I found an article online last week about new, FDA-approved education programs coming out designed to teach physicians how to safely prescribe certain classes of opioids. Since one of the themes I repeat here is the need for greater education of physicians on the risks of opioid prescriptions, you’d think I’d be overjoyed to see concrete measures being taken in that direction. In fact, though, I’m sorely disappointed by the sort of “educational” programs described in the article. It looks as though the actual programs will be put together by medical education companies (who profit by selling them) and “the drugmakers” — the pharmaceutical companies. These companies, of course, survive by persuading physicians to prescribe certain drugs, whether or not those drugs are proven to be necessary or helpful. In the constant see-saw balance of over- and under-prescription, these companies have been a great force pushing for overprescription. This isn’t a mystery; it’s how they make their money. The FDA knows that nothing could induce a pharmaceutical company to be fair and unbiased in presentation of its own product. And yet what they seem to be doing with these programs is asking the pharmaceutical companies to design presentations on the risks and benefits of the opioids they make.
I’d say that the results we should expect are obvious, but in fact they’re even more obvious than that — this isn’t the first time this has happened. This isn’t even the first time this has happened with this class of drugs. One of the reasons for the present “opioid epidemic” was shoddy opioid education back when the class of drugs was first becoming available for widespread use. Bad information early on has led to a skewed concept of what’s “normal” when it comes to opioid prescribing, and helped to set the stage for the rampant increase of addiction and overdose that we’ve seen in the past few decades.
Medicine as a whole relies, to an incredible degree, on solid information. The human body is a complex, strange, and wonderful thing, made up of countless systems all held in natural states of balance, affected by diet, environment, genetics, mood, and any other factor of thousands. In order to do any good, doctors must know what we are doing — and since it is impossible for any one person to know everything, we are forced to rely on others both in and outside of our fields. General practitioners rely on specialists, who might rely on colleagues, or hospitals, universities, or other sources of knowledge. Poisoning this stream of information with biased or slanted facts won’t just result in an incorrect news report, or a bug in a computer code; it can, and does, cost lives on a national scale. It’s absurd to me that we have not yet learned that the companies that make and sell drugs cannot be trusted to give an accurate report of what those drugs do. It’s absurd that we haven’t learned about these companies’ tendencies to downplay the risks and talk up the benefits of their products. We tend to engage with them as physicians, while they are engaging with us as salespeople. In an environment where we’re not expecting to be tricked, scammed, or misled, we become incredibly susceptible to it. It has to stop.
Every doctor is familiar with this on a smaller scale; what doctor hasn’t had a drug rep come into the office and buy lunch for the staff, or hand out small gifts? It’s all an effort to pay the doctor to prescribe that medication more than they normally would, or instead of something they’d otherwise prescribe. If we give them the chance, they’ll try to pull the exact same tactic on the national stage — offering the government money to get the chance to convince doctors to go against their better judgement.
If education is to be effective, it needs to be accurate and unbiased. This is not how we will get the education we sorely need, and I am disappointed to hear that it will be packaged as legitimate. Hopefully we will do better someday soon.