
The news industry was complicit in the opioid crisis - danso
https://www.cjr.org/opinion/opioids-news-prescription-doctor.php
======
bpaddock
My wife killed herself because of Chronic Pain. Her saga is required reading
at Duke Medical School and has become part of the documentary Pain Warriors,
to be released soon. The documentary covers the lives of those miss treated by
the Medial Establishment, including doctors that treat Chronic Pain.

Those with Chronic Pain are being left to suffer because of abusers. In April
of 2019 the CDC stated that their "guidelines" are being miss applied. Sadly
the damage is already done.

[https://www.cdc.gov/media/releases/2019/s0424-advises-
misapp...](https://www.cdc.gov/media/releases/2019/s0424-advises-
misapplication-guideline-prescribing-opioids.html)

"CDC Advises Against Misapplication of the Guideline for Prescribing Opioids
for Chronic Pain Some policies, practices attributed to the Guideline are
inconsistent with its recommendations.

In a new commentary in the New England Journal of Medicine (NEJM), authors of
the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain (Guideline)
advise against misapplication of the Guideline that can risk patient health
and safety.

CDC commends efforts by healthcare providers and systems, quality improvement
organizations, payers, and states to improve opioid prescribing and reduce
opioid misuse and overdose. However, some policies and practices that cite the
Guideline are inconsistent with, and go beyond, its recommendations. In the
NEJM commentary, the authors outline examples of misapplication of the
Guideline, and highlight advice from the Guideline that is sometimes
overlooked but is critical for safe and effective implementation of the
recommendations.

CDC is raising awareness about the following issues that could put patients at
risk:..."

~~~
vkou
A friend's wife underwent brain surgery ~8 years ago. She was prescribed pain
medication for a long while.

At some point, she realized that she may be developing a bit of a pill
problem. She went to her doctor, to see what could be worked out.

He listened her out, marked her down as drug-seeking, and cut her off, cold
turkey.

Surprise, fucking surprise, the very next thing she did was to turn to black
market oxy.

Eight years of rehab, rehab again, fighting, bargaining, threatening, and
pleading, she's once again relapsed, and their marriage is falling apart.

I speculate that if it does, she'll likely be dead in a few years.

~~~
imtringued
Doctors aren't allowed to help people to recover from drug dependencies. If a
doctor opens a clinic that gives people access to non contaminated drugs with
a dosage that is controlled by a trained professional then it will be shut
down because people get jealous that their tax money is spent on keeping
junkies "high" when in reality the dosage gets lowered successively until no
adverse health effects remain and the "high" almost completely disappears but
still satisfies the dependency enough to prevent them from seeking out black
market drugs. What most of the population also fails to realize is that the
health effects of black market drugs are almost trivial compared to the
financial damage they cause which has a far greater impact on the lifestyle of
that person. You don't become a criminal or a prostitute when you spend $50 on
"medication", but it's pretty much guaranteed when your "medication" costs you
$1000 per month. For most people that's the difference between being homeless
or not.

------
duxup
I don't buy this line of argument.

If the news reflects the medical community's POV and the medical community is
wrong, that makes them "complicit"?

>Piece after piece told readers, including young doctors and medical students
like me, that pain was under-treated and opioids were safe. Outlets championed
a paradigm shift in the way we thought about pain relief. Pain joined body
temperature, blood pressure, heart rate, and breathing rate as the fifth vital
sign.

Was that untrue? I remember those stories, lots of doctors were advocating for
a change on how pain was treated.

The article straight up says that the medical community thought opioids were
the answer.

Should the news media have rejected the medical community's position and
suggested people use something else? Essential oils? Some sort of anti vax
message?

The medical community might want to think twice about telling the news media
or anyone else that they should have disregarded their expertise in the past
as I'm not sure they'd like it if that happened today...

~~~
macspoofing
>If the news reflects the medical community's POV and the medical community is
wrong, that makes them "complicit"?

The expectation is that news are independent and practice _journalism_ and
they don't just take anyone at their word.

~~~
ben509
(I'm not taking a side on whether the opiod question is correct, just talking
about the process of journalism.)

The press's ability as an institution to contradict another institution has
practical limits.

In particular, if the broader medical community is largely on board with
opiods, for a journalist to write a story, they have to get comments from
medical authorities.

If those comments are consistently saying that opiods are necessary and good
for pain management, an ethical journalist can't just ignore all those
comments and harp on a few outliers.

And for a story to catch on, other journalists have to, in effect, replicate
that work: they have to do their own investigations, but they're going to get
a similar distribution of comments.

