Wednesday, July 31, 2013

IMS Report on Responsible Medication Use is Irresponsible

The IMS Institute for Healthcare Informatics published a report last month entitled "Avoidable Costs in the US Healthcare System: The $200 Billion Opportunity from Using Medicines More Responsibly."  My initial reaction, before reading a single word of the report, was the $200 billion seemed a little low in light of what we know about the opioid misuse epidemic in this country and it's relation to chronic pain - a condition that the Institute of Medicine has labeled a $600 billion per year problem by itself. 

So you can imagine my surprise when I didn't find a single mention of opioids, pain killers, chronic pain, or medication abuse in any of the 58 pages published.  Instead, I found an advertisement for the broader pharmaceutical industry disguised as a research piece.  "Using Medicines More Responsibly," it turns out, is code for "Use More Medicine... and Let's Temporarily Forget About the $56 billion Global Pain Management Component of the Pharmaceutical Industry and the additional $600 billion in Medical Spend, Lost Work, Criminal Justice, and Destroyed Lives it Costs Us." 

On the IMS web site, you can look at the Top 20 Therapeutic Classes in 2012.  Pain is #2 on the list... yet we see no mention of it in this report. 

The report is focused almost entirely on promoting medication adherence for chronic diseases like diabetes, congestive heart failure, hypercholesterolemia, and osteoporosis.  No doubt this is an important set of strategies for managing costs in the overall healthcare system, but to claim that a report is focused on cost savings derived from responsible medication use and to avoid any and all mention of chronic pain and it's attendant misuse of opioids, muscle relaxants, antidepressants, and several other classes of medications is absolute nonsense.   The only recommendation in the report that could possibly lead to lower revenues for the pharma industry is in the area of misuse of antibiotics.  Seriously.  The other five areas of recommendations will either lead to more prescription drugs in the healthcare system or maintain the rate of prescriptions already being written.  I was temporarily optimistic when I read the title of one particular section, "Delayed Evidence-Based Treatment Practice," hoping to read something about the fact that the medical evidence suggests little to no benefit for long term opioid use.  But alas this section speaks mainly to the need for diabetes research to work its way into clinical practice more rapidly.

IMS has unparalleled access to data.  I wish they'd use that data to help us better understand the true economic magnitude of the opioid epidemic in this country.  I don't think they'll do that, though.  A primary source of revenue for IMS... is the pharmaceutical industry. 

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