The Family Making Billions from the Opioid Crisis(esquire.com)
esquire.com
The Family Making Billions from the Opioid Crisis
http://www.esquire.com/news-politics/a12775932/sackler-family-oxycontin/?src=longreads
258 comments
Ick! This reinforces my belief that direct-to-consumer advertising of prescription drugs should be illegal.
I'm more concerned people dragoon their doctors based on some half-incoherent Super Bowl ad. They can't possibly be convinced that's ideal for their health in most cases, but I think health insurance hides the costs of wasting your doctor's time.
(Which is to say, I wouldn't be concerned about making it illegal if it stopped being so effective.)
(Which is to say, I wouldn't be concerned about making it illegal if it stopped being so effective.)
In my experience a lot of doctors are just happy when patients take real interest in their own health, even if that particular drug isn't the best choice. Jaded by too many noncompliant patients.
That's why they advertise on Superbowl, TV shows and everywhere else. To make people think they have something and their pill can make it go away. Doctor Johnson doesn't prescribe it, another one will.
Otherwise they'd only target doctors, in their offices, trade mags and all. http://www.businessinsider.com/infographic-america-is-over-m...
Otherwise they'd only target doctors, in their offices, trade mags and all. http://www.businessinsider.com/infographic-america-is-over-m...
Are you saying it's bad when patients take an interest in their own health? Doctors aren't mind readers.
It can be. Does the average patient have a medical license, know of all the side effects...etc etc? NOPE. Ask questions of course but like buying frying pans you saw on a 4am infomercial with "Only 2 left, hurry!!!" demanding the meds you saw on tv is a bad idea.
Stats say that we're way over prescribed.
Stats say that we're way over prescribed.
I've heard this happens a lot. Plus, if the person is really adamant about getting whatever drug, the doctor knows that it's possible the patient will find a new doctor to prescribe it anyway.
Sure but medicine is a profession and doctors usually don't suffer when they lose a patient to a "competitor", so they shouldn't typically feel pressured to give a patient whatever drug they want.
I've heard that and brought that up to a doctor friend of mine at the time, and they told me that they would rather give the prescription if it won't harm the person, because it's likely the patient will go to a questionable doctor / online pharmacy and the risk might be less just to comply.
Really? The FDA did a study with physicians and they thought it was quite useful![1]
- Many physicians thought that DTC ads made their patients more involved in their health care.
- The study demonstrated that when a patient asked about a specific drug, 88 percent of the time they had the condition that the drug treated.
Of course the study showed there were problems, but it was the ads had many more positive effects than negative!
[1]https://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm14356...
- Many physicians thought that DTC ads made their patients more involved in their health care.
- The study demonstrated that when a patient asked about a specific drug, 88 percent of the time they had the condition that the drug treated.
Of course the study showed there were problems, but it was the ads had many more positive effects than negative!
[1]https://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm14356...
That's not the story I got from that study. At all.
* 58% of respondents "agreed strongly that DTC ads make the drugs seem better than they really are"
* 78% of physicians believed patients understood possible benefits, however, only 40% believe patients understood the risks involved.
* 75% of "physicians surveyed believed that DTC ads cause patients to think that the drug works better than it does"
* "physicians felt some pressure to prescribe something when patients mentioned DTC ads."
So, patients are getting more involved and asking questions, which is great, but they don't understand the risks involved, the patient misrepresents how well the drug is working for them, and the physician feels pressure to give them what they ask for.
That sort of bias is a problem, especially with on-going therapy. If a patient is being misled by DTC ads about how well they are being treated, they can't raise questions that would allow them to get even better treatment. If a physician is feeling pressured to give a drug when asked, they can't try other, sometimes more effective, therapies.
* 58% of respondents "agreed strongly that DTC ads make the drugs seem better than they really are"
* 78% of physicians believed patients understood possible benefits, however, only 40% believe patients understood the risks involved.
* 75% of "physicians surveyed believed that DTC ads cause patients to think that the drug works better than it does"
* "physicians felt some pressure to prescribe something when patients mentioned DTC ads."
So, patients are getting more involved and asking questions, which is great, but they don't understand the risks involved, the patient misrepresents how well the drug is working for them, and the physician feels pressure to give them what they ask for.
That sort of bias is a problem, especially with on-going therapy. If a patient is being misled by DTC ads about how well they are being treated, they can't raise questions that would allow them to get even better treatment. If a physician is feeling pressured to give a drug when asked, they can't try other, sometimes more effective, therapies.
Sure the patients don't understand the risks, that's what the doctor is there to explain.
I guess my point is that most people see DTC ads as completely useless and harmful overall.
The study seems to suggest there are a lot of positive benefits.
One point I didn't copy paste showed that of the 80% of patient who actually had the condition, 5% were previously undiagnosed! That means a drug ad potentially saved thei life if it was a serious disease!
I guess my point is that most people see DTC ads as completely useless and harmful overall.
The study seems to suggest there are a lot of positive benefits.
One point I didn't copy paste showed that of the 80% of patient who actually had the condition, 5% were previously undiagnosed! That means a drug ad potentially saved thei life if it was a serious disease!
The doctor explaining the risks isn't working, because of the ad.
The DTC ads aren't completely useless, but they are harmful.
A patient is unable to understand that the drug is putting them at risk. 60% of people can't see their side-effects as side-effects. So dangerous side-effects like angina and depression take longer to diagnose, leaving the patient at-risk.
A patient is showing a placebo effect, so the doctor cannot tell how well the drug is working. That means, if it's a serious disease, they might be getting worse, but are unable to identify it, and for staged illnesses, that can mean more important treatment comes too late.
Remember, self-reporting is still the primary way we convey to doctors what's happening with us. If it can't be trusted to be accurate, the doctor can't be as effective as they need to be.
The DTC ads aren't completely useless, but they are harmful.
A patient is unable to understand that the drug is putting them at risk. 60% of people can't see their side-effects as side-effects. So dangerous side-effects like angina and depression take longer to diagnose, leaving the patient at-risk.
A patient is showing a placebo effect, so the doctor cannot tell how well the drug is working. That means, if it's a serious disease, they might be getting worse, but are unable to identify it, and for staged illnesses, that can mean more important treatment comes too late.
Remember, self-reporting is still the primary way we convey to doctors what's happening with us. If it can't be trusted to be accurate, the doctor can't be as effective as they need to be.
The doctor explaining the risks isn't working, because of the ad.
Not sure I understand. The survey was asking doctors if they think patients understand the risks from seeing the ad. Doctors think they do.
But patients then need to go and talk to the doctor, who should then clarify the risks since they are the medical professional, not the patient.
If the patient then decides the risks are worth it, and the doctor thinks the drug will help, the doctor writes a prescription.
Not sure I understand. The survey was asking doctors if they think patients understand the risks from seeing the ad. Doctors think they do.
But patients then need to go and talk to the doctor, who should then clarify the risks since they are the medical professional, not the patient.
If the patient then decides the risks are worth it, and the doctor thinks the drug will help, the doctor writes a prescription.
> Not sure I understand. The survey was asking doctors if they think patients understand the risks from seeing the ad. Doctors think they do.
Plainly, you read a different study than I.
This direct quote, directly disagrees with you:
> Seventy-eight percent of physicians believe their patients understand the possible benefits of the drug very well or somewhat, compared to 40 percent who believe their patients understand the possible risks, and 65 percent believe DTC ads confuse patients about the relative risks and benefits of prescription drugs.
Again, that means:
* 60% of doctors believe patients do not understand possible risks.
* 65% of doctors believe DTC ads confuse patients about risks and benefits.
Doctors do not believe that patients understand risks from seeing the ad.
> If the patient then decides the risks are worth it, and the doctor thinks the drug will help, the doctor writes a prescription.
Again, the study disagrees with your conclusions here. Here's another direct quote:
> and many physicians felt some pressure to prescribe something when patients mentioned DTC ads.
The doctor feels the need to prescribe it, based purely on the fact that the patient mentioned an ad. The doctor may or may not think the risks are worth it, but they feel the need to sign off on any drug simply because the patient saw an ad.
> But patients then need to go and talk to the doctor, who should then clarify the risks since they are the medical professional, not the patient.
And more than half of patients are turning up to doctors, confused about the benefits and risks of the drug they saw in an ad. The doctor tries to clarify the risks, but feel the need to give something to the patient anyway.
The only benefit of the advert here, is that they are actually talking to a doctor. But they don't understand the benefits of the drug, and they don't understand the risks of the drug, they just want something they saw on TV.
Plainly, you read a different study than I.
This direct quote, directly disagrees with you:
> Seventy-eight percent of physicians believe their patients understand the possible benefits of the drug very well or somewhat, compared to 40 percent who believe their patients understand the possible risks, and 65 percent believe DTC ads confuse patients about the relative risks and benefits of prescription drugs.
Again, that means:
* 60% of doctors believe patients do not understand possible risks.
* 65% of doctors believe DTC ads confuse patients about risks and benefits.
Doctors do not believe that patients understand risks from seeing the ad.
> If the patient then decides the risks are worth it, and the doctor thinks the drug will help, the doctor writes a prescription.
Again, the study disagrees with your conclusions here. Here's another direct quote:
> and many physicians felt some pressure to prescribe something when patients mentioned DTC ads.
The doctor feels the need to prescribe it, based purely on the fact that the patient mentioned an ad. The doctor may or may not think the risks are worth it, but they feel the need to sign off on any drug simply because the patient saw an ad.
> But patients then need to go and talk to the doctor, who should then clarify the risks since they are the medical professional, not the patient.
And more than half of patients are turning up to doctors, confused about the benefits and risks of the drug they saw in an ad. The doctor tries to clarify the risks, but feel the need to give something to the patient anyway.
The only benefit of the advert here, is that they are actually talking to a doctor. But they don't understand the benefits of the drug, and they don't understand the risks of the drug, they just want something they saw on TV.
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As it is in many if not most G7 countries.
It is nearly everywhere. New Zealand, USA and Brazil allow it.
If its allowed in NZ, its rare, and limited to headache medicince, asthma remedies and the like.
I'm always astonised when I'm in the US at the medical ads on TV. It seems bizarre that companies target advertising at the consumer for products that should really be selected on their behalf by a medical professional.
And those disclaimer/warning crack me up.
I'm always astonised when I'm in the US at the medical ads on TV. It seems bizarre that companies target advertising at the consumer for products that should really be selected on their behalf by a medical professional.
And those disclaimer/warning crack me up.
It’s not rare at all and it’s for a lot more than just the medications described. I can recall erectile dysfunction drugs, anti depressants, pains medications and other miscellaneous drugs. The “Family Health Diary” segment of TV was a particularly perverse one. This article below (which is long) covers the issues well.
https://www.nzma.org.nz/journal/read-the-journal/all-issues/...
That's amazing, I need to watch TV more. Have never seen any of those.
Are you saying the ideal state is when physicians are the sole keepers of all medical knowledge? Patients couldn't possibly play a role in their own health?
There is plenty of good evidence on the downsides of direct to consumer drug advertising and the link I provided to the parent covers the issues well. No one thinks patients shouldn’t be informed, it’s how they get informed that matters.
Advertising is the only source of medical knowledge?
News to me. ;-)
News to me. ;-)
No, I didn't say either of those things.
That's not a long list of countries.
It's illegal nearly everywhere.
Yea, I mean if it's only 3 out of ~194 that's a short list.
https://en.wikipedia.org/wiki/Direct-to-consumer_advertising adds Hong Kong, and that's it.
https://en.wikipedia.org/wiki/Direct-to-consumer_advertising adds Hong Kong, and that's it.
As disgusting as this story is, freedom of speech isn't a freedom if it magically disappears because a collection of people say it instead of a single person. I'd much rather have a raucous marketplace of ideas and opinions that let people choose for themselves, over having the government make their medical decisions.
For example, thousands of deaths have been attributed to the tough drug approval requirements in the US. How would you feel if you had a terminal condition and your government didn't allow you to even know of a possible treatment, or the choice of taking the risk that the treatment won't work?
For example, thousands of deaths have been attributed to the tough drug approval requirements in the US. How would you feel if you had a terminal condition and your government didn't allow you to even know of a possible treatment, or the choice of taking the risk that the treatment won't work?
Deliberate deception is not protected speech. These people deliberately lied and created the most lethal epidemic of drug abuse in our country’s history. Don’t defend their right to do it. You cheapen the notion of free speech when you do.
Fraud is not protected speech. If these people committed fraud they should be prosecuted. But outside that, stop interfering in my right to hear what they have to say.
> stop interfering in my right to hear what they have to say.
You still have every right to go to them and ask what they have to say.
You still have every right to go to them and ask what they have to say.
Let's not confuse the issue by taking about freedom of speech, at least without acknowledging that the rules for commercial speech have always been different (and much stricter).
I don't really know anyone who thinks "Remember the good old days when cigarette ads were on TV?" (that was a thing). Prescription ads on TV are a relatively recent thing anyway (really 1995 in the US), one in which a powerful lobbying group used their money and influence to help write the rules.
I don't really know anyone who thinks "Remember the good old days when cigarette ads were on TV?" (that was a thing). Prescription ads on TV are a relatively recent thing anyway (really 1995 in the US), one in which a powerful lobbying group used their money and influence to help write the rules.
The US Constitution does not treat "commercial speech" any differently than personal speech. The US Supreme court did, and it's rulings on the subject are politically biased and clearly wrong (the first made while under threat of court packing by FDR). US Court of Appeals judge Alex Kozinski stated, in regard to the 1942 ruling, "the Supreme Court plucked the commercial speech doctrine out of thin air"
Many people remember the good old days when individual rights and limits on the federal government were enforced closer to US Constitutional requirements.
Many people remember the good old days when individual rights and limits on the federal government were enforced closer to US Constitutional requirements.
How would you feel if your doctor gave you thalidomide to treat anxiety, and you ended up with a deformed baby as a result, because the raucous marketplace cared more about moving drugs than patient safety?
