Top

Published in:

01-06-2020 | Public Health | Symposium: Conflicts of Interest

Lessons from Corporate Influence in the Opioid Epidemic: Toward a Norm of Separation

Author: Jonathan H. Marks

Published in: Journal of Bioethical Inquiry | Issue 2/2020

Abstract

There is overwhelming evidence that the opioid crisis—which has cost hundreds of thousands of lives and trillions of dollars (and counting)—has been created or exacerbated by webs of influence woven by several pharmaceutical companies. These webs involve health professionals, patient advocacy groups, medical professional societies, research universities, teaching hospitals, public health agencies, policymakers, and legislators. Opioid companies built these webs as part of corporate strategies of influence that were designed to expand the opioid market from cancer patients to larger groups of patients with acute or chronic pain, to increase dosage as well as opioid use, to downplay the risks of addiction and abuse, and to characterize physicians’ concerns about the addiction and abuse risks as “opiophobia.” In the face of these pervasive strategies, conflict of interest policies have proven insufficient for addressing corporate influence in medical practice, medical research, and public health policy. Governments, the academy, and civil society need to develop counterstrategies to insulate themselves from corporate influence and to preserve their integrity and public trust. These strategies require a paradigm shift—from partnerships with the private sector, which are ordinarily vehicles for corporate influence, to a norm of separation.

The Sackler family’s arts philanthropy has attracted much attention. I focus my analysis here on relationships with entities in health and policy spheres because they appear to have most directly contributed to the opioid crisis. But I recognize that arts philanthropy also merits ethical scrutiny that I cannot provide in the space permitted.

Although university gifts made by Purdue Pharma and the Sackler family have attracted the most public scrutiny, the conviction of the former CEO of Insys, John Kapoor, drew attention to his gifts to the University of Buffalo’s School of Pharmacy and ultimately led to the removal of his name from the school’s building (McNeil 2019).

For a thoughtful critique of this definition, see Rodwin 2018. Rodwin argues that the Institute of Medicine’s 2009 definition of conflicts of interest “neglects the actor’s compromised loyalty to the party or mission she is supposed to serve” (70) and that, by referring to conflicts between primary and secondary interests rather than conflicts between obligations and interests, this definition “diminishes the conflict’s significance” (70). Rodwin also expresses concern that “[e]fforts to include so-called intellectual or nonfinancial conflicts as conflicts of interest blur the concept” (75).

Physicians are not dependent on drug companies for pens and mugs—they can afford to buy their own! But these small gifts influence them nonetheless. See, e.g., Sah and Fugh-Berman 2013; Lo and Grady 2017.

Although widely publicized investigations revealing opioid company payments to PAOs and health professional associations led to withdrawals of funding and, in a few cases, to the recipient organizations ceasing to operate, industry funding of patient advocacy groups remains pervasive. One recent study found that 83 per cent of the 104 largest groups received funding from drug, device, or biotechnology companies (McCoy et al. 2017). We should not expect disclosure alone to lead to the widespread elimination of these relationships, especially if the pervasiveness of these relationships reinforces the (problematic) view that they are acceptable or unavoidable.

Aaron, D., and M. Siegel. 2017. Sponsorship of national health organizations by two major soda companies. American Journal of Preventive Medicine 52(1): 20–30.CrossRef

American Academy of Arts and Sciences (AAAS). 2002. $3 million gift from Purdue Pharma to support MGH pain program. AAAS Eureka Alert, February 7. https://www.eurekalert.org/pub_releases/2002-02/mgh-mg020702.php. Accessed December 1, 2019.

Anson, P. 2019. Pain Management Association shutting down. Pain News Network, February 2. https://www.painnewsnetwork.org/stories/2019/2/2/pain-management-association-closing-its-doors. Accessed December 1, 2019.

Applbaum, K. 2009. Getting to yes: Corporate power and the creation of a psychopharmaceutical blockbuster. Culture, Medicine, and Psychiatry 33(2): 185–215.CrossRef

Armstrong, D. 2019. Inside Purdue Pharma’s media playbook: How it planted the opioid “anti-story.” Propublica, November 19. https://www.propublica.org/article/inside-purdue-pharma-media-playbook-how-it-planted-the-opioid-anti-story. Accessed December 1, 2019.

Associated Press 2019. Top universities in US and UK took millions from Sackler family. The Guardian, October 4. https://www.theguardian.com/us-news/2019/oct/04/universities-sackler-family-donations-opioids. Accessed December 1, 2019.

