Porter and Jick’s letter appeared alongside others like, “Bacteriuria in Schoolgirls” and “Problems with Peppermint-Flavored Lidocaine.” (Another piece of old Correspondence in NEJMinfamously launched an unfounded panic over MSG in Chinese restaurants.)Ī spokesperson for the journal says that the Correspondence section today is subject to peer review on a case-by-case basis, but it is unlikely that the original Porter and Jick letter was peer reviewed. The Correspondence section usually consists of short letters to the editor or somewhat informal observations from doctors and scientists. Scientific journals pride themselves on peer review-where outside experts evaluate research-but the Correspondence section that published Porter and Jick’s letter doesn’t usually follow the same standard. There is a perhaps understandable source of confusion. One researcher, writing in 1990 in Scientific American, called Porter and Jick an “extensive study.” A paper for the Institute for Clinical Systems Improvement called Porter and Jick “a landmark report.” Then the final anointing: Time magazine in 2001 story titled “Less Pain, More Gain,” called Porter and Jick a “landmark study” showing that the “exaggerated fear that patients would become addicted” to opiates was “basically unwarranted.” As Quinones writes in his book, the brief letter became a lot grander in retellings: (Until NEJM put its full archives online in 2010, the only way to track it down was to find a physical copy in an academic library.) And it seems like many people didn’t. If you don’t track down the original letter, it’s not obvious how brief and narrow its findings truly are. Jick recently told the AP, “I’m essentially mortified that that letter to the editor was used as an excuse to do what these drug companies did.” “That particular letter, for me, is very near the bottom of a long list of studies that I’ve done.” Porter and Jick’s letter is not the only study whose findings on opioid addiction became taken out of context, but it was one of the most prominent. Pain specialists routinely cited it in their lectures. Purdue Pharma, which makes Ox圜ontin, starting using the letter’s data to say that less than one percent of patients treated with opioids became addicted. Porter and Jick had only looked at hospitalized patients in regimented settings, but that detail got lost in the push to prescribe opioids to patients at home-an entirely different scenario. Years later, Jick would tell Quinones, “That particular letter, for me, is very near the bottom of a long list of studies that I’ve done.” And for most of the 1980s, the letter didn’t attract much attention either.īut as it began to accrue citations, its findings also began to mutate. We conclude that despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction. The drugs implicated were meperidine in two patients, Percodan in one, and hydromorphone in one. The addiction was considered major in only one instance. Although there were 11,882 patients who received at least one narcotic preparation, there were only four cases of reasonably well documented addiction in patients who had no history of addiction. Recently, we examined our current files to determine the incidence of narcotic addiction in 39,946 hospitalized medical patients who were monitored consecutively. Its brevity was commensurate with the effort involved. So he asked a graduate student, Jane Porter, to help calculate how many patients in the database got addicted after being treated with pain medicines, and dashed off a letter to the New England Journal of Medicine. Something, perhaps a newspaper article, got Jick interested in looking at addiction. Journalist Sam Quinones tells the story in his book, Dreamland: The True Tale of America's Opiate Epidemic. In the 1980s, Hershel Jick, a doctor at Boston University Medical Center, had a database of hospital records that he used to monitor side effects from drugs. It’s a new study, a bit meta, from a team led by David Juurlink at the University of Toronto that tracked how the five-sentence letter passed through the game of academic citation telephone to become evidence that opioids are safe for chronic pain. So this week, the New England Journal of Medicine, which published the original letter in 1980, is issuing a corrective. What do you do when a letter in a prestigious medical journal has been so routinely mis-cited it’s taken on a life of its own? Like when pharmaceutical companies have used its data to spin their dangerous painkillers as safe, and the resulting overprescription fueled an opioid epidemic now consuming the country?
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