The fact that the Sacklers are going to get to keep the billions harvested by ruining the lives of tens of millions of Americans bespeaks a morally bankrupt civil society. The Sackler family literally belongs in prison. Instead, they're going to use their billions to control politicians and ruin countless more lives. The sanctioning of "white collar" criminality is a major component in the USA government's increasing loss of legitimacy.
"Dow Chemical is not responsible for Bhopal disaster that killed hundreds of thousands. They just released those chemicals into the air, you had to breath in order to be effected."
If a doctor perscribes you heroin because he read a paid-for-report by the Sackler's goons, then yes, they are responsible.
Not sure how you could blame a human for doing what their doctor tells them. Oxy is pure narcotic, and never should have been prescribed to anyone, but $$$$$ is a hell of a drug too.
Read the linked new yorker article at the bottom of this one to see how they played a direct critical role in getting doctors to perscribe them for minor pain.
A doctor prescribing them and someone ingesting them are different acts. One does not harm anyone, and is just writing on a piece of paper. The other is extremely dangerous.
>The fact remains that the ultimate responsibility for what goes into the body of a functioning adult who is not coerced in any way lies solely with that adult.
This is horseshit sneak. You know it's horseshit. You're on HN, you deal with tech all the time. Would you say that responsibility for any security flaws or leaks in software lies solely with the "functioning adult who is not coerced in any way to install it"? Individually we're humans, we have fixed brain size and thermodynamics and thus have hard absolute limits on the total amount of information we can ever know and much much tighter limits on the rate at which we can ingest new information, process it, or make decisions. It is impossible for a human brain to be in charge of everything in modern society. IMPOSSIBLE. There is not enough time in a day, not enough days in a lifetime, to learn more than the tiniest fraction of what all of us use constantly. We deal with that by massively externalizing onto other people/organizations and trust frameworks, and then working to ensure there can be enough confidence in those.
So responsibility is absolutely a spectrum, in medicine, in tech, everywhere. We cannot verify it all ourselves. Something must involve external relationships, and those external relationships are themselves two way aren't they? In a relationship, BOTH sides have responsibilities.
>We fault the individual when they don't take their medicine. Why do we fault their physician when they do?
Um, because it's a two-way relationship? The patient's part of it is to seek external expertise, and then follow through on expert instructions. The medical expert's part of it is to faithfully give instructions that are wholly in the patient's best interests to the best of their knowledge and capability, without any self-interest beyond the remuneration the patient offers for said service.
>Your doctor is NOT the authority on what goes into your body: you are.
As vacuous as claiming car manufacturers are not the authority on what you drive or it should be fine for food/medicine/anything manufacturers to lie about what goes into their products because hey, your fault for not verifying it. No, that's not how any of this works.
> This is horseshit sneak. You know it's horseshit.
Not only is that plainly false (these are my sincerely held beliefs), it’s also not in any way a refutation of my claim.
> You're on HN, you deal with tech all the time. Would you say that responsibility for any security flaws or leaks in software lies solely with the "functioning adult who is not coerced in any way to install it"?
Yes, the ultimate responsibility for the code that my computer executes lies with me. I chose each and every piece of it, much of it with a context of ignorance.
That’s a silly argument to make because it completely ignores reality.
Sure: nobody forced those pills into their mouths. But when you go to the doctor and say “I have this issue, please help me” and the doctor says “take this and it will help you”, clearly that’s something. Especially if that thing will actually not help you in the long run, and a large company knew that.
When you’re dealing with large numbers of people, instructed by an authority figure, who is in turn influenced by a third party, with an end result that lives are ruined, then corporate pandering in the form of “everyone had a choice!!” seems rather odd because it clearly doesn’t absolve the doctors or the third party of any responsibility.
I'm not tremendously concerned about absolving anyone. What I'm concerned about is a world where the many people who legitimately need pain medication won't be able to get it, because we've told doctors that prescribing pain meds to people in pain is unacceptable behavior.
That's the point. Oxycontin did help people! A lot of people are speaking as though it's an inherently terrible drug only used for abusive purposes, and that's just not true - for many people it was a valuable drug needed to address their legitimate pain problems.
Before OxyContin, there were any number of narcotic painkilling drugs from those that have to be injected to ones that can be swallowed as a tablet or capsule that are made by more reputable drug companies (and have been for decades). OxyContin didn't offer anything over these earlier drugs.