Attorney-General of Massachusetts. 2019. Commonwealth of Massachusetts v. Purdue Pharma L.P. et al. First Amended Complaint. January 31. https://www.documentcloud.org/documents/5715954-Massachusetts-AGO-Amended-Complaint-2019-01-31.html. Accessed February 7, 2019.

Bachynski, K.E. and D.S. Goldberg. 2018. Time out: NFL conflicts of interest with public health efforts to prevent TBI. Injury Prevention 24(3): 180–184.

Barry, E. 2019. Tufts removes Sackler name over opioids: “Our students find it objectionable.” New York Times, December 5. https://www.nytimes.com/2019/12/05/us/tufts-sackler-name-opioids.html. Accessed December 6, 2019.

Bekelman, J.E., Y. Li, and C.P. Gross. 2003. Scope and impact of financial conflicts of interest in biomedical research: A systematic review. JAMA 289(4): 454–465.CrossRef

Bertrand, M., M. Bombardini, R. Fisman, B. Hackinen, and F. Trebbi. 2018. Hall of mirrors: Corporate philanthropy and strategic advocacy. NBER Working paper 25329 (December 2018). http://www.nber.org/papers/w25329. Accessed December 1, 2019.

Cain, D., G. Loewenstein, and D. Moore. 2005. The dirt on coming clean: Perverse effects of disclosing conflicts of interest. Journal of Legal Studies 34(1): 1–25.CrossRef

Center for Public Integrity (CPI). 2016a. Pharma lobbying held deep influence over opioid policies. September 18. https://publicintegrity.org/state-politics/pharma-lobbying-held-deep-influence-over-opioid-policies/. Accessed December 1, 2019.

———. 2016b. Politics of pain: Drugmakers fought state opioid limits amid crisis. December 15. www.publicintegrity.org/2016/09/18/20200/politics-pain-drugmakers-fought-state-opioid-limits-amid-crisis. Accessed December 1, 2019.

Centers for Disease Control and Prevention (CDC). 2019a. Prescribing practices: Changes in opioid prescribing practices. https://www.cdc.gov/drugoverdose/data/prescribing/prescribing-practices.html. Accessed December 1, 2019.

———. 2019b. Opioid data analysis and resources. https://www.cdc.gov/drugoverdose/data/analysis.html. Accessed December 1, 2019.

Chambers, T. 2017. The illusion of transparency. American Journal of Bioethics 17(6): 32–33.CrossRef

Collins, F.S. 2017. Statement from NIH director on combating opioid crisis with scientific solutions. NIH.gov, October 26. https://www.nih.gov/about-nih/who-we-are/nih-director/statements/statement-nih-director-combating-opioid-crisis-scientific-solutions. Accessed December 1, 2017.

———. 2018. Statement from NIH Director on public–private partnerships as part of the NIH HEAL initiative. NIH.gov, April 13. https://www.nih.gov/about-nih/who-we-are/nih-director/statements/statement-public-private-partnerships-part-nih-heal-initiative. Accessed December 1, 2019.

Clark, K., and H. Rogers. 2019. Corporate influence: Purdue and the WHO. Offices of the U.S. Representatives Katherine Clark and Hal Rogers, May 22. https://katherineclark.house.gov/_cache/files/a/a/aaa7536a-6db3-4192-b943-364e7c599d10/818172D42793504DD9DFE64B77A77C0E.5.22.19-who-purdue-report-final.pdf. Accessed May 31, 2019.

Corkery, M., and K. Thomas. 2018. Drug industry wages opioid fight using an anti-addiction ally. New York Times, February 2. https://www.nytimes.com/2018/02/08/business/opioids-addiction-pharma.html. Accessed December 1, 2019.

Council of Economic Advisors (CEA). 2017. The underestimated costs of the opioid crisis. Washington D.C.: Office of the President of the United States. https://www.whitehouse.gov/sites/whitehouse.gov/files/images/The%20Underestimated%20Cost%20of%20the%20Opioid%20Crisis.pdf. Accessed December 1, 2019.

———. 2019. The full cost of the opioid crisis: $2.5 trillion over four years. Washington D.C.: Office of the President of the United States. https://www.whitehouse.gov/articles/full-cost-opioid-crisis-2-5-trillion-four-years/. Accessed December 16, 2019.

