How the Sacklers shifted $10.8B of an opioid fortune built on OxyContin(bloomberg.com)
bloomberg.com
How the Sacklers shifted $10.8B of an opioid fortune built on OxyContin
https://www.bloomberg.com/graphics/2020-sackler-family-money/
229 comments
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I never understand why doctors are not blamed for prescribing these. Are doctors not supposed to be responsible for prescriptions? If they are not, should we stop allowing them to prescribe? Why don’t doctors unions throw out members who would claim to have been hoodwinked by pharmaceutical companies?
It's because doctors and hospitals are increasingly evaluated based on patient satisfaction instead of patient outcomes.
It's why you'll walk into a medical plaza lobby that looks like a 4-star hotel, with fountains and art on the wall, and why the doctor will write you a prescription for an absurd dose of narcotics after surgery. After you've been cut open, it's normal to be in some pain for a while, but if the doctor drugs you into such a daze that you feel nothing, you'll rate him or her more highly. Even if 9/10 people end up being fine and stop taking the drug when they're supposed to, 1/10 people have a new addition.
This is bizarre the end-result of the privatization of our medical system. We're just one step away from rating doctors with stars like Uber, where they offer you drugs instead of a free water bottle when you walk in.
It's why you'll walk into a medical plaza lobby that looks like a 4-star hotel, with fountains and art on the wall, and why the doctor will write you a prescription for an absurd dose of narcotics after surgery. After you've been cut open, it's normal to be in some pain for a while, but if the doctor drugs you into such a daze that you feel nothing, you'll rate him or her more highly. Even if 9/10 people end up being fine and stop taking the drug when they're supposed to, 1/10 people have a new addition.
This is bizarre the end-result of the privatization of our medical system. We're just one step away from rating doctors with stars like Uber, where they offer you drugs instead of a free water bottle when you walk in.
As an MD, I strongly agree. However, you forgot to mention the other side of this: a rating lower than two stars is combined with an immediate threat to sue.
Blame the doctors is part of the campaign to influence public opinion to save the Sacklers from the consequences of their actions. Find a different enemy to blame for everything. Just pay attention to the way the argument percolates through social media.
The field isn’t called patient satisfaction anymore. It’s called patient experience and it is pretty much ubiquitous to ensuring high quality patient care.
HealthGrades.com and RateMDs.com is already a thing.
I see these as a consequence to having no real way to remove bad doctors through the legal system. They all protect each other. There's some idiots looking for narcotics, but that isn't all of it.
The more you'll sue doctors, the more MDs will practice defensive medicine and you'll end up with shit quality overly invasive care. The way to go is to sue the institutions, but not the practitioners themselves. Then the institution punishes the doc if warranted.
In opposition to what you think, doctors are highly egoistical individuals and absolutely do not cover for one another.
In opposition to what you think, doctors are highly egoistical individuals and absolutely do not cover for one another.
We already have defensively practiced, shit quality medicine. I was diagnosed late with ADHD, had to leave that doctor's practice, and finding another doctor who agrees with that diagnosis has been impossible.
The tendency I observed when competency was questioned was to not punish in any way that had strong ramifications. They might badmouth them, but the desire to strip of their license or award large punitive damages isn't there because they are worried about it happening to them, real or imagined.
The tendency I observed when competency was questioned was to not punish in any way that had strong ramifications. They might badmouth them, but the desire to strip of their license or award large punitive damages isn't there because they are worried about it happening to them, real or imagined.
> Why don’t doctors unions throw out members who would claim to have been hoodwinked by pharmaceutical companies?
If the companies are lying about safety, how are the doctors supposed to know? The only ones with the data necessary to know the dangers of these drugs are the manufacturers and the manufacturers were lying and covering up the dangers.
If the companies are lying about safety, how are the doctors supposed to know? The only ones with the data necessary to know the dangers of these drugs are the manufacturers and the manufacturers were lying and covering up the dangers.
Exactly, there is a chain of trust involved, and when that trust is broken it makes sense to first look as far up the chain as possible.
Holding doctors responsible for their actions only starts making sense once we are talking about doctors who keep prescribing this long after the risks have become known, which I am sure has happened too. But it's not the root problem.
Holding doctors responsible for their actions only starts making sense once we are talking about doctors who keep prescribing this long after the risks have become known, which I am sure has happened too. But it's not the root problem.
They are supposed to have learned about it in medical school. If not, that's fine, maybe doctors shouldn't be allowed to prescribe and maybe only pharmacists should be allowed. My point is that it's a very valuable professional quality and we should put the responsibility where the quality is.
This is (well, was) a new drug. Doctors cannot have learned about a drug in medical school when that drug did not exist when they were studying.
My parents are retired Dutch GPs who also ran a small pharmacy[0], so I know a little about how this works, at least in the Netherlands (I admit that this is a pretty big caveat, because (aside from the obvious biases that this introduces) the opioid crisis doesn't exist here - it seems to be a US-only thing. On the other hand, that only gives me more reason to suspect that the problem is systemic, not something to be blamed on individual doctors).
Every year doctors (or any other medical professional as well) have to attend a mandatory amount of lessons to update their knowledge of recent developments in their medical field. In my parents case this also was true for pharmaceutical knowledge. This is where they learn about new medications and their usage. So yeah, they do in fact learn which drug is supposedly safe to prescribe under which circumstances. But you know what is required for all of that to work? An authoritative source of trustworthy information on drug use.
Doctors only start prescribing a drug after it has been approved by the relevant governmental bodies for their usage. So if OxyContin got through the FDA, and was marked as safe for the usage it was advertised for, then I do not understand why you suggest that it's the fault of doctors that they prescribed it in those cases.
Sure, there might have been some stories going around that this drug might not be quite as safe as claimed, but keep in mind that at any given moment hundreds of quack medicine scaremongering stories are making the rounds. When given a choice between believing those, or the official body that is supposed to verify which drugs are safe or not, doctors will usually pick the latter, and in most cases rightly so.
[0] in the Netherlands this is relatively common in small countryside villages that are too small to sustain a pharmacist, who typically needs at least 5000 clients to be sustainable
My parents are retired Dutch GPs who also ran a small pharmacy[0], so I know a little about how this works, at least in the Netherlands (I admit that this is a pretty big caveat, because (aside from the obvious biases that this introduces) the opioid crisis doesn't exist here - it seems to be a US-only thing. On the other hand, that only gives me more reason to suspect that the problem is systemic, not something to be blamed on individual doctors).
Every year doctors (or any other medical professional as well) have to attend a mandatory amount of lessons to update their knowledge of recent developments in their medical field. In my parents case this also was true for pharmaceutical knowledge. This is where they learn about new medications and their usage. So yeah, they do in fact learn which drug is supposedly safe to prescribe under which circumstances. But you know what is required for all of that to work? An authoritative source of trustworthy information on drug use.
Doctors only start prescribing a drug after it has been approved by the relevant governmental bodies for their usage. So if OxyContin got through the FDA, and was marked as safe for the usage it was advertised for, then I do not understand why you suggest that it's the fault of doctors that they prescribed it in those cases.
Sure, there might have been some stories going around that this drug might not be quite as safe as claimed, but keep in mind that at any given moment hundreds of quack medicine scaremongering stories are making the rounds. When given a choice between believing those, or the official body that is supposed to verify which drugs are safe or not, doctors will usually pick the latter, and in most cases rightly so.
[0] in the Netherlands this is relatively common in small countryside villages that are too small to sustain a pharmacist, who typically needs at least 5000 clients to be sustainable
> Doctors only start prescribing a drug after it has been approved by the relevant governmental bodies for their usage. So if OxyContin got through the FDA, and was marked as safe for the usage it was advertised for, then I do not understand why you suggest that it's the fault of doctors that they prescribed it in those cases.
The caveat is that once a drug is approved for XYZ, doctors can, and do, prescribe it for anything else in their judgement.
Oxycontin wasn’t approved for chronic non-cancer pain, because it’s a poor choice for that, but that’s where the recurring revenue is and somehow accounted for most of its usage.
Short-term post-operative pain and cancer pain just isn’t that big of a market.
The caveat is that once a drug is approved for XYZ, doctors can, and do, prescribe it for anything else in their judgement.
Oxycontin wasn’t approved for chronic non-cancer pain, because it’s a poor choice for that, but that’s where the recurring revenue is and somehow accounted for most of its usage.
Short-term post-operative pain and cancer pain just isn’t that big of a market.
> The caveat is that once a drug is approved for XYZ, doctors can, and do, prescribe it for anything else in their judgement. The caveat is that once a drug is approved for XYZ, doctors can, and do, prescribe it for anything else in their judgement.
Yes, but pharmaceutical companies cannot market the drug for non-approved uses or discuss off-label use when promoting or selling the drug. That is illegal.
That illegal activity is exactly what the courts determined Purdue did - bribery, fraudulent marketing, and more. The issue is that Purdue broke the law (and that their sentences for breaking the law were way too light).
Yes, but pharmaceutical companies cannot market the drug for non-approved uses or discuss off-label use when promoting or selling the drug. That is illegal.
That illegal activity is exactly what the courts determined Purdue did - bribery, fraudulent marketing, and more. The issue is that Purdue broke the law (and that their sentences for breaking the law were way too light).
That is a fair point, and does imply that there are other big problems with how drugs are prescribed in the US.
Oxycodone was first formulated in 1917, so it's not really "new".
There are lots of FDA-approved drugs that are highly inappropriate for most patients. One of the reasons we tolerate the professional status of physicians is because of their purported expertise in prescribing these drugs safely. If they don't know the function and habit-forming potential of opioids, one might well question that expertise. They aren't regulated in any sense by FDA, and they can't blame FDA for their ignorance.
There are lots of FDA-approved drugs that are highly inappropriate for most patients. One of the reasons we tolerate the professional status of physicians is because of their purported expertise in prescribing these drugs safely. If they don't know the function and habit-forming potential of opioids, one might well question that expertise. They aren't regulated in any sense by FDA, and they can't blame FDA for their ignorance.
> Oxycodone was first formulated in 1917, so it's not really "new"
The drug being talked about was given a new time-release formulation which was described as less addictive.
The drug company spent a lot of time and money distorting the image around addictiveness.
Here's a list of things Purdue did: https://www.feinberg.northwestern.edu/sites/ipham/conference...
The drug being talked about was given a new time-release formulation which was described as less addictive.
The drug company spent a lot of time and money distorting the image around addictiveness.
Here's a list of things Purdue did: https://www.feinberg.northwestern.edu/sites/ipham/conference...
I agree, go after the deep pockets. I sympathize with patients who became addicted to oxy, while at the same time I'm convinced that opioids should be available to those who need them. I'm glad I got some Demerol when I needed it. I even sympathize with physicians who weighed their patients' needs against the risks of addiction, carefully followed up on their oxy prescriptions, and still had some patients succumb to addiction. I don't sympathize with blanket statements like "doctors just trusted Purdue". Any physician who refilled an opioid prescription without asking the patient some blunt questions and being satisfied with the answers is a piss-poor physician.
>Doctors only start prescribing a drug after it has been approved by the relevant governmental bodies for their usage. So if OxyContin got through the FDA, and was marked as safe for the usage it was advertised for, then I do not understand why you suggest that it's the fault of doctors that they prescribed it in those cases.
Given that the same opioids are approved in the US and Netherlands, with the same warnings and information, why do you think the outcomes are so different between countries?
