I had a lady from NB once, travelling to Nfld, who ended up in our ER in CB in severe narcotic withdrawal. She was on 800mg of morphine per day for chronic pain ("fibromyalgia"). Her doctor had assured her that she would never get addicted because "she had real pain" and wasn't using it for a high like addicts. She forgot her pills at home, and got past Truro before she realized. Because (thank God!) she wasn't addicted, she didn't have to go home to get them.
RE: drug rep visits. Very quickly after starting practice (within a few months), drug rep visits went from several times per week down to almost zero. I later found out through a pharmacist friend what I've since had confirmed (and you talk about). Big Pharma buys your prescribing history from pharmacies. They can very quickly find out who prescribes cheap, generic, old-fashioned, well-studied tried-and-true drugs, and who prescribes the expensive glittery newest things that have huge profit margins for Pharma. They target their resources on the "soft targets".
I read carefully about Vioxx and didn't prescribe it, even though it was pushed HARD. I remember one drug rep vaguely threatening that, since it was safer on the stomach as they claimed, if one of my patients on an old NSAID had a GI bleed, I would be legally liable for not having prescribed Vioxx.
You mention Hitler's drug habit. There is a great book I read recently called "Blitzed" about the ubiquitous use of drugs in the Third Reich, including stimulants and narcotics. It was the start of transhumanism - the idea that we can transcend nature and become super-beings.
The other thing that really resonates with me is the complicit evil of people like Brian Goldman. He is a guy who, even when I agree with his point, manages to come across as a condescending asshole. This sounds catty, but I know someone who worked closely with him in ER in Toronto and said he was a terrible doc. Slow, ponderous, and very prone to over-testing, overdiagnosis, over-treatment and over-referral. And yet for years on White Coat Black Art he presents himself as the wise one - all-knowing, all-seeing, sitting on his perch looking down on the rest of us mere mortal physicians. When I found out years ago that he had been a pharma shill for Oxycontin, it was no surprise to me. He loves to hear himself talk, loves to be the expert, and is overly credulous. The perfect person to swallow the pharma bunk and then regurgitate it.
I have a well-read copy of Blitzed. The German attack across France to Dunkirk could not have happened if the panzer forces weren't on meth. The civilain population was also given lots of meth. Also interesting on how Hitler crushed the serious heroin addiction problem within a couple of years.
For just about any diagnosis, but especially for the less common ones and the stigmatized ones, I cannot imagine groups of patients sharing a common diagnosis spontaneously coming together to hold a meeting, develop a structure and governance model, choose leaders, acquire funding, go through the paperwork to set up as a non-profit, familiarize themselves with the science (known and evolving) of their condition, and start lobbying government and other agencies for changes in the supports (including treatment models, social/medical supports, new procedures and drugs, etc.). It’s a LOT of work to take on when you are already disabled by your condition and struggling with the medical management. In particular, drug users have generally descended into an individualistic hole (everything is about them and their next “fix”), so where do they find the time and social caring to form lobby groups?
On the other hand, drug companies and social support agencies have something to gain by creating “grassroots” groups that lobby for increased drug prescriptions and social supports. It stands to reason that they would handle the work and financing, inviting a few patients along for the sake of credibility.
Non-profits do file paperwork with the federal government, but it’s still very hard to tell where they get their funding. Big Pharma put out financial statements, but it’s very hard to see where their “unrestricted educational” grant money went.
I think more accurately they are QUANGOs - quasi non-governmental organizations.
The government funds these groups as I understand it. Once they decided that drug addicts were victims and "stakeholders", they funded groups to "represent" them. Anyone with half a brain would realize that a group of homeless drug users doesn't have their shit together enough to shower, let alone set up an organization, hold regular meetings and votes, produce position papers and create websites. The whole idea is absurd. But in 2024 Canuckistan satire and reality are very hard to slip a piece of paper between.
Even worse that the government wastes our tax dollars funding organizations of this sort and then listening to their sage advice, while ignoring the advice of independent, objective organizations.
I figure the drug companies are at work somewhere in the mix. All this safer supply, opioid replacement therapy and universal naloxone availability has to be driving their profits upward.
Rick - another great read! Thanks.
A few stories/comments.