How would you feel if there was a drug that could save your child’s life, but you and your doctor were not allowed to be made aware of it?
And since Thalidomide hundreds of thousands of Americans have died from slow drug approvals.
And since Thalidomide hundreds of thousands of Americans have died from slow drug approvals.
Where is this dystopia of forbidden trade advertising to doctors and pharmacists? Advertising for drugs seeks to mediate the doctor's expertise and knowledge. "Hey what does it hurt if people have information?" It's not the information, it's putting in the hands of unqualified people in an area where qualified people are the best judges. I'm not limiting this to Western MDs or anything like that, there's just really no use in patients asking about xeljanz or whatever it's called. If anything, it causes ailments by suggestion. Not hypochondria per se, but something, and induced.
Beyond this, I'm too lazy right now to look up drug company kickbacks to prescribing doctors, and I'm sure there's plenty, but it would probably still occur even if mass media advertising was banned.
Beyond this, I'm too lazy right now to look up drug company kickbacks to prescribing doctors, and I'm sure there's plenty, but it would probably still occur even if mass media advertising was banned.
I feel like the push to TV advertising and advertising to patients started after regulations slowing drug companies from taking doctors on vacations (think country clubs, hotels, cruises, golf) and working on them directly.
I remember when all sorts of pens, mugs, and all that would be given out with drug names on it, and then my doctor would end up giving it to me.
https://well.blogs.nytimes.com/2008/07/11/for-doctors-no-mor...
http://www.chron.com/news/houston-texas/article/New-rules-ba...
The purpose and the money don't go away, the means just move around.
I remember when all sorts of pens, mugs, and all that would be given out with drug names on it, and then my doctor would end up giving it to me.
https://well.blogs.nytimes.com/2008/07/11/for-doctors-no-mor...
http://www.chron.com/news/houston-texas/article/New-rules-ba...
The purpose and the money don't go away, the means just move around.
> ... Medical Advertising Hall of Fame...
Same thing for political candidates. Apparently Obama won advertiser of the year in 2008:
http://adage.com/article/moy-2008/obama-wins-ad-age-s-market...
Beating Nike, Apple, and Coors
Same thing for political candidates. Apparently Obama won advertiser of the year in 2008:
http://adage.com/article/moy-2008/obama-wins-ad-age-s-market...
Beating Nike, Apple, and Coors
I hadn't heard of Rozerem, so I looked it up.
"It however does not appear to speed the onset of sleep or the amount of sleep a person gets."
https://en.wikipedia.org/wiki/Ramelteon
"It however does not appear to speed the onset of sleep or the amount of sleep a person gets."
https://en.wikipedia.org/wiki/Ramelteon
The Sacklers have ingratiated themselves at the highest levels of society using a fortune that's at best built on a product of dubious value, and at worst obtained at the cost of the lives of tens of thousands of people. I think this piece points to a big problem: we worship money and those that accumulate it, and often ignore the question of how much societal value was created in exchange for it. The least we can collectively do is not confer status and prestige upon those who make money in a destructive way. I love the line of inquiry in this piece because it puts pressure on the high-society keepers-of-culture whose admiration the Sacklers likely most crave.
FYI you can also see an interview with the author on Democracy Now: https://www.democracynow.org/2017/10/19/who_profits_from_the...
(disclaimer: I am friends with the author)
FYI you can also see an interview with the author on Democracy Now: https://www.democracynow.org/2017/10/19/who_profits_from_the...
(disclaimer: I am friends with the author)
They achieved what Escobar couldn't: respectability on a mountain of skulls.
I definitely don't wanna play devils advocate for these scumbags, but can't you apply your logic to basically any product? I mean, Coca-Cola. Its at best product of dubious value, and at worst produced for the need for sugar by tens of thousands of people.
Not sure how deliberate your example was, but you can't hardly beat Coca Cola as a damaging influence on society. Coca Cola spends millions on propaganda disguised as research, designed to convince people that their product is not a health hazard. They're no better than the big tobacco companies.
And let's not forget that the sugar industry as a whole has done this on a vast scale over decades, bribing scientists and funding shoddy research in order to encourage abusive consumption of the substances they promote [2].
I don't think it's at all controversial to state that the sugar industry has cost millions of Americans their health or their lives.
1 - https://arstechnica.com/science/2016/12/the-food-industry-is...
2 - https://arstechnica.com/science/2016/09/sugar-industry-bough...
And let's not forget that the sugar industry as a whole has done this on a vast scale over decades, bribing scientists and funding shoddy research in order to encourage abusive consumption of the substances they promote [2].
I don't think it's at all controversial to state that the sugar industry has cost millions of Americans their health or their lives.
1 - https://arstechnica.com/science/2016/12/the-food-industry-is...
2 - https://arstechnica.com/science/2016/09/sugar-industry-bough...
We have been too kind to the Coca Cola brand. We tell ourselves that Coca Cola started out as the product we know and love but originally there just so happened to be trace amounts of cocaine in there. These would have been harmless quantities, not likely to have any type of effect. This is the quaint legend we have arrived at.
However.
Coca Cola started as a sugary drink laced with cocaine. Much like how beer has alcohol in it to keep you buying more, Coca Cola had that magically addictive cocaine in it to keep customers coming back for more.
The name 'Coca Cola' is a celebration of this history, really there is no more insane an idea than getting a nation hooked on class A drugs in liquid form. The name and the connotations would make a right minded person want to be disassociated from that.
In theory a 'crack pipe' could be re-purposed as a nice little vase suitable for a small child to play with. But that would make you shudder. So why is it that we are happy to have this denatured liquid cocaine drink as something we give to children? We could at least change the branding, drop the 'coke' and 'coca-' drug references. With allusions to it being the real thing?
When original Coca Cola got closed down and they had to reformulate their marketing they realised that they could do just as well getting people hooked to sugary drinks laced with caffeine and salt, the cocaine wasn't actually needed to shift product. Or even the sugar, fake sweeteners work too, perhaps even more addictively. Maybe it is the marketing that is the problem and not the product ingredients. They can even get the water hooked into buying plain bottled water, something that was never bought back in the days when tap water was a luxury.
However.
Coca Cola started as a sugary drink laced with cocaine. Much like how beer has alcohol in it to keep you buying more, Coca Cola had that magically addictive cocaine in it to keep customers coming back for more.
The name 'Coca Cola' is a celebration of this history, really there is no more insane an idea than getting a nation hooked on class A drugs in liquid form. The name and the connotations would make a right minded person want to be disassociated from that.
In theory a 'crack pipe' could be re-purposed as a nice little vase suitable for a small child to play with. But that would make you shudder. So why is it that we are happy to have this denatured liquid cocaine drink as something we give to children? We could at least change the branding, drop the 'coke' and 'coca-' drug references. With allusions to it being the real thing?
When original Coca Cola got closed down and they had to reformulate their marketing they realised that they could do just as well getting people hooked to sugary drinks laced with caffeine and salt, the cocaine wasn't actually needed to shift product. Or even the sugar, fake sweeteners work too, perhaps even more addictively. Maybe it is the marketing that is the problem and not the product ingredients. They can even get the water hooked into buying plain bottled water, something that was never bought back in the days when tap water was a luxury.
I think we all can and should apply our values towards judging companies' usefulness to society. That doesn't mean regulating or prosecuting them - moral clarity goes a long way on its own. People work hard to be held in high esteem by their peers: when we refuse to honor a useless company with prestige, it makes it harder for that company to attract talent; it reduces consumer demand for its products; it makes vendors less excited to work with them. etc. We get companies and products that reflect our values, so let's affirm the right values.
To take your example: Coca-Cola doesn't kill people as efficiently as Oxycontin, but yes, it doesn't really add much. A balanced analysis would probably acknowledge that sugar plays a huge role in our obesity crisis and other public health issues, but also acknowledge that there are many sources of sugar besides soft drinks, that sugar isn't as terrible as heroin, etc. I think Coca-Cola executives should probably feel a little bad for devoting their professional lives to it. I think schools like Emory should feel a little ashamed for taking Coca-Cola money. The fact that Coca-Cola is constantly touted as a great American company (by e.g. Warren Buffett) helps normalize the damage it inflicts on society.
I'd advocate a nuanced view: Coca-Cola isn't great, but it's not the devil. There's worse (like tobacco companies, which are probably correctly rated by society). And there's better (Bank of America, Microsoft) - those companies have their own detractors of course, but on balance they add a lot more to our lives than Coca-Cola.
To take your example: Coca-Cola doesn't kill people as efficiently as Oxycontin, but yes, it doesn't really add much. A balanced analysis would probably acknowledge that sugar plays a huge role in our obesity crisis and other public health issues, but also acknowledge that there are many sources of sugar besides soft drinks, that sugar isn't as terrible as heroin, etc. I think Coca-Cola executives should probably feel a little bad for devoting their professional lives to it. I think schools like Emory should feel a little ashamed for taking Coca-Cola money. The fact that Coca-Cola is constantly touted as a great American company (by e.g. Warren Buffett) helps normalize the damage it inflicts on society.
I'd advocate a nuanced view: Coca-Cola isn't great, but it's not the devil. There's worse (like tobacco companies, which are probably correctly rated by society). And there's better (Bank of America, Microsoft) - those companies have their own detractors of course, but on balance they add a lot more to our lives than Coca-Cola.
It's not clear that Coca Cola is just "any product". I think the "at worst" part of your characterization of it is actually right on. It can be argued that the damage inflicted on society by excessive sugar consumption, of which Coca Cola is a most prominent promoter and beneficiary, is much larger than that caused by opioids (which is already huge).
Coca Cola and its business associates are involved in actually killing people with guns so you can add that to their 'passive body counts.
http://killercoke.org/
http://killercoke.org/
>>and at worst produced for the need for sugar by tens of thousands of people.
I think you mean the want for sugar. Because humans don't need sugar.
I think you mean the want for sugar. Because humans don't need sugar.
What should humans have instead of sugar?
Fat, Animal fat, Plant fat. Fat and a little bit of protein.
There is no dietary need for sugar or carbohydrates at all, your body is capable of making the tiny amount it needs through the process of gluconeogenesis. Research the Ketogenic diet.
There is no dietary need for sugar or carbohydrates at all, your body is capable of making the tiny amount it needs through the process of gluconeogenesis. Research the Ketogenic diet.
Humans mostly don't eat sweet stuff for calorific or nutritional purposes. Rather I think they enjoy puddings, cakes, chocolate, and so on, for psychological reasons (comfort, pleasure) as well as for cultural reasons. So my question remains. What should they substitute to maintain an even mental keel? What should should be served or otherwise laid on at social gatherings that yields equivalent cheer and can be passed down from grandmother to grandaughter?
Complex carbs?
Thank the government for granting them monopoly rights.
I can hate both the player and the game, thanks.
Especially a game that the players have a hand in rigging in their favour as hard as they can.
Especially a game that the players have a hand in rigging in their favour as hard as they can.
[deleted]
Money can travel - your reputation, not so much. China has a solution, a social score that travels with you everywhere. Dystopian, but it could cure that worship of money thing.
China doesn't have a solution at all. They've unleashed one of the greatest money & wealth rushes ever seen, at the simultaneous cost of taking on the fastest large accumulation of debt in history.
Have you seen their asset manias from the last decade? Who worships money more than the Chinese these days?
Have you seen their asset manias from the last decade? Who worships money more than the Chinese these days?
I think you missed the word "dystopian."
Except that score is calculated on factors such as your loyalty to the government.
Every society has a fitness function. Why not make the code public? In China one is loyal to "the party", in the US one has to be loyal to "the parties". I don't see a large distinction.
Meh. Don't like your reputation? Just sift through the Equifax dump and pick a new one.
It should simply be illegal to advertise prescription medications.
"Ask your doctor about Klonopin today"
"Ask your doctor about coronary artery bypass grafting today"
One of these sounds completely ridiculous, and the other sounds commonplace. They should both sound ridiculous, because they're both equally completely ridiculous.
The idea that the patient should be influencing the treatment decisions of medical professionals based on things they saw on television is just absurd. It should be illegal. Doctors are all complicit in it, that should be considered medical malpractice, but doctors are put in an impossible position on this stuff and I understand why they do it.
Healthcare in general is just such a goddamn mess. There are so many completely obvious ways to improve it, but it's impossible to implement any of them, and in the meantime people just keep losing their loved ones early to all the inefficiencies and waste and stupidity.
And all the politicians just want to get their stamp on it to show their constituency how caring and benevolent they are, but they're politicians so all they're actually capable of doing is fucking everything up. So they all just keep grandstanding and fucking everything up and it just gets worse and worse every year.
"Ask your doctor about Klonopin today"
"Ask your doctor about coronary artery bypass grafting today"
One of these sounds completely ridiculous, and the other sounds commonplace. They should both sound ridiculous, because they're both equally completely ridiculous.
The idea that the patient should be influencing the treatment decisions of medical professionals based on things they saw on television is just absurd. It should be illegal. Doctors are all complicit in it, that should be considered medical malpractice, but doctors are put in an impossible position on this stuff and I understand why they do it.
Healthcare in general is just such a goddamn mess. There are so many completely obvious ways to improve it, but it's impossible to implement any of them, and in the meantime people just keep losing their loved ones early to all the inefficiencies and waste and stupidity.
And all the politicians just want to get their stamp on it to show their constituency how caring and benevolent they are, but they're politicians so all they're actually capable of doing is fucking everything up. So they all just keep grandstanding and fucking everything up and it just gets worse and worse every year.
The idea that the patient should be influencing their own treatment decisions is absurd?
The idea that the patient should be influencing treatment BASED ON WHAT THEY SAW ON TV is absurd.
It's like you didn't even read what you responded to. What is this, reddit?
It's like you didn't even read what you responded to. What is this, reddit?
How do you think people get informed? Do you really think that advertising isn't useful to informing people? Do you really think as many patients would find out about viable treatments for their conditions if you ban advertising?