Given that the same opioids are approved in the US and Netherlands, with the same warnings and information, why do you think the outcomes are so different between countries?
I cannot say, because I don't know enough about the US system
Before a doctor gets a new drug it should’ve been approved by a government agency and gone through trails. The company selling it trains doctors on its use and side affects. The problem is the company was lying and telling half truths. Not only that they pushed use cases where something as strong as Oxy was not needed.
Pill mill doctors are a different story and they are prosecuted for it.
Pill mill doctors are a different story and they are prosecuted for it.
Pharma distributors used various shady techniques - originally pioneered by Purdue - to persuade doctors to push the drug.
https://www.wbur.org/commonhealth/2020/01/12/opioid-kickback...
And while some jail time happened - for some of the distributors - the sentences were relatively light.
https://www.npr.org/2020/01/23/798973304/pharmaceutical-exec...
Purdue kept a database of doctors willing to prescribe their products "for pain relief" and have now switched sides to push a drug that treats opioid addiction under a new marketing campaign and a new industry front.
https://www.genesisrecovery.com/who-caused-the-opioid-crisis...
https://www.wbur.org/commonhealth/2020/01/12/opioid-kickback...
And while some jail time happened - for some of the distributors - the sentences were relatively light.
https://www.npr.org/2020/01/23/798973304/pharmaceutical-exec...
Purdue kept a database of doctors willing to prescribe their products "for pain relief" and have now switched sides to push a drug that treats opioid addiction under a new marketing campaign and a new industry front.
https://www.genesisrecovery.com/who-caused-the-opioid-crisis...
Doctors who were prescribing medicine at the time that OxyContin hit the market were not in medical school, they had graduated already. If pharma lies about safety there is no way for a doctor to know unless they conduct their own study, which would require lots of extra time and massive funding. Pharmacists didn't know that the safety data was fudged either. Everyone got their oxycontin from a pharmacist after a doctor prescribed it, so having a pharmacist be the only one allowed to prescribe it wouldn't have changed anything.
Sorry, I meant that they should have learned about drug safety in medical school, not that they should have learned about this specific drug.
That does change the interpretation of your earlier statement quite a lot, thank you for clarifying. Together with
Scoundreller's observation it does seem that there are a number of systemic issues working together in the US to create this problem. And one of these seems to be how doctors prescribe medication.
>They are supposed to have learned about it in medical school.
People need to realize that medical school isn't some all-knowing institution where everything knowable about human physiology is imparted unto students.
People need to realize that medical school isn't some all-knowing institution where everything knowable about human physiology is imparted unto students.
I think a casual understanding of history has numerous examples of opioids that were prescribed as being safe, and that people then got addicted to, and then we all moved on to the next one. Heroin was one, after all. I find it hard to imagine too many doctors who are unaware of the history. How they have chosen to view that history (psychiatry's triumphant "this time we got it right!" or perhaps simply shrinking away from the issue) is what informs their decisions.
Is it an opioid? Then it is probably addictive for some people.
I know that there is some experimentation involving kappa opioid receptors, trying to essentially neutralize any euphoria or uplift with the k-receptor's dysphoria "bummer," but until that has been ironed out, they're habit-forming for many. Not all, but many.
Is it an opioid? Then it is probably addictive for some people.
I know that there is some experimentation involving kappa opioid receptors, trying to essentially neutralize any euphoria or uplift with the k-receptor's dysphoria "bummer," but until that has been ironed out, they're habit-forming for many. Not all, but many.
Asking doctors to decide which research they should and should not trust based on their understanding of history seems like a more dangerous situation.
I dunno, "The history of all opioids we have ever encountered has always been associated with addiction" is not a particularly difficult concept to grasp, nor can I see it taking an inordinate amount of time to cram into their education.
A huge part of most doctors' jobs is balancing the risk of bad things with the benefits of procedures, medications, etc. One of the main reasons we have doctors is so that we can trust their educated judgment. For example, mine noted that guidance had changed on when we should test for some cancers (not as early), because the risk of false positive is higher than the risk of actually having the cancer.
In the case of opioids, doctors know they are addictive. They also unfortunately happen to be _extremely effective_ (for most people) at treating severe pains, and have to balance the benefits of pain relief (both in terms of patient happiness and the healing process) versus the risk of harm. I've definitely seen a shift in doctors' prescribing habits in the past fifteen years, in favor of starting with Ibuprofen or other NSAIDs, with the option to ask for a stronger prescription if pain is too much.
In the case of opioids, doctors know they are addictive. They also unfortunately happen to be _extremely effective_ (for most people) at treating severe pains, and have to balance the benefits of pain relief (both in terms of patient happiness and the healing process) versus the risk of harm. I've definitely seen a shift in doctors' prescribing habits in the past fifteen years, in favor of starting with Ibuprofen or other NSAIDs, with the option to ask for a stronger prescription if pain is too much.
Oh, I am well-aware, as I have been on a somewhat niche Schedule II prescription for over a decade now. It can be quite a hassle.
I am merely pointing out that the idea that medical doctors being unaware of a basic correlation between opioids and addiction, one which has progressed from one medicine to another over the decades, seems ... disingenuous? Preciously naive? Remember, I am replying to "If the companies are lying about safety, how are the doctors supposed to know?"
Here, I think the doctors are supposed to know in the case of opioids because this is an ongoing historical trend. A random new class of medicine? No, they will probably trust the safety sheet, as well they should. The umpteenth opioid? I would be viewing with a gimlet eye anything saying "Nah, no addictive potential."
I am merely pointing out that the idea that medical doctors being unaware of a basic correlation between opioids and addiction, one which has progressed from one medicine to another over the decades, seems ... disingenuous? Preciously naive? Remember, I am replying to "If the companies are lying about safety, how are the doctors supposed to know?"
Here, I think the doctors are supposed to know in the case of opioids because this is an ongoing historical trend. A random new class of medicine? No, they will probably trust the safety sheet, as well they should. The umpteenth opioid? I would be viewing with a gimlet eye anything saying "Nah, no addictive potential."
If doctors only prescribed opioids it would be simple, but they deal in all sorts of constantly evolving drugs where new research may overturn previous assumptions. Trusting the research and heavily punishing those who falsify data seems a lot more sane.
I will counter this one with a hypothetical for you. Monsanto, or Bayer now I guess, trots out a totally safe guys we pinky-swear pesticide. Would you add a little to your drinking water every day? Safety sheets say it can't hurt.
You would probably not do this because you have a historical association with pesticides turning out to be rather broader in impact than was originally let on. You understand that history.
I only suggest that this historical wariness sounds completely reasonable for opioids, whereas a brand new drug class has no history associated with it.
You would probably not do this because you have a historical association with pesticides turning out to be rather broader in impact than was originally let on. You understand that history.
I only suggest that this historical wariness sounds completely reasonable for opioids, whereas a brand new drug class has no history associated with it.
Let me amend your hypothetical. The pesticide presentation is the twentyth such presentation on various topics you've seen today. You see this many every year, and the safety sheets have always been accurate. And, if this pesticide is not used, it is known that the people of your community will suffer and/or die.
Does your understanding of the companies history outweigh your experience of the formats history?
Does your understanding of the companies history outweigh your experience of the formats history?
I am not suggesting that they didn't know or would suddenly not prescribe any opioids at all. I have been very careful to say that some, and only some, get addicted.
And I would still not add that pesticide to my drinking water. So I will ask ... would you?
And I would still not add that pesticide to my drinking water. So I will ask ... would you?
Given that I know people will suffer and die if I don't, yes.
It's a dumb hypothetical though, as my point has repeatedly been that doctors have far too many areas to be concerned about to selectively decide that this one pain killer needs more investigation before I prescribe it regularly.
It's a dumb hypothetical though, as my point has repeatedly been that doctors have far too many areas to be concerned about to selectively decide that this one pain killer needs more investigation before I prescribe it regularly.
Lying about safety? These are opioids which have been around for more than 100 years.
And pharma companies are one of many sources of information about drugs. Doctors aren’t forced to only listen to them.
And pharma companies are one of many sources of information about drugs. Doctors aren’t forced to only listen to them.
Purdue specifically claimed that oxy was safer; that it had a smaller chance of addiction.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/#__sec2...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/#__sec2...
Consider OxyContin, which the makers claimed worked for 12 hours. 2 things should be red flags here: firstly, I haven't seen an extended release formulation of anything that would work over that period; I'm not even sure if it's physically possible given the human digestion system. Secondly, the many, many patients who complained that it only worked for 6-8 hours.
Any doctor with a basic understanding of pharmacology, and basic bedside manner, should have known something was up there.
Any doctor with a basic understanding of pharmacology, and basic bedside manner, should have known something was up there.
"doctors should have known the manufacturers' claims were bogus" is shifting the blame. The real blame should be focused on the manufacturers making false claims in the first place.
It wasn't my intention to shift the blame - clearly the manufacturers should be strung up for making the false claims they did. Absolutely no argument there.
My point is though, that doctors shouldn't blindly trust whatever a manufacturer tells them, if the evidence right in front of their eyes says different.
My point is though, that doctors shouldn't blindly trust whatever a manufacturer tells them, if the evidence right in front of their eyes says different.
> My point is though, that doctors shouldn't blindly trust whatever a manufacturer tells them, if the evidence right in front of their eyes says different.
Just to be clear, you're advocating doctors eschewing published clinical data (including data from published trials and the FDA approval) on the basis of nonrandomized anecdotal data?
The issue here is that the manufacturers committed fraud - falsifying and/or misrepresenting clinical data. The courts confirmed this, finding them guilty of fraud, bribery, and more.
Unlike courts, a doctor is in no better position to such sophisticated identify fraud at that scale than a patient is. The pharmaceutical companies and manufacturers absolutely should be held accountable for that, but doctors by and large are not to blame for the fraud committed by pharmaceutical companies.
Just to be clear, you're advocating doctors eschewing published clinical data (including data from published trials and the FDA approval) on the basis of nonrandomized anecdotal data?
The issue here is that the manufacturers committed fraud - falsifying and/or misrepresenting clinical data. The courts confirmed this, finding them guilty of fraud, bribery, and more.
Unlike courts, a doctor is in no better position to such sophisticated identify fraud at that scale than a patient is. The pharmaceutical companies and manufacturers absolutely should be held accountable for that, but doctors by and large are not to blame for the fraud committed by pharmaceutical companies.
> The issue here is that the manufacturers committed fraud - falsifying and/or misrepresenting clinical data
This is my point - the claims were BS. A number of doctors should have been raising a number of red flags, because their knowledge contradicted those claims, as did patient evidence right in front of their very eyes.
I'm obviously not saying they should ignore or distrust all clinical data, but if they see such massive discrepancies then they should be speaking up.
This is my point - the claims were BS. A number of doctors should have been raising a number of red flags, because their knowledge contradicted those claims, as did patient evidence right in front of their very eyes.
I'm obviously not saying they should ignore or distrust all clinical data, but if they see such massive discrepancies then they should be speaking up.
> A number of doctors should have been raising a number of red flags, because their knowledge contradicted those claims
Purdue committed fraud, but they never made claims that were so outrageous that they would be prima facie false. (If that had been the case, Oxycontin would never have been approved in the first place). The problem wasn't that the claims were outrageously impossible; it's that the claims were wrong, and Purdue either falsified or misrepresented clinical data in order to convince doctors that Oxycontin was safer than it actually was.