Not only doctors but many of the lay public already know this. Even if the spurious/nebulous argument that OxyContin's action lasted longer or whatever, that the sheer number of alternatives would tailor for almost any patient's requirement. The corollary being that OxyContin offered nothing new of any significance. Even existing narcotics can be compounded for an individual patient's needs.
The fact is that almost everyone knows this, especially doctors and pharmacists yet the medical profession let itself be bought off and FDA didn't even wink an eyelid to stop it. Where was the FDA's corporate memory? How did its 100+year history on this matter fly out the window as if it never existed?
Essentially, in the light of a few dollars on offer from Sackler's/Purdue these damn miserable medicos said fuck the Hippocratic Oath and let their patients rot.
The Sackler's and Purdue are ratbags, but also there's many a medico who should have his/her license to practice revoked.
I don't mean to excuse the medical establishment, since it was publicly known almost immediately after it was authorized that OxyContin was being abused. But it's my understanding that their core idea of controlled-release oxycodone really was innovative and impactful for legitimate purposes.
'But it's my understanding that their core idea of controlled-release oxycodone really was innovative and impactful for legitimate purposes.'
Yeah, that's the bullshit they want you to believe. As I said, even if no older or more commonly available opiate were available that precisely matched OxyContin's duration/time release (which is a bit far fetched given the dozens others that were already available well before OxyContin was released), then any self-respecting corner-shop compounding pharmacist will blend a time release to suit any patient (or match one to Oxycontin's properties).
Blending up a time-release drug requires a knowledge of the normal properties of said drug, an ability to calculate the additional amount of drug after its duration has been extended with delaying agents and the knowledge of the properties of any third drug needed (like another different opioid) if found necessary to add one so as to tweak or fine-tune the process. Sounds complicated, but it's a snack to do for someone with a degree in pharmacy.
I think they both aggressively pushed the sale of Oxycontin, and advertised it to be used in a specific way, so that the outcome of those two things was very likely to cause addiction problems in a large number of patients.
As a peon individual, I find it incredibly hard (and it gets harder every day) to live an honest, kind and compassionate life when I see this sort of thing happening. I am influenced not by greed or power, but by the view that if I'm not defensive with regards to myself and those that I hold dear, I will be consumed by a combination of the corporate and legislative entities conspiring to make me (and everyone like me) a peon to their desire.
It's facile and wrong to think of Oxycontin as an unmitigated evil in society. What about all the people who were diagnosed with terminal cancer and were suffering from unimaginable pain? It doesn't matter if you will get a crippling addiction if you're going to be dead in 8 months anyway. From what I've read, Oxycontin was the first available drug that could be easily administered at home once or twice a day and gave meaningful pain relief even for the worst pain. The drug may well have made bearable the last months of millions of people.
Don’t think the author would disagree with you on the point that it gave pain relief. It was approved by the FDA.
But the author does raise questions on the steps taken to achieve this:
“The Sacklers have long maintained that they and their company are blameless when it comes to the opioid crisis because OxyContin was fully approved by the Food and Drug Administration. But some of the more shocking passages in the prosecution memo involve previously unreported details about the F.D.A. official in charge of issuing that approval, Dr. Curtis Wright. Prosecutors discovered significant impropriety in the way that Wright shepherded the OxyContin application through the F.D.A., describing his relationship with the company as conspicuously “informal in nature.” Not long after Wright approved the drug for sale, he stepped down from his position. A year later, he took a job at Purdue. According to the prosecution memo, his first-year compensation package was at least three hundred and seventy-nine thousand dollars—roughly three times his previous salary. (Wright declined to comment.)”
If what's implied is true, that's a failure of the FDA, not of Purdue Pharmaceuticals. Also despite being criminal investigators they refuse to state he did anything wrong. I assure you that that means they couldn't find a comma out of place. And if a single person can subvert an entire government department why bother having one at all ?
Furthermore I don't entirely get blaming this on Oxycontin. It's not like it's predecessors were any less addictive ... Morfine is famous for being both heavily addictive and very successful (and is in fact not very different from Oxycontin), as are all the more famous psychoactive drugs (that are even heavily used on children, and do lead to addiction) like Oxazepam and Ritalin.
