Kabella Dan, Apollonio Dorie, Young Halle, Knight Kelly R
Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA.
Department of Humanities & Social Sciences, University of California San Francisco, San Francisco, CA, USA.
J Gen Intern Med. 2025 May 12. doi: 10.1007/s11606-025-09600-9.
This paper examines the rise of clinical decision support algorithms used to assess risk in pain management and the opioid industry's influence on their development and implementation. To understand this influence, we conducted a qualitative study of documents related to the development of a tool that relied on artificial intelligence (AI) to suggest modifications in opioid prescribing, called NarxCare. The study began with keyword searches of the Opioid Industry Document Archive (OIDA), which contained over 3 million documents at the time of the study, to examine the pharmaceutical industry's role in shaping the digital transformation of opioid prescribing. Our findings highlight industry-driven investments, educational campaigns, corporate policy activities, and the reliance on proprietary data that facilitated the widespread implementation of NarxCare. The increasing reliance on NarxCare raises concerns about its limited transparency, unknown reliability, and potential bias which may disproportionately affect certain patient groups based on race, socioeconomic status, or health conditions. This paper argues that the promotion of technologies like NarxCare allows the pharmaceutical industry to reinforce the narrative that opioids can be effective when prescribed responsibly, using advanced, data-driven strategies. Marketed as tools that assist clinicians in making more informed prescribing decisions, NarxCare contributes to the portrayal of the industry as a responsible actor in the regulation and distribution of opioids. Shifting attention to individual risk factors rather than systemic challenges enables the pharmaceutical industry to sidestep its role in the opioid crisis and evade scrutiny for its influence over regulation, the sponsorship of education and research, lobbying, supply chain control, and public health narratives. While NarxCare aims to improve prescribing safety, it requires critical evaluation in terms of effectiveness, ethical considerations, and the continued influence of the pharmaceutical industry in its design and implementation.
本文探讨了用于评估疼痛管理风险的临床决策支持算法的兴起，以及阿片类药物行业对其开发和实施的影响。为了解这种影响，我们对与一种名为NarxCare的工具开发相关的文档进行了定性研究，该工具依靠人工智能（AI）来建议调整阿片类药物的处方。研究首先在阿片类药物行业文档存档（OIDA）中进行关键词搜索，在研究时该存档包含超过300万份文档，以考察制药行业在塑造阿片类药物处方数字化转型方面的作用。我们的研究结果突出了行业驱动的投资、教育活动、企业政策活动，以及对专有数据的依赖，这些促进了NarxCare的广泛实施。对NarxCare越来越多的依赖引发了人们对其透明度有限、可靠性未知以及潜在偏差的担忧，这些偏差可能会基于种族、社会经济地位或健康状况对某些患者群体产生不成比例的影响。本文认为，推广像NarxCare这样的技术使制药行业能够强化一种说法，即阿片类药物在负责任地开处方时可以有效，采用先进的、数据驱动的策略。NarxCare作为协助临床医生做出更明智处方决策的工具进行营销，有助于将该行业描绘成在阿片类药物监管和分发方面负责任的角色。将注意力转向个体风险因素而非系统性挑战，使制药行业能够回避其在阿片类药物危机中的作用，并逃避对其在监管影响、教育和研究赞助、游说、供应链控制以及公共卫生叙事方面的审查。虽然NarxCare旨在提高处方安全性，但需要从有效性、伦理考量以及制药行业在其设计和实施中的持续影响等方面进行批判性评估。