> Patient evidence right in front of their eyes
Encouraging people to rely overly on anecdotal observations is incredibly dangerous, especially when most doctors who prescribe opioids don't prescribe them in such numbers that these issues would be readily visible to them in the first place.
Yes, there were a small number of doctors who did aggressively overprescribe and misprescribe Oxycontin. That was the result of a direct and explicit campaign by Purdue to identify and enable those doctors. Some of those doctors were prosecuted and/or did lose their licenses, but those doctors still only amounted to a small part of the opioid crisis.
> I'm obviously not saying they should ignore or distrust all clinical data, but if they see such massive discrepancies then they should be speaking up.
Most doctors weren't seeing massive discrepancies. We know the discrepancies exist now because there were lawsuits and prosecutions which revealed the specific fraudulent behavior that Purdue and others were engaged in. But without the benefit of hindsight, these issues simply weren't reasonably visible to a typical doctor - they were only visible at large scale to Purdue, who went out of their way to mislead everyone else about it.
Purdue committed fraud, but they never made claims that were so outrageous that they would be prima facie false. (If that had been the case, Oxycontin would never have been approved in the first place). The problem wasn't that the claims were outrageously impossible; it's that the claims were wrong, and Purdue either falsified or misrepresented clinical data in order to convince doctors that Oxycontin was safer than it actually was.
> Patient evidence right in front of their eyes
Encouraging people to rely overly on anecdotal observations is incredibly dangerous, especially when most doctors who prescribe opioids don't prescribe them in such numbers that these issues would be readily visible to them in the first place.
Yes, there were a small number of doctors who did aggressively overprescribe and misprescribe Oxycontin. That was the result of a direct and explicit campaign by Purdue to identify and enable those doctors. Some of those doctors were prosecuted and/or did lose their licenses, but those doctors still only amounted to a small part of the opioid crisis.
> I'm obviously not saying they should ignore or distrust all clinical data, but if they see such massive discrepancies then they should be speaking up.
Most doctors weren't seeing massive discrepancies. We know the discrepancies exist now because there were lawsuits and prosecutions which revealed the specific fraudulent behavior that Purdue and others were engaged in. But without the benefit of hindsight, these issues simply weren't reasonably visible to a typical doctor - they were only visible at large scale to Purdue, who went out of their way to mislead everyone else about it.
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There's plenty of blame to go around, both can be at fault. My family doctor, for example, warned me to be very careful of the Oxytocin I was given by the hospital (without any warnings) after my wisdom teeth were removed.
This is the kind of thing I mean - giving someone oxycontin without any warnings is just plain irresponsible.
Furthermore, opioids shouldn't even be used as first line after wisdom teeth removal - across Europe you'd be sent home and told to take paracetamol or ibuprofen, because those medications generally work very well for inflammation-type pain.
Furthermore, opioids shouldn't even be used as first line after wisdom teeth removal - across Europe you'd be sent home and told to take paracetamol or ibuprofen, because those medications generally work very well for inflammation-type pain.
Why blame doctors when the makers of OxyContin told Congress for years that it was safe and non-addictive. It's a systemic issue with various actors/stakeholders whom all are partially to blame in various capacities.
Both should be blamed. There were plenty of doctors who noticed that the OxyContin promises didn’t work out but they kept prescribing anyway.
While doctors do share some blame, they were actively targetted by Purdue with brochures, slick salesmen etc.How is was allowed is the real issue for me.
Yes, I do blame law makers and manufacturers too.
Congress chooses which experts it listens to. Too often it chooses those "experts" based on notoriety and the conclusion they hope to reach.
Now they are "shocked" to find out they people they've been accepting money from were leading them astray -- not that they knew where that money was ever coming from.
Now they are "shocked" to find out they people they've been accepting money from were leading them astray -- not that they knew where that money was ever coming from.
1. Physicians in the US don't have a union. Some conservatives call the AMA a physicians' union, and while it shares some union functions it simply is not one. Physicians are licensed to practice by individual states.
2. Physicians are responsible for writing prescriptions, pharmacists dispense them, and patients self-administer in most cases. The opioid epidemic was caused by failures at each of these levels, not just when writing the rx.
3. Physicians are routinely prosecuted, lose their licenses, and go to jail for this: https://www.deadiversion.usdoj.gov/crim_admin_actions/index....
Your lack of information on the topic is not the same as a systemic problem. Please do a bit more due diligence before making claims like this.
2. Physicians are responsible for writing prescriptions, pharmacists dispense them, and patients self-administer in most cases. The opioid epidemic was caused by failures at each of these levels, not just when writing the rx.
3. Physicians are routinely prosecuted, lose their licenses, and go to jail for this: https://www.deadiversion.usdoj.gov/crim_admin_actions/index....
Your lack of information on the topic is not the same as a systemic problem. Please do a bit more due diligence before making claims like this.
Some doctors are blamed for over-prescribing, which is why some doctors were jailed and some doctors struck off.
That doesn't take away from the fact that the manufacturers led a campaign to deliberately mislead people for years about the addictiveness and efficacy of opioid medication to treat pain.
That doesn't take away from the fact that the manufacturers led a campaign to deliberately mislead people for years about the addictiveness and efficacy of opioid medication to treat pain.
>> Why don’t doctors unions throw out members who would claim to have been hoodwinked by pharmaceutical companies?
Because of the...money? There is/was plenty for everyone.
Because of the...money? There is/was plenty for everyone.
Do doctors get paid more for prescribing one brand of medication vs another?
Not typically in money, but in gifts, lunches, and attention paid by young, attractive pharmaceutical sales people. For opioids, specifically, there is also the factor that doctors prescribing opioids will have higher customer satisfaction in the short term because opioids are better than almost anything for pain relief. Higher customer satisfaction (not necessarily the same as better patient outcomes) usually means more recommendations and more money. If some of your patients get addicted it just means they'll come in more frequently for more prescriptions. Plus, they can't actually be addicted, since your sales rep with a bachelor's in biology said that Oxycontin is not addictive.
Saying Oxycontin isn't addictive is false but from talking to doctors they tend to not consider it addiction if you are receiving the medication for an actively treated issue.
Gifts from pharma hasn’t been true for a couple decades. They don’t even give pens now. Sure they can get a free lunch, but it’s usually brought to their office and it’s fast food.
Customer satisfaction is relevant, but only because hospitals have put so much emphasis on it.
But regardless, nobody can get these drugs without a doctor writing a script, so there is plenty of blame to go around.
Customer satisfaction is relevant, but only because hospitals have put so much emphasis on it.
But regardless, nobody can get these drugs without a doctor writing a script, so there is plenty of blame to go around.
Huh. I'd love to know where you're getting that idea from.
Through a strange series of events (extreme sports hobbies) I became friends with a group of doctors, none of them participating in anything very special or that could be seen as a career height. Most really just starting out after the hell that is med school.
They spoke of pretty regular outreach of gifts from pharma. Mainly in the form of fancy retreats (like to Hawaii - note, we were based in SoCal at the time) with pretty extravagant dinners and fancy boating stuff. These were, according to them, always filled with the brim with others like them to the point it got to be quite frankly boring, annoying, and a nuisance. No matter how hard they tried to ignore the unsolicited outreach, it wouldn't stop coming.
Just some anecdata tho.
Through a strange series of events (extreme sports hobbies) I became friends with a group of doctors, none of them participating in anything very special or that could be seen as a career height. Most really just starting out after the hell that is med school.
They spoke of pretty regular outreach of gifts from pharma. Mainly in the form of fancy retreats (like to Hawaii - note, we were based in SoCal at the time) with pretty extravagant dinners and fancy boating stuff. These were, according to them, always filled with the brim with others like them to the point it got to be quite frankly boring, annoying, and a nuisance. No matter how hard they tried to ignore the unsolicited outreach, it wouldn't stop coming.
Just some anecdata tho.
The guidelines also reiterate the group’s 2002 code, which prohibited more expensive goods and services like tickets to professional sports games and junkets to resorts. And it asks companies that finance medical courses, conferences or scholarships to leave the selection of study material and scholarship recipients to outside program coordinators.
[1]https://www.nytimes.com/2008/12/31/business/31drug.html
[1]https://www.nytimes.com/2008/12/31/business/31drug.html
Huh. Call me crazy, but it almost seems as if guidelines and codes haven't meant much for a while. Like, real life "air quotes" oh yes, we won't send them to resorts.
Well, if I had to make an educated guess, they really did cross their fingers and nobody seems to be investigating/enforcing otherwise and they're getting away with it - because I'm telling you, first hand... it's happening, quite frequently, at least on the West Coast.
Well, if I had to make an educated guess, they really did cross their fingers and nobody seems to be investigating/enforcing otherwise and they're getting away with it - because I'm telling you, first hand... it's happening, quite frequently, at least on the West Coast.
I used to work in the industry when all this changed. Could there be a one-off company doing it? Sure. They are risking being brought up on Federal charges for it. The gov't has gone after drug companies for much less.
I think there are rules against payment but as we all know, there are ways around rules when it concerns money. Looks like there is a correlation between doctors being buttered up, and them prescribing opiods.
https://lowninstitute.org/industry-payments-to-doctors-opioi...
https://lowninstitute.org/industry-payments-to-doctors-opioi...
the pharmacutical companies have developed many ways of rewarding doctors for being compliant, such as by being paid 'consultants' presenting at conferences in exotic locations. For everyday practitioners, social primping (wining, dining, rounds of golf in prestigious locations and/or company) works as well as for just about everyone.
Most organizations are not good at throwing out members that do bad things. Usually they are set up to be defensive no matter what. Looked at police unions who protect bad cops, judges (there was something on Reuter’s about judge misconduct) and doctors (it takes forever and many injured people to get bad surgeons banned). It would be grwat these organizations had higher standards for their members but they don’t.
I never understand why doctors are not blamed for prescribing these
Because doctors are human beings and in particular they’re people who are motivated by the desire to alleviate suffering. When faced with patients who repeatedly return to their office, complaining of severe pain, what can they do?
There are no miracle painkillers. We have anti-inflammatories for minor aches and pains. We have opioids for severe, temporary pain (such as recovery from surgery and end-of-life care). We do not have a painkiller suitable for chronic pain.
Purdue pharma offered doctors a way out. The institutional structure of healthcare, into which doctors and pharma companies fit, permits diffusion of responsibility [1]. Doctors escape blame because the determination of the safety and efficacy of medication is outside their area of responsibility.
[1] https://en.wikipedia.org/wiki/Diffusion_of_responsibility
Because doctors are human beings and in particular they’re people who are motivated by the desire to alleviate suffering. When faced with patients who repeatedly return to their office, complaining of severe pain, what can they do?
There are no miracle painkillers. We have anti-inflammatories for minor aches and pains. We have opioids for severe, temporary pain (such as recovery from surgery and end-of-life care). We do not have a painkiller suitable for chronic pain.
Purdue pharma offered doctors a way out. The institutional structure of healthcare, into which doctors and pharma companies fit, permits diffusion of responsibility [1]. Doctors escape blame because the determination of the safety and efficacy of medication is outside their area of responsibility.
[1] https://en.wikipedia.org/wiki/Diffusion_of_responsibility
Shifting the blame to the doctors is/was one of the major strategies pursued by influencers working for the Sacklers. You're simply playing their game here (either knowingly or unknowingly).
