Opioid Marketing Payments To Doctors Fall, ProPublica Reports : Shots – Health News : NPR
Enlarge this image Marketing payments to doctors by makers of opioids have declined. Wallace Garrison/Getty Images hide Wallace Garrison/Getty Images Marketing payments to doctors by makers of opioids have declined.
Wallace Garrison/Getty Images The past two years have been a time of reckoning for pharmaceutical manufacturers over their role in promoting opioid drugs that have fed a national epidemic.
Lawsuits and media reports have accused Purdue Pharma, the maker of OxyContin, of aggressively marketing the powerful narcotic even after it knew the drug was being misused. Prosecutors have charged the founder of Insys Therapeutics and several of the company’s sales representatives and executives for their roles in an alleged conspiracy to bribe doctors to use its fentanyl spray for unapproved uses. State and local governments have sued a host of drugmakers, alleging they deceptively marketed opioids and seeking to recoup what it costs to treat people addicted to the drugs.
But as public attention increases, the marketing tide may finally be retreating, a new ProPublica analysis shows. Pharmaceutical company payments to physicians related to opioid drugs decreased significantly in 2016 from the year before.
In 2016, drugmakers spent $15.8 million to pay doctors for speaking, consulting, meals and travel related to opioid drugs. That was down 33 percent from $23.7 million in 2015 and is 21 percent less than the $19.9 million spent in 2014. Companies are required to report the payments publicly under the Physician Payment Sunshine Act, a part of the 2010 Affordable Care Act.
ProPublica analyzed these payments in conjunction with our update of Dollars for Docs , an online tool that allows users to view and compare promotional payments to doctors from drug and medical device companies. We updated the tool Thursday to add payments to doctors for 2016. It now includes more than $9 billion in payments since 2013 to more than 900,000 doctors.
Among opioids, the biggest decreases in spending were for Subsys, the fentanyl spray that has spawned criminal charges against officials and sales representatives at drugmaker Insys, and Hysingla ER, an extended-release version of hydrocodone made by Purdue Pharma.
Payments related to Subsys decreased from more than $6 million in 2015 to less than $2.4 million in 2016. Payments for Hysingla dropped from about $6.3 million in 2015 to $2.2 million in 2016.
Dr. Scott Hadland, an assistant professor of pediatrics at Boston University School of Medicine who has studied opioid marketing, said the decreases were “impressive” but not surprising given the growing awareness and concern about pharmaceutical companies’ marketing of opioids.
He said it’s difficult to pinpoint a single reason behind the drop, but “it’s possible that the pharmaceutical companies voluntarily reduced their marketing, realizing that they may have been contributing to overprescribing.”
A number of studies have shown a correlation between marketing of opioids and doctors’ prescribing of the drugs. Hadland and his colleagues reported in May that for every meal a physician received related to an opioid product in 2014, there was an increase in opioid claims by that doctor for Medicare patients the following year. And a report from the New York State Health Foundation published this month found that physicians who received payments from opioid-makers prescribed more opioids to Medicare patients than doctors who didn’t receive the payments.
The sharp drop in marketing is more pronounced than the much-slower reduction in the use of prescription opioids. The number of opioid prescriptions in Medicare, the public health program for seniors and the disabled, peaked at 81.7 million in 2014, and then dropped to 80.2 million in 2015 and 79.5 million in 2016, according to the Centers for Medicare and Medicaid Services. (Enrollment in Medicare’s prescription drug program continued to grow during that time, so the rate of opioid prescriptions per beneficiary dropped even more.)
Shots – Health News Jump In Overdoses Shows Opioid Epidemic Has Worsened Still, the toll of opioid overdoses continues to grow. Some 42,000 people died of opioid overdoses in 2016, the most recent year available, and about 40 percent of those involved a prescription opioid. The epidemic has shifted somewhat away from prescription drugs as more people die of heroin and synthetic opioids like fentanyl.
The public attention has prompted the makers of prescription opioids to revamp their marketing practices.
