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[dupe] OxyContin's 12-hour problem (2016) (latimes.com)
124 points by nikunjk 6 days ago | hide | past | web | 86 comments | favorite






Published May 5, 2016.

Article argues that OxyContin caused strong withdrawal symptoms when used as directed. Important, imo, because at a societal level we substantially blame addiction on "drug abuse" which is not always an adequate model.


As withdrawal becomes more severe and patients develop tolerance to these medications, they need to take increasing doses to get the same effects, leading to more severe withdrawal - aka. a vicious cycle.

The crux of this article was that Purdue knew their dosing schedule was problematic but pursued it despite growing evidence it was reducing efficacy and increasing addiction. Then they hid behind their FDA certification as if that exempts them from acting on evidence that their shitty drug doesn't work right.

In general, no drug for acute _anything_ will last as long as the manufacturer advertises. They are incentivized to push an idealized dosing schedule, even when that makes the drug less effective for a significant number of patients. This is kind of a big deal when a drug causes severe physical withdrawal symptoms.


> at a societal level we substantially blame addiction on "drug abuse" which is not always an adequate model.

While I agree that this model is not accurate, I'd also point out that just because you're taking a drug as directed doesn't mean you're not abusing it.

For whatever reason most people in the U.S. seem to have a wildly unjustifiable level of faith in western medicine, either way too much or way too little. Belief and disbelief in various forms of medicine have been successfully marketed as personal identities, which is easy to see from reading most HN comment threads on health issues.


If my doctor tells me to take Pill A every 8 hours, and I do so, how am I abusing it? It might be drug abuse, but it's not on my part.

I believe the point is that many people have A LOT of faith in the doctor's hands, and/or "what the label says on the prescription". For some people there is an unwavering sense of "but doc told me to take this, so I must HAVE to", or even "But the doctor prescribed this, so there's no way it could harm me". So, they may stop holding themselves accountable for the drugs they're taking and may not even notice negative side effects (dependence and withdrawal included).

>> just because you're taking a drug as directed doesn't mean you're not abusing it.

Yes. I put "abuse" in scare quotes, because I think it's definition should be better aligned with buisiness incentives, medical advice, and actual human behavior, especially if we put people in jail for it.


What do you characterize as drug abuse?

> What do you characterize as drug abuse?

I tend to think about drug misuse, rather than drug abuse, since not taking certain drugs can be just as irrational and damaging as taking too many drugs.

But basically I think people should use drugs as tools to maximize their utility based on their needs and values. And I think that drug misuse is anything that leads to significantly suboptimal utility that's clearly not justifiable by any sort of internally coherent reasoning.


That seems like an unnecessarily abstract way of saying "make good choices".

Drug abuse seems straight forwardly defined as using a drug for purposes other than as prescribed. Not following the schedule or following it when it is unwise to shouldn't be considered abuse as long as you are still using it to manage pain. Of course that boils down to intent, which is hard to determine.


So it's not misuse if I can justify it internally.

Feed anyone sufficient doctor prescribed heroin and they will start to act like the people Attorney General Jeff Sessions wants mandatory sentencing for

For those interested in this topic and how the opiate epidemic has stretched across the US, read Dreamland by Sam Quinones (https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidem...)

There are a multitude of reasons to explain how this happened but to quickly sum up an excellent book:

- Purdue created the whole "sell-direct-to-doctor" phenomena that is now the norm in the US medical profession

- One bad study that showed opiates for pain relief are NOT addictive and this study kept being cited by sales people

- Mexican drug dealers from a very tiny area in Mexico importing black tar heroin

- A prevailing idea in the US that people should never be in pain and managing it through lifestyle changes is not acceptable; a quick fix is needed

- economic depression in the Midwest and Appalachia regions

But really, read the book. It's eye opening and well written.


