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Should Doctors Embarrass “Dopesick” On TV?

Does the television series “Dopesick” make some doctors appear gullible or greedy, easily tricked into prescribing opioids by the lure of pharmaceutical swags and paid trips to posh golf resorts?

Is it showing federal doctors responsible for ensuring the safety of the country’s prescription drugs ready to approve Purdue Pharma’s preferred label language – that the delayed uptake of OxyContin reduces the risk of abuse despite a lack of evidence – because it leads to a six- Figure job with industry?

Are many doctors portrayed as earners in the millions running pill factory clinics where drug seekers line up to get hundreds of prescriptions at increasingly higher doses, with many not receiving a physical exam?

Yes, somehow, to all of the above. In many ways, the show doesn’t put Doctors in the best light. They are not portrayed as critical thinkers asking tough questions – how can an opioid be prescribed for pain as mild as a headache or a hangover without dire consequences? How is it not addictive?

But that doesn’t mean doctors shouldn’t watch the show, said Andrew Kolodny, MD, medical director of the Opioid Policy Research Collaborative at Brandeis University in Waltham, Massachusetts, who was also a medical advisor for the show.

Public health disaster

“I think doctors should watch this series because it provides important lessons for doctors about how pharmaceutical marketing can lead to a public health disaster,” said Kolodny. To this day, doctors continue to be targeted by pharmaceutical marketing strategies, including collecting data on their prescribing practices, he said.

“Our patients ultimately pay the price for the influence that the pharmaceutical companies have,” said Kolodny.

Kolodny values ​​the “ability of the industry to find cures and treatments. But much better firewalls are needed so that drug and device manufacturers do not unduly influence medical practice,” as the show so clearly shows.

Although the prescription of opioids has declined in recent years, “there is still no other country that prescribes nearly as many opioids as we do,” he said.

The eight-episode series – the last of which aired on Hulu on November 17 – is based on the non-fiction book Dopesick: Dealers, Doctors and the Drug Company that Addicted America by Beth Macy.

The show revolves around a fictional Dr. Samuel Finnix, played by Michael Keaton, a widower who practices in a coal mining town in the Appalachian Mountains, where workers are often injured but often go to work in excruciating pain. He’s a kind, caring doctor who makes house calls, even just to make sure a patient is remembering to take her medication.

A young, ambitious Purdue salesman looking to make a lot of money sneaks into Finnix’s practice with flowers and fried chicken and manicures for his nurse. He wants Finnix to prescribe a new opioid drug that can relieve patients’ chronic pain. Best of all, following the Purdue mantra, he said, “less than 1% become addicted.”

Hangover and headache

“Backache, toothache, headache, joint ailments, arthritis, hangovers, the possibilities are endless,” a Purdue official is shown training his sales team, which targets Southwest Virginia, eastern Kentucky and rural Maine, people in Mining and logging centers injured at work.

“These people are in pain. They have hard lives and we have the cure. So we’re sending you all out into the wild to turn these country doctors from Percocet and Vicodin to OxyContin,” the officer tells the team. “Make your doctors feel special. Take them with you to expensive dinners.”

But too many of Finnix’s patients become addicted, including himself, after doubling and doubling his dose to relieve the pain from an injury he sustained when a car hit his truck.

Like many of his patients, he quickly goes downhill, after all he takes OxyContin from his own patients and finally buys it from street vendors. He learns he can sniff the drug to get a greater effect.

After he messed up a procedure and lost his license to practice medicine, he went to rehab. But even there, he craves the drug so much that he asks the Purdue rep to visit him for treatment, only to ask, “Do you think you can get me some pills?”

Although Keaton’s character is fictitious, real doctors are also portrayed by name. An actor portrays Russell Portenoy, MD, a highly regarded New York City pain specialist who tells the thousands of doctors who gathered at a lavish Purdue conference not to hesitate to prescribe OxyContin for chronic pain.

Adriane Fugh-Berman, MD, professor of pharmacology and physiology at Georgetown University in Washington, DC, and director of PharmedOut, also found parts of the series contained good lessons for doctors, although she prefers to read books that deal with the Don’t Fictionalize Events – Barry Meier’s Pain Killer: An Empire of Deception and the Origin of America’s Opioid Epidemic and Macy’s Dopesick.