There is the further compounding factor that when used as a "fix" for real problems (like a spine that needs surgery) any pain relief medication, regardless of what it is, will trigger extreme addiction symptoms ... For example, I've had the pleasure of having gall stones. Now let me assure you, I am not addicted to anything and morfine doesn't actually help much in that case, but when it makes the difference from being in constant pain so severe it takes away any and all focus (and sleep) to getting 2-3h of sleep before the pain resumes and sometimes even finishing 10 pages in a book before curling up in pain for the 20th time that day ... 2-3 days of that (needed for booking operating theatre) and you're ready to kill for it. I hate what morfine does to you, especially after finding out Diclovenac would have essentially stopped the pain for real (by relaxing the muscle that was tearing itself with billirubin crystals, it's not even technically pain relief), I mean I would have had severe leakage after eating anything with a bit of fat in it, but no pain. Let's hope I know associate opioids with the pain I felt back then. The last thing I ate before the first real pain hit was strawberries. I still (~5 years later) freeze when I see strawberries in the supermarket and feel terrified. I have to use a lot of willpower to go on. And yes, I've forced myself to eat some, it doesn't help.
If you're in need of real medical help (but, say, misdiagnosed or unable to pay), this situation can last for years or decades. But of course real medical help requires days to months of attention from real experts, but pain relief any quack can easily do. You cannot take away severe pain relief and put nothing in it's place ... I mean what's the patient to do ? Kill themselves ? (Which, by the way, seems to have increased dramatically when the opioid crisis started getting fought, so clearly that's one answer that's actually used).
And yes, Oxycontin (and Rilatin) takes away your ability to think deeply in a similar way to alcohol. But even a strong dose will not have more effect than mild drunkenness. One might wonder why (especially cheap) alcohol is kept available if you take offence at strong pain relief.
> From what I've read, Oxycontin was the first available drug that could be easily administered at home once or twice a day
There are other opioids with extended release formulas, including morphine - they are nothing new.
One of the major problems with OxyContin was that they lied about how long the effects lasted. From memory, they claimed up to 12 hours, and insisted you shouldn't take it more than twice a day. This turned out to be BS, with patients reporting it lasted for 6-8 hours max - just the same as other extended-release opioid formulations.
Aside: To Kill a Mockingbird famously had the character of Mrs. Henry Lafayette Dubose, a virulently racist morphine addict.
Despite Mrs. Dubose's hatred of Atticus, he calls her the bravest person he ever knew. This is due to her resolve to break her addiction before her death, likely a horrifically painful experience due to her terminal cancer.
In a book chock full of memorable people and events, these scenes still speak across the decades as the US struggles with the damnable effects of the Sacklers' unmitigated avarice. The book remains a must read to this day.
That wasn't a lie. Tolerance is an issue with any narcotic medicine - from amphetamines to opiates. Many patients, whether they take Oxycontin or Vyvanse, will eventually complain that their tolerance will make that claim untrue. It doesn't mean the chemical isn't in their system.
Tolerance is a separate issue than the one I brought up. The issue of lying about the length of action is not related to tolerance - even patients new to OxyContin complained.
I was prescribed OxyContin myself for a while, and know very well that it only works around 6 hours for me, just the same as other ER opioids.
Thanks for this follow-up, I did more research and came across this information [0] on Wikipedia.
I am not aware of how anyone would be able to give a guarantee on duration of action. I'm not a doctor, so this could simply be naivety, but how could they possibly make the claim about how long the medicine would work, when all they know is how long the drug takes on average to be ingested and secreted from the patient's system?
In my personal experience, I have never been able to feel the effects of opioid medicines as long as the prescribing doctor said to space out doses.
Though I have never been prescribed OxyContin or anything that powerful, I fail to see how requiring companies to "guess at" things like this is anything beyond a way to scapegoat a company post-approval when the FDA finds it convenient.
I think what's facile is to discuss the properties of the drug as though the drug itself is representative of the damage that Purdue/Sacklers have done.
They bribed physicians at scale to boost the sales of their drug. That's the crux of the problem. I am fully prepared to believe it helped a lot of people - I've had family members get oxy prescribed for serious pain - but their physician should not be getting paid to prescribe more of it.
'They bribed physicians at scale to boost the sales of their drug. That's the crux of the problem.'
Exactly, not only has Purdue's irresponsible pushing up sales of OxyContin led to more people consuming the narcotic but also and more importantly—as we've seen from the opioid epidemic—it means that thousands of patients who are not terminally ill have already become seriously addicted to the drug when otherwise they likely would not have been had they had proper medical care/pain management.
I mention terminally ill patents here both because others have done so and the fact that it's necessity to classify them separately from those who are not terminally ill because essentially both groups have very different opioid regimens to each other. For obvious reasons, concern about addiction in terminally ill patients is not as an acute a problem as it is for those who are not terminally ill whereas it is an extremely serious matter for the latter group.