Tldr: Oxycontin doesn't last for 12-hours unless doage levels exceed thresholds known to induce addiction and higher risks of death. The 12-hour claim is a marketing gimmick that the company will go to war over regardless of the collateral damage. Moreover, the US court system has repeatedly permitted the company to continue, and works with the company to seal these findings.

Good to know.


Doctors should be more skeptical of pharma companies' marketing claims, right? Who believes everything they read? There's probably a case to be made that the FDA should have been more involved, too.

The data on how fast OC released its drug would have been available to the FDA, if not doctors.


Every time one of these articles comes out, people say that the FDA should have been more involved. Every time we hear about some new drug that Europe, India, or China has that is still being cleared in the US, people say that the FDA needs to step back and let pharma companies innovate.

Which is it? I honestly don't think the FDA is culpable in this. They're there to ensure that the manufacturer is meeting a minimum standard of proof, and if the manufacturer is falsifying that proof and ignoring clinical feedback then the manufacturer is solely responsible and needs to be held accountable. But to say that the FDA isn't doing its job here isn't particularly accurate, because they're doing their best to apply the law and ensure that the claims being made are accurate.


The article paints the FDA as very involved with this. To the point it claims the person that approved the drug moved to work in the company shortly after.

Besides, "stepping back and letting pharma companies innovate" is not the same as not participating. The FDA can make drug development cheap by many means, and the required fiscalization or catching that kind of behavior is not done by increasing the weight of the approval process.


I don't really have a strong opinion about either issue, but it isn't necessarily incoherent to simply want the FDA be be better in both cases.

Like what if some of the requirements for new drugs are arbitrary (slowing approval) and the standard of proof for novel release mechanisms is too low?


If the manufacturer claims that it works for 12 hours and it clearly doesn't, then then that's false marketing. The FDA could stop them from making that false claim without taking the product off the market.

I hope I never have to take this stuff.

Watching how dependent my mom has become on this has been painful to watch.


Search "kratom" (Mitragyna speciosa). It helps people kick their opiate addiction every day. It's not a magic bullet by any means, but it helps by mitigating the withdrawals to a tolerable point. Good luck - I know how you feel.

I think it is worth mentioning that it actually kills pain and I am yet to experience any side effects. Only problem is to find the right dose, but it is a minor obstacle in comparison to the hell offered by pharmaceuticals. I have been taking Kratom for a month now and after a week dropped all pain medication prescribed by doctor. I feel like I am getting my life back. I feel that there are forces out there trying to make it illegal, because it interferes with the profits of pharmaceutical companies.

> I feel that there are forces out there trying to make it illegal, because it interferes with the profits of pharmaceutical companies.

Sadly this harmless opiate replacement is schedule 1 in seven states and counting.


I feel the same way. I watched my dad go from Vicodin to Oxy to dead by age 50. All for a neck injury + surgery. It is a painful thing to watch the man who taught you everything reduced to crying on the floor because his prescription ran out early and it would a couple days until it could be refilled.

Fantastic article, but this should have a [2016] in the title.

As noted elsewhere, this isn't new content.


This is a dupe but Pursue should be prosecuted and held accountable for the total fucking disaster Oxycontin has wrought on our country. They should be considered enemies of the state. This shit is worse than any drug lord in Mexico or any ISIS leader as far as impact to US citizens and they knowingly perpetrated it.

I'm sure this is an easy question to answer, but it was bugging me during the whole article.

What's preventing a pill that releases a dose immediately and one after 6 hours? Or something like a diabetic pump that dispenses medication continuously? Surely such systems have the potential to be safer and more effective for patients?


Concerta ER does something like that, I'm curious why it isn't more widely used.

"The system, which resembles a conventional tablet in appearance, comprises an osmotically active trilayer core surrounded by a semipermeable membrane with an immediate-release drug overcoat.

The trilayer core is composed of two drug layers containing the drug and excipients, and a push layer containing osmotically active components. There is a precision-laser drilled orifice on the drug-layer end of the tablet.