Emanuel, G., and K. Thomas. 2019. Top executives of Insys, an opioid company, are found guilty of racketeering. New York Times, May 2. https://www.nytimes.com/2019/05/02/health/insys-trial-verdict-kapoor.html. Accessed May 31, 2019.

Farzan, A.N. 2020. A tech company gave doctors free software—rigged to encourage them to prescribe opioids, prosecutors say. Washington Post, January 28. https://www.washingtonpost.com/nation/2020/01/28/opioid-kickback-software/. Accessed February 1, 2020.

Freudenberg, N. 2014. Lethal but legal: Corporations, consumption, and protecting public health. New York: Oxford University Press.

Gluck, A.R., A. Hall, and G. Curfman. 2018. Civil litigation and the opioid crisis: The role of courts in a national health crisis. Journal of Law, Medicine, and Ethics 46(2): 351–366.CrossRef

Goldberg, D.S. 2019. The Shadows of sunlight: Why disclosure should not be a priority in addressing conflicts of interest. Public Health Ethics 12(2): 202–212.

Gonzales, R. 2019. Drug distributor and former execs face first criminal charges in opioid crisis. NPR, April 23. https://www.npr.org/2019/04/23/716571375/drug-distributor-and-former-execs-face-first-criminal-charges-in-opioid-crisis. Accessed December 1, 2019.

Gornall, J. 2015. Sugar: A web of influence. BMJ 350: h231.CrossRef

Greene, J.A., and S.H. Podolsky. 2009. Keeping modern in medicine: Pharmaceutical promotion and physician education in postwar America. Bulletin of the History of Medicine 83(2): 331–377.CrossRef

Hadland, S.E., M.S. Krieger, and B.D.L. Marshall. 2017. Industry payments to physicians for opioid products, 2013–2015. American Journal of Public Health 107(9): 1493–1495.CrossRef

Hadland, S.E., M. Cerdá, Y. Li, M.S. Krieger, and B.D.L. Marshall. 2018. Association of pharmaceutical industry marketing of opioid products to physicians with subsequent opioid prescribing. JAMA Internal Medicine 178(6): 861–863.CrossRef

Hadland, S.E., A. Rivera-Aguirre, and B.D.L. Marshall. 2019. Association of Pharmaceutical Industry marketing of opioid products with mortality from opioid-related overdoses. JAMA Open 2019(1): e186007.CrossRef

Hals, T. 2019a. OxyContin maker Purdue Pharma to pay states’ lawyers, urged to help victims. New York Times, November 21. https://www.nytimes.com/reuters/2019/11/20/business/20reuters-purdue-pharma-bankruptcy.html. Accessed December 1, 2019.

———. 2019b. Bankrupt Insys reaches deal to divvy cash among opioid victims. New York Times, November 21. https://www.nytimes.com/reuters/2019/11/21/us/21reuters-insys-opioids-bankruptcy.html. Accessed December 1, 2019.

Hoffman, J. 2019a. Johnson & Johnson ordered to pay $572 million in landmark opioid trial. New York Times, August 26. https://www.nytimes.com/2019/08/26/health/oklahoma-opioids-johnson-and-johnson.html. Accessed August 27, 2019.

———. 2019b. Whoops. Judge reduces J&J opioid fine after mistaking thousands for millions. New York Times, November 15. https://www.nytimes.com/2019/11/15/health/opioids-oklahoma-johnson-fine.html. Accessed December 1, 2019.

———. 2019c. $260 million opioid settlement reached at last minute with big drug companies. New York Times, October 21. https://www.nytimes.com/2019/10/21/health/opioid-settlement.html. Accessed October 22, 2019.

———. 2019d. Drug giants close in on a $50 billion settlement of opioid cases. New York Times, October 19. https://www.nytimes.com/2019/10/16/health/opioids-settlement-distributors.html. Accessed October 20, 2019.

———. 2020a. Payout from a national opioids settlement won’t be as big as hoped. New York Times, February 17. https://www.nytimes.com/2020/02/17/health/national-opioid-settlement.html. Accessed March 14, 2020.

———. 2020b. Opioid settlement offer provokes clash between states and cities. New York Times, March 13. https://www.nytimes.com/2020/03/13/health/opioids-settlement.html. Accessed March 14, 2020.