The issue of discriminating between pain relief for terminally ill patients and for others who are NOT terminally ill has long historical roots—a fact that many, especially the regulators, (FDA et al) including those within the medical profession who have either seemed to have forgotten the facts or who never learned them in the first instance.
Excuse me for not having the exact details to hand, but when international treaties that were concerned with illicit narcotics and the illicit narcotic trade were being signed some 80 years ago, they included provisions that permitted the use of morphine for medical purposes but banned heroin (aka, diamorphine or diacetylmorphine) outright, as then it was considered too dangerous (and unmanageable) for said purpose. This was despite the fact, which was already well known at the time, that heroin is significantly better at suppressing very severe pain than is any increased amount of morphine. Thus, the inclusion of this clause in the treaty meant that heroin became illicit for any purpose.
Nevertheless, one country refused to sign the treaty in its entirety. The United Kingdom became the stand-out exception in that whilst it still signed the treaty it had clauses that banned heroin per se struck out and or had them altered to allow heroin to be used in cases of very severe pain that were unable to be adequately controlled with any quantity of morphine. Typically, these were terminally ill patients with cancer.
Whilst this enlightened and humane view put British doctors (or at least those ones who controlled policy and regulations) at odds with doctors in other countries, it meant that doctors throughout the UK could [continue] to use heroin in cases where pain was otherwise intractable (note: heroin had been in use before the treaties came into effect).
Not only did UK doctors acknowledge that heroin was essential to their pain-relieving arsenal for terminally ill patients but also they went even further in that they continued to use a combination of both heroin and cocaine (and sometimes also in combination with other drugs) in a mixture that became known as Brompton cocktail (named after the UK hospital of the same name). This combination of drugs acted synergistically to not only relieve a cancer sufferer's severe pain but it also made the patient feel substantially better and more comfortable during his or her remaining days. That doctors in other counties did not adopt this approach is, in my opinion, heartless. Whilst concoctions such as Brompton cocktail are not as relevant these days for various reasons too involved to mention here, there's still a longstanding problem with pain management that's not necessarily directly connected with opioid addiction problems. It's as if these bastards have adopted the attitude that too much pain relief is not good for one even if it has nothing to do with increasing addiction. https://en.wikipedia.org/wiki/Brompton_cocktail
Comment on my various posts to this news article: If you read my other/earlier posts here, you'll notice that I'm not only vehemently opposed to the proposed leniency that's likely to be extended to the Sacklers but also you'll see that my anger almost surges to zealot-like proportions over what both they and Purdue have done.
My reason for reacting to the extent that I have is that this Sackler/Purdue scandal is not just another instance of corporate corruption caused by the nefarious actions of bad and greedy players—rather; it goes much, much further than that. Those of us who actually understand the true extent of what has happened in this horrible saga know that the issues it crosses are those that are fundamental to underlying integrity of modern medicine.
The matter is truly that significant and the fact that so many people do not really care about it is truly tragic. Like so many other things that have gone wrong these days, it almost seems that people have willingly parted with their long-held ethical values for good.
The matter of opioid regulations was about as high as it got in international treaties. The fact that Sacklers and Purdue have completely undermined that 100-year understanding between nations is just staggering.
Moreover, as I've shown, it is not only the medical profession that was convinced of the absolute necessity to tightly control the distribution of opiates. As we can see from the universal actions of governments around the world some 80 or so years ago, in that they were all of similar minds and convinced to the extent that they were prepared to enter into international treaties that bound both them and their citizens to this effect. In addition, each government then enacted strict local drug law legislation with draconian penalties to back said treaties.
Essentially, that for the better part of a century, the regulated control and distribution of narcotic opioids and other drugs of addiction has not only been of prime concern to the medical profession worldwide but also to every government on the planet for the very reason that the unregulated distribution of these drugs would have a devastating negative affect on their citizens. Stated another way: that if the world's citizens were given unregulated and unfretted access to drugs of addiction then many of them would suffer irreparable harm and damage to themselves from having access to said drugs—is a notion upon which both the medical profession and governments almost universally agree—and they have so agreed to this notion for most of the 20th Century and they continue do so into the 21st Century.
That long-winded statement is to emphasize the universality of this position. What you have to understand is that the Sacklers and Purdue have deliberately undermined that almost universal covenant on drugs of addiction and they have done so in the most despicable, reprehensible and nefarious way possible.
