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.