The press can typically focus on an institution if there's a particular
scandal involving specific people or entities because then their questions
become more targeted.

~~~
macspoofing
>If those comments are consistently saying that opiods are necessary and good
for pain management, an ethical journalist can't just ignore all those
comments and harp on a few outliers.

They can. And they must.

Would you make this same argument when journalists cover fiance or war? In the
case of the former, there is usually 'irrational exuberance' that emanates
from financial professionals that inevitably leads to a crash. Journalist
should just take that at face value when the finance industry says subprime
derivatives are great?

How about the latter, war. Just because everyone is on-board, should
journalists stop asking questions?

If all journalism is is a mouthpiece, why do we need it in the age of
internet? I can go and read what the various agencies have to say without a
middle-man.

~~~
ben509
> Would you make this same argument when journalists cover fi[n]ance or war?

Yes. A journalist's job is to report news, not make it. Activist journalism
has virtually destroyed the reputation of the press.

What good is _any_ coverage if your audience thinks you're dishonest?

> Just because everyone is on-board, should journalists stop asking questions?

They should not be distorting their coverage of the answers.

> If all journalism is is a mouthpiece, why do we need it in the age of
> internet?

Activist journalism is just a mouthpiece for interest groups.

~~~
macspoofing
OK.

You're arguing a straw-man. Who is actually defending journalists that distort
the news?

------
pjc50
"Chronic pain is widespread and under-treated" may well still be true. It's
just that opioids do carry a risk of addiction. This is partly why so many
states have started legalizing marijuana, medical or otherwise.

I don't really like this article's tone of press-blaming: ultimately the
medical profession has to take responsibility for its treatment, both under-
or over-treatment, and has its own responsbility to find out the facts and
disseminate them through professional channels.

~~~
bilbo0s
People are looking for anyone to blame. Drug reps. Doctors. Pharmaceutical
firms.

Now we've entered the "politicians/the media is to blame" stage.

When something goes wrong in this spectacular a fashion, you can bet people
will try to lay blame wherever they can. But probably the truth is that this
was on all of us. Doctors for prescribing without disseminating incredibly
pertinent information, Parmas for creating "medicinal" opioids in the first
place, politicians for not admitting the need for stronger regulation earlier,
media for not covering the story better earlier, the people for being in
denial about the obvious signs of addiction in their friends and loved ones. I
mean the list probably goes on and on.

~~~
Loughla
I'm with you on this.

It's like conspiracy theories - people WANT someone to point to and say, "that
is the person in charge, they're the reason this has happened."

When in most cases, a really, truly shitty situation like this one does rely
on the action of a few, powerful, bad actors, but mostly it's daily choices to
simply not think made by all of us.

~~~
walshemj
Instead of banning any advertising of prescription meds to the general public.

------
DrScientist
There is general lack of basic scientific knowledge for those working in the
media and too much cut & paste.

However, _Doctors should have known better_ \- opioids are not some _new_
fangled treatment for goodness sake[1]

Doctors are highly trained, highly paid and their failure is central to the
opioid crisis.

[1] In fact they are one of the first modern medicines - a wonder drug - then
people realized the downsides. That was over 100 years ago....
[https://en.wikipedia.org/wiki/Laudanum#History](https://en.wikipedia.org/wiki/Laudanum#History)
[https://www.historic-
uk.com/HistoryUK/HistoryofBritain/Opium...](https://www.historic-
uk.com/HistoryUK/HistoryofBritain/Opium-in-Victorian-Britain/)

------
caconym_
These days I don't think you can blame the media for anything without blaming
the advertising industry as the upstream cause. We distribute unbundled
nuggets of content that are optimized to get clicks (and to drive click _rate_
, meaning you have to make your impact and turn the consumer around as quickly
as you can), because that's what's incentivized by advertising-based revenue
streams. Those optimizations are not compatible with accurate and balanced
coverage of nuanced issues.

I assume something similar was true in the 90s, or starting to be true, but I
don't have as good an understanding of how it all worked back then.

~~~
gundmc
It's pretty absurd to shift the blame to advertising.

This wasn't the age of clickbait and adtech, this was over 20 years ago. 24
hour news channels like Fox News and MSNBC were in their infancy. Isn't there
some responsibility to be had to uphold journalistic integrity?

If anything, this article shows the danger of pop science and journalists
writing authoritatively about things they don't understand well.

~~~
caconym_
Maybe you missed the first two words of my comment: "these days". I did not
restrict my context to 20 years ago, because neither does the linked article.