Because medical boards are staffed with doctors who let other doctors off the hook. Doctors are held to account about as well as police (in the US), i.e. not at all.
Of note, in california, every opiate rx is very rigidly traced in the CURES database.
I'm sure there's some complicated technical way around it, but it's not a willy-nilly rx system, at least in CA.
In general, the rule of thumb is if you need opiates, more that a simple vicodin or tramadol, we refer you to a pain management specialist.
I'm sure there's some complicated technical way around it, but it's not a willy-nilly rx system, at least in CA.
In general, the rule of thumb is if you need opiates, more that a simple vicodin or tramadol, we refer you to a pain management specialist.
In Florida, opioid prescriptions were recently as easy to get as a medical marijuana card in California before full legalization.[1] The drugs could then be smuggled by car to states with restrictive prescription tracing. The smugglers had legal protection because the prescription was in their name.
[1] https://floridadailypost.com/florida-pill-mills-gateway-opio...
[1] https://floridadailypost.com/florida-pill-mills-gateway-opio...
Doctors? Let's talk about bankers, accountants, and real estate agents. They must get paid a lot of money to turn off the part of the brain that's screaming about how dishonest this whole chain of transactions is, how much it looks like a pack of guilty people trying to put their ill-gotten wealth out of harm's way.
Because doctors are supposed to provide it to people in pain who approved it and it would rapidly turn arbitrary and Kafkaesque if they started punishing doctors for doing their job while obligating them to do so at the same time. If you punish a surgeon for having a patient die good luck ensuring access to surgeons.
they should be. One of my parents was a primary care physician. When I was growing up she had on-call duties once a month, and fielded lots of after-hours requests for opioid prescriptions or renewals. These were patients of other doctors at her clinic calling in. She always told them that she wouldn't prescribe those drugs over the phone and they'd need to go into urgent care because she was aware of the abuse and addictive potential. This happened in the mid 90s.
Not that it makes this situation any better but the entire pharma marketing landscape was FAR worse in 90s and 00s.
Doctors as a group are not that dissimilar to police unions in that their primary function is to actually shield doctors from responsibility or accountability. Both are extremely hostile to criticism of any kind. This focus on their own outcomes results in zero virtuous feedback and being dysfunctional and failing to serve their customers consistently, with frequent gross failures.
TL; DR The Sacklers extracted about $6.1bn after taxes but before capital gains or losses and propose to pay $3bn in their settlement. To my knowledge, none of them have been arrested yet, though the wheels of criminal justice turn slower than those of civil law.
This would be a awesome time for Cops tv show to go get them.
I know you're making a joke but FYI, Cops was just canceled after 31 years due to all the recent police protests.
https://www.nytimes.com/2020/06/09/business/media/cops-cance...
https://www.nytimes.com/2020/06/09/business/media/cops-cance...
criminal justice turns slow for the wealthy. for the poor you are often accelerated straight to being dead.
What this family did was pure evil, they should all be in jail not negotiating a settlement that will leave them financially secure and amongst the richest Americans.
Imagine if this scenario played out in China.
Imagine if this scenario played out in China.
I imagine a couple ways this would play out in china
1. nobody ever hears nor finds out anything because it's all kept within the party.
2. they are publically shamed and they are sent to a re-education camp never to be seen or heard again.
my 2 cents...
1. nobody ever hears nor finds out anything because it's all kept within the party.
2. they are publically shamed and they are sent to a re-education camp never to be seen or heard again.
my 2 cents...
Where would you likely get away with this crime? In a system where you must strike a deal with a party that must maintain loyalty to ideological principles most violated by your crime? Or in a system like ours, where you must strike a deal with some prosecutors? The chief concerns of these prosecutors is so often their conviction rates, public optics, and personal careers.
The political structure in the west encourage these kinds of crimes. If you can exploit millions to make billions then you can settle in the event of criminal persecution, hire a pr firm to take care of public optics, and donate generously to parties in power to ensure that the pesky prosecutor/attorney-general is sufficiently motivated not to attempt to make an example out of you.
The political structure in the west encourage these kinds of crimes. If you can exploit millions to make billions then you can settle in the event of criminal persecution, hire a pr firm to take care of public optics, and donate generously to parties in power to ensure that the pesky prosecutor/attorney-general is sufficiently motivated not to attempt to make an example out of you.
>If you can exploit millions to make billions then you can settle in the event of criminal persecution, hire a pr firm to take care of public optics, and donate generously to parties in power to ensure that the pesky prosecutor/attorney-general is sufficiently motivated not to attempt to make an example out of you.
In this case it doesn't look like they even bothered hiring a PR firm (or they're doing a piss poor job), and they seem to be getting off "fine".
In this case it doesn't look like they even bothered hiring a PR firm (or they're doing a piss poor job), and they seem to be getting off "fine".
I assumed they’d be executed on the spot for knowingly enriching themselves while addicting millions, leaving them to slowly decline mentally and physically before eventual death.
China would have zero tolerance due to their opium history that was imposed by the west. This is even more insidious however as the country’s institutions were mislead and this family made billions on the back of their countrymen’s misery.
China would have zero tolerance due to their opium history that was imposed by the west. This is even more insidious however as the country’s institutions were mislead and this family made billions on the back of their countrymen’s misery.
Maybe. In the tainted milk scandal, the executives were jailed, and it was the lower level people who were executed. https://www.nbcwashington.com/local/natlchina-issues-death-s...
They absolutely will get away with this. Zero doubt in my mind.
They'll take a plea, say "aww gee sorry", and ride off into the sunset with billions. It's the American way.
They'll take a plea, say "aww gee sorry", and ride off into the sunset with billions. It's the American way.
The China hypothetical is not really helpful, is it?
Because it didn't happen, people will just impose their own preconceptions on it.
Because it didn't happen, people will just impose their own preconceptions on it.
Why is it not helpful? Sometimes people accept the reality of a certain situation as the only possible reality. It’s helpful to suggest what might happen in an alternative situation in order to put the current situation into context.
The simple reality is that the Chinese would absolutely not accept this resolution and in fact would consider the actions of the Sacklers to be completely unforgivable, which brings the American reaction into stark contrast.
The simple reality is that the Chinese would absolutely not accept this resolution and in fact would consider the actions of the Sacklers to be completely unforgivable, which brings the American reaction into stark contrast.
Put all Sacklers actively involved in opioid business on trial under criminal RICO statute and confiscate their property including offshore assets.
Not just the Sacklers: the government and the doctors are equally at fault. There should not be a trust system here, checks and balances.
SlateStarCodex's "Against Against Pseudoaddiction" is an enlightening read for some of the complexity involved.
https://slatestarcodex.com/2019/09/16/against-against-pseudo...
https://slatestarcodex.com/2019/09/16/against-against-pseudo...
In a similar vein, this video titled, "OxyContin patients, then and now" [0] is worth a watch.
The music suggests the drug is horrible, but of the five patient cases: two are doing well on the drug and require it to function normally, one did well but died of a (not determined to be related) heart attack, one got off the drug with some difficulty, and one died after falling asleep while driving.
Opioids are a miracle drug for people living with chronic pain. More people die every year from alcohol - which has absolutely zero therapeutic benefit.
[0] https://www.youtube.com/watch?v=pkeQifzvSNE
The music suggests the drug is horrible, but of the five patient cases: two are doing well on the drug and require it to function normally, one did well but died of a (not determined to be related) heart attack, one got off the drug with some difficulty, and one died after falling asleep while driving.
Opioids are a miracle drug for people living with chronic pain. More people die every year from alcohol - which has absolutely zero therapeutic benefit.
[0] https://www.youtube.com/watch?v=pkeQifzvSNE
I'm on regular opioids for chronic pain, and they have possibly saved my life. But I tried many, many alternatives. For the majority of chronic pain sufferers, there will be a better alternative to opioids.
Part of the problem in the US is that doctors were reaching for opioids as first or second line drugs, when they should be further down the line.
Part of the problem in the US is that doctors were reaching for opioids as first or second line drugs, when they should be further down the line.
If we had a justice system, that $10.8 billion would be recoverable, and used to try to rehabilitate the victims.
But we don't have a justice system. We have a legal system, and a financial system.
But we don't have a justice system. We have a legal system, and a financial system.
When plunder becomes a way of life for a group of men in a society, over the course of time they create for themselves a legal system that authorizes it and a moral code that glorifies it.
Frédéric Bastiat
Frédéric Bastiat
Bastiat is specifically referring to rent seeking, occupational licensing, protectionism, etc.
The Bastiat quote is on point if your criticism of Purdue Pharma is that it profited from the medical licensing laws and drug prohibition laws that unfairly proscribes teenagers from buying madak cigarettes on the free market.
If the criticism is merely that they made money selling addictive drugs, this really isn't what the quote is about.
The Bastiat quote is on point if your criticism of Purdue Pharma is that it profited from the medical licensing laws and drug prohibition laws that unfairly proscribes teenagers from buying madak cigarettes on the free market.
If the criticism is merely that they made money selling addictive drugs, this really isn't what the quote is about.
Does it matter what the original intention of the quote is, if it perfectly captures the spirit of the current injustice?
a legal system that authorizes it
They did not make billions from selling yet another opioid of which there are dozens available cheaply. They made billions by subverting the medical system largely though completely legal means. Essentially they sold yet another synthetic street drug through Doctors rather than on street corners. And this worked because they jumped through the correct hoops and advertised in the correct manner.
They did not make billions from selling yet another opioid of which there are dozens available cheaply. They made billions by subverting the medical system largely though completely legal means. Essentially they sold yet another synthetic street drug through Doctors rather than on street corners. And this worked because they jumped through the correct hoops and advertised in the correct manner.
That mischaracterizes street drugs in production quality, goal, and financial model. Viagra is closer to the model of endorsed recreational usage.
If they went and produced 'Oxycotin gets you high and it is legal!' like a head shop the operation would have not reached multimillion dollar size before it got cracked down.
Jumping through the hoops is the part the system understands as important though.
Those two differences although irrelevant to end outcome being bad and condemnable are pretty damn big distinctions akin to claiming you "unleashed a savage wolf to attack unsuspecting children" when you sold out a pit bull puppy who was sourced from a dog fighting ring and the dog mauled a kid who yanked on his tail.
If they went and produced 'Oxycotin gets you high and it is legal!' like a head shop the operation would have not reached multimillion dollar size before it got cracked down.
Jumping through the hoops is the part the system understands as important though.
Those two differences although irrelevant to end outcome being bad and condemnable are pretty damn big distinctions akin to claiming you "unleashed a savage wolf to attack unsuspecting children" when you sold out a pit bull puppy who was sourced from a dog fighting ring and the dog mauled a kid who yanked on his tail.
OxyContin was a massive street drug as it is and was literally sold on the street in massive quantities. The additional legal channel for the identical substance from the same manufacturer is both a legal and illegal at the same time. Which is why Bastiat‘s quote is so interesting in this context.
I've been thinking about this a lot, and really believe America was founded on "breaking the rules" and has had really great successes, but really awful consequences. Specific to the pandemic, no one wants to wear a mask. We've been conditioned to believe that breaking the rules (ie disruption) is a good way to move forward.
Outside the pandemic, we see oil companies and other manufactures move their operations overseas to countries without power or understanding that the earth is being pillaged, or that the big company is there because they don't have modern labor laws or laws that protect their environment.