The family/company combo of Sackler/Purdue, whose ethics are as equally bad as the large illegal drug cartel barons, acted outrageously and in an irresponsible manner by deliberately co-opting and undermining the ethics of many doctors by bribing them. Many of who have since acted in a greedy and disingenuous towards their patients, not to mention also having breached their Hippocratic Oath towards them.
In summary, the Sacklers and Purdue along with their complicit doctors including the irresponsible FDA have completely undermined the very foundations of present day medical 'law',
in essence they've torn away the ethical fabric from asunder, and in so doing they have effectively destroyed the universal consensus that's been built up over the past one hundred years or so between the medical profession, the regulators such as the FDA and those countries that signed the otherwise irrevocable drug treaties. The fact that Sacklers/Purdue can wield this much power is, in my view, terrifying.
Hey, thanks for your reply, it's clear that you're passionate about the topic and that we're on the same page. Your writing on the topic is lucid and convincing, I would only point out that it's liable to get lost in the noise here on HN. I would encourage you to write essays on this and post on a personal blog and link to it on social media, or similar - or contact journalists who you see writing on this topic.
Thanks for your comments. First, I must admit to having a bad case of prolix disease so this reply will have to appear over two posts. ;-)
My main concern is driven by the fact that corporate memory seems to have deserted so many important institutions these days, matters once long settled have been forgotten or depreciated in importance by the very institutions that are supposed to be upholding those ideas. Rigor, ethics and ideals have seemingly flown out the window.
It seems very strange to me to chuck out ideas that have long since been proven to work but I accept it's part and parcel of the current zeitgeist to devalue ideas from the past without first evaluating them as to whether they're worthwhile or not. This wasn't the case until perhaps the late 1970s or early '80s, that's when postmodernist ideas began to take hold in a big way.
I'm not against all postmodernist ideas per se but some have had a devastating effect on science and engineering: once facts were just that—facts—not just 'possible maybes' as so many people consider them to be nowadays. Reason, logic and logical argument just aren't fashionable these days. Now the public's faith in science seems badly mauled and I reckon that's a bad thing. Whilst cultural changes outside of science have largely contributed to its fall from grace, there's also little doubt that science has shot itself in the foot far too many times in recent decades for it not to have had a significant negative effect on public perception. There's been too many major scientific scandals that should never have happened, some scientists have much to answer for, and scientists generally have a great deal of PR work to do to clean up the mess: https://en.wikipedia.org/wiki/List_of_scientific_misconduct_.... Nevertheless, I strongly believe that science is still the best discipline we have to prevent us from returning to the dark ages.
If you want to get an appreciation of how significantly the public's attitude to science has changed for the worse since the mid 1950s then it's worth looking at this short 1955 doco for school kids titled Why Study Science?. It's a bit trite and clichéd but there's no hiding the fact that back then the public held science in very high regard, it also shows that science and engineering held absolutely prominent and unquestionable places in society at that time: https://archive.org/details/WhyStudy1955_2. My, my how times have changed, it's a shame this doco doesn't get more of an airing by scientists (and in fact by everyone), as it seems to me to be a good reference point for comparison; moreover most scientist will be too young to have experienced how the public perceived their profession during its halcyon days, which alone is a good enough reason for them to view it.
What is so damn annoying to me about this opioid crisis is that many of those who are implicated in its creation were trained in scientific disciplines, what they did was the antithesis of what science stands for. I would further add that I don't believe doctors and scientists would have been implicated to such a degree back half a century ago (that's not to say they were above reproach, far from it).
Reading the above, I must appear to be an apologist for a past era but I'd insist it's not so. I haven't the time to expand and justify the last sentence in detail but I'll add this much. Whilst I was too young to be one of the targets of that 1955 doco, I did grow up somewhat later whilst that ethos was still current (as mentioned, things changed in the '80s and onwards). This meant that I not only learned science within that earlier culture but also I'm inculcated to think that way. Furthermore, as I'm writing this in October 2020, it means that I've witnessed the public's change in attitude towards science over these decades and, in my opinion, it's been nothing short of dramatic in the negative sense.