Advertising isn't hypnosis. People know not to take claims at face value and if they don't, US medical ads are full of disclaimers and warnings. And once you see an ad for a treatment, you have many opportunities to research it, including by discussing it with your doctor.
Do you really think doctors alone should decide your treatment?
My mother in law had terminal brain cancer. She could not eat due nausea from her chemotherapy. I accompanied her on a visit to her doctor. We told him the anti-nausea prescription wasn't working, and I asked why he didn't prescribe her medicinal marijuana. He angrily rejected it as a viable treatment and huffily said he'd change her prescription to a different anti-nausea medication. Shortly later she went on the last trip of her life, to Arizona for some sun and relaxation, but her nausea was so bad that she threw up in the airport and had to return home, where she died in bed a few months later, a 60 lb bundle of bones from barely eating for months on end.
If you want to be protected from "advertising", change the channel. I don't, so stop trying to "protect" me by restricting my right to listen to other viewpoints.
Advertising isn't hypnosis. People know not to take claims at face value and if they don't, US medical ads are full of disclaimers and warnings. And once you see an ad for a treatment, you have many opportunities to research it, including by discussing it with your doctor.
Do you really think doctors alone should decide your treatment?
My mother in law had terminal brain cancer. She could not eat due nausea from her chemotherapy. I accompanied her on a visit to her doctor. We told him the anti-nausea prescription wasn't working, and I asked why he didn't prescribe her medicinal marijuana. He angrily rejected it as a viable treatment and huffily said he'd change her prescription to a different anti-nausea medication. Shortly later she went on the last trip of her life, to Arizona for some sun and relaxation, but her nausea was so bad that she threw up in the airport and had to return home, where she died in bed a few months later, a 60 lb bundle of bones from barely eating for months on end.
If you want to be protected from "advertising", change the channel. I don't, so stop trying to "protect" me by restricting my right to listen to other viewpoints.
> Do you really think doctors alone should decide your treatment?
Yes. Not necessarily one doctor, or even two doctors. Get a second opinion, or just switch your doctor if you don't like them.
The alternative of letting profiteers peddling medicine influence a poorly educated populace is most unfortunate.
Yes. Not necessarily one doctor, or even two doctors. Get a second opinion, or just switch your doctor if you don't like them.
The alternative of letting profiteers peddling medicine influence a poorly educated populace is most unfortunate.
Just because some might not use freedom wisely doesn’t mean it should be denied to anyone.
> use freedom wisely
How many would claim that getting a 200M drug ad campaign qualifies? Hell, I watch a drug ad and it is all life style and vibe. Shots off my golf score! Luxury Yachts! Happy, Well Adjusted Grand Kids!
How many would claim that getting a 200M drug ad campaign qualifies? Hell, I watch a drug ad and it is all life style and vibe. Shots off my golf score! Luxury Yachts! Happy, Well Adjusted Grand Kids!
Try talking to a few doctors. They would love it if their patients took an active role in their own health.
In fact, I'd goes as far as saying relying 100% on your doctor for your health decisions is pretty stupid.
In fact, I'd goes as far as saying relying 100% on your doctor for your health decisions is pretty stupid.
What do you mean? The purple pill looks like fun!
I was on Oxy for about a month after smashing one of my vertibraes into pieces in a climbing accident, I was prescribed more than three times as much. I walked through hell to get out of that crap; nothing else I've encountered even comes close, including heroine and cocaine. There are several natural, less addictive and less harmful methods for treating chronic pain; cannabis, mushrooms and meditation among others. Pharma is all about creating return customers; profits, at any cost; the people involved in creating this mess have some serious karma to deal with in the near future.
Perdue Pharma, the producer of Oxy, is basically making half of its customers into drug addicts by lying about "12-hours" of "effective" pain relief.
The LA Times ran an investigation into Perdue Pharma's claim[1] and the article is incredibly disturbing. This is the killer quote:
> "More than half of long-term OxyContin users are on doses that public health officials consider dangerously high, according to an analysis of nationwide prescription data conducted for The Times."
Perdue Pharma has been lying about the 12-hour pain relief effect for decades. They wanted to dominate the 12-hour pain relief market. Whenever a doctor prescribed for a smaller interval of time, Perdue screamed bloody murder and sought to "refocus" doctors at all cost on the "12-hour rule" to ensure the drug stays in the 12-hour market share. To "refocus" doctors, Perdue Pharma tells doctors to prescribe stronger doses, rather than more frequent ones, and this leads to serious problems with reliance.
[1]: http://www.latimes.com/projects/oxycontin-part1/
The LA Times ran an investigation into Perdue Pharma's claim[1] and the article is incredibly disturbing. This is the killer quote:
> "More than half of long-term OxyContin users are on doses that public health officials consider dangerously high, according to an analysis of nationwide prescription data conducted for The Times."
Perdue Pharma has been lying about the 12-hour pain relief effect for decades. They wanted to dominate the 12-hour pain relief market. Whenever a doctor prescribed for a smaller interval of time, Perdue screamed bloody murder and sought to "refocus" doctors at all cost on the "12-hour rule" to ensure the drug stays in the 12-hour market share. To "refocus" doctors, Perdue Pharma tells doctors to prescribe stronger doses, rather than more frequent ones, and this leads to serious problems with reliance.
[1]: http://www.latimes.com/projects/oxycontin-part1/
Relevant excerpts from the linked article:
> when it doesn’t last, patients can experience excruciating symptoms of withdrawal, including an intense craving for the drug.
> Even before OxyContin went on the market, clinical trials showed many patients weren’t getting 12 hours of relief.
> OxyContin’s market dominance and its high price — up to hundreds of dollars per bottle — hinge on its 12-hour duration. Without that, it offers little advantage over less expensive painkillers.
> Purdue tells doctors to prescribe stronger doses, not more frequent ones, when patients complain that OxyContin doesn’t last 12 hours.
> Research shows that the more potent the dose of an opioid such as OxyContin, the greater the possibility of overdose and death.
> when it doesn’t last, patients can experience excruciating symptoms of withdrawal, including an intense craving for the drug.
> Even before OxyContin went on the market, clinical trials showed many patients weren’t getting 12 hours of relief.
> OxyContin’s market dominance and its high price — up to hundreds of dollars per bottle — hinge on its 12-hour duration. Without that, it offers little advantage over less expensive painkillers.
> Purdue tells doctors to prescribe stronger doses, not more frequent ones, when patients complain that OxyContin doesn’t last 12 hours.
> Research shows that the more potent the dose of an opioid such as OxyContin, the greater the possibility of overdose and death.
From my perspective, OxyContin is obviously designed to be as addictive as possible; and they have been lying all along. These people are not fully functioning humans, they will do whatever it takes to generate more profits. I promised myself to never touch their artificial crap again; if it doesn't grow on the ground, I'm not interested.
Medication is thruroughly tested and there are plenty of good painkillers that aren't as addictive. Many are synthetic of course, and still have known side effects.
The evil here isn't that the drug is addictive but that doctors and pharmaceutical companies prescribe it despite the known side effects. It's almost unheard of outside the US.
The evil here isn't that the drug is addictive but that doctors and pharmaceutical companies prescribe it despite the known side effects. It's almost unheard of outside the US.
They're tested by the same psychos that created the drugs and their bought fan club, otherwise things like Oxy would never have made it to market. It's worth repeating, big pharma is all about creating return customers; nothing that comes out of that mess is ever going to solve problems.
If it was the case that these people somehow rigged the testing to make it seem less harmful (which isn't that far fetched), then that would be the scandal. But it isn't. This is known, even in the US.
This thing is known to be this addictive. That's basically only prescribed in exceptional cases elsewhere in the world. Basically it's not prescribed to otherwise healthy people who only suffer from pain (back pains, surgery pains etc). It's only prescribed to terminally ill people. Because it's better to use a slightly less potent painkiller and be in slightly more pain, than to be addicted to an opioid.
This thing is known to be this addictive. That's basically only prescribed in exceptional cases elsewhere in the world. Basically it's not prescribed to otherwise healthy people who only suffer from pain (back pains, surgery pains etc). It's only prescribed to terminally ill people. Because it's better to use a slightly less potent painkiller and be in slightly more pain, than to be addicted to an opioid.
So what does that say about the medical practitioners on the front lines prescribing this shit at these insane levels? Hippocratic oath means nothing? Kickbacks from the pharma companies too sweet to ignore?
You do realize that if Purdue talked about any other dosing regimen other than 12 hours that would be illegal off-label promotion right?
In Arizona big pharma was the biggest contributor to the campaign to defeat marijuana legalization.
Links, sources, please.
One example.
http://www.phoenixnewtimes.com/news/sheila-polk-anti-prop-20...
$500k is a huge amount in Arizona politics.
http://www.phoenixnewtimes.com/news/sheila-polk-anti-prop-20...
$500k is a huge amount in Arizona politics.
Still amazed that US doctors prescribe oxycontin to patients that aren't suffering from late stage cancer pain and other conditions where addiction isn't really an issue.
I think the benefits of oxycontin for acute pain are highly contentious.
For advanced cancer pain, oxycontin is effective and the rates of addiction are very low. Patients can't wait to get off it usually if the pain improves. There are likely to be many physiological and psychological factors explaining these differences.
For advanced cancer pain, oxycontin is effective and the rates of addiction are very low. Patients can't wait to get off it usually if the pain improves. There are likely to be many physiological and psychological factors explaining these differences.
I'd really like to see some citations for your statement that patients with advanced cancer pain "can't wait to get off" of their opiods "if the pain improves."
"Advanced cancer pain" and "pain improves" [to a level where withdrawal seems like a good idea] seem like things that rarely go together. I could see people getting off of oxycontin to go onto stronger painkillers in hospice, but that feels like a very different thing to me.
"Advanced cancer pain" and "pain improves" [to a level where withdrawal seems like a good idea] seem like things that rarely go together. I could see people getting off of oxycontin to go onto stronger painkillers in hospice, but that feels like a very different thing to me.
Advanced cancer is treatable of course! The median survival for some types of advanced breast cancer is 7 years from diagnosis. Those patients may present with pain, start treatment, and get better. Happens all the time.
As for a citation, well nobody has done a study on that specific point, I'm talking from my experience of 500 or so patients.
As for a citation, well nobody has done a study on that specific point, I'm talking from my experience of 500 or so patients.
Also kratom
Why not just go back to prescribing cocaine instead of Oxy?
Very good write-up from Esquire, I'm thoroughly impressed with the article.
That said, my visceral emotional response is strongly negative especially when reading the following paragraph:
>In May, a dozen lawmakers in Congress, inspired by the L.A. Times investigation, sent a bipartisan letter to the World Health Organization warning that Sackler-owned companies were preparing to flood foreign countries with legal narcotics. “Purdue began the opioid crisis that has devastated American communities,” the letter reads. “Today, Mundipharma is using many of the same deceptive and reckless practices to sell OxyContin abroad.” Significantly, the letter calls out the Sackler family by name, leaving no room for the public to wonder about the identities of the people who stood behind Mundipharma.
That said, my visceral emotional response is strongly negative especially when reading the following paragraph:
>In May, a dozen lawmakers in Congress, inspired by the L.A. Times investigation, sent a bipartisan letter to the World Health Organization warning that Sackler-owned companies were preparing to flood foreign countries with legal narcotics. “Purdue began the opioid crisis that has devastated American communities,” the letter reads. “Today, Mundipharma is using many of the same deceptive and reckless practices to sell OxyContin abroad.” Significantly, the letter calls out the Sackler family by name, leaving no room for the public to wonder about the identities of the people who stood behind Mundipharma.
In the Massachusetts episode of Parts Unknown, Bourdain talks to a general physician who explains how patients who were administered OxyContin for routine procedures & injuries quickly developed a habit for the drug and when they couldn't find it post-treatment moved to illegal variants like Heroin and now Fentanyl.[1][2]
Bourdain travels to Franklin County to explore the heroin epidemic that’s spreading throughout this and other New England towns.[1]
Dr. Ruth Potee of Greenfield, Massachusetts talks about how they were taught in their residency that their ER / Hospital performance was tied to their pain scores and the generous administration of pain medication to patients.[1][2]
Purdue Pharmaceuticals promotion from 1996 can also be seen.
[1] Video - Parts Unknown - Massachusetts
https://archive.org/details/AnthonyBourdainPartsUnknownMassa...
22:16 Purdue Pharmaceuticals Promotion from 1996
25:10 Dr. Ruth Potee of Greenfield, Massachusetts
[2] Transcript - Parts Unknown - Massachusetts -- CNN
http://transcripts.cnn.com/TRANSCRIPTS/1502/20/abpu.01.html
Edit: Another link to the same Parts Unknown - Massachusetts video
http://www.dailymotion.com/video/x58d4ci
Bourdain travels to Franklin County to explore the heroin epidemic that’s spreading throughout this and other New England towns.[1]
Dr. Ruth Potee of Greenfield, Massachusetts talks about how they were taught in their residency that their ER / Hospital performance was tied to their pain scores and the generous administration of pain medication to patients.[1][2]
Purdue Pharmaceuticals promotion from 1996 can also be seen.
[1] Video - Parts Unknown - Massachusetts
https://archive.org/details/AnthonyBourdainPartsUnknownMassa...
22:16 Purdue Pharmaceuticals Promotion from 1996
25:10 Dr. Ruth Potee of Greenfield, Massachusetts
[2] Transcript - Parts Unknown - Massachusetts -- CNN
http://transcripts.cnn.com/TRANSCRIPTS/1502/20/abpu.01.html
Edit: Another link to the same Parts Unknown - Massachusetts video
http://www.dailymotion.com/video/x58d4ci
> ER / Hospital performance was tied to their pain scores and the generous administration of pain medication to patients...
Trace back how these performance metrics were chosen, look in history if there was any advocacy or studies funded by Sackler-controlled/-influenced parties to tilt the selection of performance measurements towards subjective pain "scoring". It would be interesting to find out if Arthur's insight of nebulous broad applications was generalized to pushing for these kinds of metrics.