In an aqueous environment, such as the gastrointestinal tract, the drug overcoat dissolves within one hour, providing an initial dose of methylphenidate. Water permeates through the membrane into the tablet core. As the osmotically active polymer excipients expand, methylphenidate is released through the orifice. The membrane controls the rate at which water enters the tablet core, which in turn controls drug delivery."


in terms of ADHD Vyvanse/Elvanse/Lisdexamphetamine is more interesting in my opinion, its dexamphetamine bound to lysene. your body naturally strips the lysene away releasing the dexamphetamine over a period of 12 hours.

it doesnt rely on being mixed with something to delay its action or be pressed into a solid pill, in fact you can open up the capsules and eat the powder inside and there is no change in its effects (its also ineffective intranasally or as far as i am aware even if injected) its rate of release is difficult to change, its just how long the average body takes to strip the lysene away from the chemical.


> What's preventing a pill that releases a dose immediately and one after 6 hours?

Being plopped into a bath of hydrochloric acid makes this a little tricky, I am led to understand.

> Or something like a diabetic pump that dispenses medication continuously?

And this led me down a brief Google walk for what these are, and...huh, that's a really good question...


Expense and convenience (a thing with access to your blood isn't very convenient).

IV pain management often includes a button the patient can push (that releases a dose and sets a timer for the next dose). Or at least it used to, I don't know if it is still done.


> What's preventing a pill that releases a dose immediately and one after 6 hours? Or something like a diabetic pump that dispenses medication continuously? Surely such systems have the potential to be safer and more effective for patients?

Nothing. There are such pills for stuff like Adderall and Ritalin already, on the mass market.


Why would it need an automatic pill? What about 1/n dosage taken n times per day? Less convenient sure, but you can pick whatever n works.

Less about convenience, more about letting patients get a full night's sleep. Maybe the answer is to alter the sleep schedule of chronic pain sufferers, but it would probably require some form accommodation at the workplace.

There's fentanyl patches.

Can somebody give some context on the root cause of the problem - the chronic pain epidemic in US. What caused it, why it is more than in other parts of the world and why so many painkillers?

Is it cultural?


>What caused it, why it is more than in other parts of the world and why so many painkillers?

>Is it cultural?

That's actually a really common misconception on HN. The United States ranks 27th among countries which abuse opiates, [1] behind many first-world countries like the UK, Italy, Spain, Switzerland, Ireland, and Russia, to name a few.

What's the cause? A lot of HNers like to pin it on unemployment and low-wage, low-skill jobs. I think that's narrowing the field in the right direction, but it isn't quite right; I know many very happy people who just make ends meet. There's something more that no one has been able to pinpoint quite yet.

1. https://en.wikipedia.org/wiki/List_of_countries_by_prevalenc...


I think part of it is how the social safety net is done in the US. Americans have to "deserve" help, so when the lumber mill closes down for good, the 50 year old manual laborer has to become "disabled" due to his back pain in order to access the money he needs to survive. I've heard anecdotes of doctors asking whether patients have college degrees when they come in complaining of back pain. And the ranks of the disabled have swelled tremendously in recent years.

Those data for opiate use, not abuse. I suspect the percentage of the population who have used any opiates at least once in the past year tells you very little about about opiate-related problems - using cocodamol once a year is obviously very different to the habitual use of oxycodone.

I further suspect that the availability of opiate-containing drugs over the counter in some countries accounts for some of the differences in those statistics (e.g. cocodamol in the UK).


Your source lists opiates - products of opium poppy - not opioids (the superset that includes poppy products and synthetic product).

Since this discussion is about synthetic opioids it's not a useful source.

Have a look here. The US has considerably higher use than each of the countries you list when we talk about prescription meds.

http://www.unodc.org/documents/data-and-analysis/WDR2011/Sta...


That table is for opiate use, which needs not be (at all) ab-use. Your argument does not stand on that data.

People take painkillers because they can't afford surgery.

