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PaperclipPerfector  2mo ago (text post)   28342 thread views

Culture War Roundup for the week of June 24, 2024

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If the doctors don't have any extra rewards dangled before their eyes, I'd say their incentive would imply prescribing the lowest dose possible to get the job done. If you do dangle rewards for how much they prescribe, the incentives shift to "give as much as the patient can take".

I don't think the click-throughs actually have this, though. The marketing materials they used were not mustache-twirling evil; they used the standard sort of medical language to basically try to say exactly what you're saying - prescribe the dose that gets the job done... but if the current dose is not getting the job done, then titrate up to higher doses. The argument is entirely about what counts as "not getting the job done", which is completely analogous to asking what is "necessary". There's nothing in the click-throughs that can be interpreted as "give as much as the patient can take". There's nothing like "try the highest dose, look for side effects, then reduce if necessary". It's literally the other way around; increase the dose if it seems to be useful. This is obviously presented by plaintiffs as "encouraging them to increase the dose", but you can kinda only make these sorts of jumps if you have a magic metric for what is "necessary" or for what "gets the job done"... and then you sort of close your eyes and imagine that doctors aren't "really" doing that, that they're really just doing something else because of some alternate incentive that isn't even in evidence. It's entirely because we have no such metric that this entire kayfabe is even a plausible discussion.

Frankly, it's probably even more absurd than having hard liquor advertisements that have a little tag at the end saying "drink responsibly". At least in the click-through documents, they paid significantly more lip service to precisely the type of behavior that you're suggesting would be the Good and Right way to do it. They weren't like, "CHECK OUT HOW FUCKING AWESOME OUR HIGHEST DOSE IS! (...btw, try to be responsible with how you prescribe stuff)".

So I might need to actually click in order to participate in thus conversation, but for now I'll just ask: this is only about a bunch of marketing materials? There's no mention of any sort of referral program, which would translate higher prescriptions into more cash in doctors' pockets?

Hey, I missed this reply, but the answer to this is actually yes, contra to the reply you received.

Each of these in-person sales visits cost Purdue money — on average more than$200 per visit. But Purdue made that money back many times over, because it convinced doctors to prescribe its addictive drugs. When Purdue identified a doctor as a profitable target, Purdue visited the doctor frequently: often weekly, sometimes almost every day. Purdue salespeople asked doctors to list specific patients they were scheduled to see and pressed the doctors to commit to put the patients on Purdue opioids. By the time a patient walked into a clinic, the doctor, in Purdue’s words, had already “guaranteed” that he would prescribe Purdue’s drugs. Purdue rewarded high-prescribing doctors with coffee, ice cream, catered lunches, and cash. Purdue has given meals, money, or other gifts to more than 2,000 Massachusetts prescribers.

I don't see anything about a referral program along those lines. Closest I can see to having money go back to doctors is that they had the standard sort of "we pay doctors to give speeches promoting our product" that basically every drug company does. Scott has talked about this before with a bunch of other drugs. But yeah, there's nothing that I see in the long documents about any program more directly along the lines of "if you prescribe higher doses or more pills, we, like, kick you back some money or something".

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