Hollander, M., J.M. Donohue, B.D. Stein, and E.E. Krans. 2019. Association between opioid prescribing in Medicare and pharmaceutical company gifts by physician specialty. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-019-05470-0.

Homeland Security and Government Affairs Committee (HSGAC). 2018a. Fueling an epidemic—Report Two: Exposing financial ties between opioid manufacturers and third party advocacy groups. Washington, D.C.: U.S. Senate. https://www.hsdl.org/?view&did=808171. Accessed December 1, 2019.

———. 2018b. Fueling an epidemic—Report Four: Inside the Insys strategy for boosting fentanyl sales. Washington D.C.: U.S. Senate. https://www.hsdl.org/?view&did=818447. Accessed December 1, 2019.

Horwitz, S., S. Higham, D. Bennett, and M. Kornfield. 2019. Inside the opioid industry’s marketing machine: Unsealed court documents reveal how drug companies ramped up sales during the epidemic, Washington Post, December 6. https://www.washingtonpost.com/graphics/2019/investigations/opioid-marketing/. Accessed December 7, 2019.

Joseph, A. 2019a. “A blizzard of prescriptions”: Documents reveal new details about Purdue’s marketing of OxyContin. STAT, January 15. https://www.statnews.com/2019/01/15/massachusetts-purdue-lawsuit-new-details/. Accessed December 1, 2019.

———. 2019b. Purdue cemented ties with universities and hospitals to expand opioid sales, documents contend. STAT, January 16. https://www.statnews.com/2019/01/16/purdue-pharma-cemented-ties-to-universities-hospitals/. Access December 1, 2019.

———. 2019c. “We owe much to the Sackler family”: How gifts to a top medical school advanced the interests of Purdue Pharma. STAT, April 9. https://www.statnews.com/2019/04/09/sackler-purdue-pharma-gifts-to-tufts-advanced-company-interests/. Accessed December 1, 2019.

Kanter, G.P. 2018. Extending the Sunshine Act from physicians to patient advocacy organizations. AJPH 108(8): 978–979.CrossRef

Kanter, G.P., and G. Loewenstein. 2019. Evaluating open payments. JAMA 322(5): 401–402.CrossRef

Kanter, G.P., D. Carpenter, L. Lehmann, and M. Mello. 2019. Effect of the public disclosure of industry payments information on patients: Results from a population-based natural experiment. BMJ Open, no. 024020.

Kaplan, S. and J. Hoffman. 2020. Mallinckrodt reaches $1.6 billion deal to settle opioid lawsuits. New York Times, February 25. http://www.nytimes.com/2020/02/25/health/mallinckrodt-opioid-settlement.html. Accessed March 14, 2020.

Keefe, P.R. 2017. The family that built an empire of pain. New Yorker, October 30. 34–49.

Kinetz, E. 2019. Fake doctors, pilfered medical records drive Oxy China sales. Associated Press, November 20. https://apnews.com/4122af46fdba42119ae3db30aa13537c. Accessed December 1, 2019.

Lesser, B., D. Levine, L. Girion, and J. Dowdell. 2019. How judges added to the grim toll of opioids. Reuters.com, June 25. https://www.reuters.com/investigates/special-report/usa-courts-secrecy-judges/. Accessed December 1, 2019.

Lessig, L. 2015. Republic, lost: The corruption of equality and the steps to end it. New York: Twelve.

Lin, D.H., E. Lucas, I.B. Murimi, et al. 2017. Financial conflicts of interest and the Centers for Disease Control and Prevention’s 2016 guideline for prescribing opioids for chronic pain. JAMA Internal Medicine 177(3): 427–428.

Lo, B., and M. Field. 2009. Conflict of interest in medical research, education, and practice. Washington, D.C.: National Academies Press.

Lo, B., and D. Grady. 2017. Payments to physicians: Does the amount of money make a difference? JAMA 317(17): 1719–1720.CrossRef

Loewenstein, G., D.M. Cain, and S. Sah. 2011. The limits of transparency: Pitfalls and potential of disclosing conflicts of interest. American Economic Review 101(3): 423–428.CrossRef

Loewenstein, G., S. Sah, and D. Cain. 2012. The unintended consequences of conflict of interest disclosure. JAMA 307(7): 669–670.CrossRef

Lundh A., J. Lexchin, B. Mintzes, J. Schroll, and L. Bero. 2017. Industry sponsorship and research outcome. Cochrane Database of Systematic Reviews. Issue 2. Art. No.: MR000033.