Say you have a messed up disk in your spine. Surgery is tens of thousands of dollars. Getting a prescription for opioids from a primary care physician is a bit cheaper.

You don't see doctors in europe routinely prescribing hard pain killers because they try to fix the problem instead.

Healthcare in america is set up in such a way that hospitals just bill whatever and then have the lawyers argue over whats reasonable. That kinda works when youre part of the medicare system and their lawyers represent your side, but when youre on your own, you're suddenly in hospital recovering from major surgery, facing bankruptcy and have to hire a lawyer to tell the hospital to suck it.

So you just take the painkillers and hope for the best.


> Say you have a messed up disk in your spine. Surgery is tens of thousands of dollars.

There are situations where risks from surgery are potentially worse than the (yes, possibly misinformed) side effects of painkillers.

Is there any data on this? Anecdotally, I know a few people who are either living with pain or taking medication because surgery is too risky.


I'm not saying that everything has to be surgically repaired. Whatever the surgeons decide to do I'm cool with 99.9% of the time.

Its just that there are people who "should" have surgery who "can't" have it because money.

Another issue is that just because a doctor advises you to take opioids doesn't mean that you're not abusing them. Doctors tell you to do all kinds of things that are bad for you because they are the lesser evil. The prime example being chemotherapy.

The primary use-case of morphine-like substances is to treat acute pain. Taking any kind of opioid for prolonged periods of time leads to systemic adaptation and you end up an "addict".

Is there data on this? Probably. Depends on what you want data for. The fact that america is under-insured when it comes to healthcare is well-established fact.

I don't buy "people take opioids because their lives are lame" - because its bullshit. There are drugs that are way easier to acquire that provide a lot more "fun". You don't start on heroin and then switch to vicodin, either. A heroin addiction is treated with methadone.

If you want a really clean "feel awesome" high, you want a benzodiazepine like Lorazepam. I had a prescription for that once. Popping one of those pills, you smile from ear to ear within seconds and experience pure bliss. If you intentionally try to have negative thoughts, you just laugh harder because it feels so ridiculous. If you wanted to "trick" a doctor into prescribing those, faking the necessary symptoms is really simple.

The drug industry has a pretty good grasp on how to engineer drugs to do one specific thing really well without causing a bunch of secondary effects. Modern painkillers are good at dealing with pain, without turning people into loonies. But opioids are opioids and if you take them indefinitely, you mess with brain chemistry.


People also take painkillers to recover from surgery...That is how many folks get hooked, and in some cases, eventually switch to heroin (because they can't afford the pills off-script at black market prices)

You mean there's a non-trivial number of patients who are prescribed opioids to essentially self-medicate at home because keeping them in the hospital until they're recovered is "too expensive" - who are then told to deal with their addiction themselves because no doctor felt the need to actually guide them through responsibly using their drugs?

Who are THEN told that they just can't get drugs anymore because now they're just filthy addicts. That's actually impressive. For a glorious nation like the united states of america. Borderline malice.


There's no "chronic pain epidemic". As is often the case, the pharma market created (or rather, in this case, reshaped) a problem for a particular kind of product to solve.

Obviously, ceteris paribus, less pain is much better than more pain, and there will probably always be acute and chronic pain for therapeutic innovation to tackle. There's no virtue in the experience of chronic pain. But the evidence strongly suggests that patients are worse off with casual access to powerful opiates, and that these products are packaged and sold irresponsibly.

No legitimate underlying medical phenomenon spurred the uptake in opiates.


> There's no "chronic pain epidemic".

50% of American adults suffer from chronic pain. If those levels don't qualify as an epidemic, what levels would?


What does that actually mean? If I stop and think about it, I'm experiencing a variety of chronic pains right now. Most of them don't warrant an aspirin, but they're pain nonetheless. Your response here is really a quibble over definitions: in context, I'm clearly talking about "chronic pain whose severity warrants powerful opiate analgesia" ("powerful" because maybe we should have T2 or something like it available in the US).