Purdue Pharma, which has received the most attention because of its one-time blockbuster OxyContin, has ratcheted back its spending on doctors, especially for programs in which doctors talk to their peers over lunch or dinner to help companies market their products. Purdue ended its speaker program for OxyContin at the end of 2016 and for Hysingla ER in November 2017. Earlier this year, it ended all direct promotion of its opioids to prescribers and last week, the company laid off its remaining sales representatives.
Purdue spokesman Robert Josephson said in an email that payments to doctors related to opioids have decreased since 2016 and that there would be very little such spending in 2018.
In 2007, Purdue and three of its executives pleaded guilty to charges of “misbranding” OxyContin and collectively agreed to pay more than $634 million in penalties. In more recent years, though, the company has pushed back against allegations that it has fanned the opioid epidemic, saying it has worked to be part of the solution.
Insys also has been the subject of multiple federal and state investigations related to its marketing of Subsys. The company ended its speaker program for Subsys earlier this year and said it has refocused its sales staff primarily on oncologists who treat patients with severe cancer-related pain, what the drug was initially approved to treat. “Insys is a new company in important aspects, comprised of people who are firmly and sincerely committed to helping patients in need and doing the right things in the right way,” company spokesman Joseph McGrath said in an email.
Insys’ founder John Kapoor has pleaded not guilty to charges of conspiracy to commit racketeering, mail fraud and wire fraud. Some former sales representatives, managers and doctors have pleaded guilty for their roles in the conspiracy detailed by federal prosecutors; others are awaiting trial.
Shots – Health News How A Painkiller Designed To Deter Abuse Helped Spark An HIV Outbreak One product that saw increased promotion in 2016 was Opana ER, a pain medication made by Endo Pharmaceuticals. The company pulled the drug from the market in late 2017 at the request of the Food and Drug Administration, after it was linked to a 2015 outbreak of HIV in rural Indiana among intravenous drug users who crushed Opana and injected it with shared needles.
Endo spent about $121,000 on payments to doctors related to Opana in 2015 and $229,000 in 2016.
“Pharmaceutical manufacturers are legally permitted in the U.S. to promote all FDA-approved products to physicians in accordance with the subject product’s label,” Endo said in a statement. “This includes opioid products, which are safely used by millions of Americans to improve their quality of life.”
That said, Endo said it stopped promoting Opana ER in the United States in January 2017 before voluntarily withdrawing the drug in September. “Today, Endo does not promote any opioid products to U.S. physicians,” the company said in a statement.
Some opioids that contain the drug buprenorphine also bucked the downward trend in payments to doctors. Companies spent more than $4.4 million in 2016 promoting the drugs Belbuca, Butrans and buprenorphine, which experts say are less prone to abuse and carry a lower risk of overdose. That was nearly double the amount spent on those drugs in 2015. Almost the entire difference was attributable to Belbuca, which was approved by the FDA in late 2015.
Purdue, which makes Butrans, stopped its speaker program for the drug at the end of 2016. Endo marketed Belbuca until December 2016 and then returned its license to BioDelivery Sciences International Inc., which has marketed the product since then.
Dr. Michael Barnett, an assistant professor of health policy and management at Harvard School of Public Health, said it’s hard to say for certain why marketing has decreased for opioids.
“Given the deluge of media attention with the opioid epidemic, I think we’ve seen the pendulum swing in the opposite direction,” he said, from opioids being seen as a compassionate way to treat pain to “being viewed as pretty toxic and only to be used as a last resort.”
Barnett said if marketing of opioids continues to decline, “it’s potentially good news.”
“If this is actually a result of manufacturers actually saying, ‘Holy crap, people actually care about opioids being used responsibly’ and they’re aware that their advocacy and payments to physicians could be seen as pushing these medications in a way that is ethically dubious, then that’s a beneficial development and something I’d like to see more of.”
Check whether your doctor has received payments from pharmaceutical and medical device companies using our Dollars for Docs tool .