Macy, B. 2018. Dopesick: dealers, doctors, and the drug company that addicted America. New York: Little, Brown & Co.

Marks, J.H. 2017. Caveat partner: Sharing responsibility for health with the food industry. American Journal of Public Health 107(3): 360–361.CrossRef

———. 2019a. The Perils of partnership: Industry influence, institutional integrity, and public health. New York: Oxford University Press.

———. 2019b. Opioid crisis shows partnering with industry can be bad for public health. The Conversation, March 6. https://theconversation.com/opioid-crisis-shows-partnering-with-industry-can-be-bad-for-public-health-112649. Accessed December 1, 2019.

———. 2019c. Are corporations nudging the nudgers? American Journal of Bioethics 19(5): 70–72.

———. 2020. Beyond disclosure: Developing law and policy to tackle corporate influence. American Journal of Law and Medicine 46 (forthcoming). https://doi.org/10.1177/0098858820933499.

McCoy, M.S., M. Carniol, K. Chockley, J.W. Urwin, E.J. Emanuel, and H. Schmidt. 2017. Conflict of interest for patient advocacy organizations. New England Journal of Medicine 376: 880–885.CrossRef

McCoy, M.S. 2018. Industry support of patient advocacy organizations: The case for an extension of the Sunshine Act provisions of the Affordable Care Act. American Journal of Public Health 108(8): 1026–1030.CrossRef

McCoy, M.S., and G.P. Kanter. 2018. Campaign contributions from political action committees to members of congressional committees responding to the opioid crisis. JAMA 320(14): 1489–1491.CrossRef

McGreal, C. 2018. American overdose: The opioid tragedy in three acts. New York: Hachette.

———. 2019. US medical group that pushed doctors to prescribe painkillers forced to close. The Guardian, May 25. https://www.theguardian.com/us-news/2019/may/25/american-pain-society-doctors-painkillers. Accessed May 31, 2019.

McNeil, H. 2019. UB renames structure “Pharmacy Building” after removing convicted alumnus’ name. The Buffalo News, June 20. https://buffalonews.com/2019/06/20/ub-renames-structure-pharmacy-building-after-removing-convicted-alumnus-name/. Accessed December 1, 2019.

Meier, B. 2007. In guilty plea, OxyContin maker to pay $600 million. New York Times, May 10. https://www.nytimes.com/2007/05/10/business/11drug-web.html. Accessed December 1, 2018.

———. 2018. Pain killer: An empire of deceit and the origin of America’s opioid epidemic. New York: Random House.

Michaels, D. 2008. Doubt is our product: How industry’s assault on science threatens your health. New York: Oxford University Press.

———. 2020. The triumph of doubt: Dark money and the science of deception. New York: Oxford University Press.

National Institutes of Health (NIH) Working Group. 2018. Ethical considerations for industry partnership on research to help end the opioid crisis: Draft report. March 20. Washington, D.C.: National Institutes of Health. https://acd.od.nih.gov/documents/presentations/032018_opioids-draft-report.pdf. Accessed December 1, 2019.

———. 2019. HEAL Initiative: News and Events. https://heal.nih.gov/news. Accessed December 1, 2019.

Ornstein, C., and K. Thomas. 2018. What these medical journals don’t reveal: Top doctors’ ties to industry. New York Times, December 8. https://www.nytimes.com/2018/12/08/health/medical-journals-conflicts-of-interest.html. Accessed December 31, 2018.

Ornstein, C., and T. Weber. 2012. American Pain Foundation shuts down as Senators launch investigation of prescription narcotics. Propublica, May 8. https://www.propublica.org/article/senate-panel-investigates-drug-company-ties-to-pain-groups. Accessed December 1, 2019.

Pharmaceutical Research and Manufacturers of America (PhRMA). 2017. PhRMA announces major commitment to address the opioid crisis in America. Press release, December 12. https://www.phrma.org/press-release/phrma-announces-major-commitment-to-address-the-opioid-crisis-in-america. Accessed December 1, 2019.

Podolsky, S.H. 2015. The antibiotic era: Reform, resistance, and the pursuit of a rational therapeutics. Baltimore: Johns Hopkins University Press.