After reading how Epipen configured a de facto monopoly, I've wondered where else this kind of corporate behavior shows up within our economic landscape. None of it breaks any laws, but I have to wonder if anyone involved regrets the consequences engendered.
Trace back how these performance metrics were chosen, look in history if there was any advocacy or studies funded by Sackler-controlled/-influenced parties to tilt the selection of performance measurements towards subjective pain "scoring". It would be interesting to find out if Arthur's insight of nebulous broad applications was generalized to pushing for these kinds of metrics.
After reading how Epipen configured a de facto monopoly, I've wondered where else this kind of corporate behavior shows up within our economic landscape. None of it breaks any laws, but I have to wonder if anyone involved regrets the consequences engendered.
That more about managed care and managing ER outcomes like help desk tickets. The old fee for service models are going away as costs increase.
Medicare and Medicaid HMOs pay for “results”, not visits. So you need to either get admitted or get the hell out and don’t come back to the ERir they lose revenue.
Medicare and Medicaid HMOs pay for “results”, not visits. So you need to either get admitted or get the hell out and don’t come back to the ERir they lose revenue.
And to top it off, they've even purchased/negotiated prosecutorial immunity:
The Sacklers, though, will likely emerge untouched: Because of a sweeping non-prosecution agreement negotiated during the 2007 settlement, most new criminal litigation against Purdue can only address activity that occurred after that date. Neither Richard nor any other family members have occupied an executive position at the company since 2003.
The Sacklers, though, will likely emerge untouched: Because of a sweeping non-prosecution agreement negotiated during the 2007 settlement, most new criminal litigation against Purdue can only address activity that occurred after that date. Neither Richard nor any other family members have occupied an executive position at the company since 2003.
Brilliant. Who says lawyers aren't worth the money?
which part bothers you?
There's a hypocrisy intrinsic in claiming that OxyContin is too dangerously addictive to go generic but still pushing it in under-saturated markets. It's the disregard of human life/experience innate in this line of behavior.
I don't think you cited the portion of the article you intended to. Your whole comment is confusing.
Aren’t the doctors to blame for this as well? It always surprised me how quickly and easily they prescribe serious painkillers. A few years ago I had a tooth pulled, and the doctor gave me prescription painkiller. In the end, I ended up using regular ibuprofen, and that was more than enough.
I wonder how much of this comes pharmaceutical sales reps pressuring the doctors to use their medicine. That whole system seems broken and unethical to me.
I wonder how much of this comes pharmaceutical sales reps pressuring the doctors to use their medicine. That whole system seems broken and unethical to me.
I've had a couple of surgeries. Honestly, ibuprofen worked better because it dealt more directly with the inflammation. The oxy was more fun in the sense that I didn't care about the pain as much, but after the prescription ran out, I won't lie - I wanted more. The story ends there, fortunately. Seeing what's going on now, I won't even fill another prescription for it if I'm ever given one.
I really wish they'd take a harder look at referring patients to cannabis. I'm not one of those people that thinks its entirely without side effects or that it's a cure for everything, but it seems like it'd be a lower risk alternative for at least some kinds of pain.
I really wish they'd take a harder look at referring patients to cannabis. I'm not one of those people that thinks its entirely without side effects or that it's a cure for everything, but it seems like it'd be a lower risk alternative for at least some kinds of pain.
A decade ago there was a giant push in the media government, and hospital administrations calling doctors heartless for not prescribing more painkillers. Hours of mandatory classes on using opioids in all sorts of situations. Exposes on chronic pain patients made to suffer.
This isn't really something that happened behind closed doors with drug reps. There was a concerted public effort to change the culture in medicine.
This isn't really something that happened behind closed doors with drug reps. There was a concerted public effort to change the culture in medicine.
about 5-6 years ago, my wife had a small eye problem and we went to a local urgent care clinic. resolved the problem, but it was still inflamed and had some discomfort. the physician offered to write a prescription for either oxy or hydrocodone. (I can't remember which). "No, I'll be OK" my wife said. "Well, here, take this anyway", and she gave us a prescription for... 7 days of the stuff (IIRC).
2 years ago, both urgent care clinics in our town had signs out front saying "no prescriptions for oxycontin or similar painkillers will be given here". So... more legitimate use cases are now shut out from measured uses because there was such a rash of unneeded prescriptions years before.
2 years ago, both urgent care clinics in our town had signs out front saying "no prescriptions for oxycontin or similar painkillers will be given here". So... more legitimate use cases are now shut out from measured uses because there was such a rash of unneeded prescriptions years before.
So basically a doctor prescribed a hugely addictive opioid for something described as "discomfort". That shouldn't just mean you lose your license it should mean you go to jail.
Worse than literal drug dealers, because they took the Hippocratic oath and have a much more informed understanding of addiction and its repercussions.
The signs out front are to discourage drug seekers from coming in the door. They’ll prescribe it if you need it.
There's rampant corruption in healthcare, even after the Sunshine act passed into law in 2010.
Common methods include: - Paid "speeches" - Paid surveys - "Training/Education" retreats at swanky resorts
Also look into Outcome Health, a newly minted "unicorn" based out of Chicago. Their marketing spin is about how their mission is to help patients receive the most optimal treatments and "outcomes", but in reality the whole business model is based on installing "free" tv screens and tablets in physicians' offices and then pushing ads. Im sure there are kickbacks involved with the individual physicians. There was a WSJ expose about it a couple of weeks ago (http://archive.is/QZnTN).
Common methods include: - Paid "speeches" - Paid surveys - "Training/Education" retreats at swanky resorts
Also look into Outcome Health, a newly minted "unicorn" based out of Chicago. Their marketing spin is about how their mission is to help patients receive the most optimal treatments and "outcomes", but in reality the whole business model is based on installing "free" tv screens and tablets in physicians' offices and then pushing ads. Im sure there are kickbacks involved with the individual physicians. There was a WSJ expose about it a couple of weeks ago (http://archive.is/QZnTN).
"Improving patient outcomes" is quite possibly the most disgusting, 1984-esque buzzphrase right now.
It's worded so that like, "who could be against that?" is what anyone would think.
So some shady ads pushing startup is out there trying to handwave how they're making everyones life better and improving outcomes, despite not providing any innovation.
It would be like saying my meth dealer is improving my life outcome because I have more energy now.
It's worded so that like, "who could be against that?" is what anyone would think.
So some shady ads pushing startup is out there trying to handwave how they're making everyones life better and improving outcomes, despite not providing any innovation.
It would be like saying my meth dealer is improving my life outcome because I have more energy now.
It depends different people have different responses to pain I had a kidney transplant and needed very little pain killers they took out the pain buster after a 48 hours and I managed on the occasional paracetamol and I don't really need te full does just one before bed
Later on a guy in the next bed had an infected kidney out and he was in immense pain and needed much stronger pain relief
Later on a guy in the next bed had an infected kidney out and he was in immense pain and needed much stronger pain relief
There was some research that downplayed the addictiveness of opioids, and a push from the VA to recognise and treat more pain. Then drug companies promoted their product with time release versions, claiming this reduced the risk of addiction.
That was a devastating combination.
That was a devastating combination.
Capitalist medicine is to blame, when you can vote with your money you can pick the doctor who does what you want, not what's best for you.
Ah not so its the same in France everyone demands a second opinion I recall a BBC program where a French doctor admired the NHS's strictness in that regard.
What? Even in single payer systems you can choose your doctor!
Not always. I recently moved, and was forced to change doctor (NHS in the UK). My new GP surgery is farther away from my new apartment than my old surgery was, I’m far less happy with the doctors there, and it’s far more oversubscribed than my previous GP was.
If your doctor is making actual medical decisions based on a pharma. rep's sales pitch, find yourself another doctor pronto.
I'd agree doctors are partly to blame, and I've had a similar experience.
A couple years ago I went to the ER to get a dislocated shoulder fixed, and they sent me home with percocet, even though I told them repeatedly that the pain wasn't too bad any more and I didn't want it.
A couple years ago I went to the ER to get a dislocated shoulder fixed, and they sent me home with percocet, even though I told them repeatedly that the pain wasn't too bad any more and I didn't want it.
Please be aware how figured are paid and rated. They're micromanaged nowadays like they work at Arby's. If you come to the ER and later come back for the same reason, the doctor not only doesn't get paid for the second visit, they get dinged from insurance and from the hospital. They're highly incentivized to get you in and out.
"Behind every great fortune there is a crime." —Balzac (apocryphal)
The full quote isn't apocryphal. It's from a character in Balzac's Le Père Goriot.
Roughly translated: "The secret of great unexplained fortunes is a forgotten crime, because it has been properly executed."
The quote isn't really applicable in this case. Everyone reading the article knows how the Sackler family made their money.
Roughly translated: "The secret of great unexplained fortunes is a forgotten crime, because it has been properly executed."
The quote isn't really applicable in this case. Everyone reading the article knows how the Sackler family made their money.
Everyone reading the article knows the source of the fortune. The millions of people who have interacted with Sackler supported cultural institutions likely had zero idea of where the money came from, myself included.
Is Warren Buffett's fortune a crime as well?
Warren Buffett has made his money through a few businesses that aren't quite in line with his folksy image.
For example, his Mobile Home Empire: https://www.seattletimes.com/seattle-news/times-watchdog/min... empire-clayton-homes/
Berkshire Hathaway have the largest single stake in Wells Fargo: https://www.bloomberg.com/gadfly/articles/2017-10-03/wells-f...
And here's a charming bit about one of his Kidney related investments and some of their practices: http://money.cnn.com/2017/05/15/investing/davita-dialysis-jo...
Finally, an interesting column in the Financial Times: https://www.ft.com/content/fd27245a-9790-11e7-a652-cde3f882d...
One question stands - can you ethically deploy the amount of capital Buffett & Berkshire Hathaway have? I'm not sure.
For example, his Mobile Home Empire: https://www.seattletimes.com/seattle-news/times-watchdog/min... empire-clayton-homes/
Berkshire Hathaway have the largest single stake in Wells Fargo: https://www.bloomberg.com/gadfly/articles/2017-10-03/wells-f...
And here's a charming bit about one of his Kidney related investments and some of their practices: http://money.cnn.com/2017/05/15/investing/davita-dialysis-jo...
Finally, an interesting column in the Financial Times: https://www.ft.com/content/fd27245a-9790-11e7-a652-cde3f882d...
One question stands - can you ethically deploy the amount of capital Buffett & Berkshire Hathaway have? I'm not sure.
A follow up question would be, is he personally running the companies which you have mentioned and doing those "crimes" or covering up for them or is it the people who are actually running those companies doing it?
His job is to assess the long term value of the business, part of that is an evaluation of the content of managements character. He's bought at least a hundred businesses, and invested in hundreds of public companies. He's proven a great judge of character, but that doesn't make him perfect.
Clayton Homes makes mobile homes, which are super cheap homes for low income people. Their customers are poor credit risks and default frequently, so Clayton compensates by charging high interest rates.
So is Clayton preying on their desire to have a home?
Or is Clayton offering people who can't afford traditional homes the opportunity to have their own?
Should their customers instead save their money for many more years till they are able to afford a traditional home and improve their a credit score to get a better loan?
Critics of Clayton greatly over-simplify the ethics of its business and how it runs it.
Clayton Homes makes mobile homes, which are super cheap homes for low income people. Their customers are poor credit risks and default frequently, so Clayton compensates by charging high interest rates.
So is Clayton preying on their desire to have a home?
Or is Clayton offering people who can't afford traditional homes the opportunity to have their own?
Should their customers instead save their money for many more years till they are able to afford a traditional home and improve their a credit score to get a better loan?
Critics of Clayton greatly over-simplify the ethics of its business and how it runs it.
LOL. Those are all clearly legal businesses. Warren's job is to find the highest return investments for his investors, not make fine ethical distinctions. And still, he refused to buy tobacco companies 40-50 years ago even though they perfectly fit his criteria for great investments.
In the case of Wells Fargo, Warren invested nearly 30 years ago, because it was a great business. 10% shareholders don't get to hire and fire management, or even pick board members. He's been very critical publicly of management and the board, going so far as to suggesting directors return 5 years of pay as recompense for their failures. He's also sold shares, which he almost never does in existing investments.
Maybe Davita is a loser, if so it won't be his first. He's been great at detecting management bullshit during his career, but he's not perfect, he has no supernatural lie detector. Guaranteed he didn't pick Davita because he thought they were misleading patients. Aside from the ethics, that's a horrible investment, you can't build a lasting business on fraud.
As far whether Buffett can ethically deploy the amount of capital Berkshire Hathaway has, it's a hugely silly question. BRK has $250 Billion in net capital. The S&P 500 comprises the largest 500 companies on the NYSE & NASDAQ exchanges, which have a total market value of over $20 Trillion. There are nearly 6,000 more public companies on those two exchanges alone, and that doesn't count thousands of companies on foreign exchanges, and tens of thousands of private companies Berkshire could purchase. Or the thousands of bonds and other fixed income investments that have billion dollar capacities.
In total his universe of possible investments is likely close to $100 Trillion, having capital comprising 1/4000th of that universe doesn't require making any ethical shortcuts. Buffet's large capital base is a hindrance to his returns but he doesn't care and never has. He no longer can achieve the 40% annualized returns of the Buffett Partnerships, or the 25% annualized returns of Berkshire when it was far smaller. But he's still beating the market by a substantial amount, and that's all he cares about.
Go read Barbarians at the Gate. Buffett was quoted about what a great business tobacco companies were. "It costs a penny to make. Sell it for a dollar. It's addictive. And there's fantastic brand loyalty." But he passed on an opportunity to make a bunch of money off the RJR Nabisco takeover. "I'm wealthy enough where I don't need to own a tobacco company and deal with the consequences of public ownership".