It's not as if back then people were slaves to the scientific elite, that's definitely not so as that was the time of the Cold War and the Bomb so there was much criticism of those who developed and tested it. The disparity between then and now is that in those days most people had a much better understanding of the difference between scientific progress for the betterment of society and science that is used for nefarious purposes and I believe that the media had much do with this more positive attitude, as reporting was much more objective and balanced back then. Furthermore, we didn't have the internet full of millions of self-styled experts to criticize science (and for that matter criticize just about everything else, both good and bad). Unfortunately, internet's 'noise' now drowns out much worthwhile stuff.
As I alluded to at the outset, there are many reasons for the opioid crisis, but I return to the fact that these days institutions such as the FDA simply do not have structures in place to remember the importance of why certain decisions were made in the past. The fact that opioid addiction has been high on the medical agenda for ≈150 years and very high on the agenda of both local and international politics for about a century and the fact that it has been effectively forgotten by the FDA says not only a great deal about said institution but also much about modern culture.
[If all goes well, I'll provide you with some examples in a reply below.]
<...> Let me illustrate what I mean with several examples. Probably the best one is about a wonderful woman named Frances Kathleen Oldham Kelsey, she was with the US FDA in the early 1960s at the time of the thalidomide crisis. She was the person who refused to authorize it for use in the US market because she had concerns about the drug's safety despite very considerable pressure on her (and the FDA) to do so from the drug's manufacturers. Moreover, she had strong backing† for her stance from senior execs within FDA. Her actions saved thousands of US children from birth defects: https://en.wikipedia.org/wiki/Frances_Oldham_Kelsey.
† (Support for staff from execs who properly perform their jobs in the light of external criticism is sorely missing from today's corporate culture. Had this happened today, I'd bet she'd have been isolated and kids would have suffered the harrowing consequences!)
It's hard to compare the FDA's virtuous and honorable action of some six decades ago with how it has totally fucked up both the approval and ongoing monitoring of OxyContin (Oxycodone) of recent years without becoming very upset. Moreover, it's hard to believe these two comparisons actually refer to the same organization. (That's the tragedy, they aren't the same except in name only!)
The example of Frances Kelsey and the FDA's actions over thalidomide versus the FDA's present-day actions with respect to OxyContin has to be the quintessential example of its kind and this message ought to preached out loud from rooftops by all and sundry.
Here's a current example: authoritative information about COVID-19/SARS-CoV-2 was unduly late—so late that many lives have been tragically lost through such negligence. Given the experience of past pandemics, the WHO and health departments worldwide should have acted much sooner than they did. Thus, the deliberate and wilful campaigns to spread disinformation about COVID-19 worldwide were not immediately quashed by governments, especially so in the US where some administrators and the President acted with outrageous negligence by suggesting the disinformation was actually true (or essentially so), thus aiding and abetting its spread. (In my opinion, they're culpable at law for the loss of many lives.)
OK, with such sweeping statements, let's look at the facts (I'll try to keep them as short as possible):
1. Most people (including doctors and health administrators) have never seen a fully blown flu-like pandemic before so there's some excuse for the delay early on. That said, better protocols should have been in place as epidemiologists have been whingeing for decades that another pandemic was on its way.
2. Pandemics are not new; many have come and gone, thus, once recognized, health departments should have acted immediately from well-prepared and well-scripted emergency response procedures. That they didn't act so in response to the pandemic is yet another instance of corporate knowledge having gone walkabout from medical agencies/departments (after all, they had experience from many past pandemics to fall back upon—from the Spanish Flu through to MERS and Ebola—but they did not do so).
3. To make matters much worse, we've also had the truly amazing debacle over the wearing of facemasks. Given the supposed sophistication of our modern-day world, this example seems almost unbelievable except for the fact that we been actually watching it play out. It has so many truly rotten aspects to it that you'd be forgiven for thinking the story had been concocted by a bunch of novelists competing for the best plot.
From the outset, many health professions lied to the public over whether masks were effective or not—which they are and there's never been any doubt about that—and they did so by vacillating around the truth. By lying, these medicos put doubt in everyone's minds (and, even now, tragically, many members of the public still have serious doubts as to the effectiveness of masks). Of course, the medico's reasons for lying was to ensure that they were first in line for the few N95 masks available (again, given past pandemics, the shortage of these masks was very foreseeable and should never have happened). Had pandemic protocols been in place, lying would have been unnecessary, as in the event of a shortage, medicos would have automatically been assured first preference!
With many of the medical profession and the WHO not immediately coming out to give full support to the wearing of masks at the beginning of the pandemic, they gave the rabidly stupid libertarians a glorious opportunity to say their rights and freedoms had been violated. The difference between these idiots and other libertarians (especially the libertarian left) is that the latter recognize the difference between political freedoms and the necessity to obey laws when living in a civilized society.