Podolsky, S.H, D. Hertzberg, and J.A. Greene. 2019. Preying on prescribers (and their patients)—Pharmaceutical marketing, iatrogenic epidemics, and the Sackler legacy. New England Journal of Medicine 380(19): 1785–1787.CrossRef

Poston, B. 2018. Capping years of criticism, Purdue Pharma will stop promoting its opioid drugs to doctors. Los Angeles Times, February 10. https://www.latimes.com/local/lanow/la-me-ln-purdue-marketing-20180210-story.html. Accessed December 1, 2019.

Purdue Pharma. 2018. We manufacture prescription opioids. How could we not help fight the prescription and illicit opioid abuse crisis? New York Times, January 2. http://bit.ly/PurduePartnerAd. Accessed January 31, 2018.

Quinones, S. 2006. Dreamland: The true tale of America’s opiate epidemic. New York: Bloomsbury.

Raymond, N. 2019. Judge partly vacates convictions of opioid maker Insys’ founder, executives. New York Times, November 26. https://www.nytimes.com/reuters/2019/11/26/us/26reuters-insys-opioids.html. Accessed November 27, 2019.

Relman, A.S. 1980. The new medical-industrial complex. New England Journal of Medicine 303(17): 963–970.CrossRef

———. 1984. Dealing with conflicts of interest. New England Journal of Medicine 310(18): 1182–1183.

Richardson, E. 2014. Health policy brief: The Physician Payments Sunshine Act. Health Affairs, October 2. https://www.healthaffairs.org/do/10.1377/hpb20141002.272302/full/. Accessed December 1, 2019.

Rodwin, M. 2018. Attempts to redefine conflicts of interest. Accountability in Research 25(2): 67–78.CrossRef

Rose, S.L. 2013. Patient advocacy organizations: Institutional conflicts of interest, trust, and trustworthiness. Journal of Law, Medicine, and Ethics 41(3): 680–687.CrossRef

Rose, S.L., J. Highland, M.T. Karafa, and S. Joffe. 2017. Patient advocacy organizations, industry funding, and conflicts of interest. JAMA Internal Medicine 177(3): 344–350.CrossRef

Rose, S.L., S. Sah, R. Dweik, et al. 2019. Patient responses to physician disclosures of industry conflicts of interest: A randomized field experiment. Organizational Behavior and Human Decision Processes. https://doi.org/10.1016/j.obhdp.2019.03.005.

Ross, C. 2019. Purdue’s Richard Sackler proposed plan to play down OxyContin risks, and wanted drug maker feared “like a tiger,” files show. STAT News, December 2. https://www.statnews.com/2019/12/02/purdue-richard-sackler-proposed-plan-play-down-oxycontin-risks/. Accessed December 1, 2019.

Ross, J., K. Hill, D. Egilman, and H. Krumholz. 2008. Guest authorship and ghostwriting in publications related to Rofecoxib: A case study of industry documents from Rofecoxib litigation. JAMA 299(15): 1800–1812.CrossRef

Ryan, S., L. Girion, and S. Glover. 2016. OxyContin goes global—“We’re only just getting started.” Los Angeles Times, December 18. https://www.latimes.com/projects/la-me-oxycontin-part3/. Accessed December 1, 2019.

Sah, S. 2016. The paradox of disclosure. New York Times, July 8. https://www.nytimes.com/2016/07/10/opinion/sunday/the-paradox-of-disclosure.html. Accessed December 1, 2019.

———. 2019. Conflict of interest disclosure as a reminder of professional norms: Clients first! Organizational Behavior and Human Decision Processes 154: 62–79.

Sah, S., and A. Fugh-Berman. 2013. Physicians under the influence: Social psychology and industry marketing strategies. Journal of Law, Medicine, and Ethics 41(3): 665–672.CrossRef

Sah, S., G. Loewenstein, and D. Cain. 2019. Insinuation anxiety: Concern that advice rejection will signal distrust after conflict of interest disclosure. Personal and Social Psychology Bulletin 45(7): 1099–1112.

Schulte, F. 2018. Purdue Pharma edits public service ad in Washington Post. Washington Post, July 24. https://www.washingtonpost.com/national/health-science/purdue-pharma-edits-public-service-ad-in-washington-post/2018/07/24/2f1ddefc-8f7c-11e8-ae59-01880eac5f1d_story.html. Accessed December 1, 2019.