I tried to avoid this pointless debate with a second paragraph to immunize my argument from the trope that arguments against opiates are arguments in favor of pain.

My point --- I think obviously --- is that no underlying medical pathology occurred to spur the uptake in consumer opiate products.


> no underlying medical pathology occurred to spur the uptake in consumer opiate products.

The uptake of opiates wasn't driven by any change in pathology, but it was partially driven by a change in how we think about pathology. The IOM report I linked to helped to popularize the idea of treating pain itself as a disease that should be treated, rather than as a symptom which shouldn't be treated until the underlying cause is known:

"Because pain often produces psychological and cognitive effects—anxiety, depression, and anger among them—interdisciplinary, biopsychosocial approaches are the most promising for treating patients with persistent pain. But for most patients (and clinicians), such care is a difficult-to-attain ideal, impeded by numerous structural barriers—institutional, educational, organizational, and reimbursement-related. [...] In addition, adequate pain treatment and follow-up may be thwarted by a mix of uncertain diagnosis and societal stigma consciously or unconsciously applied to people reporting pain, particularly when they do not respond readily to treatment. [...] Understanding chronic pain as a disease means that it requires direct treatment, rather than being sidelined while clinicians attempt to identify some underlying condition that may have caused it."

I'm definitely not arguing that opioids should be first line treatments for chronic pain, but I also agree with the IOM that they should be more accessible when needed.


That sounds unbelievable. This Washington Post article pegs it at 11%:

https://www.washingtonpost.com/news/to-your-health/wp/2015/0...


The article you just linked to literally says it's over 50%. The 11% statistic is the percentage of Americans who are currently in pain. Whereas chronic pain is basically pain that's intermittent.

C.f. the IOM report on pain in America: https://www.nap.edu/catalog/13172/relieving-pain-in-america-...


Wow. That's a spectacular claim. Almost unbelievable, and certainly in need of strong empirical support.

Anecdotal evidence over six decades of life on Planet Earth suggests otherwise.


The root cause is Purdue Pharma, who successfully marketed the drug to primary care physicians by lying about the risk of addiction:

Perhaps knowing that doctors would be vigilant against prescribing drugs with the potential for abuse, Purdue set out to distinguish OxyContin from rivals as soon as it dropped. The cornerstone of its marketing campaign was the drug's incredibly low risk of addiction, an enviable characteristic made possible by its patented time-release formula. Through an array of promotional materials, including literature, brochures, videotapes, and Web content, Purdue proudly asserted that the potential for addiction was very small, at one point stating it to be "less than 1 percent." (http://theweek.com/articles/541564/how-american-opiate-epide...)


Overeagerness to prescribe. Other countries have similar problems too.

Conversely, the country I live has a benzo problem. Hell, go into any doctor complaining you haven't been sleeping properly and he'll happily prescribe you clonazepam to help you with that. You have just been prescribed an addictive and strong psychoactive drug, just like that. He won't care if you have been working too much, or not eating or sleeping well, he will not care at all about possible factors that may be causing your current insomnia.

"take this and come back to reassess in 2 months", the doctor will say, and ofc, in 2 months you will come back saying this helped immensely, and from that there's a whole slew of problems that everyone knows: try to wane off it, insomnia comes back, sometimes worse. or maybe some new anxiety gets thrown in....

They want money, because if they wanted you to get well they you'd be treating the cause of your symptoms and not your symptoms :D


> and from that there's a whole slew of problems

That's the whole point - doctors have more work, so they can ask for more money and pharmaceutical companies make a killing. Doctors are not interested in curing their patients nowadays, they are interested in making money for pharma.


What's the evidence backing the explanation of overeagerness to prescribe?

I know a handful of doctors as well as pain patients, but I'm curious to get more context outside of the small bubble I know.


totally anecdotal, yes, but reading several local news articles about the 'benzo epidemic' here I think doctors just don't care. It's easier for them to just walk you out after 3 minutes of consultation instead of trying to solve the puzzle in front of them. It's also more profitable to them as well so you can see how dangerous this can turn for us... doctors aren't exempt from corruption.

