Opioid crisis shows partnering with industry can be bad for public health

“Show me the bodies!” someone demanded at the end of my lecture a few years ago.

As a scholar of public health ethics, law and policy, I had just warned an audience of professors and university administrators about the perils of partnering with, or taking money from, corporations – a common practice in public health research and policymaking.

It’s not always possible to prove harm like that, I said. But there are other reasons for government, the academy and public health organizations to maintain arm’s length relationships with corporations. Among them, preserving integrity and public trust.

As I document extensively in my book on corporate influence in public health, partnerships distort research agendas, not merely of individual researchers but of entire fields of research. They also reinforce the framing of public health problems and their solutions in ways that are most favorable to the corporate partners.

These concerns are most acute when corporations are creating or exacerbating a public health problem. Think of a soda company sponsoring exercise initiatives to burnish its reputation and deflect attention from the role of its brands in the obesity epidemic. But close relationships with corporations can be problematic even when companies are working on medicines or other potential solutions to health problems.

Not surprisingly, opioid manufacturers want to sell more opioids. AP Photo/Toby Talbot
I failed to convince that skeptical audience member. But recent research found the bodies, or, at the very least, pointed to one place where we might start digging: the opioid crisis. The new study concluded that drug companies’ marketing of opioids to physicians was “associated with increased opioid prescribing and, subsequently, with elevated mortality from overdoses.” Recent court filings also suggest that doctors who met with opioid drug reps were 10 times more likely to have prescribed opioids to patients who later died of an overdose.

Marketing to physicians is only one of the strategies employed by opioid manufacturers. Between 2012 and 2017, five opioid manufacturers gave nearly US$9 million to 14 patient advocacy groups and medical societies. Although this sum is a drop in the ocean for drug companies with billions of dollars in opioid revenues, these were substantial sums for the recipients. And the companies’ investments paid off.

Many of the groups issued guidelines minimizing the addiction risks of prescription opioids. They also lobbied extensively to defeat legislation restricting opioid prescribing. When the CDC issued its draft guidelines to limit opioid use in 2016, opposition was significantly higher among organizations that had received industry funding.

The most commonly touted solution to financial conflicts of interest is disclosure of the conflict. The Physician Payments Sunshine Act of 2010 requires drug companies to disclose gifts to physicians and teaching hospitals. Democratic senator Claire McCaskill has introduced a bill to extend these provisions to cover payments made to patient advocacy groups.