FDA revolving door

One of those lessons is the recognition that “there is still a revolving door between the FDA and pharmacy,” which begs the question, “Are there any other officials at the FDA who are auditioning for jobs in the pharmaceutical industry that may pose a problem ? ” said Fugh-Berman.

She spoke of Curtis Wright, MD, whose character is featured on the show. Wright was the FDA’s chief review officer overseeing the approval of the label and advising clinicians on the use of OxyContin as requested by Purdue officials. The wording states that OxyContin “should reduce the risk of misuse of the drug”. Just over a year later, the real Wright took a job at Purdue with a salary of $ 379,000.

“We don’t want FDA staff to make industry-friendly decisions that are against public health or the principles by which the FDA should operate,” said Fugh-Berman. And she said 13% of OxyContin users became addicted – no less than 1%.

Doctors could see themselves portrayed as more trusting on the show than most of the others, she continued. “Many social psychology principles are used by corporations to emotionally manipulate doctors, and they work as well or better than manipulating other people emotionally,” she said.

Conclusion: Opioid marketing is not a thing of the past. “It’s still going on, and we’ve been documenting news that goes against science,” said Fugh-Berman.

Another real person and star villain on the show is Richard Sackler, MD, played by actor Michael Stuhlbarg. Sackler’s family owns Purdue, and he is on a mission to grow the company by making OxyContin the “first billion dollar drug” and the “greatest pain reliever in the history of human civilization”.

Born to be addicted

When it turned out that thousands were overdosed and died, Sackler is emphatically portrayed: “This is not our fault. These people want to get addicted.” You are born perpetrators, he said.

Fugh-Berman said that Sackler’s account is not only an accurate account, but that the strategy of “blaming the addicts, they are the guilty” is still a belief of some specialized agencies who insist that legitimate pain sufferers do not get addicted “and that’s not true.”

The prescribers’ gullibility and confidence in what the sales reps tell them is pervasive throughout the show.

For example, Purdue’s claim that a study in the New England Journal of Medicine showed the drug was not addictive is based on a lie that makes one wonder why more doctors don’t see it.

In fact, Purdue was referring not to a study but to a five-sentence correspondence from Hershel Jick, MD, of the Boston Collaborative Drug Surveillance Program. It was based on patients taking hydromorphone, percodan, and meperidine, not OxyContin.

Doctors can be embarrassed to see how easily their colleagues have been deceived in other ways. For example, Purdue created a table showing that patients’ blood levels did not have the spikes and drops that would be expected with opioids. But the graph’s axis was compressed in a way that, as one scientist told federal investigators, was “utterly deceptive” because the graph, when displayed correctly, clearly showed dramatic spikes and dips.

But they shouldn’t be embarrassed, said Kolodny. “It has to be recognized that doctors heard from all directions that we had prescribed too few opioids out of exaggerated fear of addiction and that patients suffered unnecessarily.”

The fifth vital sign

Doctors heard this message from state medical associations, professional societies, hospitals and pain specialists in their field. You heard it from “grassroots patient organizations” established by the pharmaceutical industry, as well as from the mass press, Kolodny said.

“If you were going to be prescribing more opioids from every direction you hear and not getting addicted to patients with legitimate pain, it would have been very difficult not to be swayed,” he said.

Kevin Zacharoff, MD, a pain and addiction specialist at Stony Brook University in New York, said he hoped doctors who watch the series will realize that information “probably isn’t the best when it comes from a drug company, that’s basically trying to make a single “. Thing: sell more product. “

The show’s message also highlights an issue that is becoming increasingly recognized as deaths from overdose and hospitalizations continue to scare families and stress health facilities: most doctors are not trained in pain management either in medical school or family practice. Finnix “was forced to study while he was going,” said Zacharoff.

The show also takes most pain societies as examples of how drug company-funded training that is not supposed to be promotional is actually very promotional, he said. The firewall that is supposed to be present has “leakage”.

“What the show was trying to portray with the American Pain Society and American Pain Foundation and others logo is that when money is moved, basically messages are being sent. That might resonate with clinicians who watch this show. “Said Zacharoff. Both organizations have now been dissolved.

Macy, the author of the book the show is based on, told MedPage Today in an email through a spokesman that the show definitely contains messages for doctors. Doctors, she said, “played a role in creating this iatrogenic epidemic, and they should play a role in delivering it to the more than 2 million Americans with opioid use disorders.”

  • Cheryl Clark has been a medical and science writer for more than three decades.

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