Hell, the amount of beer cans on the side of the road in my suburban neighborhood and surrounding parks areas indicates that there's a portion of the population that can't handle not drinking and driving.
I wonder if this is specific to America/capitalism, but I don't really have a frame of reference for other cultures that champion values like community over the individual, following the rules, etc.
Outside the pandemic, we see oil companies and other manufactures move their operations overseas to countries without power or understanding that the earth is being pillaged, or that the big company is there because they don't have modern labor laws or laws that protect their environment.
Hell, the amount of beer cans on the side of the road in my suburban neighborhood and surrounding parks areas indicates that there's a portion of the population that can't handle not drinking and driving.
I wonder if this is specific to America/capitalism, but I don't really have a frame of reference for other cultures that champion values like community over the individual, following the rules, etc.
A lot of US history boils down to criminals and cult leaders, whereas Europe is mostly about spoiled brats.
Wilding of America by Charles Derber is one text on this subject. It's an interesting theory. In another interpretation, the end of the frontier has also meant that the barbarism and roguery once relegated to the periphery of the country is now omnipresent.
Interesting take. I've always held that Americans only care about those that they can see from the edge of their property line (neighbors and whatnot). Everyone else? Fuck em. Distrust of all forms of government is practically bred into us, and it shows at all levels. Corporations have pretty much filled that power vacuum.
Plus, we Americans embrace or at least excuse this corporate power. Elected government tries to control what we can say online? Censorship! Overreach! Unaccountable Facebook and Twitter try to control what we say online? Yes, please! No problem! If you don't like it, leave! It's not censorship because corporate power is doing it rather than government power!
While I somewhat agree with the sentiment, there is a big difference between our government which has the power to take away our rights and a corporation censoring us.
Is there a big difference though? Especially considering we got Zucked into believing that TikTok needs to be banned/sold to an American company?
> Specific to the pandemic, no one wants to wear a mask.
This is another one of those situations where the crazies are driving the conversation, because they are much louder than their actual portion of the population. According to Gallup the portion of their panel who “never” wear a mask outside of their home is 10%, while those who “rarely” wear a mask is 2%.
The vast majority of the population wears masks “always” (50%), “very often” (27%), or at least “sometimes” (11%). The vast majority of us are complying with mask regulations; we’re just not making a lot of noise about it.
This is another one of those situations where the crazies are driving the conversation, because they are much louder than their actual portion of the population. According to Gallup the portion of their panel who “never” wear a mask outside of their home is 10%, while those who “rarely” wear a mask is 2%.
The vast majority of the population wears masks “always” (50%), “very often” (27%), or at least “sometimes” (11%). The vast majority of us are complying with mask regulations; we’re just not making a lot of noise about it.
Are those Gallup results national-level? If so, then we all know that the 12% of "never or rarely" mask-wearers are unevenly distributed.
That's a nice sentiment, but it's built on the idea that one should just ignore the crazies and they'll automatically be marginalized. It doesn't address the situation where one big group decides to weaponize its finge contingent, or where an angry fringe forces itself into what was intended to be a less heated conversations, as in this recent example: https://www.npr.org/2020/08/25/905785548/unmasked-protesters...
They repeated the stunt approximately yesterday but one of the organizers was arrested this time; he handcuffed himself to a chair but didn't consider that it was on wheels, so they just rolled him out of the building. https://www.npr.org/2020/08/25/906046911/ammon-bundy-is-arre...
They repeated the stunt approximately yesterday but one of the organizers was arrested this time; he handcuffed himself to a chair but didn't consider that it was on wheels, so they just rolled him out of the building. https://www.npr.org/2020/08/25/906046911/ammon-bundy-is-arre...
It’s only tangentially related to the point you’re making, but I think it’s hilarious the difference between how tough Bundy thought he was being, and the sad image of him being wheeled out of the legislature on the cheapest office chair Office Depot has to offer. He looks like a child that’s just realizing that holding his breath might not be an effective way to get what it wants.
while the 12% that never/rarely wear a mask reflects your "vast majority of the population wears masks" statement, 12% is very significant.
MRantiHATE(2)
> If we had a justice system, that $10.8 billion would be recoverable
We’re in the midst of a series of lawsuits and criminal probes seeking to do exactly that. When public pressure rushes prosecutors, we get nonsense like Arizona getting rejected for original jurisdiction by SCOTUS.
We have due process. Not mob rule.
We’re in the midst of a series of lawsuits and criminal probes seeking to do exactly that. When public pressure rushes prosecutors, we get nonsense like Arizona getting rejected for original jurisdiction by SCOTUS.
We have due process. Not mob rule.
Much of the money is diffucult to recover by being tied up in byzantine arrangements of LLCs and overseas accounts. That's generally how the rich avoid paying taxes as well.
We have due process for the privileged. Tell all of the poor defendants who have been held in Rikers for over a year without a trial that they have due process.
We have due process for the privileged. Tell all of the poor defendants who have been held in Rikers for over a year without a trial that they have due process.
> Much of the money is diffucult to recover by being tied up in byzantine arrangements of LLCs and overseas accounts
Yet this reporter was able to assemble the trail from court documents.
For every person creating Byzantine structures there are several adept at untangling them.
> Tell all of the poor defendants who have been held in Rikers for over a year without a trial
Not arguing that they aren’t getting an advantage. Just that there is zero evidence so far that they’re going to get away with it.
Also, New York has abolished cash bail. If someone is in pre-trial detention, it’s because they were deemed to be a flight risk. Not because they couldn’t afford bail. (EDIT: Never mind, we rolled back most of the changes in April after a purported crime surge)
Yet this reporter was able to assemble the trail from court documents.
For every person creating Byzantine structures there are several adept at untangling them.
> Tell all of the poor defendants who have been held in Rikers for over a year without a trial
Not arguing that they aren’t getting an advantage. Just that there is zero evidence so far that they’re going to get away with it.
Also, New York has abolished cash bail. If someone is in pre-trial detention, it’s because they were deemed to be a flight risk. Not because they couldn’t afford bail. (EDIT: Never mind, we rolled back most of the changes in April after a purported crime surge)
"search warrant sacklers" 0 results
It's hard to make a case for something being prosecuted in good faith if there is never any attempt at using the tools that are otherwise so vastly abused in prosecuting the most meaningless "crimes".
It's hard to make a case for something being prosecuted in good faith if there is never any attempt at using the tools that are otherwise so vastly abused in prosecuting the most meaningless "crimes".
Very good point. People suspected of far less serious crimes based on far more tenuous “evidence” get their door kicked in, their kids rooms flashbanged, dogs shot, etc.
New York has not eliminated cash bail.
https://www.google.com/search?q=new+york+cash+bail
https://www.google.com/search?q=new+york+cash+bail
Ok so maybe improve the laws instead of burning down the entire legal system? I mean even if you want to burn down the entire legal system you are never going to get that without a very bloody revolution.
This is why I am puzzled when people say 'you should fight your battles in the courts, not through protests'. It has always been about who can afford better lawyers, who can win the war of attrition, and a whole lot of luck along the way. Quite a few articles have showed up on HN the past week that reinforce this.
I think, generally, the people saying that are the ones who have the advantage when it comes to court battles...
Some thoughts attributed to ca. 600 BC:
http://www.perseus.tufts.edu/hopper/text?doc=Perseus:text:20...
Ha, perfect, thanks.
Fighting battles through protests seems like it is mainly a case of who can afford better PR companies, win the war of attrition and has a whole lot of luck along the way. In addition, at least with a court case you can be sure public opinion doesn't just forget about it in a few months and moves on to the next hot item to protest.
Yeah, cuz that how every social change occurred in the world.
Via two people talking in the room...
Give me a break, legal system never changes itself.
From Ghandi, Bolshevik revolution, Solidarity, French revolution to MLK.
Change only occurs due to mass civil dissonance or armed revolutions.
Never because you talk in a court and all people in power agreed you make sense.
Give me a break, legal system never changes itself.
From Ghandi, Bolshevik revolution, Solidarity, French revolution to MLK.
Change only occurs due to mass civil dissonance or armed revolutions.
Never because you talk in a court and all people in power agreed you make sense.
You're arguing a different point than I made. Legal systems are as averse to change as the large masses of society (ie very averse). They do move eventually btw, but it's more on the scale of decades than months.
What I was getting at is that protesting is not a very reliable way to effect change either. The "other side" of any protest is also trying to change the narrative and can often just wait out the protests. Look at how the various Occupy movements eventually dissolved after a few months because they weren't getting anywhere. Even the "main" camp (if one can talk about such a thing with Occupy) was eventually cleared by the police and didn't bother reforming somewhere else anymore. The gilets jaunes in France are currently experiencing the same problem.
I'd be quite interested in a way to reliably bring about societal change in a reasonable amount of time and in a morally defensible way, but I have not found any yet. Since philosophers have been debating this since the days of the ancient Greeks I'm a bit doubtful that this is the time when we'll finally figure it out.
What I was getting at is that protesting is not a very reliable way to effect change either. The "other side" of any protest is also trying to change the narrative and can often just wait out the protests. Look at how the various Occupy movements eventually dissolved after a few months because they weren't getting anywhere. Even the "main" camp (if one can talk about such a thing with Occupy) was eventually cleared by the police and didn't bother reforming somewhere else anymore. The gilets jaunes in France are currently experiencing the same problem.
I'd be quite interested in a way to reliably bring about societal change in a reasonable amount of time and in a morally defensible way, but I have not found any yet. Since philosophers have been debating this since the days of the ancient Greeks I'm a bit doubtful that this is the time when we'll finally figure it out.
Protesting is very effective when you do actual direct action and civil disobedience. Americans have gotten used to running ignorable police-sanctioned parades and calling them protests.
[deleted]
The court case is capital fighting capital. If it's the government, then it's the public's capital vs. private capital. The government is often at a disadvantage in this situation due to conflicts of interest and concerns over funds, as private capital is often far richer than anything the government can put forward.
Proper protests etc. are direct action by the people against capital. There are still disadvantages, but they can be drowned out by simple numbers.
Proper protests etc. are direct action by the people against capital. There are still disadvantages, but they can be drowned out by simple numbers.
If the system was honest, everyone would be taught at least the basics about law, medicine and finance, but you dont, you get taught enough to be a slave.
They are taught - they just don't pay attention or remember the "boring stuff we will never use" and then after going with the flow for decades with no forward thinking look for somebody to blame for their own failures.
Seriously, all of those who goofed off in home ec and math complaining years later that they don't know how to cook or balance a checkbook.
The immediate resources were often subpar I will admit but don't say you weren't taught.
Seriously, all of those who goofed off in home ec and math complaining years later that they don't know how to cook or balance a checkbook.
The immediate resources were often subpar I will admit but don't say you weren't taught.
You are making excuses for teacher's & parents failings to teach so that someone understands the lesson. You are also by definition accepting that discrimination is essential for a successful society. My issue is where the state, parents want authority over someone but dont perform their basic requirements properly. Alot of people are stupid for even accepting the failings and accepting of the authority these entities have over people.
Everyone should teach themselves the basics of law, medicine, finance.
Its easy to start. Just pick up some textbooks.
Its easy to start. Just pick up some textbooks.
You have no authority with your opinion though if you are not qualified. The exam process doesnt give your papers back to check your results against the text books and what the teachers have stated, so using science and previous observations going back at least 12,000years namely the various religions invented over time, people in authority can reinforce their positions by making sure trouble makers fail even as kids.
