SaveSave story

Study: Doctors from elite schools prescribe fewer opioids

Doctors from the lowest-ranked U.S. medical schools are three times as likely to prescribe opioids as those trained at Harvard, the top-ranked U.S. school, according to a new research paper.

Why it matters: The authors argue that doctor training is an overlooked driver of the American opiate epidemic.

Data: National Bureau of Economic Research; Chart: Andrew Witherspoon / Axios

In a paper published Monday with the National Bureau of Economic Research, Princeton economists Molly Schnell and Janet Currie find a "striking relationship" between the frequency of prescriptions and medical school attended: doctors trained at top-ranked medical schools like Harvard, Johns Hopkins, Penn, Stanford and Washington University in St. Louis "are less likely to write any opioid prescriptions," they write. And such doctors who do prescribe opiates do so at a lower rate than the typical MD.

How the study was done: The paper is based on a cross-referencing of prescription data from 2006 to 2014 and medical school rankings by U.S. News and World Report.

The authors considered the possibility that their study reflected a propensity of elite medical students to develop a conservative approach to prescribing opiates, rather than their education at these institutions. They also considered the possibility that doctors from less elite schools are systematically more likely to see more patients in need of opiates.

  • But the authors batted away the first point by showing that the difference in prescription rates between elite and lower-ranked schools has shrunk over time, even as the top schools have become more selective. They argue this shows a diffusion of good educational methods from top institutions to the rest.
  • If the difference in prescription rates were about the type of students at elite institutions, they said, the difference would have grown over time.
  • The study also finds the difference in prescription rates is maintained when you control for the doctor's speciality and place of practice.

The GP Problem: Another important finding was general practitioners accounted for 48% of opioid prescriptions, even though they were just 27% of the doctors studied.

  • General practitioners were less likely to be from elite schools, but when they were trained at Harvard, they averaged 180 opioid prescriptions a year; when they were from the lowest-ranked schools, they handed out an average of 550 opioid prescriptions a year.
  • "If all GPs prescribed like those from [Harvard], we would have had 56.5% fewer opioid prescriptions and 8.5% fewer deaths over the period 2006 to 2014," they wrote, making outreach to this type of doctor critical.

What should policymakers do: This paper argues that training matters, but it doesn't investigate what elite institutions are specifically doing to produce more restrained prescribers. That said, the authors point to data showing that the effect of a pedigree is lessened when the doctor — regardless of medical school — is in a practice requiring specialized pain management training. They argue this could be reason to require all MDs to take classes as well, and the Trump Administration's Chris Christie- led opiate commission recommended that such training be mandated.

Caitlin Owens 27 mins ago
SaveSave story

Congress doesn't love the spending bill, but it'll pass anyway

Congressional leaders
Speaker Paul Ryan, Senate Majority Leader Mitch McConnell, Senate Minority Leader Chuck Schumer, and House Minority Leader Nancy Pelosi. (Photo: Matt McClain / The Washington Post via Getty Images)

House Speaker Paul Ryan touted the defense spending increase, Sen. Rand Paul angrily tweeted about arcane government spending, and Democrats shook their head at the lack of gun control measures. But most members of Congress are accepting the omnibus spending bill for what it is: A giant collection of what has to get done to keep the government functioning, while mustering enough votes to pass.

Why it matters: This is a $1.3 trillion dollar bill affecting every branch of government that will pass mostly because it has to. Members voted/will vote on it without really reading it, as it was released Wednesday night and must pass the Senate by midnight.

Ina Fried 4 hours ago
SaveSave story

Craigslist pulls personal ads after passage of sex-trafficking bill

Craigslist site
Craigslist site, with personals still listed as an option. Screenshot: Axios

Online classified site Craigslist has pulled its entire personal ad section after Congress passed a new sex-trafficking bill that puts more liability on Web sites.

Why it matters: Smaller tech companies and advocates for sex workers had feared a chilling effect if the bill becomes law.