------
scarface74
Why is it that when “rural America” and the suburbs got caught up in a drug
epidemic people blame the media, corporations, the lack of opportunity, and
call it an illness, but when it was happening in the “inner city” it was all
about “the culture”, “moral failings”, “getting tough on crime”, and “the war
on drugs”.

I wonder what could the difference possibly be....

~~~
equalunique
Recently had a conversation about "inner city" communities with a coworker.
We're in Baltimore and she's an immigrant from Russia. She's concerned about
the aggressive behavior/vandalism/crime of "inner city youths" \- but being
new to this country, she's unaware of how they got there/came to be there in
the first place. Slaves fled to northern cities like Baltimore with _nothing_.
Post-slavery, the communities and wealth they built were in most cases
repeatedly destroyed/quashed/displaced by racists holding positions of power.
The anger seen today is from being constantly cheated, generation by
generation, by people who claim to have the moral high ground.

~~~
deogeo
> she's an immigrant from Russia.

Most Russians were literally owned by their landlords until 1861 [1]. After
that, they suffered the most deaths of any country in both world wars, and
many famines and purges under Stalin, and extreme repression in general in the
Soviet Union.

Try not to frame her as completely ignorant of oppression.

[1]
[https://en.wikipedia.org/wiki/Serfdom_in_Russia](https://en.wikipedia.org/wiki/Serfdom_in_Russia)

~~~
equalunique
Great points, and I didn't mean to, especially as a reflection of "all
Russians" or something like that.

------
same_as_today
Today the same media is praising Cannabis and CBD, and says that marijuana is
the miracle cure for depression, ...

Of course, you can't question that, especially on HN where every anti-cannabis
opinion is downvoted.

~~~
kibwen
This is a sweeping statement, can I ask for at least one sourced example? I've
seen no source attempting to claim that marijuana is a miracle cure for
depression, or that CBD is anything other than a fad propped up by a
regulatory fluke. At most, I have seen articles regarding the potentially
beneficial painkilling effects of marijuana for terminal cancer patients.

~~~
same_as_today
All of these articles from very reputable sources say that many view marijuana
as a miracle cure. Of course, they are balanced and also question this
narrative, but why do they say this view is widespread?

> _How one molecule from the cannabis plant came to be seen as a therapeutic
> cure-all_ :

[https://www.nytimes.com/interactive/2019/05/14/magazine/cbd-...](https://www.nytimes.com/interactive/2019/05/14/magazine/cbd-
cannabis-cure.html)

> _More Australians are using medicinal cannabis to treat a host of health
> problems as reports of its supposed healing powers flood the media_ :

[https://www.theguardian.com/society/2019/aug/11/medicinal-
ca...](https://www.theguardian.com/society/2019/aug/11/medicinal-cannabis-the-
hype-is-strong-but-the-evidence-is-weak)

[https://www.theguardian.com/society/2019/may/05/cbd-a-
mariju...](https://www.theguardian.com/society/2019/may/05/cbd-a-marijuana-
miracle-or-another-health-fad-cannabidiol-anxiety-epilepsy)

[https://eu.usatoday.com/story/news/world/2017/04/25/marijuan...](https://eu.usatoday.com/story/news/world/2017/04/25/marijuana-
pot-treatment-children-autism-cannabis-oil/100381156/)

------
ineedasername
I think complicit is too strong of a word. They were reporting on the
established (at the time) medical opinion. If the news industry hyped these
drugs beyond what the medical establishment held to be accurate, then I would
agree, but this article doesn't really indicate that.

~~~
mieseratte
Perhaps news agencies should include some measure of due-diligence and
skepticism, rather than parroting.

~~~
ineedasername
You assume they didn't due any due diligence. Maybe they didn't, but maybe
they did too. Either way, what would have sufficed beyond verifying that it
was indeed the prevalent medical opinion of the time _and_ that it wasn't
contradicted in any significant way? It's not the role of news media to verify
scientific research further than that-- it's the role of the research
establishment which, yes, failed at that task until it was too late to avoid a
crisis.

If there had been significant opposition to this at the time, I would agree
that news media failed. But I just searched through ProQuest and Google
Scholar for research journals during 1990-2000 and I didn't find much at all
that points towards significant risks of increased prescribing of these drugs.
Quite the opposite, they pointed towards them being underutilized and leaving
patients in significant pain despite low risk of addiction.

As it turns out, doctors were wrong. But it's only in the last few years that
the scope of the issue has really come to light. I can't fault the media for
not knowing 25 years ago what the medical establishment has only recently come
to accept.

