Opioid addiction is pervasive and growing rapidly. Medicine and Science are threatened by the phenomenon.
Last November here in P & I. I described the deadly epidemic of opioid addiction that has so far claimed more than 400,000 American lives and has of late become a major problem here. The principle cause of the tragedy was the acceptance by doctors of advice given them by the largest distributors of opioids (Purdue and Johnson and Johnson pharmaceuticals) that it was safe to use long term opioid medications for the control of non-cancer related pain. The lies were sugar coated with financial inducements to doctors and health regulators to the tune of 2.5 Billion dollars.
In 2015, 15 million opioid prescriptions were dispensed in Australia. It is estimated that 750,000 Australians may be addicted. This addiction to opioids kills many more of us than does Heroin. Last year 1123 of us died from using opioids with accidental overdose being a very common cause. This represents a marked increase in deaths related to opioid use which were in the 400 a year range a decade ago.The latest figures reveal that each day 150 Australians are admitted to hospital because of opioid harm. Again, sad to say, many Australian doctors have allowed financial and other inducements from drug companies to influence their prescribing habits. The international arm of the American company Purdue, Mundipharma, has been much criticised for its marketing tactics in promoting its oxycodone based drug “Targin” in Australia.
Given the huge fine levied on Purdue and Johnson and Johnson in the US and the irreparable damage to reputations because of such unethical behaviour, it is extraordinary that Mundipharma continued to mislead Australian doctors about its opioid pain relief products. Late in December the Therapeutic Goods Administration (TGA) fined the company just over $300,000 for a series of advertisements it sent to doctors and other health professionals. The adds contained bald-faced lies misrepresenting statements from the Faculty of Pain Medicine and the Royal Australian College of General practitioners (RACGP).
The offending material suggested that for moderate to severe chronic pain the Faculty of Pain Medicine recommends the use of a long acting opioid and the RACGP suggests that the use of weak opioids be used cautiously as these preparations are less effective and have more adverse effects.
For once the TGA acted decisively noting that the company was falsely advertising, finding that its marketing to GPs was, “misleading, imbalanced and otherwise inaccurate”. The TGA is notoriously weak and ineffective in protecting consumers from health care fraud but they got this right.
To illustrate my point about truth being seen as a subjective concept, The company stated that, “Mundipharma respectfully disagrees with the TGA’s assessment of the statements. Munidpharma’s intent was to proactively and voluntarily urge caution when health care professionals chose to prescribe an opioid” Really?
Pain specialist Simon Holliday who reported his concerns to the TGA stated “The fines would amount to little more than a slap on the wrist for the multi-national and probably come out of the petty cash tin. Now they have actually been pinged for misleading and aggressive advertising, hopefully, this will lead the TGA to reflect on how commercial influences can corrupt excellent health care”.
Another example. Recently I was asked to comment on a press release from scientists at Griffith University who were studying the immune boosting properties of mushrooms! The university claimed its research showed that a powdered mushroom extract, “could ultimately help to boost the immune system protecting people from microbes, toxins and carcinogens”. Turns out however that the Queensland based university did not disclose on its website or in its press release that the research was paid for by Integria Healthcare, a company that sells mushroom based pills and powders.
You may remember the controversy that descended on LaTrobe university when it accepted 12 million dollars from Suisse Wellness to prove that its products did what they claimed they could do. Arguing that Universities should not accept funding for research where positive results, mired with conflicts of interest, would benefit the sponsor and the university, Professor Ken Harvey, Professor of Public Health and tireless advocate for evidence based health care, resigned in disgust.
The University of Griffith case amply demonstrates the veracity of Harvey’s concerns. The results of scientific studies done, in no way supported the wildly exaggerated claims for mushroom products and, stupidly, from an integrity point of view, the university allowed Integria to vet a draft of the press release. The studies which involved exposing human cells in a laboratory to mushroom extracts showed changes that in no way supported the claims made. However Integria went ahead and marketed a “scientifically proven” mushroom based product to boost immunity. In my response to media questions I argued that-
“Griffith University should have demanded that the press release by its investigators contain appropriate caveats about the preliminary nature of the results which should not at this stage be associated with any claims for clinical benefits.”
In responding to criticisms from here and abroad, the professor who led the research team claimed that this was “a really nice example of the way academia and industry can work together to boost scientific progress as well as inform the general public and consumers about these products.”
Hans Wohlmuth, head of research and development at Integria actually denied that the press release made any claims about the human health effects of mushrooms!
A related story for another time involves the “Stem cell” scams that are robbing so many and raising false hope. In a review of the topic in the Medical Republic recently an author, using very colourful language, headlined her article, “The promise of stem cells in Medicine is a Metropolis of glittering skyscrapers and flying cars, The current clinical reality is more like a wild west of dusty saloons and gunslinger”
In a world where a president of the United States of America can have 63 million people accept as truth 15,000 lies it is obvious that, “truth” in so many arenas is in a parlous condition.
Professor John Dwyer founded the Australian Health Care Reform Alliance and is an Emeritus Professor of Medicine at UNSW.
Professor John Dwyer AO, is an Immunologist, Emeritus Professor of Medicine at UNSW and for many years heavily involved in efforts to improve the delivery of healthcare in Australia. He was the founder of the Australian Healthcare Reform Alliance.
Comments
4 responses to “JOHN DWYER. The lack of truth in Medicine and Science.”
Given the gravity of this article and the credibility of its author, where is the appropriate political response? Will it happen?
Or is Health Minister Greg Hunt so embroiled with this commercial corruption that he (and the rest of the Cabinet) is rendered mute and impotent by it?
Hi John. Agree with all you say.
With regard to Mundipharma and the TGA’s finding of misleading advertising: I am a specialist anaesthetist. Mundipharma is the biggest pharmaceutical sponsor of the activities of my specialist college, ANZCA. I have written to ANZCA, urging them to immediately sever ties with Mundipharma; it is not a good look to have the College which trains pain specialists receiving sponsorship from a disreputable supplier of pain medications. (Bill Legge, I acknowledge your comments – but that is exactly why we should have decisions about the value of these medications untainted by inappropriate influences on the prescribers)
That you Bill. There are effective alternatives that should be available to many more Australians who suffer very severe non-cancer related pain. Much safer and very often satisfactory control of pain requires professional help from specialists knowledgeable in both the treatment of addiction and non-drug dependent pain relief techniques. We have pioneered such techniques in Australia but at the moment there are only four clinics nation wide with the expertise to simultaneously tackle the treatment of opioid addiction and non-pharmaceutical pain relief techniques. For those suffering chronic pain but are not addicted to opioids there are many pain clinics that can help
There are two principal elements to this article. With respect to the corruption of university research integrity I have no argument at all. I note this is an intended outcome of neo-liberal economics, so it’s hardly surprising.
On the subject of the harms of opioid medications I do not dispute Prof. Dwyer’s numbers regarding morbidity. However, there is a very large number of people in our community living with non-cancer related chronic pain. I would argue that a great many of them are very aware of the negative consequences of long-term opioid use and would love to be free of the need for them. Sadly, the pain specialists, and more broadly the clinical community are hitherto unable to offer any effective alternatives. So, the long-term chronic pain sufferer is offered a choice between a partially effective, although undoubtedly harmful medication which can enable some semblance of a normal life, and crippling, life-destroying pain – some choice.
The increase in opioid consumption is not just the product of an undoubtedly corrupt, anti-social pharmaceutical cartel, it is also an indication of the levels of pain in the community. Without that pain the market for the product would not exist.