Unfortunately knowledge alone does not equal access to mechanisms of these disciplines. Without wealth, good luck using your law or medical knowledge to improve your situation aside from preventative measures. However, if knowledge is all you got, it's better than nothing at all and puts you ahead of many who won't be bothered.
I disagree. Knowledge is the great equalizer. You can't buy knowledge with money.
> This is why I am puzzled when people say 'you should fight your battles in the courts, not through protests'.
Sounds like it was worded wrong (depending what you mean by "protests"). "fight your battles in the courts" is generally a statement about non-violence, meant to suggest metaphorical fighting in courts instead of actual violence.
Sounds like it was worded wrong (depending what you mean by "protests"). "fight your battles in the courts" is generally a statement about non-violence, meant to suggest metaphorical fighting in courts instead of actual violence.
According to the article $4.8bn of the $10.8bn has already been paid in tax. So that portion has been 'recovered'. The remaining $6bn though is still in play. What I don't see being mentioned is jail time. So it's not criminal to push habit forming narcotics from behind a corporate curtain?
Don't forget, there is also a reputation system. It should be made clear that whatever the justice system decides, much of their wealth has derived from an activity that was net negative for humanity.
And yes, I have heard that PR companies exist to clean up reputations, but it should be possible to at least make it clear what happened.
I think I read somewhere that a hedge fund had decided not to take an allocation from the Sacklers. That's exactly the kind of thing reputation is supposed to do. It's a blunt instrument, but people deciding to partially ostracize those who have done wrong is how things should work.
And yes, I have heard that PR companies exist to clean up reputations, but it should be possible to at least make it clear what happened.
I think I read somewhere that a hedge fund had decided not to take an allocation from the Sacklers. That's exactly the kind of thing reputation is supposed to do. It's a blunt instrument, but people deciding to partially ostracize those who have done wrong is how things should work.
In 5-10 years we get a longform glossy magazine profile of one of the younger Sacklers. The headline will end with a question mark.
It will talk about how the heir has become an active philanthropist, dedicating his/her life to “making things right”. It will list their accomplishments since the family was exposed. It will end with an open ended question about “the sins of our fathers.” It will really make you think.
They will spend their life slowly giving away half their fortune, one gala at a time. They will start a foundation. It will have a name not too dissimilar from a pharmaceutical brand name—meaningless but vaguely positive (too bad Altria is taken). They will max out that foundation’s board with Big Names in that world—just so long as their name isn’t Sackler.
Their investment of half of the payout they kept will grow larger than the original started at, and they’ll never pay more than a nominal dime in taxes thanks to those sweet 501(c)3 write-offs.
Their reputation will be laundered, at least enough for their checkbooks invited back to the parties. And their kids? Home free.
In a few generation the hundreds of thousands of deaths on their hands will be forgotten, except by the families of the victims that were just the cost of doing business for them.
It will talk about how the heir has become an active philanthropist, dedicating his/her life to “making things right”. It will list their accomplishments since the family was exposed. It will end with an open ended question about “the sins of our fathers.” It will really make you think.
They will spend their life slowly giving away half their fortune, one gala at a time. They will start a foundation. It will have a name not too dissimilar from a pharmaceutical brand name—meaningless but vaguely positive (too bad Altria is taken). They will max out that foundation’s board with Big Names in that world—just so long as their name isn’t Sackler.
Their investment of half of the payout they kept will grow larger than the original started at, and they’ll never pay more than a nominal dime in taxes thanks to those sweet 501(c)3 write-offs.
Their reputation will be laundered, at least enough for their checkbooks invited back to the parties. And their kids? Home free.
In a few generation the hundreds of thousands of deaths on their hands will be forgotten, except by the families of the victims that were just the cost of doing business for them.
I’m sorry but this is so naive.
They were billionaires yesterday and they’re going to be billionaires tomorrow. Their reputation is going to be fine because we live in a society that absolutely worships money and those who have it. People with that kind of money can pay to scrub the internet.
They were billionaires yesterday and they’re going to be billionaires tomorrow. Their reputation is going to be fine because we live in a society that absolutely worships money and those who have it. People with that kind of money can pay to scrub the internet.
> People with that kind of money can pay to scrub the internet.
I'm sorry but this is so naive.
Maybe true if you've got a bit of money and a little bit of notoriety, but I don't think that it would be possible to dissociate the Sacklers' name from the opioid crisis anytime soon.
I'm sorry but this is so naive.
Maybe true if you've got a bit of money and a little bit of notoriety, but I don't think that it would be possible to dissociate the Sacklers' name from the opioid crisis anytime soon.
> I don't think that it would be possible to dissociate the Sacklers' name from the opioid crisis anytime soon
Attention is short. I wouldn't rule it out; pr goes a long way. Spend a couple million on a completely unrelated but well regarded cause of charity and folks who don't have skin in the opioid-game won't associate them for the bad they did (but for their most recent memories).
What will keep the association alive for a while will be documentaries and those who watch them, but lets be real: that's not the public.
Attention is short. I wouldn't rule it out; pr goes a long way. Spend a couple million on a completely unrelated but well regarded cause of charity and folks who don't have skin in the opioid-game won't associate them for the bad they did (but for their most recent memories).
What will keep the association alive for a while will be documentaries and those who watch them, but lets be real: that's not the public.
I dare to say that I'll never donate for a charity which takes money from the Sacklers. I will remember the name for the rest of my life.
I think this is too big to be easily cleaned up.
I think this is too big to be easily cleaned up.
I think you vastly overestimate the attention span of the public on this. If you asked 100 random people on the street who was behind the opioid crisis, I’d be shocked if 10 knew. You also don’t acknowledge how easy it is for the wealthy to hide their money via intermediary organizations and shell companies. It’s not like they absolutely have to donate using the Sackler name.
> If you asked 100 random people on the street who was behind the opioid crisis, I’d be shocked if 10 knew.
Never argued against that, and I don't disagree with that at all. But if someone cares to do even the bare minimum of research, it's easy to come up with the Sacklers. What I am arguing against is that the Sacklers will somehow be able to use their wealth to scrub Google et al of their association with OxyContin.
> It’s not like they absolutely have to donate using the Sackler name.
For folks like them, though, then what's the point? After a certain level of Midas-like wealth, the only point is societal standing and legacy. The Sacklers don't seem like the type of folks who are going to get inner joy by donating anonymously.
Never argued against that, and I don't disagree with that at all. But if someone cares to do even the bare minimum of research, it's easy to come up with the Sacklers. What I am arguing against is that the Sacklers will somehow be able to use their wealth to scrub Google et al of their association with OxyContin.
> It’s not like they absolutely have to donate using the Sackler name.
For folks like them, though, then what's the point? After a certain level of Midas-like wealth, the only point is societal standing and legacy. The Sacklers don't seem like the type of folks who are going to get inner joy by donating anonymously.
> ...if someone cares to do even the bare minimum of research...
Aye, there's the rub.
Aye, there's the rub.
Wait a few years, let them put their names on some charitable foundations and giving away a small or large percentage of their gains and they will have stellar reputations. Worked for Bill Gates, Andrew Carnegie, Michael Milken and many others.
https://www.nytimes.com/2019/05/15/arts/design/met-museum-sa...
The Sacklers have been donating huge sums to put their name on things for a long time.
The Sacklers have been donating huge sums to put their name on things for a long time.
[deleted]
It's not naive. They have enough money that if it isn't taken they can simply outlast any hit to their reputation.
Everyone likes money, but that doesn't mean they respect those who have it. Do you think more highly of the oil countries that have bought a football club? In a way it's kinda satisfying that the price of respectability is so high; nobody thinks the gulf states are any better than before they decided to pay a bunch of young men exorbitant wages to kick a ball around.
> Do you think more highly of the oil countries that have bought a football club?
No, but I don’t see how that deters them from misbehaving. How many billionaire oil or pharma magnates just wish they had a little more respectability? You think they care at all what people think about them? If they did, they wouldn’t have done what made them their blood money in the first place.
The Sacklers enabled the deaths of hundreds of thousands of people, and yet which did they choose to protect: their money or their reputation?
No, but I don’t see how that deters them from misbehaving. How many billionaire oil or pharma magnates just wish they had a little more respectability? You think they care at all what people think about them? If they did, they wouldn’t have done what made them their blood money in the first place.
The Sacklers enabled the deaths of hundreds of thousands of people, and yet which did they choose to protect: their money or their reputation?
Most billionaires haven't created a genocidal drug plague in America. Those who have should be at the very least shunned socially if we can't muster up a way of bankrupting them and throwing them in prison. I see the devastation of this all around me; this isn't some minor oopsie that resulted in a large fortune -it was the deliberate poisoning of large swathes of the country for profit.
You should make people aware of it when they invite you to events or places with their name on it. I've seen people call out Jeff Dean for inviting people to some Sackler named event; he seemed pretty horrified as well he should be.
You should make people aware of it when they invite you to events or places with their name on it. I've seen people call out Jeff Dean for inviting people to some Sackler named event; he seemed pretty horrified as well he should be.
They might even run for president.
Or the current president might place them as the head of Health and Human Services.
Surely 100% of opiod usage isn't bad? So 100% of the $10.8B isn't blood money? I'm sure some % of the opioids really helped people. For example, my grandpa has extremely painful back pain, and opioids were a godsend. Yeah, he got addicted, but he's in his 90s anyway, so at least he can live the rest of his life without dealing with crippling back pain.
The cost to market and develop the drug could easily outstrip the revenue from legitimate uses, especially if they spent a lot of money marketing the drug towards people that shouldn't be taking it. So yeah, all $10.8B could be blood money.
How much "development" did it take? Oxy was first manufactured in 1917. "Opioids relieve pain and are much sought by opioid users", film at eleven. Any physician who didn't know what would obviously happen when this drug was prescribed is one whose care I would avoid.
But yeah, take all their money. The actions described in TFA obliterate the corporate veil. Frankly I don't know how they've avoided assassination attempts by the families of addicts.
But yeah, take all their money. The actions described in TFA obliterate the corporate veil. Frankly I don't know how they've avoided assassination attempts by the families of addicts.
Sure, there are good applications of opiates. However, from my understanding, the $10.8B number is the amount that the court has ordered, i.e. the "blood money" and punitive amount, not the total profit.
Is all that money tainted? While oxycontin holds a huge potential for abuse I know plenty of people who have taken it for real pain, been helped by it, and moved on. "Just take it all" doesn't sound like justice either.
Taking it all seems fair to me. When someone steals from a retailer, we don't just make them pay for it and send them on their way, because that doesn't disincentivize stealing in the first place. The Sacklers/Purdue would need to be punished for the predatory, antisocial scheme to prevent others like it.
While an additional fine might be fair, again, just "taking it all" isn't. The Sacklers, while they might have played a small part, are being unfairly scapegoated for the whole of the opioid epidemic. This ignores the responsibility borne by states, physicians, and most importantly, those who choose to take the pills. This was also done with FDA approval.
More importantly, this is a part of the larger narrative that everything has been caused by overprescribed opioids. However, there's no correlation between increased prescriptions and increased illicit usage [0]. Rather, it seems there's been a large growth over time of illicit opioid use [1]. The only place this sort of thing has been effectively combated is in Portugal due to its decriminalization and attempts to make things safer. Politicians caused this with their stupid "war on drugs". They are now pointing and saying, "Look, the big bad Sacklers did it!" so their own failures are ignored. Stop scapegoating one family for a political and societal issue.