Jahi McMath, Teen At Center Of Medical And Religious Debate On Brain Death, Has Died : NPR
Jahi McMath, Teen At Center Of Medical And Religious Debate On Brain Death, Has Died Facebook
Nailah Winkfield (left) and Omari Sealey, the mother and uncle of Jahi McMath, listen to doctors speak during a news conference in San Francisco in 2014. Eric Risberg/AP hide caption toggle caption Eric Risberg/AP Nailah Winkfield (left) and Omari Sealey, the mother and uncle of Jahi McMath, listen to doctors speak during a news conference in San Francisco in 2014. Eric Risberg/AP
Jahi McMath, the teenager who was at the center of a medical and religious debate over brain death, has died, according to her family’s lawyer. She was 17.
McMath died June 22 at a hospital in New Jersey, the family’s lawyer, Christopher Dolan, said in a statement . He said a hospital doctor listed the preliminary cause of death as bleeding due to liver failure.
Nailah Winkfield, McMath’s mother, said in the statement that she is “devastated by the loss of her daughter” but that Jahi ultimately “has forced the world to rethink the issue of brain death.”
McMath had been on a ventilator since 2013. In December of that year, she had a tonsillectomy at UCSF Benioff Children’s Hospital Oakland in California, which resulted in complications. Doctors there said McMath had irreversible brain damage, and a coroner issued a death certificate. Why Hospitals And Families Still Struggle To Define Death
But Winkfield refused to agree with that assessment and took the battle to court to keep McMath on life support. She cited her Christian beliefs and that her daughter still sometimes moved her toes and fingers. Winkfield believed that her daughter was not dead.
A judge extended life support for McMath, who was 13 at the time.
Eventually, Winkfield transferred her daughter to a hospital in New Jersey. According to a New Jersey statute , death can’t be declared “in violation of individual’s religious beliefs.”
This legal battle spurred a nationwide debate over brain death — and what constitutes death.
The Uniform Declaration of Death Act , which has been in place since 1981, defines death as the “irreversible cessation of all functions of the entire brain, including the brain stem.”
In the world of medical ethics, as NPR’s Maanvi Singh reported in 2014 , there are varying views on death.
“There’s the commonly accepted view that a person is dead when all brain functions cease,” Singh wrote. “But there’s also the view that a person is only dead after their heart stops beating.”
And another view, according to Singh, holds that “a person can be brain-dead even if certain minor functions of the brain remain. For example, if a patient shows a gag reflex, but no other signs of life, they should be considered brain-dead.”
Winkfield continues to assert that her daughter died June 22, 2018 — not in 2013.
“Jahi McMath was not brain-dead or any other kind of dead,” Winkfield said in a statement. “She was a little girl who deserved to be cared for and protected not called a dead body. When she finally was treated like a human being, she got better.”
Winkfield said the way she communicated with her daughter might not have been like how other parents communicate with their children. But she said that her daughter’s heart rate would increase when Winkfield walked into the room, and that her daughter could respond to Winkfield’s voice with slight body movements.
Dolan, the family’s lawyer, said, “The fight to hold the negligent doctors who allowed Jahi to suffer a severe brain injury will continue.” He has filed a wrongful death suit in California Superior Court in Alameda County, as well as a federal lawsuit seeking to have her 2013 death certificate reversed and her date of death marked as June 22, 2018.
Top US court rules public sector union fees violate first amendment – BBC News
US Supreme Court rules public sector union fees violate first amendment 27 June 2018 These are external links and will open in a new window Close share panel Image copyright Getty Images Image caption Activists at the Supreme Court earlier this year when the case was heard The top court in the US has ruled that states and public sector unions may no longer collect fees from workers without their consent, a defeat for supporters of organised labour.
The US Supreme Court said such fees are unconstitutional and force people to support ideas they may not believe.
It said that violates first amendment rights under the US constitution,
The 5-4 decision is expected to undermine the public unions’ financial stability.
While the power of private sector unions have shrunk in recent years, more than a third of public sector workers remain represented by a union.