And that was the 80s. He's far wealthier now. Some Buffett quotes.
"It takes 20 years to build a reputation and five minutes to ruin it. If you think about that, you'll do things differently."
"It's better to hang out with people better than you. Pick out associates whose behavior is better than yours and you'll drift in that direction."
"The smarter the journalists are, the better off society is. For to a degree, people read the press to inform themselves - and the better the teacher, the better the student body"
In the case of Wells Fargo, Warren invested nearly 30 years ago, because it was a great business. 10% shareholders don't get to hire and fire management, or even pick board members. He's been very critical publicly of management and the board, going so far as to suggesting directors return 5 years of pay as recompense for their failures. He's also sold shares, which he almost never does in existing investments.
Maybe Davita is a loser, if so it won't be his first. He's been great at detecting management bullshit during his career, but he's not perfect, he has no supernatural lie detector. Guaranteed he didn't pick Davita because he thought they were misleading patients. Aside from the ethics, that's a horrible investment, you can't build a lasting business on fraud.
As far whether Buffett can ethically deploy the amount of capital Berkshire Hathaway has, it's a hugely silly question. BRK has $250 Billion in net capital. The S&P 500 comprises the largest 500 companies on the NYSE & NASDAQ exchanges, which have a total market value of over $20 Trillion. There are nearly 6,000 more public companies on those two exchanges alone, and that doesn't count thousands of companies on foreign exchanges, and tens of thousands of private companies Berkshire could purchase. Or the thousands of bonds and other fixed income investments that have billion dollar capacities.
In total his universe of possible investments is likely close to $100 Trillion, having capital comprising 1/4000th of that universe doesn't require making any ethical shortcuts. Buffet's large capital base is a hindrance to his returns but he doesn't care and never has. He no longer can achieve the 40% annualized returns of the Buffett Partnerships, or the 25% annualized returns of Berkshire when it was far smaller. But he's still beating the market by a substantial amount, and that's all he cares about.
Go read Barbarians at the Gate. Buffett was quoted about what a great business tobacco companies were. "It costs a penny to make. Sell it for a dollar. It's addictive. And there's fantastic brand loyalty." But he passed on an opportunity to make a bunch of money off the RJR Nabisco takeover. "I'm wealthy enough where I don't need to own a tobacco company and deal with the consequences of public ownership".
And that was the 80s. He's far wealthier now. Some Buffett quotes.
"It takes 20 years to build a reputation and five minutes to ruin it. If you think about that, you'll do things differently."
"It's better to hang out with people better than you. Pick out associates whose behavior is better than yours and you'll drift in that direction."
"The smarter the journalists are, the better off society is. For to a degree, people read the press to inform themselves - and the better the teacher, the better the student body"
There is definitely some tax evasion in there somewhere, plus insurance practices and all the free money seems pretty messed up but maybe not a crime. Also lots of lobbying state governments for favorable regulations.
The quote is sort of non falsifiable... It's a hidden crime we're talking about after all.
The quote is sort of non falsifiable... It's a hidden crime we're talking about after all.
LOL. There isn't a sniff of any tax evasion or crime to Buffett's wealth. I'm also pretty doubtful he's ever lobbied anyone for any personal advantage, remember this is a guy who has publicly lobbied for higher taxes on the wealthy, including himself.
"If anything, taxes for the lower and middle class and maybe even the upper middle class should even probably be cut further. But I think that people at the high end - people like myself - should be paying a lot more in taxes. We have it better than we've ever had it." - Warren Buffett
Warren Buffett is just a guy who believed in the power of compounding from an early age, lived below his means so he could invest every dime possible, and became the world's best at investing in businesses.
The amazing thing about Warren is that if he had wanted to be worth far more than he is, he easily could have been. He ran an investment partnership for 13 years where he earned 25% of the profits, and averaged 40% per year just investing in the stock market. Then he switched to running Berkshire Hathaway, where anyone can call up their broker and buy shares in to have Warren manage your money nearly for free (his salary is $100,000 per year. No. Really). If he had kept his profit share arrangement (and easily could have) he'd easily be worth over $200B today.
"If anything, taxes for the lower and middle class and maybe even the upper middle class should even probably be cut further. But I think that people at the high end - people like myself - should be paying a lot more in taxes. We have it better than we've ever had it." - Warren Buffett
Warren Buffett is just a guy who believed in the power of compounding from an early age, lived below his means so he could invest every dime possible, and became the world's best at investing in businesses.
The amazing thing about Warren is that if he had wanted to be worth far more than he is, he easily could have been. He ran an investment partnership for 13 years where he earned 25% of the profits, and averaged 40% per year just investing in the stock market. Then he switched to running Berkshire Hathaway, where anyone can call up their broker and buy shares in to have Warren manage your money nearly for free (his salary is $100,000 per year. No. Really). If he had kept his profit share arrangement (and easily could have) he'd easily be worth over $200B today.
No, I would not assume buying Berkshire and going in that direction was anything but a purely profit seeking decision unless you have evidence to the contrary.
By tax evasion I mean buying companies and taking their profits as dividends, which means 15% tax or no tax at all in many cases. Yes it's reinvested but it's clearly an effort to avoid capital gains/income taxes. Buffets recent comments on tax policy have no effect on his tax position, for he does not play by the same rules as your average fund manager.
Same with insurance float, that's an interest free loan from policy holders to play with.
As I said, we are talking about hidden crimes here so that would almost by definition comprise 1) things that are unethical but not illegal, 2) things that would normally be illegal but can be reclassified as legal, or 3) illegal things that we don't know about.
By tax evasion I mean buying companies and taking their profits as dividends, which means 15% tax or no tax at all in many cases. Yes it's reinvested but it's clearly an effort to avoid capital gains/income taxes. Buffets recent comments on tax policy have no effect on his tax position, for he does not play by the same rules as your average fund manager.
Same with insurance float, that's an interest free loan from policy holders to play with.
As I said, we are talking about hidden crimes here so that would almost by definition comprise 1) things that are unethical but not illegal, 2) things that would normally be illegal but can be reclassified as legal, or 3) illegal things that we don't know about.
Buying Berkshire and running it as an investment vehicle clearly was a “profit seeking” decision, it also clearly wasn’t a profit maximization decision. The most mediocre hedge fund manager alive gets 2% of the fund a year for “expenses”, and 20% of the profits. Buffett obviously could have gotten the same, which would have doubled or tripled his current net worth.
If he had that perfectly standard money management arrangement, Buffett would have made $10B last year, and been able to shield it from taxes as long term capital gains. Instead he made $100,000 in salary, and paid regular taxes on it. The last 4 years alone a 2/20 profit share would have been worth close to $40B, nearly doubling his net worth just from those years, ignoring the profit share from the 40 years before that.
The reason Buffett chose Berkshire as a vehicle and doesn’t take his rightful fees from it, is he was already wealthy when he started with it. He had shutdown the Buffett Partnerships and briefly retired after making himself and his investors (a collection of mostly Omaha doctors and dentists) all multi-millionaires in only 13 years. When he decided to restart his friends and investors jumped in with him and he didn’t need or want to charge them fees. So every BRK shareholder since has gotten that glorious free ride.
The dividend tax rate is another spurious issue. Coke pays federal and state taxes on its profits, the pays most all of what’s left as dividends to its investors. Berkshire only pays around a 10% tax rate on those dividends, less than the 15-20% individual investors pay, but for good reason, because the corporate dividend tax is the first level of a DOUBLE taxation. If Buffett ever wants to pocket those Coke dividends, Berkshire has to pay them as dividends and shareholders would owe another 15% dividend tax rate on top and Buffett himself would have to pay 20% because he’s top bracket. That 10% is an extra tax Berkshire shareholders have to pay to own Coke thru Berkshire instead of directly.
This also shows how Berkshire’s tax structure is so inefficient. Even with the “discount” on dividend earnings, Berkshire paid over $7B in taxes last year on $33B in eanings. If he was still running an investment partnership, not only could he pay himself massive fees, but those fees would be considered “carried interest” and treated like long term capital gains, and only taxed when he sold shares, at low long term capital gains rates.
If insurance float is an interest free loan, in what world is it tax evasion? Taxes are owed on profits, not loans. And float is only interest free if you run your insurance companies exceptionally well. Ordinary insurers take a loss on float as a cost of doing business. But Buffett refuses to own insurers that are that crappy, and it’s the discipline of his insurance companies that makes Berkshire one of the rare insurers to have free float.
Lastly “crime” has a meaning, and you don’t get to redefine it as things you regard as “unethical”. Buffett has been investing very publicly for over 60 years with a total tally of zero crimes, and zero unethical acts. You may wish for some to maintain your silly desire that people can only be more successful than you by cheating and committing crimes, but they ain’t coming.
If he had that perfectly standard money management arrangement, Buffett would have made $10B last year, and been able to shield it from taxes as long term capital gains. Instead he made $100,000 in salary, and paid regular taxes on it. The last 4 years alone a 2/20 profit share would have been worth close to $40B, nearly doubling his net worth just from those years, ignoring the profit share from the 40 years before that.
The reason Buffett chose Berkshire as a vehicle and doesn’t take his rightful fees from it, is he was already wealthy when he started with it. He had shutdown the Buffett Partnerships and briefly retired after making himself and his investors (a collection of mostly Omaha doctors and dentists) all multi-millionaires in only 13 years. When he decided to restart his friends and investors jumped in with him and he didn’t need or want to charge them fees. So every BRK shareholder since has gotten that glorious free ride.
The dividend tax rate is another spurious issue. Coke pays federal and state taxes on its profits, the pays most all of what’s left as dividends to its investors. Berkshire only pays around a 10% tax rate on those dividends, less than the 15-20% individual investors pay, but for good reason, because the corporate dividend tax is the first level of a DOUBLE taxation. If Buffett ever wants to pocket those Coke dividends, Berkshire has to pay them as dividends and shareholders would owe another 15% dividend tax rate on top and Buffett himself would have to pay 20% because he’s top bracket. That 10% is an extra tax Berkshire shareholders have to pay to own Coke thru Berkshire instead of directly.
This also shows how Berkshire’s tax structure is so inefficient. Even with the “discount” on dividend earnings, Berkshire paid over $7B in taxes last year on $33B in eanings. If he was still running an investment partnership, not only could he pay himself massive fees, but those fees would be considered “carried interest” and treated like long term capital gains, and only taxed when he sold shares, at low long term capital gains rates.
If insurance float is an interest free loan, in what world is it tax evasion? Taxes are owed on profits, not loans. And float is only interest free if you run your insurance companies exceptionally well. Ordinary insurers take a loss on float as a cost of doing business. But Buffett refuses to own insurers that are that crappy, and it’s the discipline of his insurance companies that makes Berkshire one of the rare insurers to have free float.
Lastly “crime” has a meaning, and you don’t get to redefine it as things you regard as “unethical”. Buffett has been investing very publicly for over 60 years with a total tally of zero crimes, and zero unethical acts. You may wish for some to maintain your silly desire that people can only be more successful than you by cheating and committing crimes, but they ain’t coming.
What was Steve Wozniak's crime?
In America, we worship people that create great fortunes. We idolize them and consider them geniuses. The source of their wealth is not important, even if it is obviously illegal or immoral. The only consideration is whether they built a successful business and managed to retain most of their money. This is the dark side of capitalism and the profit motive.
This is why the US is so ahead in entrepreneurship. It also can be seen in individuals: Bill Gates was claimed to be ruthless at early times, but now he's known for his philanthropy.
In my experience with local philanthropy, there are donors who have no interest in "naming opportunities" and those for whom it is all about the name. To me it says a lot about the character of the donor if they specifically want as little fuss as possible about the donation, and especially if they do not want something named after them. It is the cause they support, not their own egos. Personally, the more often I see a particular donor's name attached to a building, the less admiration I have for the person. So for me the ethical defects of the company are consistent with the desire for the family name to be emblazoned everywhere.
Reminds me of the quote by George Steinbrenner[1].
"If you do something nice for somebody, and more than just the two of you know about it, maybe you're doing it for the wrong reason"
[1] https://tree.mindbloom.com/apps/inspiration/detail/quote/563...
"If you do something nice for somebody, and more than just the two of you know about it, maybe you're doing it for the wrong reason"
[1] https://tree.mindbloom.com/apps/inspiration/detail/quote/563...
The Bible teaches this too.
Yes, but it's tied up in a bunch of other bits like not eating pork and worshipping a particular deity.
The secular quip raises the same questions about human motivations without the other baggage.
The secular quip raises the same questions about human motivations without the other baggage.
Because clearly George Steinbrenner is a better moral teacher than Jesus.
Jesus didn't talk about eating pork or not though.
True, but he did teach about not doing good deeds just to show off, which was the original point.
If GS taught the same without claiming to be the son of god, then yes.
Please keep HN threads free of religious flamewar. The parent comment wasn't particularly substantive but veering into general litigation of (biblical) religion definitely leads nowhere good. All such discussions are the same and therefore off-topic here.
This quote really irritates me; if we don't allow people to be judged by the good they do, more people die, because fewer people give. It's as simple as that. People shouldn't just feel free to talk about how they are contributing to saving lives, they should be encouraged. Introducing a social stigma that one isn't allowed to be publically happy or proud of doing good is cruel and counterproductive.
I have personal cynical hypotheses about why the state of affairs is as it is. None of it has to do with the qualities of those who donate.
I have personal cynical hypotheses about why the state of affairs is as it is. None of it has to do with the qualities of those who donate.
Many people are recognized for doing good without needing to tell people they're doing good. If you feel you're doing good and not being recognized for it then maybe the kind of good you're doing isn't really necessary.
It's called being humble.
It's called being humble.
I'm sure all those people who didn't die of malaria but otherwise would have disagree on whether said intervention was necessary. If the virtues of being "humble" mean another billion people die of easily preventable diseases, fuck being humble.
Are you Bill Gates? Then by all means use your high profile to promote your cause.
