This is a difficult essay to write for someone who has spent his entire professional career as a public health scientist. We live in a world based on scientific discoveries. Your health, your comfort, your food and shelter, and, virtually every aspect of your life have benefited from past scientific breakthroughs. The pursuit of knowledge through rigorous science is possibly man’s greatest endeavor, more important even than music, art, and literature. Every once in a while, though, science fails us and when that happens the results can be catastrophic. Here’s a recent example of just such a failing.

(Note: The factual information in this essay has, for the most part, been taken from a recent LA Times article.)

In 1980, Jane Porter and Dr. Hershel Jick sent a letter to the editor of the prestigious New England Journal of Medicine. In this letter, they described a simple analysis of 11,822 hospital patients who had been given a narcotic painkiller at least once during their hospital stay. Based on this rudimentary study, the authors made this observation, “There were only 4 cases of reasonable well documented addiction in patients who had no history of addiction.”  And then this astounding, sweeping statement, “We conclude that despite the widespread use of narcotics in hospitals, the development of addiction is rare in medical patients with no history of addiction”. Bad enough on its own. It is horrible science to make such a broad statement with no qualifiers based on a “grab-bag” study reported in a 5 sentence letter to the editor. It may not surprise you to know that in 1980, letters to the editor did not undergo the same rigorous peer-review as other submissions for publications in scientific journals. The real damage from this letter, however, came after its publication.

This letter and this half-baked analysis was then cited in other publications 608 times between 1980 and March 2017. 608 represents an incredibly high number of citations for a letter to the editor. Other letters to the editors of NEJM in 1980 have been cited an average of 11 times. Many of these 608 citations were “secondary citations”. In other words, the researchers citing the study never looked at the original letter, but cited the study based on its citation in a subsequent article. Therefore, this little study and its 5 sentence report took on a life of its own and ended up providing much of the scientific support for the medical care providers and pharmaceutical industry position that prescribing opioids would not cause addiction. Scientific publication citations of this study increased after Oxycontin was released onto the market. Purdue Pharma, the makers of Oxycontin, used this publication from a prestigious medical journal continually in their marketing pitch to physicians on the safety of prescribing their horribly addictive drug. In 2007, Purdue Pharma and 3 of its top executives pleaded guilty to misleading regulators, doctors, and patients about Oxy’s addictive qualities.

Let’s look at the damage. According to CDC, about 25% of patients who receive a prescription for an opioid end up becoming addicted. Between 1999 and 2015, 183,000 people died from addiction to prescribed opioids and the epidemic is worsening. For the first time in over 100 years, the life span for middle aged whites in this country decreased in the last few years, primarily because of drug addiction and suicide. Millions of Americans are currently addicted to opioids and the epidemic is destroying this country’s small towns and cities.

There are many reasons for America’s opioid epidemic, but sloppy medical science and lazy scientists are leading the pack. The findings from this rudimentary study were not generalizable to the non-hospitalized patient population for whom these opioids were being marketed and prescribed. Other scientists never took the time to search this study (Back in 1980, studies were not available on the Internet as they now are. You had to have a hard copy found through a service, printed, and sent to you.) and find that it was not, in fact, a well designed study but simply a review of some easily available hospital data reported in a letter. Not the quality of a study on which to base any public health decisions. Yet, the original authors and subsequent authors made sweeping statements attesting to the safety of these addictive drugs and, by doing so, provided a pseudo-scientific basis for our current scourge.

I don’t mean to devalue the role of science in our society or for our future. There are already too many people filling that role. In addition, no readers of this should sit back and say, “This is the same as climate change.” No, it is not. In the fields of climate change, all publications are rigorously reviewed and challenged. When a climate scientist coughs, there are 3 other scientists asking what he really meant. No, this sad chapter is here to remind us that even medical science can be lazy and inept and, when that happens, the results can be calamitous. The good news is that peer reviews are even more rigorous now than they were in 1980 and editors are more aware of the impacts of publications.

I have great respect for the medical and public health researchers in this country and around the world. The ones I know are dedicated, thorough, and, occasionally, brilliant. We need to remain vigilant, though, because every once in a while . . .