The organisations are a major force in political campaigns, typically offering support for the Democratic Party. Under-30s turn away from unions despite wage stagnation
The case was brought by Richard Janus, an Illinois state employee who was represented by a union, but did not want to be a member because he objected to many of its positions.
Under prior law, public sector unions could collect a fee from non-members for their services, provided the money was not used toward political activities and other ideological work.
An estimated five million non-union workers currently pay such fees.
In Mr Janus’s case, the fee represented about 78% of the total dues, or more than $500 annually. ‘Judicial disruption’
Unions have said such fees are important, arguing they are essential due to “free riders” who would benefit from the pay and other perks secured by unions on behalf of their members.
In the majority opinion, Justice Samuel Alito said concerns about free riders could not override considerations for the first amendment, and overturned a prior ruling allowing the fees.
The decision was opposed by the court’s liberal justices.
Justice Elena Kagan wrote: “Across the country, the relationships of public employees and employers will alter in both predictable and wholly unexpected ways…Judicial disruption does not get any greater than what the Court does today.”
Richard Trumka, president of the AFL-CIO, which includes the American Federation of State County and Municipal Employees, said the decision showed the court “has conceded to the dark web of corporations and wealthy donors who wish to take away the freedoms of working people”. A look at the UK
Analysis by Natalie Sherman
The Supreme Court’s decision, which limits labour union’s rights to collect fees, is viewed as dealing a potentially fatal blow to the organisations.
A look at the UK, where trade unions collect a separate levy from members to fund political activities, is instructive.
In 2015, the government proposed to change the rules so that members would have to opt in to paying the political levy, rather than – as it currently stands – leaving them to opt out if they choose.
Opponents decried the plan as an attempt to undermine Labour Party finances. Indeed, a previous experiment with such a change had triggered a precipitous decline in contributions.
This time around, the plan was defeated.
Still, membership in UK trade unions is hovering near record lows, suggesting the challenges facing such organisations extend beyond their funding. Related Topics
AL Attorney General Opens Up About Late Wife’s Mental Health And Dependence Struggles : NPR
Enlarge this image Alabama Attorney General Steve Marshall, pictured earlier this month on Capitol Hill, spoke Wednesday about the recent suicide of his wife after a long struggle with depression, chronic pain and opioid dependence. J. Scott Applewhite/AP hide caption
toggle caption J. Scott Applewhite/AP Alabama Attorney General Steve Marshall, pictured earlier this month on Capitol Hill, spoke Wednesday about the recent suicide of his wife after a long struggle with depression, chronic pain and opioid dependence.
J. Scott Applewhite/AP “This is tough,” Attorney General of Alabama Steve Marshall said through tears on Wednesday as he stood at the lectern of his hometown Baptist church in rural Alabama, facing news cameras and dozens of people, three days after the sudden death of his wife, Bridgette Marshall, 45.
The cause, Marshall said, was suicide. But that was not his focus.
“What we want to be able to focus on is the story of her life,” he said flanked by family members, who sometimes stood with their heads bowed, quietly crying.
In fact, he said he was “forced to be here today” after his family had come across news accounts describing his wife’s death Sunday in Tennessee.
Marshall said those reports angered him. But then he and his family came to a realization.
“Maybe being transparent about how we got to the point where we did last Sunday could be helpful,” he said. “Because we know that we are not the only family that has had to deal with a family member who’s suffered from mental health issues. And we know that Bridgette is not the only person that ever considered suicide.”
Marshall began by describing his wife’s suffering from debilitating migraines from an early age.
She sought medical help and was eventually prescribed Oxycodone, then Fentanyl — “an amazingly powerful drug,” he said.
“And Bridgette became dependent.”
Again, she sought help and went to inpatient treatment.
“But even to the time of her death, (she) did not always handle her medication the way that she should,” Marshall said. “It’s one reason why, professionally you hear me talk about opioids, it’s personal.”
Marshall serves as co-chair of Governor Kay Ivey’s Opioid Overdose and Addiction Council.