If you're joe millionaire the only reason you're putting your name on something is because you have status anxiety. You know it, the people you're giving the money to know it and the public knows it. This goes 1000x more for the $20 donation you brag about on facebook.
If you're joe millionaire the only reason you're putting your name on something is because you have status anxiety. You know it, the people you're giving the money to know it and the public knows it. This goes 1000x more for the $20 donation you brag about on facebook.
Or maybe people want to be allowed to talk about the charity they do because it's important to them and talking about it encourages other people to join in.
Painting givers who want to discuss as selfish narcissists, as you have, is unkind. More importantly, it means more people die preventable deaths.
A more measured argument than my own is at Giving What We Can: https://www.givingwhatwecan.org/post/2016/08/its-good-to-tal....
Painting givers who want to discuss as selfish narcissists, as you have, is unkind. More importantly, it means more people die preventable deaths.
A more measured argument than my own is at Giving What We Can: https://www.givingwhatwecan.org/post/2016/08/its-good-to-tal....
Notice that these are two distinct things; talking about a charity (even saying you gave) and telling people how much you gave. Sometimes you don't even have to say how much you gave because your name on the Harvard dining hall speaks for itself.
It's not exactly a secret that donating money is often about more than altruism or stopping "preventable deaths."
Even if you believe in the cause you're donating to in the purest most altruistic sense you should know that the conversation is tainted for any rational person living in the real world. No one but people either kissing your ass or trying to get their hand in your pocket is going to hear "I give 10% of my income to save lives" no matter how dignified you think that sounds.
Or as your link says:
>You can't have a good friendship if you hide your true beliefs or feelings, including about effective giving.
I wouldn't be a good friend if I didn't say everything I said above about the "10% donation" proposal. The question is would you be a good friend to someone who disagreed? Or are your friendships predicated on "when I share something I feel strongly about you either agree or are basically complicit in killing 40 people?"
It's not exactly a secret that donating money is often about more than altruism or stopping "preventable deaths."
Even if you believe in the cause you're donating to in the purest most altruistic sense you should know that the conversation is tainted for any rational person living in the real world. No one but people either kissing your ass or trying to get their hand in your pocket is going to hear "I give 10% of my income to save lives" no matter how dignified you think that sounds.
Or as your link says:
>You can't have a good friendship if you hide your true beliefs or feelings, including about effective giving.
I wouldn't be a good friend if I didn't say everything I said above about the "10% donation" proposal. The question is would you be a good friend to someone who disagreed? Or are your friendships predicated on "when I share something I feel strongly about you either agree or are basically complicit in killing 40 people?"
> you should know that the conversation is tainted
By no means do I think people should pretend the stigma isn't there. What I take issue with is the George Steinbrenner quote that's pasted every other discussion on charity, as if there was anything remotely noble about constantly reminding people that if anyone else so much as happens to hear about their actions, people would judge them for it.
It is hard to take your last question in good faith. Why do you still feel the need to paint me with that brush?
By no means do I think people should pretend the stigma isn't there. What I take issue with is the George Steinbrenner quote that's pasted every other discussion on charity, as if there was anything remotely noble about constantly reminding people that if anyone else so much as happens to hear about their actions, people would judge them for it.
It is hard to take your last question in good faith. Why do you still feel the need to paint me with that brush?
Sometimes buildings are named after folks just because they were awesome. Too bad it's not easy to distinguish between awesome people who had buildings named after them from the much less awesome people who essentially bought the naming rights to a building.
One indicator is whether the person was still alive when the building was named. Naming stuff after yourself when you're still alive (https://chanzuckerberg.com) is a good way to cheapen it.
No, naming it after yourself cheapens it, dead or alive. Someone else has to do it.
Kinda hard to name something after yourself when you're dead.
Personally, a bigger issue is the level of control the donor requires over the activities of the donation.
Cf. the Peter O'Donnell building at UT Austin. (https://research.utexas.edu/acesit/aces-building/)
Cf. the Peter O'Donnell building at UT Austin. (https://research.utexas.edu/acesit/aces-building/)
I agree, and I feel the same way about other public figures. Anytime I see a famous actor/actress that live a mostly private life, I immediately start thinking of them in a positive light.
Just know that many times a family has done it on behalf of someone deceased. A name on a plaque doesn’t mean that person said, “put my name on it!” Although it can mean that, and when it does I agree with your assessment.
Of course, when Larry David is involved, things can get a little more complicated:
https://www.youtube.com/watch?v=De90ozOOquY
https://www.youtube.com/watch?v=De90ozOOquY
I see where you're coming from, but consider the effects public philanthropy has.
Bill & Melinda Gates, for example, have become role models, changing the cultural norms of behaviour for the super rich. Warren Buffet's addition to their foundation can be directly linked to their efforts, but there are without a doubt hundreds more following their lead less explicitly. Zuckerberg comes to mind (although I'm not sure how 'real' his efforts are).
That's far better than what previously defined that slice of society, i. e. golf, private jets, and faux-gold interiors.
Bill & Melinda Gates, for example, have become role models, changing the cultural norms of behaviour for the super rich. Warren Buffet's addition to their foundation can be directly linked to their efforts, but there are without a doubt hundreds more following their lead less explicitly. Zuckerberg comes to mind (although I'm not sure how 'real' his efforts are).
That's far better than what previously defined that slice of society, i. e. golf, private jets, and faux-gold interiors.
I thought it was Buffet that helped bring Bill Gates around to charity rather than vice versa, with Melinda the primary driver in the Gates' philanthropy.
Steven Spielberg rarely gives his name to donations and philanthropy because, as he said in an interview years ago why he lent his name to the Shoah foundation, to the Jews god does not recognize a good deed unless it is anonymous. Meaning it has to be done with humility and doing it for name sake is a matter of pride so it goes unnoticed by god.
I believe this is true for most religions. It should also be part of "common decency", for lack of a better word.
Of all the ways a person, especially a rich one, can stroke their ego, philanthropy is probably one of the better ones.
IMO "Ego" should not be considered a bad word. We all have one, and we all enjoy stroking it. It's human. For some reason we have a hard time acknowledging that.
IMO "Ego" should not be considered a bad word. We all have one, and we all enjoy stroking it. It's human. For some reason we have a hard time acknowledging that.
And it went well beyond the names, to financial gain as well as "personal favors".
People who donate anonymously still get a reward - they feel good about it.
I’m more of a consequentialist; I consider a larger philanthropist who cares about public attribution to be more admirable than someone who is a smaller philanthropist but doesn’t care about public attribution. Personally, I would absolutely like to have my name on something if I were to donate tens or hundreds of millions of dollars towards it.
In my opinion the intention or ego of a philanthropist is approximately negligible when it comes to their charity and donations. If a billionaire wants to solve a problem out of a sense of personal grandiosity, or in a vain attempt at figurative immortality: so be it. At least they have the capability to do something good and are actually following through with it. In a vague sense there might be more nobility in anonymous charity, but nobility doesn’t contribute real resources to a problem.
Phrased another way: if a billionaire donates $100M to a charity and a pauper donates $1 to the same charity, but the billionaire requires his name to be affiliated, which of the two is doing more “good”? If you believe the answer is the poorer person, your axioms are fundamentally incompatible with consequentialism, because you’re incorporating selflessness into your definition of good. But if you believe that the billionaire is doing more good in this example despite his vanity, you’re a consequentialist - as they say, we’ve established terms, and now we’re just haggling.
In my opinion the intention or ego of a philanthropist is approximately negligible when it comes to their charity and donations. If a billionaire wants to solve a problem out of a sense of personal grandiosity, or in a vain attempt at figurative immortality: so be it. At least they have the capability to do something good and are actually following through with it. In a vague sense there might be more nobility in anonymous charity, but nobility doesn’t contribute real resources to a problem.
Phrased another way: if a billionaire donates $100M to a charity and a pauper donates $1 to the same charity, but the billionaire requires his name to be affiliated, which of the two is doing more “good”? If you believe the answer is the poorer person, your axioms are fundamentally incompatible with consequentialism, because you’re incorporating selflessness into your definition of good. But if you believe that the billionaire is doing more good in this example despite his vanity, you’re a consequentialist - as they say, we’ve established terms, and now we’re just haggling.
It is not a question of "good" it is a question of my admiration of the donor. On my organizations drives, I completely supported the naming campaigns because I accepted the view that some donors generosity is tied to their naming. I am happy that those named people chose to support a cause that I care about. But I always instructed staff members to honour the small donor as much as the large - it might be as much of a percentage of their net worth in both cases. And I will always have respect for the donors of large amounts who do not need to be named.
It's not about doing "good," they're both doing "good." It's about milking the charity like you can't give money away without getting something in return.
My point in this line of questioning is purely dialectic; in essense, I am indirectly targeting the question, “Why is something undesirable, if it is not bad?”
So we have a few possibilities:
- Is demanding attribution in philanthropy bad? If it’s bad, how does it decrease the concrete “goodness” of the philanthropy?
- Is it not bad? Then why is it undesirable?
- Is it neither bad nor undesirable? Then why is it relevant?
People have (normative) reasons for personal admiration, and they can’t really be right or wrong. I’m interested in digging at the normatives.
Generalizing this further, we can say that people are easily offended by grandiosity and vanity, or at the very least find it distasteful. As a philosophical question I consider it interesting to wonder why that is the case, in a scenario where that person is not doing anything “bad” from a consequentialist perspective. As it turns out, anonymity and attribution in philanthopy seem to be a good real-world setting for this question, because narcissism appears to become invalid as a signalling heuristic.
So we have a few possibilities:
- Is demanding attribution in philanthropy bad? If it’s bad, how does it decrease the concrete “goodness” of the philanthropy?
- Is it not bad? Then why is it undesirable?
- Is it neither bad nor undesirable? Then why is it relevant?
People have (normative) reasons for personal admiration, and they can’t really be right or wrong. I’m interested in digging at the normatives.
Generalizing this further, we can say that people are easily offended by grandiosity and vanity, or at the very least find it distasteful. As a philosophical question I consider it interesting to wonder why that is the case, in a scenario where that person is not doing anything “bad” from a consequentialist perspective. As it turns out, anonymity and attribution in philanthopy seem to be a good real-world setting for this question, because narcissism appears to become invalid as a signalling heuristic.
I think the answer to your question relates to the ability of the billionaire to do what he wants on his terms.
You have to ask yourself what are the implicating consequences of this kind of concentrated influence?
So I think in terms of consequentialism, you need to look bigger. Should the billionaire be further rewarded for philanthropic actions? What else would he have done with the money without those rewards? How do the rewards to big donors affect the donations and volunteering of smaller participators? What was the long lasting consequence of the big donation which awarded rewards to a big donor?
The answer to that is complicated, but could change the consequence of the system, so are relevent to a consequentialist perspective.
Of most noteworthy to me, I think is the idea that a single entity can have so much concentrated wealth in the first place, where we now need to put motivations in place for them to give it away. Why award so much wealth to that entity to begin with? What consequences does this has on the moral objective you're looking to get as a consequence of our system?
And so, if you believe having billionaires generates overall bad consequences, then you'll want to demotivate people to become one, thus you might start by shaming them for their wealth, by conveying to their ego that they are not special, loved or admired for those traits, and that their big donations is frowned upon, that we'd rather they just volunteered their time, because no one cares to know how much they were able to donate.
But, if you frame the problem in the small, and don't explore alternatives, or quesrion the consequences of the given frame, ya, a billionaire which gives hundreds of million to charity in exchange for a thousand of dollar statue is an all around good deal for the charity in terms of consequentialism.
You have to ask yourself what are the implicating consequences of this kind of concentrated influence?
So I think in terms of consequentialism, you need to look bigger. Should the billionaire be further rewarded for philanthropic actions? What else would he have done with the money without those rewards? How do the rewards to big donors affect the donations and volunteering of smaller participators? What was the long lasting consequence of the big donation which awarded rewards to a big donor?
The answer to that is complicated, but could change the consequence of the system, so are relevent to a consequentialist perspective.
Of most noteworthy to me, I think is the idea that a single entity can have so much concentrated wealth in the first place, where we now need to put motivations in place for them to give it away. Why award so much wealth to that entity to begin with? What consequences does this has on the moral objective you're looking to get as a consequence of our system?
And so, if you believe having billionaires generates overall bad consequences, then you'll want to demotivate people to become one, thus you might start by shaming them for their wealth, by conveying to their ego that they are not special, loved or admired for those traits, and that their big donations is frowned upon, that we'd rather they just volunteered their time, because no one cares to know how much they were able to donate.
But, if you frame the problem in the small, and don't explore alternatives, or quesrion the consequences of the given frame, ya, a billionaire which gives hundreds of million to charity in exchange for a thousand of dollar statue is an all around good deal for the charity in terms of consequentialism.
In the context of Hegel's dialectic, my understanding is that "undesirable" would be the synthesis of "bad" and "something that tempers the badness," which could simply be "low intensity." Said another way, I don't think your question is all that valid, it's like asking "Why is something pink, if it is not red?" Which if you ask me sounds like a pondering from a pre-Socratic also-ran, and at any rate the question can be dispensed by saying that pink is a less intense red. All in all, they're all value judgments, so the good-faith answer is: like all value-judgements, it's because the perceiver says so.
I’m interested in digging at the normatives.
Assuming this isn't to indicate a search for consensus where there isn't any, the "normative" is that someone donating $1 can't make these demands, so maybe a better question would be why do rich people demand namings, and could it be merely a personality flaw to force people to use their name to refer to something oriented around their donation (building, fund, etc.)? That is, rather than right or wrong, can we ask whether it's selfish? Immature? Something else? Fire up your dialectic if you like.
How ridiculous would it be to create "The Barney Google Fund for Helping People Reach a State of Getting Things Named After Themselves?" I'd say if you think, "say, that's not a bad idea!" then you probably don't see a problem with donations purchasing naming rights. Plain and simple, no dialectic necessary.
