Marketing doctor related to opioid overdoses

Welcome to Impact Factor, your weekly dose of comments on a breakthrough medical study. I am Perry Wilson.

Forty million dollars. This is the amount that pharmaceutical companies spent to sell opioids to doctors over 1.5 years – in lunches, conference fees and consulting contracts. Forty million, it is really a drop of water for Pharma. But this week, an article appeared in JAMA Network open now establishes a link between pharmaceutical payments to physicians and deaths due to opioids in the United States.

There is no free meal, guys.

The badysis used three main data sources. First, the authors used data from the Sunshine Act to determine how long pharmaceutical companies spent on marketing to physicians, county by county. If you have not played with this site, you should do it. Find your doctor. Find a pharmaceutical company. You can see here that Purdue Pharma, the makers of OxyContin, has spent about $ 6.8 million in 2017 to promote directly to physicians.

Source: OpenPaymentsData.CMS.gov

The authors then linked the data to a CDC database of opioid prescribing rates and, finally, to the CDC data on opioid deaths.

With all the pieces in place for badysis, the results from the top line may not have been surprising. The more a pharmaceutical company spent on physicians in a county, the higher the number of doctors prescribing opioids prescribed by physicians, and the higher the opioid overdose rate.

Overall, for every four additional physician payments made per 100,000 population in a county, there were 13,000 additional opioid prescriptions and an 18% increase in the number of opioid overdose deaths. .

But it should be noted some nuances. The first is the question of causality. Do businesses that spend more money lead to more prescriptions, leading to more overdoses? Or maybe companies simply spend money in places where doctors are already write more prescriptions?

To remedy this, the authors have linked before-year of expenses to currentPrescription rate over a year, but given that the current year and current year spending rates are probably highly correlated, I do not think it totally eliminates the problem of reverse causality.

The authors conducted an intelligent mediation badysis to determine the extent to which the ratio of pharmacy dollars to opioid deaths is influenced by physician prescriptions.

According to their data, about 25% are related, suggesting that reducing physician prescriptions could be a reasonable strategy for reducing the number of overdose deaths. It also means that 75% of the relationship is due to something else, and the solution may be to limit pharmaceutical expenses in marketing, period.

Now, I should mention that there is no negative control in this study. It would have been interesting to see if marketing expenses spent, for example, on cholesterol drugs were badociated with opioid overdoses. If they were, it would suggest that there is an unmeasured factor, for example the use of health care, that the badysis does not take into account. So, this is not an open and closed case.

And yet, I can not help but wonder what public good can come from this type of marketing. Perhaps the $ 40 million spent on selling opioids to physicians already knowledgeable about opioids would be better spent educating the public that these drugs are often not needed.