In recent years, Alabama has ranked first in the nation per capita for opioid prescriptions. In 2016, there were 121 prescriptions per 100 people, according to a council report. That’s more than one prescription for every man, woman and child in Alabama.
The Council — and Marshall — are working to stem those numbers through a multi-pronged approach that includes prevention, treatment and community response.
Still, as the report concedes, substance abuse disorders are complex.
“I’ve lived it and I’ve watched it and I’ve seen how it has destroyed her in many ways,” he said of his wife’s battle.
Under the Trump administration , the Department of Justice has made the national opioid epidemic a centerpiece issue.
Law Federal Prosecutor Takes On New Case As DOJ Point Person For Opioid Crisis On Thursday, Attorney General Jeff Sessions announced progress the DOJ has made in a nation-wide “opioid takedown” related to health care fraud.
Since January 2017, more than 400 doctors and other medical personnel have been charged with opioid-related crimes, according to Sessions. 16 of those doctors prescribed more than 20.3 million pills illegally.
Marshall did not go into details about his wife’s history of opioid use.
The Centers for Disease Control notes that substance abuse can be a contributing factor to suicide.
Earlier this month, the CDC released stark figures about suicide, saying rates have risen in nearly every state in recent years.
Some 45 thousand people lost their lives to suicide in 2016.
Recent high-profile deaths ruled as suicides, including chef and television host Anthony Bourdain and designer Kate Spade , have also brought the issue to the forefront.
“Mental health conditions are often seen as the cause of suicide,” the CDC said, “but suicide is rarely caused by any single factor.”
In fact, many people who have taken their own lives had no diagnosed mental health conditions, according to the CDC.
Marshall said his wife also, “suffered from a depressive disorder and anxiety.”
He said that because she was anxious, being in the public eye was difficult and he wondered whether things would have been different if he hadn’t become Attorney General.
“I will be haunted (by) that for the rest of my life,” he said.
Bridgette Gentry Marshall was born June 6, 1973, in Boaz, AL, according to the obituary on the McRae Funeral Home’s web site.
She was a homemaker and worked as a hospice volunteer.
The funeral is scheduled for Friday.
Marshall said he felt compelled to make public the story of a woman who never wanted to be a public figure.
“And we don’t share that lightly, because it’s the most personal secret this family has,” he said.
“It is our hope today to share our story to also give strength to those families who have endured what we have endured, and maybe for that person who felt like (doing what) Bridgette did on Sunday morning, to know that there is hope and that there are people that love them.”
STATEMENT FROM THE OFFICE OF ALABAMA ATTORNEY GENERAL: We are saddened to report that Bridgette Marshall, wife of Attorney General Steve Marshall, passed away this morning after a long struggle with mental illness. (1 of 2)
— AG Steve Marshall (@AGSteveMarshall) June 24, 2018 Bridgette was a devoted and much beloved daughter, wife and mother. We ask that the people of Alabama keep the Marshall family in their prayers during this most difficult time. (2 of 2)
— AG Steve Marshall (@AGSteveMarshall) June 24, 2018
Marco Rubio complains about state of media after Capital-Gazette reporter says f**k on CNN
Marco Rubio (AP/Susan Walsh) Marco Rubio complains about state of media after Capital-Gazette reporter says f**k on CNN “Sign of our times”: The Florida Republican has tweeted his criticisms of the media several times this week June 29, 2018 1:26pm (UTC)
Sen. Marco Rubio’s morning Twitter routine is starting to resemble Donald Trump’s.
The Florida Republican woke up nearly every morning this week and fired off a tweet critiquing the media , often d eflecting responsibility for any breakdown in public discourse and civility away from the president. On Friday, less than 24 hours after a gunman opened fire in a Maryland newsroom and killed five staffers , the largest number of journalists killed on any day in the U.S. since 9-11, Rubio again directed his morning critiques at the media.