~~~
mieseratte
> I just search through ProQuest and Google Scholar for research journals
> during 1990-2000 and I didn't find much at all that points towards
> significant risks of increased prescribing of these drugs.

And how many of those studies were funded by the institutions pushing the
products being studied? This type of conflict-of-interest / research-funding
is nothing new, cigarette companies arguably pioneered this practice decades
before.

> But it's only in the last few years that the scope of the issue has really
> come to light.

Sure, because of a non-ignorable problem. I'm advocating for skepticism,
investigative journalism, and research, rather than parroting what industry
says is true. I'm seeking reporting, not cheap public-relations pieces.

Instead of waiting for a problem, how about we ask questions of how things
might fail before it does.

~~~
ineedasername
In the context of due diligence, it doesn't matter how many articles were
sponsored by institutions pushing the products if there were not also articles
or other materials that news outlets would have been able to find that
countered either the sponsored or independent opinions. They might have noted
that sponsored research supported this opinion, but then also have had to
admit that independent opinions also did so.

Skepticism is all well & good, but it's not the place of news media to be
_blindly_ skeptical. This isn't about what turned out to be correct or
incorrect, it's about whether any amount of reasonable due diligence by news
media would have changed their reporting. And the available information at the
time doesn't indicate that it would.

Of course hind sight is 20/20, but you assume that media was simply parroting,
that they didn't look into available research and come up empty. Maybe some
didn't, maybe some did, but the fact remains that if they did, they would have
come up empty. If the medical establishment, those actually tasked with the
type of skepticism you advocate for, didn't do their job, that's on them. It's
not on the media to be able to predict the future. You are simply blindly
repeating "They should have done _something_ " when nothing in the historical
record would have supported it.

------
_iyig
Seems like a good place to link Paul Graham’s essay on PR firms, and their
relation with news media outlets:

[http://www.paulgraham.com/submarine.html](http://www.paulgraham.com/submarine.html)

------
lambersley
Though I can accept that news industry may have had a role to play in the
influencing the thoughts and opinions of inexperienced medical professionals,
I cannot accept that they are 'complicit' in the opioid crisis.

Its hard to accept that the medical practice in the Americas is comprised of
mostly "young doctors and students." In 2018, ~69% [1] of physicians in
America were over 46 years old. I am more inclined to believe that bad actors,
lobbying and general incompetence is to be blamed.

This topic reminded me of "The $100 billion per year back pain industry is
mostly a hoax"[2] piece which highlighted drug companies who spent millions on
marketing, borrowing a page from Big-Tobacco, doctors who over-prescribed and
frustrated patients who too matters into their own hands.

[1] [https://www.statista.com/statistics/415961/share-of-age-
amon...](https://www.statista.com/statistics/415961/share-of-age-among-us-
physicians/) [2] [https://qz.com/1010259/the-100-billion-per-year-back-pain-
in...](https://qz.com/1010259/the-100-billion-per-year-back-pain-industry-is-
mostly-a-hoax/)

------
ashelmire
I think it's interesting that out of 120+ comments on opioids, nobody mentions
the elephant in the room:

Some studies find NSAIDs are as effective in the treatment of pain [1]. You
can find several other studies with a quick search, though most of the ones
I've found were short-term.

An additional issue is that opioids are not a treatment for the causes of
pain. Pain is generally a symptom, not the underlying pathology. Physical
therapy and other reliefs (nonsurgical) can treat the causes of pain and
eliminate the need for any pain treatments.

And as for an anecdote - my stepfather went from large doses of opioids after
back surgery and severe pain (for an issue they wouldn't recommend surgery for
anymore, but would instead recommend physical therapy) for years, to a
reasonable level of prescribed marijuana consumption.

Just some things to think about, since most of voices in the room seem to be
pro-opioid.

1\. [https://jamanetwork.com/journals/jama/article-
abstract/26739...](https://jamanetwork.com/journals/jama/article-
abstract/2673971)

------
BucketSort
Let's be honest, what aren't they complicit in?

~~~
happytoexplain
Broad condemnation of a broad group of a people is a dangerous path.

~~~
Clubber
Yes, but you have to admit, the news doesn't really serve its intended purpose
of speaking out against power. It seems more like a conduit that's pretending
it's not.

~~~
inetknght
News' intended purpose isn't just about speaking out against power. It's about
providing a means for people to obtain information about current events --
political, medical, whatever. It's supposed to help augment your education.

