Tag Archives: Wisconsin

Network drives increase in painkiller prescriptions

In the latest installment of his ongoing investigation for the Milwaukee Journal Sentinel and MedPage Today, John Fauber looks for the source of America’s prescription painkiller boom (graphic), outlining what he describes as “a network of pain organizations, doctors and researchers that pushed for expanded use of the drugs while taking in millions of dollars from the companies that made them.”pills-and-money

Beginning 15 years ago, the network helped create a body of dubious information that can be found in prescribing guidelines, patient literature, position statements, books and doctor education courses, all which favored drugs known as opioid analgesics.

Apparently, that network has been effective. Federal data shows that prescription painkiller sales have quadrupled in the past decade or so, Fauber found, and some of those sales may not have been warranted.

A band of doctors who get little or no money from opioid makers has begun to challenge the hype behind the drugs. They say pharmaceutical industry clout has caused doctors to go overboard in prescribing the drugs, leading to addiction, thousands of overdose deaths each year and other serious complications.

Several of the pain industry’s core beliefs about chronic pain and opioids are not supported by sound research, the Journal Sentinel/MedPage Today investigation found. Among them:

  • The risk of addiction is low in patients with prescriptions.
  • There is no unsafe maximum dose of the drugs.
  • The concept of “pseudoaddiction.”

That concept holds those who display addictive behavior, such as seeking more drugs or higher doses, may not be actual addicts – they are people who need even more opioids to treat their pain.

His investigation dips deep into each of those beliefs and how they helped push painkillers. For a case study, see this companion infographic.

New Wisc. rules lead to interesting disclosures

Thanks to new disclosure requirements from the University of Wisconsin’s doctor group, the Wisconsin State Journal‘s David Wahlberg was able to report that 10 UW-Madison doctors received $48,000 or more from drug and device companies.

Thomas Zdeblick, M.D., pulled in almost $1.7 million. In fact, most of them were orthopedic surgeons, a fact which shouldn’t surprise anyone who’s been following the State Journal‘s conflict-of-interest work, as well as that of the Journal Sentinel‘s John Fauber.

Before 2010, doctors only had to report that they’d received more than $20,000 from such industry associations. Now, they have to disclose specific amounts. The disclosure requirements are currently the most prominent component of the schools’ crackdown of conflicts of interest, but activists say conflict disclosure is only half the battle.

A policy adopted in 2009 by the UW Medical Foundation, the university’s doctor group, bans doctors from doing promotional speeches for companies and accepting gifts such as free meals. Surgeons, however, can use materials created by device companies to conduct government-required training sessions, Golden said.
The foundation’s policy prohibits doctors from receiving royalties for using products at UW Health, which removes any incentive to use the doctors’ products instead of others, Golden said.

An interesting side note: UW clinics post signs detailing how patients can obtain their doctor’s disclosure form, but such requests have been few and far between, Wahlberg found “14 in 2009, 18 in 2010 and seven” in 2011.

Reporter’s narrative illuminates little-researched birth defect

When Wisconsin State Journal reporter David Wahlberg investigated what appeared to be rural Wisconsin’s increase in gastroschisis, a rare birth defect in which the intestines grow outside of an infant’s body and must be replaced after delivery, the lack of institutional research, statistics or easy answers seemed to raise far more questions than it answered, particularly in relation to rural incidence and pesticide use.

Wahlberg’s solution to this roadblock is to dive headlong into the human component of the story. In a two-part narrative (Part 1, Part 2), he puts these larger questions on the back burner and instead follows a family, in real time, as they deliver an infant boy who had been diagnosed with the condition during an ultrasound. No amount of summary would do Wahlberg’s piece justice, so I encourage you to simply invest a few minutes and bury yourself in the details. You’ll exit with an understanding of the condition and the toll it takes that no amount of statistical analysis could match.

MJS finds attempts to improve infant mortality rates are fragmented

This year, a team at the Milwaukee Journal Sentinel launched “Empty Cradles,” a yearlong reporting effort to find out why infant mortality is so high in the region and whether it must be that way. As we near the halfway point, their effort has already produced some powerful journalism and given new impetus to an issue that had been simmering, almost ignored, on the front burner all long.

Lakisha Stinson holds her newborn daughter, Rashyia, in their Milwaukee home. Stinson’s first daughter, Kelviana, died of sudden infant death syndrome in 2004. Infant mortality is a problem that plagues the Milwaukee area. Photo: Rick Wood/Milwaukee Journal Sentinel
Lakisha Stinson holds her daughter, Rashyia, in their Milwaukee home. Stinson’s first daughter, Kelviana, died of sudden infant death syndrome in 2004. Photo: Rick Wood/Milwaukee Journal Sentinel

In their latest major installment, in which they explore potential solutions to the crisis (and the recent lack thereof), reporters Crocker Stephenson and Ben Poston sum up the reason for their investigation in two damning paragraphs.

In Central Harlem, babies once died at a rate twice that of Milwaukee. But through a unified effort, the community has slashed its infant mortality rate by 78% since 1990. The rate there is now about 6 deaths per 1,000 births, lower than the state of Wisconsin as a whole.

In Milwaukee – where tens of millions of tax dollars have been spent in the past decade – 11 out of every 1,000 infants die before their first birthday. The city continues to have one of the worst infant mortality rates in the nation, especially for African-Americans, whose babies die at a rate about 2.5 times that of whites.

The problem, it seems, is that while the state supports 110  infant mortality reduction initiatives, they have so far failed to coalesce into a united public health effort.

Milwaukee and a few other urban areas are looking to change that, starting with the Lifecourse Initiative for Healthy Families which began in 2009. Modeled on successful programs in places like Harlem, the effort seeks to address the full spectrum of social factors that lurk behind high mortality rates.

In an earlier installment, reporters Mark Johnson and Tia Ghose looked at a medical mystery: African Americans in the United States are at a much higher risk than white Americans to have premature births, babies with low birth weights and infant mortality.

A married, college-educated African-American woman faces worse odds than a white, unmarried woman who dropped out of high school.

For more on how the series came together, see the background article editor Greg Borowski wrote for AHCJ this spring. It’s a great explanation of how to take a problem that everyone regards and common knowledge and report it into a deep, engaging, yearlong series. For more on previous installments in the series, see our coverage from January.

Drug-funded research group failed to disclose ties to makers of painkillers

In his latest conflict of interest investigation, Milwaukee Journal Sentinel reporter John Fauber takes on a challenge that, even by his standards, is an ambitious one.

Photo by somegeekintn via Flickr.

He attempts to show the effect pharmaceutical money and the local researchers who received it had on national opinions toward powerful prescription painkillers and how it all influenced the American epidemic of opiate abuse.

He focuses on the University of Wisconsin Pain and Policy Studies Group, which has received millions from painkiller manufacturers while publishing drug-friendly research and warning against increased regulation of OxyContin and its ilk. Many of these millions, Fauber found, appear not to have been disclosed in relevant publications even as the group was paving the way for the rapid rise of painkiller prescriptions in America.

The drugs had initially been approved for a very narrow range of uses, but became extremely popular as off-label use for the management of chronic pain spread like wildfire. It’s not easy to draw clean lines between the Wisconsin group and off-label use, but Fauber’s deft investigative work and careful sourcing make a strong case.


Read more of Fauber’s work