“Sign of our times… the F word is now routinely used in news stories, tweets etc It’s not even F*** anymore. Who made that decision???,” he tweeted. Sign of our times… the F word is now routinely used in news stories, tweets etc It’s not even F*** anymore. Who made that decision???
— Marco Rubio (@marcorubio) June 29, 2018
It is unclear what media coverage exactly set Rubio off, but hours before a griefing staffer of the Capital Post-Gazette used the f-word on CNN. The curse word was left uncensored.
“Our whole lives have been shattered. So thanks for your prayers, but I couldn’t give a fuck about them if there’s nothing else,” Selene San Felice, staff writer for the Capital Gazette, told CNN’s Anderson Cooper. “I’ve heard that Pres. Trump sent his prayers. I’m not trying to make this political right? But we need more than prayers… I want your prayers but I want something else.”
Capital Gazette writer Selene San Felice says her life has been “shattered” after witnessing the attack pic.twitter.com/mUwVZBjpmo
— Anderson Cooper 360° (@AC360) June 29, 2018
San Felice told Cooper that the attack had left her “shaken” and she recalled her thoughts while covering the 2016 Pulse nightclub shooting in Rubio’s state of Florida.
“I remember being so upset hearing about the victims who were texting their families,” she said. “And there I was sitting under a desk texting my parents, telling them that I love them.”
After yet another mass shooting in America, this one leaving several of her own colleagues dead, San Felice said she has little patience for the typical politicians’ empty platitudes and prayers. Prior to departing Wisconsin, I was briefed on the shooting at Capital Gazette in Annapolis, Maryland. My thoughts and prayers are with the victims and their families. Thank you to all of the First Responders who are currently on the scene.
— Donald J. Trump (@realDonaldTrump) June 28, 2018
“I’ve heard that President Trump sent his prayers. I’m not trying to make this political, right? But we need more than prayers. I appreciate the prayers. I was praying the entire time I was [hiding] under that desk. I want your prayers but I want something else,” San Felice said.
It should be noted that Rubio, whose most memorable contribution to civil discourse was making dick jokes about Donald Trump on the 2016 campaign trail, has yet to tweet about Thursday’s deadly mass shooting. Instead, he’s used his platform to blame the media for causing “no space for nuance or 3rd way on any issue.” Re-upping this tweet from 2 days ago. GOP voters defend Trump when attacked by media,OFTEN DESPITE NOT LIKING WHAT HE DID OR SAID,because they view media as unfair & biased. And generally,elected Republicans &elected Democrats for that matter don’t like being crossways with base https://t.co/sw9P3SEGGZ
— Marco Rubio (@marcorubio) June 28, 2018 As expected,the reaction of the “usual suspects” to this tweet yesterday either proved my point or missed it. Many in the media & Trump bashers are not self aware enough to realize how biased & dishonest a very large % of GOP voters & officeholders view them & the impact it has https://t.co/4Nnlh6OxoV
— Marco Rubio (@marcorubio) June 28, 2018 BTW I’m not happy about this reality. It’s terrible for country. Lack of trust in reporting leaves us vulnerable to conspiracy theories & unable to have debates b/c we can’t even agree on baseline facts. We are all ALL to blame for this mess. Sorry, that includes many in media https://t.co/rYLKtjCezU
— Marco Rubio (@marcorubio) June 28, 2018 McCain is hero & patriot. But in 2008 “journalists” who now extol his virtues portrayed him as a madman & the @nytimes smeared him the day after he sealed GOP nomination. Romney behaved with respect & dignity. But in 2012 media savaged him & portrayed him as a misogynist #BIAS
— Marco Rubio (@marcorubio) June 28, 2018 Sophia Tesfaye
Sophia Tesfaye is Salon’s Deputy Politics Editor and resides in Washington, D.C. You can find her on Twitter at @SophiaTesfaye. MORE FROM Sophia Tesfaye • FOLLOW @SophiaTesfaye THIS WEEK ON Fearless journalism in your inbox every day Sign up for our free newsletter By signing up you agree to receive email newsletters or alerts from Salon.com. You can unsubscribe at any time.