I certainly know people here (Denmark) who are hooked on prescribed opiates for no real good reasons at all. They are, in all but their own perception, addicts.

Seems to me it comes down to competence and ethics of individual doctors, as well as to preferences and susceptability of individual patients, of course.

We are not experiencing quite the epidemic proportions of the US, presumably owing to a different structure of health services, and probably a higher general level of scepticism towards medical authority, but the mechanisms and the potential are clearly in place.


Hospitals are funded based on patient satisfaction and pain was added to patient satisfaction scores. To boost their ratings and funding hospitals and their doctors started heavily prescribing pain killers - in a way that pushes the problem from their hospital.

https://www.medpagetoday.com/publichealthpolicy/publichealth...


Something I've noticed: in the US people generally have an aversion to being even mildly uncomfortable.

And, it's culturally acceptable to be on medication so people take it for basically any inconvenience.

Sweating a little? Crank the AC. Small headache? take a pill. Bad day? Have a drink. Workout left muscles sore? Another pill. Sprained ankle? Obviously you need pain medication!

It's easy to see how there is a low threshold to abusing pain medication.


This! Living in the UK for the last few years, the difference is remarkable. Yes, the UK has its hypochondriacs, but the comfort culture in the US takes it to a whole other level. Great for business, I imagine.

Ive actually seen people take pain killers for being sore from working out as you mentioned. It's mind blowing.

I think you could say the same thing about almost any first world country.

The US has more people using opioid medication than any other first world country.

For people who've used opioid medication in the past year most of the developed world has a figure of around 1% or 2%. The US has over 5%.


I'm pretty sure other parts of the world have chronic pain, I've seen it a lot here in South America.

What we don't have is the drug culture, people look for alternative ways to mitigate the pain.

A quick googling gave me this WHO paper:

https://www.hrw.org/sites/default/files/reports/hhr0511W.pdf

We found enormous unmet need for pain treatment. Fourteen countries reported no consumption of opioid pain medicines between 2006 and 2008, meaning that there are no medicines to treat moderate to severe pain available through legitimate medical channels in those countries.

These countries are concentrated in Sub-Saharan Africa, but are also found in Asia, the Middle East and North Africa, and Central America


The book Dreamland covers this quite a bit, and is a good read on the subject:

https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidem...

My takeaway was that opiates were incorrectly classified as a non-addictive way to treat pain, so doctors started dolling them out far too liberally. Hospitals also started employing pain specialists who's sole job was to treat pain in patients. It's pretty easy to find people in any sort of "pain" if that's all you're looking for.


Read the article. It's economic - the makers of these opiate drugs have large marketing budgets they employ to encourage physicians to prescribe these addictive drugs and there has been essentially no governmental oversight on these marketing efforts because these marketing budgets also fund lobbying activities.

There have been a few prosecutions of individual sales/marketing people for knowingly supplying pill mills, but it's just a cost of business expense for large pharma companies.


Yeah but the problem goes deeper. Not sure how to properly describe it. The initial sentence people waking up to take painkillers is unbelievably weird. If you manage to fell asleep - then the pain itself is unlikely to wake you up.

What the farma company did was exploit already existing predisposition of people to take painkillers. They were working on fertile ground.

I don't know - having large population of people that need constant painkillers in their day to day life is just strange. Abusing the people is despicable. But why did this population existed in the first place?


Article argues that patent evergreening necessitated dishonest marketing and resulted in a "created market" type of strategy.

The patent for OxyContin was predicated on the claim that each dose lasted longer than older poducts. When that didn't work they raised the dose instead of shortening dosing intervals, which caused a reward/withdrawal cycle in patients.


Yes, it is cultural. Money/greed on the supply side. Lack of happiness on the demand side.

