Dopesick - Beth Macy Page 0,130
“New Efforts Against an Old Foe.”
No one questioned whether: John Walsh, “The Enduring Mystery of Pain Measurement,” Atlantic, Jan. 10, 2017.
not only did reliance on pain scales not correlate: Effectiveness of pain scales dissected in Anna Lembke’s Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop (Baltimore: Johns Hopkins University Press, 2016), 66–67.
“Every single physician I knew…”: Author interview, Dr. John Burton, March 20, 2017.
The Press Ganey survey upped the pressure: Author interview, Dr. David Davis, March 16, 2017.
financial toll of $1 trillion: As reported in Altarum, “Economic Toll of Opioid Crisis in U.S. Exceeded $1 Trillion Since 2001,” Feb. 13, 2018. “An additional $500 billion is estimated through 2020 if current conditions persist,” the health care firm estimated. The White House Council of Economic Advisers calculated the costs at $504 billion in 2015 alone, according to “Council of Economic Advisers Report: The Underestimated Cost of the Opioid Crisis,” Nov. 20, 2017, whitehouse.gov/briefings-statements/cea-report-underestimated-cost-opioid-crisis/.
only a few voices of dissent: Seddon R. Savage, “Long-Term Opioid Therapy: Assessment of Consequences and Risks,” Journal of Pain and Symptom Management, May 1996: 274. Dennis Turk wrote in that same paper: “Arguments both pro and con are based on small segments of the pain populations with unique psychosocial and behavioral, as well as disease characteristics.”
CHAPTER TWO. SWAG ’N’ DASH
Interviews: Dr. Steve Huff, Rosemary Hopkins, Ray Kohl, Dr. Sue Cantrell, Dr. Art Van Zee, Sue Ella Kobak, Dr. Vince Stravino, Jan Mosley, Greg Stewart, Dr. Molly O’Dell, Debbie Honaker, Jennifer Ball, Crystal Street, Sister Beth Davies, John Kelly, Doug Clark, Dennis Lee, Emmitt Yeary, Sheriff Gary Parsons, Rev. Clyde Hester, Tony Lawson
detailed television ads touting specific medical claims: Dylan Scott, “The Untold Story of TV’s First Prescription Drug Ad,” STAT, Dec. 11, 2015, statnews/2015/12/11/untold-story-tvs-first-prescription-drug-ad/.
companies spent more plying: Chris Adams, “Doctors ‘Dine ’n’ Dash’ in Style, as Drug Firms Pick Up the Tab,” Wall Street Journal, May 14, 2001.
there were scant industry or federal guidelines: U.S. General Accountability Office report, “OxyContin Abuse and Diversion and Efforts to Address the Problem,” December 2003, 15–17, gao.gov/new.items/d04110.pdf. Voluntary guidelines regarding drug company marketing and promotion were issued by July 2002 by the Pharmaceutical Research and Manufacturers of America. In April 2003, voluntary guidelines were issued by the Office of Inspector General, U.S. Department of Health and Human Services.
Purdue handpicked the physicians: Barry Meier, Pain Killer: A “Wonder” Drug’s Trail of Addiction and Death (New York: Rodale Press, 2003), 99–101.
If a doctor was already prescribing lots of Percocet: Ibid., 103. High-prescriber target was also outlined in Purdue Pharma’s 1996 Budget Plan for OxyContin, 56.
a term reps use as a predictor: Deciles are based on volume, past prescribing history, managed care mix, and adopter status, and are used as a way of getting reps to prioritize time and resources; author interview, longtime pharmaceutical sales rep, Dec. 18, 2017.
the more visits that doctor received: Purdue Pharma’s 1999 Budget Plan, 65. Meier, 99–103. GAO report, “OxyContin Abuse and Diversion,” 15–20: “Purdue directed its sales representatives to focus on the physicians in their sales territories who were high opioid prescribers.”
who often brought along “reminders”: Purdue Pharma’s 1999 Budget Plan, 65.
the higher the milligrams a doctor prescribed: Author interview, former Purdue Pharma OxyContin sales rep, Jan. 26, 2017.
family doctors now the largest single group: Paul Tough, “The Alchemy of OxyContin,” New York Times Magazine, July 29, 2001.
Reps began coming by before holidays: Author interview, pharmaceutical sales rep, July 28, 2016.
Purdue reps were heavily incentivized: David Armstrong, “Secret Trove Reveals Bold ‘Crusade’ to Make OxyContin a Blockbuster,” STAT, Sept. 22, 2016.
“We were impressionable young doctors”: Author interview, Dr. Steve Huff, Aug. 7, 2016.
When he set about trying to coax: Ibid., Sept. 26, 2017.
“Cadillac high”: Author interview, Rosemary Hopkins, Sept. 23, 2016.
in nearby Galax, a factory town: Author interview, Ray Kohl, director of tourism for Galax, Aug. 8, 2016.
Cantrell remembered setting up: Author interview, Dr. Sue Cantrell, March 23, 2016.
Jobs in coal mining: Brad Plumer, “Here’s Why Central Appalachia’s Coal Industry Is Dying,” Washington Post, Nov. 4, 2013; Nathan Bomey, “Coal’s Demise Threatens Appalachian Miners, Firms as Production Moves West,” USA Today, April 19, 2016.
That’s where he met his wife: Author interview, Dr. Art Van Zee, Sept. 3, 2017.
“‘The best doctor in America’”: Author interview, Dr. Vince Stravino, March 13, 2017.
Locals often compared Van Zee… to Abraham Lincoln: Author interview, Jan Mosley, June 30, 2016.
“When his patients are admitted to the ER”: Ibid.
accompany a patient in cardiac arrest: Author interview, Greg Stewart, Sept. 23, 2016.
The time when he cracked three ribs: