In the background of phytotoxicity problems due to overdose of the analgesic "opioid" there was a benefit from the pharmaceutical company to the doctor

ByVCU CNS

Painkiller with strong analgesic effect "Opioid"Has been prescribed for patients who do not necessarily need it, it is a big problem in the United States that many people are getting intoxicating symptoms. Regarding the surge of deaths due to the abuse of opioids including overdose, President Donald Tramp also declared a public health emergency as an "opioid crisis", but behind it was a drug to a doctor prescribing opioids The existence of a large rebate from the company is highlighting the investigation by CNN and Harvard University.

For doctors, more opioid prescriptions bring more money - CNN
https://edition.cnn.com/2018/03/11/health/prescription-opioid-payments-eprise/index.html

According to CNN's report, in the two years from 2014 and 2015, pharmaceutical companies manufacturing opioids had paid hundreds of thousands of dollars (tens of millions of yen) in hundreds of doctors across the country It is clear that it is. This was paid for the consultation and consulting expenses to the doctor and it also knows that thousands of doctors received more than 25 thousand dollars (about 2.6 million yen).

I was also aware that I was a doctor prescribing large amounts of opioids, especially that I was paid a lot, and I thought that the composition "I got enough to prescribe opioids" was completed. Dr. Andrew Colony, who is an officer of the physician organization 'Physicians for Responsible Opioid Prescribing' (PROP: doctor responsible for prescribing responsible opioids) said, "This is something very serious I have not seen before" "It smells like a doctor is taking a bribe to sell drugs, it is terrible."


Researchers at Harvard University said that this payment is "encouraging physicians to prescribe company medicines" or conversely "If a pharmaceutical company already finds a doctor who is giving a prescription a lot and gives a reward It is not clear whether it is "whether it is". However, Dr. Michael Burnett of Harvard TH Chung School of Public Health says, "I do not know whether prescription is given out with money but prescription will give a prescription, but in both cases, it can end in a vicious circle There is sex. "

To do this analysis, CNN, like Dr. Burnett and Dr. Ampam Jena of Harvard University, studied the two federal government databases. One is the payment from the pharmaceutical company to the doctor and the other is the one that the doctor tracks the prescription written to the recipient of Medicare. From the data of 2014 and 2015, over 81 million doctors are between the public medical insurance system for the elderly and disabledMedicareIt is clear that nearly half of them prescribe opioids at least once. It was also revealed that more than 200,000 doctors, 54% of which received payment from a pharmaceutical company that manufactures opioids.


Also from here I heard that doctors who prescribed many opioids tended to be more likely to receive money from pharmaceutical companies and that their amounts tended to rise. 72% of the top 25% of doctors who prescribed opioids received payment, and 84% of the doctors included in the fifth highest ranking percentile received payment. Also, it is also made clear that 95% of the doctors included in the top 1% receive payment.

On average, a doctor whose opioid prescription volume is in the top 5% receives twice the price from the opioid manufacturer compared to the median prescribed medicine doctor. In addition, the top 1% doctor prescribing opioids receives an average 4 times the amount of typical doctors. And, on average, doctors in the top 10% receive nine times more money than typical doctors. "The correlation we find here is very powerful, the amazing thing about the findings is that not only is the amount important, but as the amount increases, It means that payment will increase further. "


It is legal that the person in charge of the pharmaceutical company talks to the doctor, consults, paying expenses for other services. This has been advocated by experts in that field as a means of sharing important experiences and information on drugs, but there has been room for discussion for a long time. Payment from a pharmaceutical company to a doctor is not limited to opioids. Pharmaceutical companies pay doctors billions of dollars for various services, and in 2015 48% of doctors receive some payment from the pharmaceutical company. However, it is illegal for a doctor to prescribe a medicine in exchange for a rebate payment from a manufacturer.

Dr. Stephen Stannos of the American Academy of Pain Medicine said that doctors who frequently prescribe a medicine will be chosen to give a lecture on the medicine and will not be surprised to receive payment It is. Mr. Stannos says, "Because there is a deep understanding about a medicine, there are things that prescribe many medicines." According to a recent report of the Senate Homeland Security and Government Committee, Mr. Stannos' group is expected to sell approximately $ 1.2 million (about 130 million) from five of the largest opioid manufacturers in the United States between 2012 and 2017 I understand that you are receiving yen). Mr. Stanos said he said that money is being used for various projects including safe opioid prescription course.

However, Dr. Daniel Carlatt, a former director of the non-profit organization Pew Charitable Trust, said, "The findings of CNN and Harvard suggest that pharmaceutical companies' funds influence doctor's prescription habits It is in agreement with the study of ". Karlatt, a psychiatrist who operates a blog about conflict of interest, said, "Although it is not firm evidence, it is evidence that marketing-related payments from pharmaceutical companies are not suitable for pharmaceuticals or patient care It is an important data point of the base, I am extremely worried about this. "

ByMarco Verch

Mr. Burnett of Harvard College, who cooperated with CNN (noted above) also said, "Pharmaceutical companies are not wasting money, if they are not effective they will not be using this money, He says that there is a reason for the company to pay the doctor.

According to a statement by the American Research and Pharmaceutical Manufacturers Association (PhRMA), "Pharmaceutical companies are supporting forced and continuous training for prescribers regarding appropriate treatment of pain." Here PhRMA says "PhRMA establishes precautionary measures to prevent over-signs while supporting a number of policies to ensure that patients' legitimate medical needs are met." .