But we can come up with reasons not to do something all day. So, assuming for simplicity that naming is optional and the money would be given regardless, in what ways are named donations a good thing? I find this approach more readily exposes the details.
I’m interested in digging at the normatives.
Assuming this isn't to indicate a search for consensus where there isn't any, the "normative" is that someone donating $1 can't make these demands, so maybe a better question would be why do rich people demand namings, and could it be merely a personality flaw to force people to use their name to refer to something oriented around their donation (building, fund, etc.)? That is, rather than right or wrong, can we ask whether it's selfish? Immature? Something else? Fire up your dialectic if you like.
How ridiculous would it be to create "The Barney Google Fund for Helping People Reach a State of Getting Things Named After Themselves?" I'd say if you think, "say, that's not a bad idea!" then you probably don't see a problem with donations purchasing naming rights. Plain and simple, no dialectic necessary.
But we can come up with reasons not to do something all day. So, assuming for simplicity that naming is optional and the money would be given regardless, in what ways are named donations a good thing? I find this approach more readily exposes the details.
Charitable gift exchange is a zero-sum game between giver and recipient. On the table is the money in question, attribution, tax relief, future control of the money, and the conditions for future gifts.
Attribution is essentially a public statement on behalf of the recipient that the giver is a good person. These statements have a value. You could not pay me $10 to say that Bill Gates is a good person, but you could probably pay me $100,000. However if Bill Gates wanted to give me $100,000 without attribution, I would be spared the cost of saying I thought he was a good person in public.
Attribution is essentially a public statement on behalf of the recipient that the giver is a good person. These statements have a value. You could not pay me $10 to say that Bill Gates is a good person, but you could probably pay me $100,000. However if Bill Gates wanted to give me $100,000 without attribution, I would be spared the cost of saying I thought he was a good person in public.
A better comparison may be, (a) $100M for a museum named after the donor, versus (b) Elon Musk spending his last $100M on SpaceX.
Donor (a) seems long on ego, short on imagination and ability.
We wouldn’t have the same view of the person donating a dollar to the same museum.
Donor (a) seems long on ego, short on imagination and ability.
We wouldn’t have the same view of the person donating a dollar to the same museum.
I agree. For example, the consequence of the Koch brother’s philathropy is the normalization of their radical (belligerently anti-democratic) political agenda.
You seem to be implying that philanthropists who don't do naming rights only give smaller donations. Any evidence to back that up?
If Philanthropist A donates $10 million and asks for his name on the building, while Philanthropist B donates $10 million and requests no name on the building, I will absolutely have much more respect for Philanthropist B.
If Philanthropist A donates $10 million and asks for his name on the building, while Philanthropist B donates $10 million and requests no name on the building, I will absolutely have much more respect for Philanthropist B.
> You seem to be implying that philanthropists who don't do naming rights only give smaller donations.
No, I’m not. I constructed extreme upper and lower bounds as a baseline for comparing axioms. That was the purpose of my reference to the apocryphal, “now we’re just haggling over price” quote.
No, I’m not. I constructed extreme upper and lower bounds as a baseline for comparing axioms. That was the purpose of my reference to the apocryphal, “now we’re just haggling over price” quote.
Axioms that don't exist in the comment you replied to, so I'm unsure why you're bringing them up here.
Of course they do. Axioms are inherent to all positive statements, even if they’re implicit. And you can’t construct (coherent) normative statements without positive ones.
Free Splunk app that shows how to detect anomalies in drug prescriptions including anomalies in narcotics prescriptions and fraudulent providers (doctors):
https://splunkbase.splunk.com/app/3693/
Comes with 2014 medicare dataset. All supporting data can be downloaded from data.cms.gov
Story: https://www.splunk.com/blog/2017/09/28/building-a-60-billion...
https://splunkbase.splunk.com/app/3693/
Comes with 2014 medicare dataset. All supporting data can be downloaded from data.cms.gov
Story: https://www.splunk.com/blog/2017/09/28/building-a-60-billion...
Regardless of how it started, I'm confused as to why/how this crisis has been allowed to persist and grow for so long. No checks? No balance? Zero to epidemic and nothing to prevent it?
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Wow, and this has been known for years...and yet OxyContin is still legal in the U.S. and being sold every day.
It's interesting how HN has near-universal disdain for people covertly making billions off an addictive product.
But much of our industry is explicitly, openly trying to create addictive experiences.
But much of our industry is explicitly, openly trying to create addictive experiences.
This smells of whataboutism and whatever the ethics of making addictive software, it's killed far fewer people so far.
I'm not equating the harms, or attempting to distract from this serious issue.
But, if we feel clear outrage about another industry, we should consider applying the same standards to our own.
Most everyone who works in opioid marketing probably thinks they are a good person too.
But, if we feel clear outrage about another industry, we should consider applying the same standards to our own.
Most everyone who works in opioid marketing probably thinks they are a good person too.
> we
The fallacy in your comment isn't that you're wrong about addictions, it's that you're assuming two population samples are the same: 'HN users who complain about drug addiction' and 'HN users who create addictive technology'. Those are two different values of 'we'. (I worry about being in the latter group. HN is pretty addictive.)
The fallacy in your comment isn't that you're wrong about addictions, it's that you're assuming two population samples are the same: 'HN users who complain about drug addiction' and 'HN users who create addictive technology'. Those are two different values of 'we'. (I worry about being in the latter group. HN is pretty addictive.)
>it's killed far fewer people so far.
Sitting curled up in a chair for hours straight staring into a phone is killing you a lot quicker than you might think.
Sitting curled up in a chair for hours straight staring into a phone is killing you a lot quicker than you might think.
There's a fine line between physical and psychological addictive experiences. You can always delete Candy Crush from your phone, not that easy to delete opiods from your system
Once you get the physical addiction out of your system, you then spend the rest of your life dealing with the psychological addiction.
I'm reminded of that line from Chinatown. "Why are you doing it? How much better can you eat? What can you buy that you can't already afford?" Is there really no point of diminishing returns, where you can tell yourself you've made enough money?
> made enough money
My fantasy about money is not about better cars or nicer houses. I'd like to do what Elon Musk is doing - try to advance human civilization through projects like space exploration. I'd be launching space telescopes, more probes to outer planets, etc.
My fantasy about money is not about better cars or nicer houses. I'd like to do what Elon Musk is doing - try to advance human civilization through projects like space exploration. I'd be launching space telescopes, more probes to outer planets, etc.
As I have stated before, I feel like if you have a pro-social mission to further human civilization the first step is "don't enmiserate large numbers of humans by getting them addicted to opioids." Maybe that's just me, though.
The Mexican Fisherman
The American investment banker was at the pier of a small coastal Mexican village when a small boat with just one fisherman docked.
Inside the small boat were several large yellow fin tuna. The American complimented the Mexican on the quality of his fish and asked how long it took to catch them.
The Mexican replied, “Only a little while.”
The American then asked, “Why didn’t you stay out longer and catch more fish?”
The Mexican said, “With this I have more than enough to support my family’s needs.”
The American then asked, “But what do you do with the rest of your time?”
The Mexican fisherman said, “I sleep late, fish a little, play with my children, take siesta with my wife, Maria, stroll into the village each evening where I sip wine and play guitar with my amigos, I have a full and busy life.”
The American scoffed, “I am a Harvard MBA and could help you. You should spend more time fishing; and with the proceeds, buy a bigger boat: With the proceeds from the bigger boat you could buy several boats. Eventually you would have a fleet of fishing boats. Instead of selling your catch to a middleman you would sell directly to the processor; eventually opening your own cannery. You would control the product, processing and distribution. You would need to leave this small coastal fishing village and move to Mexico City, then Los Angeles and eventually New York where you will run your ever-expanding enterprise.”
The Mexican fisherman asked, “But, how long will this all take?”
To which the American replied, “15 to 20 years.”
“But what then?” asked the Mexican.
The American laughed and said that’s the best part. “When the time is right you would announce an IPO and sell your company stock to the public and become very rich, you would make millions.”
“Millions?…Then what?”
The American said, “Then you would retire. Move to a small coastal fishing village where you would sleep late, fish a little, play with your kids, take siesta with your wife, stroll to the village in the evenings where you could sip wine and play your guitar with your amigos."
(Of course, the MBA glosses over scaling the catching of fish, as though all fish have the same qualities.)
The American investment banker was at the pier of a small coastal Mexican village when a small boat with just one fisherman docked.
Inside the small boat were several large yellow fin tuna. The American complimented the Mexican on the quality of his fish and asked how long it took to catch them.
The Mexican replied, “Only a little while.”
The American then asked, “Why didn’t you stay out longer and catch more fish?”
The Mexican said, “With this I have more than enough to support my family’s needs.”
The American then asked, “But what do you do with the rest of your time?”
The Mexican fisherman said, “I sleep late, fish a little, play with my children, take siesta with my wife, Maria, stroll into the village each evening where I sip wine and play guitar with my amigos, I have a full and busy life.”
The American scoffed, “I am a Harvard MBA and could help you. You should spend more time fishing; and with the proceeds, buy a bigger boat: With the proceeds from the bigger boat you could buy several boats. Eventually you would have a fleet of fishing boats. Instead of selling your catch to a middleman you would sell directly to the processor; eventually opening your own cannery. You would control the product, processing and distribution. You would need to leave this small coastal fishing village and move to Mexico City, then Los Angeles and eventually New York where you will run your ever-expanding enterprise.”
The Mexican fisherman asked, “But, how long will this all take?”
To which the American replied, “15 to 20 years.”
“But what then?” asked the Mexican.
The American laughed and said that’s the best part. “When the time is right you would announce an IPO and sell your company stock to the public and become very rich, you would make millions.”
“Millions?…Then what?”
The American said, “Then you would retire. Move to a small coastal fishing village where you would sleep late, fish a little, play with your kids, take siesta with your wife, stroll to the village in the evenings where you could sip wine and play your guitar with your amigos."
(Of course, the MBA glosses over scaling the catching of fish, as though all fish have the same qualities.)
It's all about perspective. To a third world citizen, that statement applies to the lifestyle of a middle class american. To us, having a second jet seems like a ludicrous luxury. To them, having a second car probably seems like just as ludicrous a luxury.
So, I feel like you haven't seen the movie. It's being posed by an investigator to a man who has committed murder, who is engaged in fraud and worse, who is conspiring to have dozens of farmers go bankrupt and lose their livelihoods. It's not a question of perspective. It's a question of, what kind of a person are you and why?
If you can’t usefully spend arbitrarily large amounts of money, it’s a creativity problem. Sure, if your only interests are eating and watching TV then a billion dollars isn’t going to do much for you.
The easy way to productively spend $X billion is to invest it in space/physics/medical research or development. If you need to blow a few hundred billion, you could launch an asteroid mining venture with a reasonable chance of turning that money into a few trillion and making space development vastly more affordable for the rest of humanity.
The easy way to productively spend $X billion is to invest it in space/physics/medical research or development. If you need to blow a few hundred billion, you could launch an asteroid mining venture with a reasonable chance of turning that money into a few trillion and making space development vastly more affordable for the rest of humanity.
I mean, the most effective contribution they could make to society is to stop lobbying Congress so effectively to protect their sales of Oxy, but sure, let's talk about how those profits could be rolled over into speculative investments in aerospace.
EDIT: And of course, the response to that line in the movie is "The future, Mr. Gittes."
EDIT: And of course, the response to that line in the movie is "The future, Mr. Gittes."
That reminds me of an old joke:
Q: How do you make $1 million in aerospace?
A: Start with $1 billion
Q: How do you make $1 million in aerospace?
A: Start with $1 billion
Can you elaborate on your point?
In your example, it seems like you are saying "there is more happiness in mining asteroids than in being able to live very comfortably, indefinitely, without having to work to support yourself".
Except for a very narrow portion of humanity, this seems implausible. Would mining asteroids really bring fulfillment to a person who has experienced ennui when climbing a mountain, scuba diving the barrier reef, yachting the Mediterranean, or designing their own home?
Failure of imagination, sure, but I think you're going to be disappointed if you think that a billion is going to be deeply fulfilling relative to 20 million.
In your example, it seems like you are saying "there is more happiness in mining asteroids than in being able to live very comfortably, indefinitely, without having to work to support yourself".
Except for a very narrow portion of humanity, this seems implausible. Would mining asteroids really bring fulfillment to a person who has experienced ennui when climbing a mountain, scuba diving the barrier reef, yachting the Mediterranean, or designing their own home?
Failure of imagination, sure, but I think you're going to be disappointed if you think that a billion is going to be deeply fulfilling relative to 20 million.
You're confusing "spending money" with "starting a business."
it's about power
Sad. Hope the family gets what's due -- being burnt alive would be a good start.
The thinly-veiled anti-Semitism of this article is abhorrent. Going after a family like this is shameful, the real people to blame are those taking drugs with solid medical uses and abusing them. Ever try to recover from surgery w/o painkillers? Pray you never do, you'll be thanking the Sacklers.
I love how the article switches between OxyContin and opioids throughout the article, particularly when talking about deaths. It's a clever way to include drugs like heroin, fentanyl, etc in the numbers to inflate them and make the story more gripping.
Of course it's silly to hold OxyContin's manufacturer responsible for all opioid deaths.
Of course it's silly to hold OxyContin's manufacturer responsible for all opioid deaths.
The company and the family is responsible for dramatically increasing number of opioid prescriptions based on fraudulent marketing and made up evidence. A lot of people, who, as a result, got addicted to Oxy, at some point ended up switching to heroin because it's cheaper. So, the manufacturer is not responsible for all opioid deaths, but is responsible for a significant percentage of those deaths.
> A lot of people, who, as a result, got addicted to Oxy, at some point ended up switching to heroin because it's cheaper.
Counter-point: no, they largely did not.
There is a huge population using prescription opiates and a tiny tiny population using heroin.
Check out https://grokinfullness.blogspot.com/2017/09/debunking-standa... for a lot more detail.