>Money/greed on the supply side. Lack of happiness on the demand side.

You have nothing to back that up. In fact, all the evidence I've seen points towards the opposite: the places with the least opiate abuse are (1) not happy countries (2) with very strict laws. See Qatar, Saudi Arabia, Singapore, etc.

If money and greed on the supply side, and lack of happiness on the demand side is the true cause of this, surely those countries would be ravaged with an opiate epidemic. But they are not. The problem is much more nuanced than you make it out to be.


It's hard to be scientific about this. For example, you wrote of Singapore being unhappy, but in my experience in Singapore people seem really happy. A lot more than in the States, as far as I can tell (and especially far, far less anger).

Poor diet and lifestyle, plus drug culture

I just got ACL surgery and am doing the entire recovery (day 11) without any painkillers stronger than ibuprofin. This is not because I'm so brave, but because I know the pain associated with opioids to be so much than the physical pain in my knee. We've got to aggressively pursue alternatives.

Or maybe your pain is not as severe as the pain for which others take opioids.

That is almost certainly true. ACL surgery pain is intense and taking prescription painkillers is strongly recommended, but certainly, there are more intense pains people experience. I don't really think that's relevant to my point but perhaps it is.

The real problem here is that human pain gauge is ridiculously wide. xkcd was totally right on this part in https://xkcd.com/883/

Can we please fix something to add dynamic compression to pain signals? log(x) will be a good idea past some pain level.


Previous discussion has this top comment (https://news.ycombinator.com/item?id=11652159) by cant_kant, which I believe is worth posting here:

Sensible doctors do not believe drug company marketing.

I get large amounts of ad-junk from drug companies that ends up unread in the bin. I refuse to meet with drug company representatives. I smile politely at them if I bump into them in the corridor and suggest that they leave their ad-junk with my secretary. My staff then file their ad-junk in the trash bin.

On Friday, I had a drug company representative attempt to tell me ( he was hanging around my coffee area ) about the joys of Targin, a fixed-dose combination of oxycodone and naloxone. I gently shook him off, and directed him to my secretary.

Drug company representatives are usually decent human beings with lives and families. However they are poorly educated, poorly informed salesmen and women with sales targets to meet and product managers to keep happy. Even worse, they and the drug company have no accountability if a patient dies because of their recommendations. If avoidable death supervenes or if there are non-lethal complications or even just therapeutic failure, I am accountable.

Instead of relying on marketing, I rely on information from good, well performed randomised controlled studies published in reputable peer reviewed journals ( I like the NEJM ) and on meta-analyses of these. I view the results of these through a filter of scepticism, cynicism, pragmatism and a modicum of hope.

Many of my colleagues do likewise. I trust that you do the same in your respective vocations. Regrettably, there is a bell curve. I am sure that the drug companies find enough gullible prescribers out in the wild for their purposes.


That sounds like a good, responsible, doctor. I probably wouldn't believe them if they were my doctor. I've been through a repaired Achilles and knee surgery and haven't gone to get the prescriptions filled for any of it. I don't trust any doctor anymore to give me something that is actually good for me - I suspect they're giving me something that's good for them.

I happen to have direct exposure to the medical industry at the practice level. I can tell you unequivocally that entire industry is compromised. Maybe you're a good doctor, and you have my best interests at heart, but you're in the minority, and your peers have ensured I won't be trusting you.


Original: https://news.ycombinator.com/item?id=11652159

Also, this should probably have a "[2016]" tag in the title.


By that definition, most doctors aren't sensible.

All doctors are human. They probably have higher averages on [X things required to make it through med school and residency] but that doesn't guarantee they are above average on anything else. Like ethics. Or avoiding certain biases.

I meant to insult his definition. Clearly most doctors are sensible. Humans just aren't the rational logicians his standards require.

You should probably link the comment and discussion in question instead of just lifting someone else's words unattributed.

Good point, done. In my defense, I did post a link to the previous discussion below :-)



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