CNN covered the two women suffering from opioid poisoning and noted the feeling of "betrayal" felt when a doctor knew that a doctor was receiving a large amount of money from a manufacturer of medicines that produced great confusion It is.

Carrie Burrow, one of the victims, trusted the doctor and talked about thinking that opioid prescription was the best option for dealing with pain. However, Mr. Burrow then learned that the opioid manufacturer had paid over $ 1 million (about 100 million yen) over 2 years to the doctor and said, "Is that really what you thought of me? I wondered if it was to maximize his interests. "

Byfrankieleon

Another woman, Angela Cantone, says that he wanted to know that the opioid maker paid hundreds of thousands of dollars to her doctor. Mr. Cantone is a pain specialist in Greenville, South CarolinaAathirayen Thiyagarajah doctorFrom March 2013 to July 2015, it was prescribed opioids for suppressing abdominal pain called "subsys" of Crohn's disease for about two and a half years. According to the Centers for Disease Control and Prevention, Subsis is 50 to 100 times more potent analgesic than morphine.

According to Mr. Cantone, Dr. Thiyagarajah said "This medicine will bring magic to me, it's really simple and easy," it's just to spray in your mouth " I will look back on what was prescribed. Mr. Canton said that subsyxia relieved the pain, but at the same time Mr. Cantone said he had made it "like a zombie". Cantone had three young children, two of whom needed autism or other special care, but often suffered from a situation in which consciousness was lost due to side effects caused by drugs about. "I have always fainted, I noticed that I had fallen down on the kitchen floor or the front yard of my house," he says.

Mr. Cantone said he was worried about doctor Thiyagarajah, but doctors said that there was an answer that health problems are not subsidiary. "I trusted him, as if to trust a police officer who instructed traffic when a blackout occurred," Mr. Cantone said, but finally to Thiyagarajah doctor to switch to a non-opioid drug When holding it, the doctor says that it became militant. Mr. Kantone said that from the pharmaceutical company to the doctor Thiyagarajah during the period from August 2013 to December 2016 payment to the doctor from the pharmaceutical company that there was a payment of more than $ 200,000 (about 21 million yen) It is decided to know from the federal government database "Open Payments" tracking.

CNN compares the amount of "190,000 dollars" (about 20 million yen) received by Thiyagarajah doctor from 2014 to 2015 to other prescribers in the same medical field and gets more than average I understood the actual condition that it is.


Mr. Cantone now complains to Thiyagarajah doctor and accuses her to "cheat and betray" her for "the sole objective of increasing subsidies prescription, sales, consumption and increasing profits". Meanwhile, Thiyagarajah denied illegal acts through lawyers, but refused to comment on this story due to a pending litigation.

Thiyagarajah lawyer said that prescriptions such as subsis were appropriate. However, it is obvious that the prescriptions of subsis and other opioids are abnormally large compared to other doctors who have the same certificate. According to the analysis by CNN and Harvard University, in 2014 and 2015, the average doctor is writing an average of 3.7 opioid prescriptions per Medicare patient average. However, Thiyagarajah doctor has created more than 7 opioid prescriptions per equivalent patient.


According to affidavits by investigators of drug enforcement agencies, the office of Dr. Thiyagarajah was inspected by the Drug Enforcement Administration in June 2015 and in violation of federal law, another office for "unlawful medical needs" It turned out to be prescribing opioid buprenorphine. In addition, in March 2016 another examination was done, 45 medical records related to subsection were confiscated.

Mr. Cantone also said he is suing Insys, subsidiary pharmaceutical company. Insys has denied allegations of misconduct against the complaint, but John Kaplar, the founder and insider's largest shareholder, is charged with giving bribes to physicians who over-declare drugs in October 2017 You are under arrest. Tom Baker who is in charge of Mr. Kapul, said, "Dr. Kapoor does not misbehave and refutes all charges with the strongest words." "He is completely justified after daily in the courtroom I am looking forward to it. "

According to Insys 'news release, Mr. Kapoor resigned from Insys' board of directors in October 2017. In addition, several other Insys executives are being arrested for charges of violence and also being subject to investigation by the senators. In a letter addressed to Senator McArthur in September 2017, Ms. Saeed Motahari, President and CEO of Insys, said, "I was worried about previous Insys employee mistakes and unacceptable acts , The majority of sales staff at that time no longer has any relation with the company.

According to the American Center for Disease Control and Prevention, from 1999 to 2015, more than 183,000 people in the United States died of opioid overdose. President Donald Trump also announced in October 2017 that the epidemic of opioids is a citizen's public health emergency. Under such circumstances, at least one company stops paying money to doctors through propaganda to doctors.

As of 2018, Mr. Cantone looks back at the time when he was treated by Doctor Thiyagarajah with sorrow. Mr. Cantone saw that "sleeping" was written as "Mother's wish" written on the "Mother's Day" card that my daughter made in kindergarten. Mr. Cantone was shocked by that there was written "sleeping" rather than "hugging children" or "taking you to the park", "I feel like I failed as a parent It is said that he said. Mr. Cantone was angered by the huge amount of money paid by the pharmaceutical company to the doctor and said, "The medicine prescribed to me was not mine but for his benefit" ... apparently ...