New York Times reporter Barry Meier has written his first Kindle Single A World of Hurt: Fixing Pain Medicine's Biggest Mistake. In it, he looks at the over-prescription of the drug OxyContin. Within a week of publication, the book already landed among the top 10 best-selling e-book singles.
Meier has been a reporter at The New York Times since 1989 focusing on the messy intersection of business, medicine and the public's health. But OxyContin is Meier's Watergate. Something about the powerful pain medication keeps drawing him back to writing about it.
Thin Reads, which features interviews of prominent e-book single authors, recently conducted this email interview Meier.
Thin Reads: Why is this story being published as an e-book single instead of a page 1 story in your paper or a lead article in the Sunday magazine?
The story told in A World of Hurt is a pretty complicated one. It unfolds over a decade or so and charts a series of changes in the treatment of pain and the resulting fallout for patients and public health. My aim was to try and tell it in a concise way. But doing so required a fair amount of space, far more than the front page of the Times or the magazine could accommodate.
Thin Reads: Your two books -- A World of Hurt and Pain Killer: A 'Wonder' Drug's Trail of Addiction and Death-- both focus on the dangers of OxyContin. What is it about the drug keeps drawing you back to write about it?
That's a good question because I never intended or expected to write a second piece about narcotic painkillers such as OxyContin. But two developments drew me back. The first one was the growing number of annual overdose deaths related to opioids; by 2012, that number had reached 16,000, four times the level in 2003, the year that Pain Killer was published. Also, the calculus between the benefits and risks of these drugs for patients has dramatically changed, Back in 2003,the debate over OxyContin centered on its potential for abuse by teenagers and others. In fact, a "bright line" supposedly separated the benefits of such drugs for patients from their dangers when abused. In recent years, that line has blurred amid growing evidence that opioids are often not effective in treating long-term pain and are exacting a toll on patient health.
Thin Reads: Does the drug industry wield too much power over the medical profession and public policy? If so, is this situation getting better or worse?
The influence of the drug industry has probably dwindled, at least on a superficial level. In recent years, some professional groups that represent doctors have put limits on how much money they take from drug makers and companies now have to disclose financial payments to doctors. That is far different than the way things were a decade ago when doctors went on junkets funded by drug makers. Still, drug makers do still play a large part in influencing how doctors treat patients because those who might advocate other approaches - say ones less focused on drugs - do not have similar clout, lobbying operations or money.
Thin Reads: A World of Hurt comes across as a serious indictment of the way the medical profession handles patients with severe and chronic pain. Can our system ever be improved?
There is no question in my mind that doctors want to do what is best for patients. That said, most physicians acknowledge that treating patients with long-term pain is frustrating, time-consuming and difficult. So it is natural for them to go with the prevailing wisdom or the advice of experts. That explains why the use of opioids boomed during the past decade. Some patients benefit from long-term opioid use but many patients have ended up "parked" on high doses of these drugs for years and are suffering significant side effects. So the big issue out there is whether those who pay for health care - private insurers and government - will pay for other treatment strategies such as physical therapy and behavior modification that studies show can also be effective in treating pain.
Thin Reads: You seem to suggest that some patients have to face the difficult choice of living with constant pain or essentially numbing themselves into near oblivion with powerful painkillers. That's a pretty bleak scenario. Is there some hope you can offer sufferers of chronic pain?
It is hard to imagine a more "bleak" situation than the one that currently exists: Thousands of patients taking powerful drugs that really are not benefiting them and may be harming them. The book, I hope, points to a way out by highlighting that patients can and do benefit from other kinds of treatments beside high dosages of drugs.
Thin Reads: Would you ever take OxyContin or a similar drug to manage your pain?
I would not hesitate to take any drug if needed. And it is important to emphasize that narcotic painkillers such as OxyContin have vital medical roles such as in the treatment of cancer pain, palliative care and the treatment of acute pain like after surgery. The problem is that these drugs were promoted as a cure-all for chronic pain.