When they did, Purdue was exposed.

That's not ok. Why weren't those part of the initial testing? Thank God there's doctors willing to challenge the status quo indeed.

Stories like this are a huge black eye. Nobody should wonder why people would want to be a little skeptical and take a look at all the options.

This may not be your local PCP intentionally misleading anyone, but nobody can wonder why trust isn't easy to come by and the stakes are pretty high when it's your life in someone else's hands.

You just don’t get it.

It does kind of suck I guess that a lot of people died.

But apparently “That's how it works “

Yeah, once again, I doubt this kind of tone/snark/sarcasm/whatever you want to call it would be tolerated by others usually.

And to your previous "tone" question, no idea why you're being passive aggressive about being called out on it. You've been quite disparaging of physicians, continually lumping them in with this "medical complex" despite being told by more than one poster that's not the reality of it, accusing physicians in general of being financially motivated and lacking some magical altruism when that's exactly what most adhere to.

Frankly, it's insulting and I would expect you to be better than that.

I'm out.

truth, it’s his board and he always keeps his twitter right wing **** here and then deletes everything else on this board away. it’s wild

Wow my notebook is bad. I thought Joe leaned left.

No, your notebook is accurate. We’re not going to take this on a political tangent as this isn’t about politics. But for the record I’m in the middle. Some would say left leaning as I haven’t voted for the GOP presidential candidate in 30+ years. In reality in the middle,. And that’s all the politics were going to do here.

 

[Joe Bryant]

Given that prescribing opioids is always going to carry non-zero risk, where do you think the line is on balancing that risk in an acceptable manner with treating pain?

Again, I’m no expert, but it feels to me like the current state we’re in where the balance has shifted to be way more cautious and careful with the addiction is about right.

 

[The Longtime Lurker]

I had/have (unclear, but appears resolved) a novel illness from a novel disease. Multiple doctors, multiple specialists, multiple researchers threw up their hands and downplayed my symptoms not because they weren't real (when i found medical professionals, real doctors not quacks, to dig a little deeper and run tests more advanced than a CBC all kinds of strange results were found) , but imo, because they didn't understand. Told it was anxiety, age, would magically resolve in time. Meanwhile my resting HR of 48 consistent for years jumped to 85 (where it remained for years). I was told as long as it's under 100 I'm good, what, it jumped up 40 bpm overnight, stayed there and I'm good?. I was made to feel ashamed when they couldn't understand and when i found others complaining of the same symptoms and i tried to bring that up i was accused point blank by a nurse of being "Dr Google". I was sick, scared, and felt abused by the system and the doctors I initially saw. I understand there's hypochondriacs and the professionally ill, but my doctor at the time knew that wasn't me and that made accusations upsetting.

I had to "research" with others suffering the same condition what tests their doctors were doing and crowd source info based on limited data. I don't blame doctors for not understanding, but i can blame their attitude. I didn't have a choice and neither do countless others suffering chronic and not well understood illnesses.

I took offense to the initial post because "doing my research" saved my life. It lead to lifestyle modifications, the right doctors and specialists, treatments, and ultimately a return to health and quality of life. I wasn't going to be able to go on living like i was. To say it was the darkest period of my life is an understatement. Did i get everything right? Certainly not. I did enough right to get my life back though.

All that said from the posts I've read and conversations I've had with @Terminalxylem he's been knowledgeable and willing to discuss, while providing good sources. I know exactly what he means with "doing your research" vs asking good questions.

The wealth of information at our fingertips is like nothing humanity has ever had, people are going to "Dr Google", pretty hard to resist with all these resources. Ofcourse deferring to your doctor’s expertise is optimal, but at the same time you have to advocate for yourself. If something is wrong then something is wrong and sometimes you have to fight to be heard.

 

[Uruk-Hai]

I haven't read the entire thread but, man, the last page or so has gotten weird.

 

[Sparky Polastri]

That's not ok. Why weren't those part of the initial testing? Thank God there's doctors willing to challenge the status quo indeed.

Stories like this are a huge black eye. Nobody should wonder why people would want to be a little skeptical and take a look at all the options.

This may not be your local PCP intentionally misleading anyone, but nobody can wonder why trust isn't easy to come by and the stakes are pretty high when it's your life in someone else's hands.

You're right that it wasn't ok and it's why Purdue should be paying dearly if not completely bankrupted by the whole thing. The "why" and "how" behind it is pretty political and litigious. This thread is already off the rails from the original intent with snark, emotion and quipping. I'm not sure going into it would be allowed by a person like myself. We can take it to PMs if you like. It should also be pointed out that this event with Purdue is clearly an exception and not the rule. That's not making an excuse for them. It's to point out this sort of thing doesn't happen often at all.

 

[The Longtime Lurker]

That's not ok. Why weren't those part of the initial testing? Thank God there's doctors willing to challenge the status quo indeed.

Stories like this are a huge black eye. Nobody should wonder why people would want to be a little skeptical and take a look at all the options.

This may not be your local PCP intentionally misleading anyone, but nobody can wonder why trust isn't easy to come by and the stakes are pretty high when it's your life in someone else's hands.