0: https://www.researchgate.net/publication/330922982_Today%27s...
1: https://www.sciencedaily.com/releases/2018/09/180920161028.h...
More importantly, this is a part of the larger narrative that everything has been caused by overprescribed opioids. However, there's no correlation between increased prescriptions and increased illicit usage [0]. Rather, it seems there's been a large growth over time of illicit opioid use [1]. The only place this sort of thing has been effectively combated is in Portugal due to its decriminalization and attempts to make things safer. Politicians caused this with their stupid "war on drugs". They are now pointing and saying, "Look, the big bad Sacklers did it!" so their own failures are ignored. Stop scapegoating one family for a political and societal issue.
0: https://www.researchgate.net/publication/330922982_Today%27s...
1: https://www.sciencedaily.com/releases/2018/09/180920161028.h...
I don't think they're being unfairly scapegoated. Oxycontin was an epidemic in itself. I've seen plenty of evidence from a variety of sources that their pills were aggressively and deceptively marketed as non-addictive, and that their wide availability led to an increase in opioid abuse. That includes knowing people who started on opioid addictions with brand name oxycontin and having heard countless anecdotes of the same. I'm having trouble understanding the motive for minimizing Purdue's role. The deception in marketing and all its consequences belong to them. It's difficult to imagine they merely made a mistake in trying to be effective marketers as opposed to knowingly misrepresenting what they sold in a way that was likely to harm the public.
All that said, I generally favor your stance that ending prohibition would yield the greatest harm reduction.
All that said, I generally favor your stance that ending prohibition would yield the greatest harm reduction.
<Karl Llewellyn enters the thread>
And what would a justice system look like, not in terms of vague sentiments or specific outcomes but in terms of process.
Justice is inherently subjective. A "justice system" to you is a facist dictatorship as implemented because it inherently relies on all justice coming from the subjective opinions of a single person, you.
Justice is inherently subjective. A "justice system" to you is a facist dictatorship as implemented because it inherently relies on all justice coming from the subjective opinions of a single person, you.
Almost half to tax seems quite high actually compared to other major companies
I totally get and support that said profits should be seized by the government and distributed to help affected communities.
But doing only this is like beheading hydras: you cut one head off and nine new appear in its place. And with drugs, it's even worse than that - as users who previously were on medical quality clean stuff from legit pharmacies paid for by insurance, they are moving on to street stuff with all the side effects associated (criminal behavior to finance the addiction, contamination due to cutting agents, overdoses due to inconsistent dosing, gang fights, ...).
The opioid crisis must be tackled at the root level, and that is a lack of physical and mental healthcare combined with the lack of a social security network and appropriate governmental aid to regions devastated by 30 years worth of globalization, modernization and rabid capitalism - to continue with the hydra analogy, the US needs to burn off the necks and then kill the body of the beast.
But doing only this is like beheading hydras: you cut one head off and nine new appear in its place. And with drugs, it's even worse than that - as users who previously were on medical quality clean stuff from legit pharmacies paid for by insurance, they are moving on to street stuff with all the side effects associated (criminal behavior to finance the addiction, contamination due to cutting agents, overdoses due to inconsistent dosing, gang fights, ...).
The opioid crisis must be tackled at the root level, and that is a lack of physical and mental healthcare combined with the lack of a social security network and appropriate governmental aid to regions devastated by 30 years worth of globalization, modernization and rabid capitalism - to continue with the hydra analogy, the US needs to burn off the necks and then kill the body of the beast.
All-around-tech-bro-knowledge is strong in this thread.
Doctors prescribe opiates all over the world, including oxycontin. Nowhere else is it a problem as big as in the US. Before wanting to withdraw prescription rights and sue MDs on a personal basis, perhaps people could think about the american exception?
The US opiate problem is cultural and the responsibility is on both sides of the doctor-patient fence. The more people will be able and willing to sue MDs, the bigger the problem. Legal action on a personal basis is _so_ the wrong path. This is depressing.
Doctors prescribe opiates all over the world, including oxycontin. Nowhere else is it a problem as big as in the US. Before wanting to withdraw prescription rights and sue MDs on a personal basis, perhaps people could think about the american exception?
The US opiate problem is cultural and the responsibility is on both sides of the doctor-patient fence. The more people will be able and willing to sue MDs, the bigger the problem. Legal action on a personal basis is _so_ the wrong path. This is depressing.
Opiates are a huge problem everywhere.
But the US and NZ are the only two countries that allow DTC drug marketing. And Purdue in particular was monstrous (in size and as an evil creature) in their direct to healthcare provider marketing.
I would argue this a MUCH larger contributing factor than any cultural differences, and actually causing some 'cultural' differences.
Where else is a drug pusher allowed to legally access a database of all scripts written by which doctors in order to target the top 1% of script writers who make up a large % of the profit. Then pay HUGE commissions to pushy non-educated salespeople - armed with criminally false 'research' funded by shell 'non-profits' - to bribe doctors to write even more.
Not to mention Purdue actively incentivizing pill mill Doctors, actively reaching out to obvious criminal MDs to get them to sell more drugs!!!!
It's disgusting and they need to be held accountable for manslaughter. all ill-gotten gains should be reposed and used for treatment.
If this were any other drug dealer their cash/cars/etc would be seized immediately and the accused would have to prove the money was not ill-gotten to get it back.
Put the Sackler's on the treasury sanctions list just like we do with Cartel leaders. Maybe them museums will start chiseling their names off of the buildings.
But the US and NZ are the only two countries that allow DTC drug marketing. And Purdue in particular was monstrous (in size and as an evil creature) in their direct to healthcare provider marketing.
I would argue this a MUCH larger contributing factor than any cultural differences, and actually causing some 'cultural' differences.
Where else is a drug pusher allowed to legally access a database of all scripts written by which doctors in order to target the top 1% of script writers who make up a large % of the profit. Then pay HUGE commissions to pushy non-educated salespeople - armed with criminally false 'research' funded by shell 'non-profits' - to bribe doctors to write even more.
Not to mention Purdue actively incentivizing pill mill Doctors, actively reaching out to obvious criminal MDs to get them to sell more drugs!!!!
It's disgusting and they need to be held accountable for manslaughter. all ill-gotten gains should be reposed and used for treatment.
If this were any other drug dealer their cash/cars/etc would be seized immediately and the accused would have to prove the money was not ill-gotten to get it back.
Put the Sackler's on the treasury sanctions list just like we do with Cartel leaders. Maybe them museums will start chiseling their names off of the buildings.
There are huge problems with opiods in many countries, but the USA has the most data. Canada has major issues, but only some provinces are tracking it.[1]
[1] https://www.cbc.ca/news/canada/british-columbia/bc-overdose-...
[1] https://www.cbc.ca/news/canada/british-columbia/bc-overdose-...
Yes, Canada... a country with a similar healthcare culture.
What about Europe, Asia? They also have oxycontin. How about Germany, for example? How do they manage?
I've practiced both in Europe and in the US. I wouldn't go back to care for americans even for a million bucks. Healthcare culture in the US is incredibly toxic.
What about Europe, Asia? They also have oxycontin. How about Germany, for example? How do they manage?
I've practiced both in Europe and in the US. I wouldn't go back to care for americans even for a million bucks. Healthcare culture in the US is incredibly toxic.
What? Canada has a similar healthcare culture? Canada is one of very few single-payer-only systems. Canada and the USA have polar opposite healthcare systems.
Yep, completely different system. Same attitude, though.
I really don't understand what you mean by 'culture' and 'attitude'; please explain.
By culture and attitude, I do not mean the objective criteria defining the healthcare system. I mean how things go when you have a patient encounter. American patients are perceived as far more legally agressive and vindicative. True or not, this results in an overly defensive response from american MDs. Unfortunately, medicine has that in common with war that a dead patient is less problematic than an injured patient. Hence, the opiate crisis.
This is purely cultural. European patients and MDs are much less aggressive.
This is purely cultural. European patients and MDs are much less aggressive.
The USA is definitely very litigious, but I am not sure that Canada is similar. Cultural explanations are interesting, but they can be molded to explain almost anything. I could for instance say that US doctors are motivated to prevent overdoses, as their patients are a source of recurring revenue, whereas Canadian and European doctors and systems see their patients as cost centres.
Yes, of course my assertions are subjective and based upon personal experience. However, here is a very objective thing: you're a US doc and your patient is in pain. Very simple, you prescribe oxycodone and it solves the immediate problem. Then, your patient dies of overdose. But most of the time, you won't even be aware of the cause of death and simply archive the file. And, most important of all: _the patient did not overdose on your prescription, but on self-medication/street drugs_.
So in fact the difference is how MDs solve the immediate pain problem. In the US, they would try to suppress the pain (and legal threats with it). In Europe, they would try to make it bearable while keeping the patient functional, because they are not afraid of their patient.
Everyone benefits from a less tense relationship.
So in fact the difference is how MDs solve the immediate pain problem. In the US, they would try to suppress the pain (and legal threats with it). In Europe, they would try to make it bearable while keeping the patient functional, because they are not afraid of their patient.
Everyone benefits from a less tense relationship.
I understand that you think it's an incentive problem, and I agree that opiod issues are probably driven by incentive issues, but I am not sure we have the data to support your explanation. I also don't think most doctors keep track of patient fatalities at all, let alone the causes of death.
For example: am Canadian, had to get stitches for a nerve-damaged lacerated finger. Doctor tried to prescribe me Oxy — which was absolutely ridiculous for such a small injury, so I refused it. I'm pretty certain that I'd be an opioid addict had I accepted that prescription, knowing myself.
Canadian healthcare is great, and dissimilar to American, in that it's treated as a public good.
Canadian healthcare is not great, and similar to American, in that a lot of prescription decisions are made from a similar cultural perspective as in the US, ie drugs are handed out like candy.
Canadian healthcare is great, and dissimilar to American, in that it's treated as a public good.
Canadian healthcare is not great, and similar to American, in that a lot of prescription decisions are made from a similar cultural perspective as in the US, ie drugs are handed out like candy.
I am not american and I remember hearing about OxyCotin for more around 10 years. So I wonder why controling this problem which casued so many loses of lifes (not necessary deaths), took this long to be the target of the government. I also wonder was there one of these stupid political shows that US is used to them now that was stopping anyone to handle it.
In the long legal battle I do not think this money is going to be recoverable (at least most of it).
In the long legal battle I do not think this money is going to be recoverable (at least most of it).
I remember it being discussed on drug (recreational) boards 20 years ago. It is not new
> So I wonder why controling this problem which casued so many loses of lifes
Did you not read $10billion in profit. People point to Mexico and the corruption the narcos bring to the Mexican state. It is the same in the US for this case. Just looked at who profited. Drs, lawyers, politicians, lobbists. Whilst the gravy train is running people are not asking questions at best and doing their best to stop them being asked.
The corruption regarding oxycotin, ran from the top to the bottom of the system
> So I wonder why controling this problem which casued so many loses of lifes
Did you not read $10billion in profit. People point to Mexico and the corruption the narcos bring to the Mexican state. It is the same in the US for this case. Just looked at who profited. Drs, lawyers, politicians, lobbists. Whilst the gravy train is running people are not asking questions at best and doing their best to stop them being asked.