> There is no convincing evidence that prior prescription opioid use caused subsequent heroin use. ... This is much like the argument, popular among drug warriors, that marijuana is a gateway drug because most users of hard drugs start with marijuana. There are simply so many current and past prescription opioid users that most heroin users will probably have had past experience with these drugs, but that says nothing at all about a causal link. Indeed, the vast majority of prescription opioid users never go on to use heroin, so the causal link is dubious.
> In 2015, 85 million people used prescription opioids legally, and there were ~200 million legal prescriptions. By contrast, there were half a million heroin users. But there were comparable numbers of deaths in both categories (~13,000 from prescription opioids and 12,000 heroin deaths, or 18,500 heroin deaths if you add the "heroin" and "synthetic opioids" together to capture the fact that some dealers have been mixing fentanyl in with heroin). Some relevant numbers in my piece here, once again from the CDC's website. Deaths per legal opioid user are in the 0.015% range; deaths per heroin user are probably somewhere in the 1% to 3.5% range.
> In other words, the prescription opioid deaths are a very small risk applied to a very large population. The heroin-related deaths are an extremely high risk applied to a relatively small population. These are very different issues with very different underlying social causes.
Counter-point: no, they largely did not.
There is a huge population using prescription opiates and a tiny tiny population using heroin.
Check out https://grokinfullness.blogspot.com/2017/09/debunking-standa... for a lot more detail.
> There is no convincing evidence that prior prescription opioid use caused subsequent heroin use. ... This is much like the argument, popular among drug warriors, that marijuana is a gateway drug because most users of hard drugs start with marijuana. There are simply so many current and past prescription opioid users that most heroin users will probably have had past experience with these drugs, but that says nothing at all about a causal link. Indeed, the vast majority of prescription opioid users never go on to use heroin, so the causal link is dubious.
> In 2015, 85 million people used prescription opioids legally, and there were ~200 million legal prescriptions. By contrast, there were half a million heroin users. But there were comparable numbers of deaths in both categories (~13,000 from prescription opioids and 12,000 heroin deaths, or 18,500 heroin deaths if you add the "heroin" and "synthetic opioids" together to capture the fact that some dealers have been mixing fentanyl in with heroin). Some relevant numbers in my piece here, once again from the CDC's website. Deaths per legal opioid user are in the 0.015% range; deaths per heroin user are probably somewhere in the 1% to 3.5% range.
> In other words, the prescription opioid deaths are a very small risk applied to a very large population. The heroin-related deaths are an extremely high risk applied to a relatively small population. These are very different issues with very different underlying social causes.
>"There is no convincing evidence that prior prescription opioid use caused subsequent heroin use. ... This is much like the argument, popular among drug warriors, that marijuana is a gateway drug because most users of hard drugs start with marijuana."
Except there are actually studies and data that do show a link between prior prescription opioid use amongst heroin users, along with a demographic shift:
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...
And the second part of that comment "This is much like the argument, popular among drug warriors, that marijuana is a gateway drug ..." is a total strawman.
Except there are actually studies and data that do show a link between prior prescription opioid use amongst heroin users, along with a demographic shift:
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...
And the second part of that comment "This is much like the argument, popular among drug warriors, that marijuana is a gateway drug ..." is a total strawman.
> > In 2015, 85 million people used prescription opioids legally, and there were ~200 million legal prescriptions.
In a country of 350 million people this right here is all the evidence you need: it's obvious that US opioid prescribing is abusive.
In a country of 350 million people this right here is all the evidence you need: it's obvious that US opioid prescribing is abusive.
I've been prescribed opiates twice in my life, once after wisdom teeth removal and once after breaking my ankle. I'm sure I counted in the 85 million figure for that year despite never actually taking the drugs, as the pain was not bad enough to merit them.
I wish doctors were less liberal about prescribing these serious drugs. It should be messaged as "If the pain is really unbearable, even with standard over-the-counter pain relievers, then consider a stronger alternative." Instead, it was more like "Oh you broke your ankle? Here's a prescription for strong drugs."
Breaking my ankle doesn't even crack my top five most painful moments of my life -- those are all related to the flu/norovirus/food poisoning.
I wish doctors were less liberal about prescribing these serious drugs. It should be messaged as "If the pain is really unbearable, even with standard over-the-counter pain relievers, then consider a stronger alternative." Instead, it was more like "Oh you broke your ankle? Here's a prescription for strong drugs."
Breaking my ankle doesn't even crack my top five most painful moments of my life -- those are all related to the flu/norovirus/food poisoning.
Your case is probably a legitimate case and most people probably would not get addicted after short term limited usage. The problem is prescribing it for more longer term situations.
You know what country has the highest opioid use per capita? Canada!
You know why? Codeine is available OTC. However I don't know many people that went from codeine to heroin.
You know why? Codeine is available OTC. However I don't know many people that went from codeine to heroin.
[deleted]
OTC Codeine is much weaker and is sold in much smaller doses than oxy.
Yes, but when you see stats about opioid use, weak opioids are included.
I would estimate a huge percentage of US opioid utilization is codeine in the form of Tylenol #3.
I would estimate a huge percentage of US opioid utilization is codeine in the form of Tylenol #3.
You don't think that the US using 99% of the world's supply of hydrocodone is a factor?
You keep mentioning Canada, bu Canada has its own opioid crisis and public health officials are working hard to reduce canadian prescribing of opioids.
You've also said that canada has higher per capita use - do you have a cite for that? Because it doesn't match any data I've seen.
You keep mentioning Canada, bu Canada has its own opioid crisis and public health officials are working hard to reduce canadian prescribing of opioids.
You've also said that canada has higher per capita use - do you have a cite for that? Because it doesn't match any data I've seen.
For more on this, see https://youtu.be/5pdPrQFjo2o?t=164
"How many people here moved from prescription drugs to heroin?" Everybody raised their hands.
"How many people here moved from prescription drugs to heroin?" Everybody raised their hands.
There absolutely are grounds to hold the manufacturer accountable. As the article mentions, the company marketed OxyContin as a medication supposed to be used for all kinds of ailments, almost casually. Purdue Pharmaceuticals advertised to doctors, and directly contributed to the overprescription of opioids, knowing full well the addiction potential. There are absolutely legitimate uses for OxyContin - I myself was prescribed it for a week or so after a particularly invasive knee surgery - but many many cases of pain management should have been dealt with using much tamer and less addictive treatments. In search of profits, the company influenced decisions at all parts of the prescription process that have directly led to the deaths of tens of thousands. They should be held accountable for that.
Do you have ties to Purdue or the pharama industries? You seem super defensive about this/not open to discussion and your submission history seems to be pharma related.
Over-prescription of OxyContin is considered a major reason many heroin and fentanyl users became addicted. If street price of OxyContin would be lower they'd still be using that.
What do you mean by switching? All of the drugs you listed are opioids. It's not clever, it's a fact.
It's called reading with a critical eye. They talk about OxyContin, then talk about the hundreds of thousands of opioid deaths. If you're not paying attention, you'd think OxyContin caused all of them.
OxyContin was certainly a catalyst to this entire epidemic.
Certainly? I think the point the parent was trying to make is that the evidence damning Oxy is not nearly as compelling as people claim & the way this article is worded lends credence to his claim.
I’m no expert on this & have seen enough oxy abuse to be skeptical but saying it’s a certainty seems unfounded in the face of the argument.
I’m no expert on this & have seen enough oxy abuse to be skeptical but saying it’s a certainty seems unfounded in the face of the argument.
How many people on heroin or fentanyl started on Rx Oxy?
Good question! I don't know and I assume others don't as well.
But we need a scapegoat right? Purdue will suffice.
But we need a scapegoat right? Purdue will suffice.
In the article they note that epidemic opioid addiction was correlated with OxyContin prescription volume in a region.
This article isn't about Purdue, it's about the Sackler's that influence Purdue, MundiPhrama, and a number of other global pharmaceutical companies to increase their wealth while also "braiding their name" into high society.
This article isn't about Purdue, it's about the Sackler's that influence Purdue, MundiPhrama, and a number of other global pharmaceutical companies to increase their wealth while also "braiding their name" into high society.
There was a resurgence of heroin use back in the 1970's in the US. So it's clear it can happen even without a legal opioid driving it.
So why are we so quick to claim causation when there is only correlation?
I know, because it sells newspapers!
So why are we so quick to claim causation when there is only correlation?
I know, because it sells newspapers!
That was attributed to returning veterans from Vietnam being hooked on opiates and creating a massive market, also the baby boomer generation coming off of "free love" didn't help the problem.
It's generally understood for both that epidemic and the current how the problem arose, in part this understanding was achieved through interviews with addicts.
Going back to the original morphine epidemic in the 19th/20th century it parallels closely the current Purdue/OxyContin epidemic lending further evidence to the driver being OxyContin.
Do you really think that OxyContin is not a driver and only correlated? If so, what is driving the ever-increasing opiate usage?
It's generally understood for both that epidemic and the current how the problem arose, in part this understanding was achieved through interviews with addicts.
Going back to the original morphine epidemic in the 19th/20th century it parallels closely the current Purdue/OxyContin epidemic lending further evidence to the driver being OxyContin.
Do you really think that OxyContin is not a driver and only correlated? If so, what is driving the ever-increasing opiate usage?
Good question! I don't know and I assume others don't as well.
Unsafe assumption. Why not go the self-education route before taking the "angry preacher" role so seriously?
Unsafe assumption. Why not go the self-education route before taking the "angry preacher" role so seriously?
Not angry in the least! Just surprised how quick people are to believe something without data.
I guess it's just human trait to simply problems into "that person is at fault" rather than appreciate the multiple factors that resulted in a complex problem.
I guess it's just human trait to simply problems into "that person is at fault" rather than appreciate the multiple factors that resulted in a complex problem.
Again, you’re making assumptions, and offering only rhetoric. Why?
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"In May 2007 the company pleaded guilty to misleading the public about Oxycontin's risk of addiction and agreed to pay $600 million in one of the largest pharmaceutical settlements in U.S. history. Its president, top lawyer and former chief medical officer pleaded guilty as individuals to misbranding charges, a criminal violation and agreed to pay a total of $34.5 million in fines. Those executives are: Michael Friedman, the company’s president, who agreed to pay $19 million in fines; Howard R. Udell, its top lawyer, who agreed to pay $8 million; and Dr. Paul D. Goldenheim, its former medical director, who agreed to pay $7.5 million.
"In addition three top executives were charged with a felony and sentenced to 400 hours of community service in drug treatment programs."
https://en.wikipedia.org/wiki/Purdue_Pharma?wprov=sfla1
I wouldn't really consider them a scapegoat.
"As shown in Figure 1A, the selection of OxyContin as a primary drug of abuse decreased from 35.6% of respondents before the release of the abuse-deterrent formulation to just 12.8% 21 months later (P<0.001). Simultaneously, selection of hydrocodone and other oxycodone agents increased slightly, whereas for other opioids, including high-potency fentanyl and hydromorphone, selection rose markedly, from 20.1% to 32.3% (P=0.005). Of all opioids used to “get high in the past 30 days at least once” (Figure 1B), OxyContin fell from 47.4% of respondents to 30.0% (P<0.001), whereas heroin use nearly doubled."
http://www.nejm.org/doi/full/10.1056/NEJMc1204141
The abuse-resistant version had some unhappy consequences.
"Available data indicate that the nonmedical use of prescription opioids is a strong risk factor for heroin use. Yet, although the majority of current heroin users report having used prescription opioids nonmedically before they initiated heroin use, heroin use among people who use prescription opioids for nonmedical reasons is rare, and the transition to heroin use appears to occur at a low rate."
http://www.nejm.org/doi/full/10.1056/NEJMra1508490#conclusio...
Of course, the issue here is not that oxycontin is a gateway drug, but that prescription opioids are being abused, and Purdue and oxycontin are undoubtedly at the forefront of that.
"In addition three top executives were charged with a felony and sentenced to 400 hours of community service in drug treatment programs."
https://en.wikipedia.org/wiki/Purdue_Pharma?wprov=sfla1
I wouldn't really consider them a scapegoat.
"As shown in Figure 1A, the selection of OxyContin as a primary drug of abuse decreased from 35.6% of respondents before the release of the abuse-deterrent formulation to just 12.8% 21 months later (P<0.001). Simultaneously, selection of hydrocodone and other oxycodone agents increased slightly, whereas for other opioids, including high-potency fentanyl and hydromorphone, selection rose markedly, from 20.1% to 32.3% (P=0.005). Of all opioids used to “get high in the past 30 days at least once” (Figure 1B), OxyContin fell from 47.4% of respondents to 30.0% (P<0.001), whereas heroin use nearly doubled."
http://www.nejm.org/doi/full/10.1056/NEJMc1204141
The abuse-resistant version had some unhappy consequences.
"Available data indicate that the nonmedical use of prescription opioids is a strong risk factor for heroin use. Yet, although the majority of current heroin users report having used prescription opioids nonmedically before they initiated heroin use, heroin use among people who use prescription opioids for nonmedical reasons is rare, and the transition to heroin use appears to occur at a low rate."
http://www.nejm.org/doi/full/10.1056/NEJMra1508490#conclusio...
Of course, the issue here is not that oxycontin is a gateway drug, but that prescription opioids are being abused, and Purdue and oxycontin are undoubtedly at the forefront of that.
This is a real thing.[1] They really give out awards for medical advertising. Typical writeup: "Ambien dominated the insomnia market like few products ever have. Our goal was to introduce a new way of thinking about sleep, and to introduce Rozerem as a new option for the treatment of insomnia. In order to take down Goliath, Rozerem needed to spend BIG. $200 million in broadcast media spend big. With millions of eyeballs being driven to the website we had to ensure that we provided a seamless, immersive brand experience with absolutely no tradeoffs."[2]
It's am award program for scumbags.
[1] https://www.mahf.com
[2] https://www.mahf.com/digital-pioneer-award-winners/