Stating the damn obvious: one obeys laws out of utilitarian necessity, which is another way of saying laws protect those of us who are minding our own business from others who would otherwise act contrary to our own best interests and safety. If people near me refuse to wear masks then, ipso facto, they are endangering my health and safety, thus during a pandemic I have every right to demand that they wear masks whenever they are near to me—and I expect the law to support me in upholding my stance. For those who don't know it, this is basic democracy 101—for demanding that people must wear facemasks in a pandemic is, at law, logically no different to any other law that protects me from any other form of assault. QED!
4. When advice finally came about keeping a safe distance from one another, it turned out to be essentially worthless. In most countries that advice was to maintain about 5, 6 feet, or 1.5 meters between one another. It turns out that in such circumstances one's protection is essentially non-existent unless one also wears a mask (even then, it's preferable that both parties wear masks as this effectively multiplies the protection between both of them).
The reasons become clear when one reads a Hacker News link of several days ago. It took us to a particularly relevant article by Karen Kruse Thomas dated July 17, 2020 on the Johns Hopkins Bloomberg School of Public Health website with an unusually long title of 'The Experiment that Proved Airborne Disease Transmission'—'How Richard Riley’s findings about tuberculosis transmission inform our COVID-19 response today'. The article describes an old but very cleaver experiment carried out 64 years ago in 1956 that essentially proves beyond reasonable doubt that protection offered by such small separations of about 1.5 meters without facemasks are essentially ineffective, it then goes on to show from experiment that airborne transmission of disease over much greater distances is indeed possible: https://www.jhsph.edu/covid-19/articles/the-experiment-that-...
Again, there are several aspects about this article that are truly tragic; the first is that this critical information seems to have only become commonly available well into the pandemic; and second, top medicos including those at the WHO seem to have been unaware of the research until now. Here again, as with the opioid/OxyContin epidemic, critical corporate memory has been lost (or perhaps was never collated in the first instance).
This is not only disgraceful; it's damn-well outrageous. It's little wonder that the public has lost faith in science when the custodians of science allow this sort of travesty to happen. What the hell has the WHO been doing all these many years, and why isn't this research already common knowledge among medicos? Frankly, I'm lost for adjectives to describe how annoyed I feel about this incompetence. (We really do need to go to 'war' over this given the fact that the key institutions that are charged with protecting our health have failed so miserably in doing so.)
Let me add however, the fact that airborne transmission over much greater distances is possible has also been reported in other recent research carried out earlier on in the pandemic and it backs up the earlier 1956 research. Unfortunately, authorities never reported this newer in ways that were meaningful to the public. Why you may well ask. The cynic in me suggests that in the trade off between human life and economics here we may well have proof that economics is the real winner.
From quite early on in the pandemic, I've assumed that airborne transmission was highly likely (given that I'd heard about it in association with other diseases long before COVID-19 arrived), so I've always worn a mask from the outset. (Luckily, I also had a box of N95 masks that I'd been using as dust protection on industrial sites pre COVID-19.) Incidentally, my personal criteria for safe-distancing is based on the typical distance over which one could smell a smoker's cigarette smoke in that that smoke had been actually breathed out by the smoker. As most will know, a non-smoker can easily detect the presence of a smoker across a very large room without the need to set eye on him or her. *(Note, is not a recommendation, it's just what I do.)
With reference to your comment about me writing an essay on the subject, I must say that I don't consider myself sufficiently qualified to do so. Even though I'm passionate about the topic, I'm not a doctor so my criticisms of those responsible for the opioid/OxyContin epidemic are essentially limited to 'failures of process'. True, I do have some knowledge of the matter as early on, I was going to be a pharmacist and my better half works in the medical game, so I have understood the crux of the addiction problem long before OxyContin came along not to mention that I've also numerous books the matter.
Another reason I feel strongly about the need for institutions to maintain a continuity of ideas across multiple generations is that over the years I've been on various standards committees and I have written a few standards (albeit not in this area), so the need to maintain standards is well ingrained upon my psyche.
I'd add one final point, which is that earlier today I reread my posts here and to me they read as if they've been written with the zealotry of a reformed opioid addict! Very fortunately, I can assure you that this has never been the case.
