To those who think doctors make money on opioids

A casual reader scanning the headlines would rightly infer a direct cause-and-effect relationship between pharmaceutical company payments and the number of opioid prescriptions written based on this headline displayed prominently on the CNN homepage. What follows is nothing short of a character assassination of the medical profession, portrayed as complicit drug pushers in bed with the pharmaceutical industry. Rather than a reasoned look at the history of causes of the opioid epidemic — which has undoubtedly ravaged our country — there are cherry-picked patient quotes in large type such as: “I trusted my doctor.” The piece de resistance, however, must be the illustration of a doctor handing a pill bottle to an outstretched patient’s hand while a smirking executive standing behind the doctor rests one hand on the doctor’s shoulder and with his other hand stuffs money in the doctor’s white coat pocket.

There are helpful charts and graphs, no doubt to point out that this investigative piece must be factually correct and unbiased, from data obtained from the Center for Medicare and Medicaid Services no less. Let’s look at one of these damning illustrations:

A bar graph showing the payment ranges of 200,000 doctors that have received payments from pharmaceutical companies is displayed. Of the 200,000 listed physicians $172,991 (86.5%) are $1,000 or under while 76,481 (38.2%) are $100 or under. The source of this information is listed at “Analysis of Medicare Part D prescription data and pharmaceutical company payment data obtained from the Center for Medicare and Medicaid Services, 2014-2015”. For further context, the graph has a large type caption above it that reads: “More than 200,000 doctors who wrote opioid prescriptions received payments from pharmaceutical companies that make opioids.”

Let’s look at this carefully. The clear majority of doctors received payments of $1,000 or less — which as we know from the Sunshine Law is everything from coffee brought by a sales representative to your office to a dinner you may attend for an update on a drug or other educational event. Additionally, look at the wording — “companies that make opioids.” A separate link on CNN that explained the methodology behind the article shows they “flagged all payments by manufacturers who produced opioids and discarded the unreliable drug ‘name’ field in the database. As a result, some of the records considered opioid-related include records where there was no drug listed or where other drugs may have been listed.” Mind you, these “other drugs” are from companies that produce non-opioid drugs as well.

In fact, you must scroll 2/3 of the way through the article to find the section titled “The Analysis.” Here, buried deep in the piece, is a quote from a spokeswoman from the American Medical Association that points out: “such analyses show only an association between payments and prescribing habits and don’t prove that one causes the other.”

Opioid prescribing is not the only target of this “exclusive,” the oncologists are not let off the hook either. A quote about an analysis from researchers at the University of North Carolina that examined two government databases “found that when doctors received payments from manufacturers of certain cancer drugs, they were more likely to prescribe those drugs to their patients.” Oncology is a field where there may be only a few drugs in a class that treat advanced cancers, such as immune checkpoint inhibitors for melanoma such as nivolumab and ipilimumab.

This response is not intended to be a defense of the pharmaceutical industry or the few bad apples that do receive inappropriate payment or other remuneration from them for altering their prescribing habits. But for too long, doctors have a whole have been scapegoated as greedy practitioners who are the major cause of skyrocketing health care costs and epidemics such as the current opioid crisis. Like most things, there are multiple factors and nuances that do not easily play into a “clickbait” headline that all contribute to these important issues facing our health care system and county.

For our sakes, and our patients, I hope that we continue to use all our knowledge and resources — academic, professional organizations and industry — to advance the boundaries of what’s possible in the drugs available to our patients while making sure that they remain accessible and affordable for anyone who needs them.

Ryan Steele is an allergy-immunology physician. You can follow hiim on Twitter @drallergist.

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