I had a lady from NB once, travelling to Nfld, who ended up in our ER in CB in severe narcotic withdrawal. She was on 800mg of morphine per day for chronic pain ("fibromyalgia"). Her doctor had assured her that she would never get addicted because "she had real pain" and wasn't using it for a high like addicts. She forgot her pills at home, and got past Truro before she realized. Because (thank God!) she wasn't addicted, she didn't have to go home to get them.
RE: drug rep visits. Very quickly after starting practice (within a few months), drug rep visits went from several times per week down to almost zero. I later found out through a pharmacist friend what I've since had confirmed (and you talk about). Big Pharma buys your prescribing history from pharmacies. They can very quickly find out who prescribes cheap, generic, old-fashioned, well-studied tried-and-true drugs, and who prescribes the expensive glittery newest things that have huge profit margins for Pharma. They target their resources on the "soft targets".
I read carefully about Vioxx and didn't prescribe it, even though it was pushed HARD. I remember one drug rep vaguely threatening that, since it was safer on the stomach as they claimed, if one of my patients on an old NSAID had a GI bleed, I would be legally liable for not having prescribed Vioxx.
You mention Hitler's drug habit. There is a great book I read recently called "Blitzed" about the ubiquitous use of drugs in the Third Reich, including stimulants and narcotics. It was the start of transhumanism - the idea that we can transcend nature and become super-beings.
The other thing that really resonates with me is the complicit evil of people like Brian Goldman. He is a guy who, even when I agree with his point, manages to come across as a condescending asshole. This sounds catty, but I know someone who worked closely with him in ER in Toronto and said he was a terrible doc. Slow, ponderous, and very prone to over-testing, overdiagnosis, over-treatment and over-referral. And yet for years on White Coat Black Art he presents himself as the wise one - all-knowing, all-seeing, sitting on his perch looking down on the rest of us mere mortal physicians. When I found out years ago that he had been a pharma shill for Oxycontin, it was no surprise to me. He loves to hear himself talk, loves to be the expert, and is overly credulous. The perfect person to swallow the pharma bunk and then regurgitate it.
I have a well-read copy of Blitzed. The German attack across France to Dunkirk could not have happened if the panzer forces weren't on meth. The civilain population was also given lots of meth. Also interesting on how Hitler crushed the serious heroin addiction problem within a couple of years.
I suppose the various Drug User Liberation Fronts may also be Astroturf organizations.
My suspicion is that they are astroturfed.
For just about any diagnosis, but especially for the less common ones and the stigmatized ones, I cannot imagine groups of patients sharing a common diagnosis spontaneously coming together to hold a meeting, develop a structure and governance model, choose leaders, acquire funding, go through the paperwork to set up as a non-profit, familiarize themselves with the science (known and evolving) of their condition, and start lobbying government and other agencies for changes in the supports (including treatment models, social/medical supports, new procedures and drugs, etc.). It’s a LOT of work to take on when you are already disabled by your condition and struggling with the medical management. In particular, drug users have generally descended into an individualistic hole (everything is about them and their next “fix”), so where do they find the time and social caring to form lobby groups?
On the other hand, drug companies and social support agencies have something to gain by creating “grassroots” groups that lobby for increased drug prescriptions and social supports. It stands to reason that they would handle the work and financing, inviting a few patients along for the sake of credibility.
Non-profits do file paperwork with the federal government, but it’s still very hard to tell where they get their funding. Big Pharma put out financial statements, but it’s very hard to see where their “unrestricted educational” grant money went.
I think more accurately they are QUANGOs - quasi non-governmental organizations.
The government funds these groups as I understand it. Once they decided that drug addicts were victims and "stakeholders", they funded groups to "represent" them. Anyone with half a brain would realize that a group of homeless drug users doesn't have their shit together enough to shower, let alone set up an organization, hold regular meetings and votes, produce position papers and create websites. The whole idea is absurd. But in 2024 Canuckistan satire and reality are very hard to slip a piece of paper between.
Even worse that the government wastes our tax dollars funding organizations of this sort and then listening to their sage advice, while ignoring the advice of independent, objective organizations.
I figure the drug companies are at work somewhere in the mix. All this safer supply, opioid replacement therapy and universal naloxone availability has to be driving their profits upward.
I haven't heard the term QUANGOs - quasi non-governmental organizations before. I'll add it to my growing list of definitions.
Have you heard Kristyn Wong Tam's coining of her ""Canadian Tire English" slur?
https://x.com/ChanLPfa/status/1800266712912117885
I like Canadian Tire English. Far better language than what our "betters" speak.