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?
So this week, the New England Journal of Medicine, which published the original letter in 1980, is issuing a corrective. 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. In fact, it said no such thing.
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. Journalist Sam Quinones tells the story in his book, Dreamland: The True Tale of America's Opiate Epidemic. Something, perhaps a newspaper article, got Jick interested in looking at addiction. 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. Its brevity was commensurate with the effort involved. Here it is in full:
Recently, we examined our current files to determine the incidence of narcotic addiction in 39,946 hospitalized medical patients who were monitored consecutively. 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. The addiction was considered major in only one instance. The drugs implicated were meperidine in two patients, Percodan in one, and hydromorphone in one. 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.
He didn’t think much of it. 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.