Schwab, T. 2019. US opioid prescribing: The federal government advisers with recent ties to big pharma. BMJ 366: I5167.CrossRef

Silverman, E. 2019. Teva reaches $85 million settlement on eve of opioid trial in Oklahoma. STAT News, May 26. https://www.statnews.com/pharmalot/2019/05/26/teva-opioid-oklahoma-trial-settlement/. Accessed May 27, 2019.

Sismondo, S. 2018. Ghost-managed medicine: Big pharma's invisible hands. Manchester, U.K.: Mattering Press.

Steinman, M., L. Bero, M. Chren, and C. Landefeld. 2006. Narrative review: The promotion of gabapentin: An analysis of internal industry documents. Annals of Internal Medicine 145(4): 284–293.CrossRef

Thomas, K. 2019. Insys, the opioid drug maker, to pay $225 million to settle fraud charges. New York Times, June 5. https://www.nytimes.com/2019/06/05/health/insys-opioid-fentanyl-settlement.html. Accessed June 6, 2019.

———. 2020. Insys Founder Gets 5½ Years in Prison in Opioid Kickback Scheme. New York Times, January 23. https://www.nytimes.com/2020/01/23/health/opioids-insys-kapoor-prison.html. Accessed January 24, 2020.

Volkow, N., and F.S. Collins. 2017. The role of science in addressing the opioid crisis. New England Journal of Medicine 377(4): 391–394.CrossRef

Woodson, C. 2019. Stripper turned pharma executive gave doctor a lap dance to get him to prescribe drug, officials say. Washington Post, January 30. https://www.washingtonpost.com/business/2019/01/30/stripper-turned-pharma-exec-gave-doctor-lap-dance-get-him-prescribe-drugs-officials-say/?utm_term=.6a5e1ba00c20. Accessed February 1, 2019.

World Health Organization (WHO). 2011. Ensuring balance in national policies on controlled substances: Guidance for availability and accessibility of controlled medicines. https://www.who.int/medicines/areas/quality_safety/GLs_Ens_Balance_NOCP_Col_EN_sanend.pdf. Accessed January 31, 2018.

———. 2012. Guidelines on the pharmacological treatment of persisting pain in children with medical illnesses. Geneva: WHO. https://apps.who.int/iris/bitstream/handle/10665/44540/9789241548120_Guidelines.pdf. Accessed January 31, 2018.

———. 2019. Web statement on pain management guidance. June 20. https://www.who.int/medicines/areas/quality_safety/guide_on_pain/en/. Accessed June 20, 2019.

Young, I.M. 2011. Responsibility for justice. New York: Oxford University Press.CrossRef

Yurko, S., and Remz, P.C. 2019. Report and recommendations concerning the relationship of the Sackler family and Purdue Pharma with Tufts University. https://president.tufts.edu/wp-content/uploads/Final-Report-Tufts-Sackler-and-Purdue-Pharma-December-2019.pdf. Accessed December 16, 2019.

Zezima, K., and Bernstein, L. 2019. “Hammer on the abusers”: Mass. attorney general alleges Purdue Pharma tried to shift blame for opioid addiction. Washington Post, January 15. https://www.washingtonpost.com/national/hammer-on-the-abusers-mass-attorney-general-alleges-purdue-pharma-tried-to-shift-blame-for-opioid-addiction/2019/01/15/4af25c4c-190c-11e9-88fe-f9f77a3bcb6c_story.html. Accessed December 1, 2019.

Title: Lessons from Corporate Influence in the Opioid Epidemic: Toward a Norm of Separation
Author: Jonathan H. Marks
Publication date: 01-06-2020
Publisher: Springer Singapore
Keywords: Public Health
Opioids
Opioids
Published in: Journal of Bioethical Inquiry / Issue 2/2020
Print ISSN: 1176-7529
Electronic ISSN: 1872-4353
DOI: https://doi.org/10.1007/s11673-020-09982-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Lessons from Corporate Influence in the Opioid Epidemic: Toward a Norm of Separation

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2020

Conflict of Interest in Scientific Research in China: A Socio-ethical Analysis of He Jiankui’s Human Genome-editing Experiment

Status, Respect, and Stigma: A Qualitative Study of Non-financial Interests in Medicine

Beyond Money: Conscientious Objection in Medicine as a Conflict of Interests

Mitochondrial Donation: The Australian Story

Human Dignity and Gene Editing: Additional Support for Raposo’s Arguments

Symposium Lead Essay—Conflict of Interest: Opening Up New Territories