The corruption regarding oxycotin, ran from the top to the bottom of the system
> I wonder why controling this problem which casued so many loses of lifes (not necessary deaths), took this long to be the target of the government.
Lots of shit falling apart here...
Lots of shit falling apart here...
The United States is neoliberal with a couple social programs tacked on top. The interests of capital nearly always win. Individuals at the top are nearly always shielded from liability using various levels of companies in between them and the "consumer" and plausible deniability. The typical worst-case scenario is that the company has to pay a large fee that is still smaller than the profits they made through their monstrous actions.
These are well-known forces that have acted this way for 150 years. Unfortunately, these systemic problems are not taught in school. Quite the opposite, they are treated more as minor aberrations that are fixed with a touch of social democratic intervention or regulation. And even that is considered an extremist position, extending to all kinds of subjects relevant to this community regarding how tech companies should be structured, labor organized, compensation structured (including healthcare), or even just having more coherent and explicit control over your personal data.
These are well-known forces that have acted this way for 150 years. Unfortunately, these systemic problems are not taught in school. Quite the opposite, they are treated more as minor aberrations that are fixed with a touch of social democratic intervention or regulation. And even that is considered an extremist position, extending to all kinds of subjects relevant to this community regarding how tech companies should be structured, labor organized, compensation structured (including healthcare), or even just having more coherent and explicit control over your personal data.
It took so long because the Sacklers contributed to many causes and philanthropies favored by the elite, and because the Obama Administration simply did not care about midwestern White people dying. And, the Trump Administration does not care about anything at all.
Paywall, didn’t read
Small amount of text, large number of big grey rectangles with "Loading" in the middle.
Me either. Imagine a world where the poor have no news access, and instead depend on Facebook for news.
I am trying to imagine a world where everyone think they should get for free other persons' labor. I wonder what that thing is called.
For some reason people online think writers and journalists are paid in Likes/Retweets
Open source software?
Silliest paywall ever:
1. Open dev tools
2. Delete the overlay element (id = graphics-paywall-overlay)
3. Disable 'overflow: hidden' on body
document.getElementById("graphics-paywall-overlay").remove()
document.body.style.overflow = 'inherit'Yeah, the security on physical newspaper vending machines is laughably easy to defeat as well. Just smash the glass on the front with a rock and you can take as many papers as you want, for free. Or for a less destructive route you can use a special tubular lock pick.
https://archive.is/EBOzY
don't be lazy.
don't be lazy.
TIL: Oxytocin and OxyCotin are different drugs that are both pain killers. I remember being prescribed Oxytocin after my surgery and it was a fun woozy drug. Never tried OxyContin.
Oxytocin is a hormone, completely unrelated. The words you're thinking of are oxycodone and oxycontin, and they are not different drugs. Oxycontin is a time-release formulation of oxycodone.
Expanding on this, oxytocin has many known (and likely unknown) purposes but is most closely associated with context dependent social bonding and exclusion, sex, and childbirth.
Somewhat coincidentally for the purposes of this conversation, it also inhibits chemical dependence (including opioids, which includes oxycontin and oxycodone). [1][2]
[1] https://www.sciencedirect.com/science/article/pii/S009130571...
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5089904/
This concludes the reply relevant section of my comment.
Sidenote (mostly me screaming into the void): due to excruciating constant chronic pain from a botched surgery, I took three oxycodone for 4 years (March 2015-August 2019) every single day. It enabled me to work and live a (greatly diminished) life. For all of the harm the crisis inflicted—and the Sacklers did great evil for great reward—there is really not another class of medication that would have kept me functioning.
Fortunately for me, I managed to get a very good job with great healthcare and I immediately used that to have a corrective surgery with the best surgery center in the country. This took me from about 65% functional (medicated) to about 85% functional, unmedicated. That last 15% is never coming back, and I have to live with the fact a doctor permanently damaged my body in an uncorrectable way.
But, over the course of my treatment, the backlash against opioids began to make it difficult for my pain management clinic to provide the treatment I needed even though I was completely compliant (and had the regular drug tests to prove it—so many cups of pee). I would be dead without opioids. I would have killed myself. There are many more like me who still suffer from unmanageable pain who either cannot get the medication they need. There are many people who are not here because of opioids as well so I completely understand the backlash, I just hope we don’t overcorrect.
The Sacklers harm cannot be undone, but their reward can be—expropriate it all (leave them an apartment with running water and a roof so that it’s technically legal).
Somewhat coincidentally for the purposes of this conversation, it also inhibits chemical dependence (including opioids, which includes oxycontin and oxycodone). [1][2]
[1] https://www.sciencedirect.com/science/article/pii/S009130571...
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5089904/
This concludes the reply relevant section of my comment.
Sidenote (mostly me screaming into the void): due to excruciating constant chronic pain from a botched surgery, I took three oxycodone for 4 years (March 2015-August 2019) every single day. It enabled me to work and live a (greatly diminished) life. For all of the harm the crisis inflicted—and the Sacklers did great evil for great reward—there is really not another class of medication that would have kept me functioning.
Fortunately for me, I managed to get a very good job with great healthcare and I immediately used that to have a corrective surgery with the best surgery center in the country. This took me from about 65% functional (medicated) to about 85% functional, unmedicated. That last 15% is never coming back, and I have to live with the fact a doctor permanently damaged my body in an uncorrectable way.
But, over the course of my treatment, the backlash against opioids began to make it difficult for my pain management clinic to provide the treatment I needed even though I was completely compliant (and had the regular drug tests to prove it—so many cups of pee). I would be dead without opioids. I would have killed myself. There are many more like me who still suffer from unmanageable pain who either cannot get the medication they need. There are many people who are not here because of opioids as well so I completely understand the backlash, I just hope we don’t overcorrect.
The Sacklers harm cannot be undone, but their reward can be—expropriate it all (leave them an apartment with running water and a roof so that it’s technically legal).
Comments like this are really important, and should be a part of every conversation about opioids. Chronic pain is among the worst of medicine's unsolved problems.
Curious: how much did your pain affect your sleep? Did you need the pills to sleep too?
Curious: how much did your pain affect your sleep? Did you need the pills to sleep too?
The US right now: "Some doctors told us the negative effects of opioids are not that dangerous compared to the short term benefits on physical pain. We sell that in pharmacies. This is a billion dollar industry. This was definitely a bad choice, we should have listened to the people talking about the danger of that addiction. Let's burn the skarks that were responsible for that".
Also the US right now : "Some doctors are telling us the negative effect of THC are not that dangerous compared to the short term benefits on mental wellbeing. We sell that in dispensaries. This is a billion dollar industry. This is definitely a good choice, we don't need to listen to the people showing the danger of addiction. Let's praise the progressist that are responsible for that".
Also the US right now : "Some doctors are telling us the negative effect of THC are not that dangerous compared to the short term benefits on mental wellbeing. We sell that in dispensaries. This is a billion dollar industry. This is definitely a good choice, we don't need to listen to the people showing the danger of addiction. Let's praise the progressist that are responsible for that".
I have no doubt that the US is being willy-nilly with THC legalization and ignoring the abuse potential to some extent, but do you really think that widespread THC addiction poses the same danger as widespread opioid addiction?
It's a good point to raise - at the same time, I think it's generally accepted that THC is on the safer side of the "problematic drug" spectrum, while opioids are on the riskier side?
I agree that opiods are definitely on the riskier side of the spectrum, while THC definitely seem on the safer side - at least for adults. But we know that: that's why opioids are mainly sold after a prescription by a doctor and in a pharmacy. At least we are trying to limit access to opioids.
On the other hand THC is currently almost advertised as being "good for you" (see all the papers/studies around it), and a socially acceptable/fun thing to do. While I don't really see anyone posting on social media a picture of themselves crushing some oxy pills. Overall we can expect the number of people negatively impacted by a THC addiction to be significantly higher in the next few years than for opioids. Even if at the individual level, the effects are lower.
At the macro level this makes THC widespread use worrying - just like the opioids use is worrying. The really interesting thing is the difference in narrative. We know want to lock down one as much as possible, while we want to open the other as much as possible.
PR wise, it's incredible. The arguments used in this article against opioids (it was a great business making lots of money !), are exactly the argument used in favour of THC (it is going a great business making lots of [tax] money !).
On the other hand THC is currently almost advertised as being "good for you" (see all the papers/studies around it), and a socially acceptable/fun thing to do. While I don't really see anyone posting on social media a picture of themselves crushing some oxy pills. Overall we can expect the number of people negatively impacted by a THC addiction to be significantly higher in the next few years than for opioids. Even if at the individual level, the effects are lower.
At the macro level this makes THC widespread use worrying - just like the opioids use is worrying. The really interesting thing is the difference in narrative. We know want to lock down one as much as possible, while we want to open the other as much as possible.
PR wise, it's incredible. The arguments used in this article against opioids (it was a great business making lots of money !), are exactly the argument used in favour of THC (it is going a great business making lots of [tax] money !).
The reason THC is even an issue is because the law has insistently been an ass for over half a century. The DEA has a complete tautology of Schedule 1 classification when its effects are far less dangerous. Yet it is federally more controlled than cocaine.
The consequences make a huge difference. So a plan to make a million dollars selling sandwiches vs killing people on the street to rifle through their pockets should be treated very differently.
The consequences make a huge difference. So a plan to make a million dollars selling sandwiches vs killing people on the street to rifle through their pockets should be treated very differently.
The reason why THC is an issue is...because it's bad for you. At least for 90% of the population.
If THC has benefits in a narrow range of situation, doctors should absolutely be able to experiment with it. And the DEA classification should be reviewed under that light.
But there is a whooooole range of possible options that sit between "it's the worst substance ever. Anyone consuming it should be put in jail after 3 strikes. No one can even dream of making medical trials with it" and "Meh, it looks relatively harmless and fun, let's distribute that like candies with close to no control"
If THC has benefits in a narrow range of situation, doctors should absolutely be able to experiment with it. And the DEA classification should be reviewed under that light.
But there is a whooooole range of possible options that sit between "it's the worst substance ever. Anyone consuming it should be put in jail after 3 strikes. No one can even dream of making medical trials with it" and "Meh, it looks relatively harmless and fun, let's distribute that like candies with close to no control"
10.8 Billion Dollars (not million, billion with a 'b'), of which 4.6 Billion, close to half of it, went to the Government as tax payments...
And yet the article seems to imply fault of some sort that various Sacklers moved millions (millions with an 'm') -- an order of magnitude less money of their post-tax-paid-for money, when 4.6 Billion, close to half of it, went to the Government as tax payments.
I mean, with respect to the people that paid for the opioids, the Government doesn't give that tax money they collected, that $4.6 Billion back to the opioid purchasers, does it?
Also, why is it that federal investigators seem to have no problems finding all sorts of ways that big corporate entities misspend millions of dollars -- but simultaneously overlook government misspending in the billions of dollars?
I for one (and I realize my opinion is in the minority!), think the opioid addicts should get their $4.6 Billion dollars directly back from the Government -- and in cash -- not in political promises, treatment programs, hammers, or government cheese...
You know, like give them all a "hey, you were an opioid addict and here's the money we took from you (as Sackler tax money!) back as an opiod stimulus package, an opioid stimulus check!" <g>
And yes, I realize my opinions are politically incorrect. <g>