Consider OxyContin, which the makers claimed worked for 12 hours. 2 things should be red flags here: firstly, I haven't seen an extended release formulation of anything that would work over that period; I'm not even sure if it's physically possible given the human digestion system. Secondly, the many, many patients who complained that it only worked for 6-8 hours.
Any doctor with a basic understanding of pharmacology, and basic bedside manner, should have known something was up there.
"doctors should have known the manufacturers' claims were bogus" is shifting the blame. The real blame should be focused on the manufacturers making false claims in the first place.
It wasn't my intention to shift the blame - clearly the manufacturers should be strung up for making the false claims they did. Absolutely no argument there.
My point is though, that doctors shouldn't blindly trust whatever a manufacturer tells them, if the evidence right in front of their eyes says different.
> My point is though, that doctors shouldn't blindly trust whatever a manufacturer tells them, if the evidence right in front of their eyes says different.
Just to be clear, you're advocating doctors eschewing published clinical data (including data from published trials and the FDA approval) on the basis of nonrandomized anecdotal data?
The issue here is that the manufacturers committed fraud - falsifying and/or misrepresenting clinical data. The courts confirmed this, finding them guilty of fraud, bribery, and more.
Unlike courts, a doctor is in no better position to such sophisticated identify fraud at that scale than a patient is. The pharmaceutical companies and manufacturers absolutely should be held accountable for that, but doctors by and large are not to blame for the fraud committed by pharmaceutical companies.
> The issue here is that the manufacturers committed fraud - falsifying and/or misrepresenting clinical data
This is my point - the claims were BS. A number of doctors should have been raising a number of red flags, because their knowledge contradicted those claims, as did patient evidence right in front of their very eyes.
I'm obviously not saying they should ignore or distrust all clinical data, but if they see such massive discrepancies then they should be speaking up.
> A number of doctors should have been raising a number of red flags, because their knowledge contradicted those claims
Purdue committed fraud, but they never made claims that were so outrageous that they would be prima facie false. (If that had been the case, Oxycontin would never have been approved in the first place). The problem wasn't that the claims were outrageously impossible; it's that the claims were wrong, and Purdue either falsified or misrepresented clinical data in order to convince doctors that Oxycontin was safer than it actually was.
> Patient evidence right in front of their eyes
Encouraging people to rely overly on anecdotal observations is incredibly dangerous, especially when most doctors who prescribe opioids don't prescribe them in such numbers that these issues would be readily visible to them in the first place.
Yes, there were a small number of doctors who did aggressively overprescribe and misprescribe Oxycontin. That was the result of a direct and explicit campaign by Purdue to identify and enable those doctors. Some of those doctors were prosecuted and/or did lose their licenses, but those doctors still only amounted to a small part of the opioid crisis.
> I'm obviously not saying they should ignore or distrust all clinical data, but if they see such massive discrepancies then they should be speaking up.
Most doctors weren't seeing massive discrepancies. We know the discrepancies exist now because there were lawsuits and prosecutions which revealed the specific fraudulent behavior that Purdue and others were engaged in. But without the benefit of hindsight, these issues simply weren't reasonably visible to a typical doctor - they were only visible at large scale to Purdue, who went out of their way to mislead everyone else about it.
There's plenty of blame to go around, both can be at fault. My family doctor, for example, warned me to be very careful of the Oxytocin I was given by the hospital (without any warnings) after my wisdom teeth were removed.
This is the kind of thing I mean - giving someone oxycontin without any warnings is just plain irresponsible.
Furthermore, opioids shouldn't even be used as first line after wisdom teeth removal - across Europe you'd be sent home and told to take paracetamol or ibuprofen, because those medications generally work very well for inflammation-type pain.
Any doctor with a basic understanding of pharmacology, and basic bedside manner, should have known something was up there.