You know, the same education which is thoroughly gutted in America.

------
ademup
I wish I could use the fallacious "No TRUE doctor would use The Times to
inform medical decisions." Because it seems like it should be universally
true. On the one hand I am glad this one is telling their truth, now I feel
more informed. On the other, I am appalled and terrified that this may apply
to a significant percentage of "true" doctors.

------
epmaybe
Looking at my own experience with doctors who were practicing throughout this
scandal, I always try to think: what will our generation's scandal in the
medical community be?

The loss of the doctor-patient relationship could be one.

Our trust and financial relationship with the pharmaceutical/insurance
industries, or maybe our salaries in general?

------
nprz
>A 2001 US News and World Report story described OxyContin as a “safe,
effective medication with few side effects,” and put the chances of addiction
at one percent

>we now know that between eight and 12 percent of patients prescribed opioids
for chronic pain develop an addiction

I wonder how the state of the economy influences rate of addiction?

~~~
codeddesign
I would imagine that the rate directly correlates with other additions such as
alcohol. While addition happens to all classes of society, those in
impoverished areas tend to have a greater concentration of addition (at least
reported).

------
1121redblackgo
If there are any of chronic pain sufferers in here that have not yet explored
the connection between emotions and pain, if you see this then now may be your
lucky day.

There is no correlation between structural changes in your body and the level
of pain you have to endure, and you can be fully cured from your chronic pain
within months.

It is hard work, and you will have to deeply examine your life, but if you are
ready I encourage you to check out Dr. Sarno and fall down the Healing Back
Pain rabbit hole. Nicole Sachs has some excellent youtube videos that I
recommend. As well there is Steve Ozanich's incredible book.

I suffered for a decade with debilitating back pain, arm pain, neck pain,
headaches, arthritis, knee pain, jaw pain, tendinitis, all of it, every day,
all day, my entire life was my pain for a decade. And like thousands and
thousands of others before me, once I discovered the real source of my pain I
could actually work on healing it, and within months I was fully cured, and
now have a toolset to interface with stress and pain in a healthy way that
will last me forever.

You don't have to suffer, but you will need to work at this.

~~~
1121redblackgo
A small addendum. This comment was downvoted '-1' pretty quickly. Like Eric
Weinstein and the IDW suggest, we need the voices that were cast aside and
disregarded if we are going to move forward in a new paradigm. I'm not lying
or selling anything here. I am healed. So can you be. Your choice.

------
PaulHoule
Lately Google and Bing have been pushing searches for medical terms away from
Wikipedia and towards WebMD, but that article says WebMD is funded by drug
companies, and is itself suspect.

Wikipedia has remarkably fair treatment of controversial topics such as rBST.

------
CrankyBear
Complicit? Reporters aren't medical experts. They reported what the medical
pros of the 90s said. And, the doctors at the time all nodded their heads and
said it was great stuff.

~~~
base698
Yup, and the literature misquoted said the same 16 years ago, appears some of
the media was into it then:

Drug companies amplified that theme in materials sent to doctors and
pharmacists. For example, Janssen Pharmaceutica, the producer of Duragesic,
called the risk of addiction ''relatively rare'' in a package insert with the
drug. Endo termed the risk ''very rare'' in presentations to hospital
pharmacists. Purdue Pharma, the manufacturer of the powerful narcotic
OxyContin, distributed a brochure to chronic pain patients called ''From One
Pain Patient to Another,'' contending that it and similar drugs posed minimal
risks.

''Some patients may be afraid of taking opioids because they are perceived as
too strong or addictive,'' the brochure stated. ''But that is far from actual
fact. Less than 1 percent of patients taking opioids actually become
addicted.''

The trouble, however, was that studies that looked at the experience of pain
patients who used long-acting narcotics for extended periods of time did not
exist. So narcotics advocates like Dr. Portenoy and drug companies like Purdue
Pharma had looked elsewhere, at surveys of patients whose use of narcotics was
limited. And those reports were not always put into proper context.

[https://www.nytimes.com/2003/11/25/science/the-delicate-
bala...](https://www.nytimes.com/2003/11/25/science/the-delicate-balance-of-
pain-and-addiction.html)

------
vertoc
Related good read: [https://slatestarcodex.com/2019/09/16/against-against-
pseudo...](https://slatestarcodex.com/2019/09/16/against-against-
pseudoaddiction/)

------
simplecomplex
The war on drugs doesn’t work. the government should not have the authority to
interfere with what people put inside their body.

Stop blaming drug addiction on everybody but the drug addicts.