You're right that it wasn't ok and it's why Purdue should be paying dearly if not completely bankrupted by the whole thing. The "why" and "how" behind it is pretty political and litigious. This thread is already off the rails from the original intent with snark, emotion and quipping. I'm not sure going into it would be allowed by a person like myself. We can take it to PMs if you like. It should also be pointed out that this event with Purdue is clearly an exception and not the rule. That's not making an excuse for them. It's to point out this sort of thing doesn't happen often at all.

Yeah, this thread took a turn from conversation and into train wreck, emotions are running hot. We're getting away from original intent going down this fork too. A link to a previous thread on opioids was provided earlier and I'll take a look when i get a chance.

I understand what you're saying and that forces stronger than data were at play. I think I've said all i have on this and the thread overall. This one seems to have run its course.

 

[Joe Bryant]

That's not ok. Why weren't those part of the initial testing? Thank God there's doctors willing to challenge the status quo indeed.

Stories like this are a huge black eye. Nobody should wonder why people would want to be a little skeptical and take a look at all the options.

This may not be your local PCP intentionally misleading anyone, but nobody can wonder why trust isn't easy to come by and the stakes are pretty high when it's your life in someone else's hands.

You're right that it wasn't ok and it's why Purdue should be paying dearly if not completely bankrupted by the whole thing. The "why" and "how" behind it is pretty political and litigious. This thread is already off the rails from the original intent with snark, emotion and quipping. I'm not sure going into it would be allowed by a person like myself. We can take it to PMs if you like. It should also be pointed out that this event with Purdue is clearly an exception and not the rule. That's not making an excuse for them. It's to point out this sort of thing doesn't happen often at all.

Yeah, this thread took a turn from conversation and into train wreck, emotions are running hot. We're getting away from original intent going down this fork too. A link to a previous thread on opioids was provided earlier and I'll take a look when i get a chance.

I understand what you're saying and that forces stronger than data were at play. I think I've said all i have on this and the thread overall. This one seems to have run its course.

Agreed, this one turned into a train wreck. I apologize for my role in helping with that and I could’ve used softer and less challenging words.

Being able to question authority is something I feel strongly about. And I shared honestly.

And I felt there were some remarkable other opinions expressed. I think words matter, and with a written form, they are what we have to work with here. It’s why I always ask for a link to the quote when people claim a poster does this or that.

It seems people can sometimes quickly jump to assume everything medical disconnected to vaccines. I don’t think that at all. My main questions are about the medical industrial complex as a whole. And the roles and factors from the different components.

And mostly bottom line, my concern of how it seems we have as Americans a fairly low standard of overall health.

That feels like a serious problem to me. And pulling back to the big picture and asking questions of how we got here and what can be done to improve seems important.

I would hope everyone understands that’s not political and I assume the health of our population is important to most people.

Good timing as I have my follow up appointment for my annual physical today with my MD.

 

[Sparky Polastri]

That's not ok. Why weren't those part of the initial testing? Thank God there's doctors willing to challenge the status quo indeed.

Stories like this are a huge black eye. Nobody should wonder why people would want to be a little skeptical and take a look at all the options.

This may not be your local PCP intentionally misleading anyone, but nobody can wonder why trust isn't easy to come by and the stakes are pretty high when it's your life in someone else's hands.

You're right that it wasn't ok and it's why Purdue should be paying dearly if not completely bankrupted by the whole thing. The "why" and "how" behind it is pretty political and litigious. This thread is already off the rails from the original intent with snark, emotion and quipping. I'm not sure going into it would be allowed by a person like myself. We can take it to PMs if you like. It should also be pointed out that this event with Purdue is clearly an exception and not the rule. That's not making an excuse for them. It's to point out this sort of thing doesn't happen often at all.

Yeah, this thread took a turn from conversation and into train wreck, emotions are running hot. We're getting away from original intent going down this fork too. A link to a previous thread on opioids was provided earlier and I'll take a look when i get a chance.

I understand what you're saying and that forces stronger than data were at play. I think I've said all i have on this and the thread overall. This one seems to have run its course.

Opioid thread was a good read, though I never really participated because there were a bunch of discussions based on personal anecdotes and personal experiences, which is cool. This place is usually a good place for people to vent their frustrations, concerns, stresses on that and can get it out. Happy to talk more about it if you're interested. Just not gonna happen in this thread.

 

[uwillbsoon]

What I'm hearing Joe say is that I shouldn't rely on experts because they're wrong sometimes and have a profit motive. I should do my own research.

I'm going to take his advice and let my FBG subscription lapse and rely on BigDEnergy from Reddit, who plays in an entirely different type of league than me with totally different scoring, for my fantasy football advice.

 

[RCon]

Sorry to hear my opinion of including physicians as part of the industrial medical complex offends you. That’s not passive aggressive or posting better. And certainly not being called out. That’s my opinion and my viewpoint.

Having an opinion is fine. Repeatedly posting snarky responses like "but apparently that's how it works" and "but the research" aren't and you should stop pretending you aren't doing something that would get other people a timeout.