BTW, I agree with your point that my comments here on HN will easily get lost in the noise. Unfortunately, I killed off my personal web pages some years so I've no personal blog at the moment but I've been thinking about bringing it back in the near future. Of course, others if they so wish can always point journalists and other interested parties to these links. Methinks, that seems like a good idea.
> It's facile and wrong to think of Oxycontin as an unmitigated evil in society. What about all the people who were diagnosed with terminal cancer and were suffering from unimaginable pain? It doesn't matter if you will get a crippling addiction if you're going to be dead in 8 months anyway. From what I've read, Oxycontin was the first available drug that could be easily administered at home once or twice a day and gave meaningful pain relief even for the worst pain. The drug may well have made bearable the last months of millions of people.
Problem is that it was pushed on people who didn't suffer from terminal disease but milder chronic pain, only to make more money, not for the sake of their health. Yes it was effective but it turned people in hardcore addicts who then turned to nastier drugs when they couldn't get their fix. It killed a lot of people and destroyed a lot of families.
So, in this scenario, you have a pill and a doctor. You have an inanimate object that cannot defend itself against being prescribed to a person unnecessarily... and you have a doctor, who prescribes drugs to patients.
You are choosing to blame the inanimate object, when it is clearly the doctor who has acted unscrupulously.
Precisely - I ignored it out of convenience. OxyContin could grow on trees for all I care - it doesn't matter who made it, and that property doesn't do anything to strengthen or diminish my argument.
To make the argument you're making, you would have to prove that it doesn't need to exist and was fraudulently made and promoted to deceive, not to help. The problem is that the thing exists, it has a necessary purpose for existing, and by existing it makes the world better for millions of people.
That doesn’t give the company a free pass on anything else. The drug helped some, it hurt others. In an effort to increase sales, Purdue misled doctors and broke acceptable marketing practices in an effort to indiscriminately increase usage - good and bad.
The claim is not that oxy didn’t help. The claim is that it also hurt, Purdue knew this, but ignored it for the sake of profit.
Pushed by whom? Who was prescribing these drugs and why? How did this become standard care? There’s obviously plenty of blame to go around but it appears to be a general failure of the healthcare system.
edit: I get people want to assign blame on one single malicious actor but its not that simple. this article [0] explores the failings of the system and calls out some of the main actors: "Purdue Pharmaceutical, the Joint Commission, Press-Ganey, and CMS and hospital administrators ."
When people exploit the system in order to benefit at the expense of others: yes, it is a failure of the system. But it is also a moral failing on the people exploiting the system, knowing the kind of damage they're causing. One does not preclude the other.
> They found a widespread pattern of illegal misconduct in which Purdue systematically misled doctors (and the general public) about the risks associated with OxyContin
Pushed by the company AND(!!!) also by doctors. The company spent a lot of money on spreading lies and belittling negative information. Same what the tobacco guys did. Doctors aren't faultless either. A lot of them must have seen what was happening.
Doctors, who were taught that "pain is the fifth vital sign" in studies and "direction" lead by research institutes that were funded by pharma companies, hidden via layers of indirection.
Doctors that were assured that OxyContin was not addictive and "low risk" in the educational material supplied to them by the suppliers.
'Doctors that were assured that OxyContin was not addictive and "low risk" in the educational material supplied to them by the suppliers.'
If gullible doctors actually believed this 'low risk' nonsense then it's a terrible blight on the medical profession's training. Every doctor knows (or he or she ought to) that for most opioids used for pain relief, the respective amount of any specific opioid used to provide x amount of pain relief has y amount of potential for addiction. That's to say, an amount of one type of opiate necessary to achieve a specific level of pain reduction has about the same addictive properties and another different opioid that achieves the same level of pain reduction as the first one. There are some differences such as pethidine which works wonders in renal colic for instance (but it's not as effective even in high doses for some other types of pain as are other opioids).
I don't want to get bogged down in detail here but the principle difference between opioids is in their different strengths and in the different way they are administered. Irrespective of how they're administered, if they kill pain and they're not administered with considerable care the patient will likely get addicted, especially so if the drug is administered over a longish time and or the patient is given too much.
Essentially there's no such thing as a low risk opioids except at perhaps the very margins. We've been down this well-trodden road before with heroin. At the turn of the 20th Century ca 1900, Bayer released heroin, it was supposedly not as addictive as morphine when in fact it was even more addictive. It didn't take long to realize that its ability to suppress pain to a deeper level than any amount of morphine also went hand-in-hand with it to be significantly more addictive.
This low risk argument is absolutely outrageous. The fact that I have to labor facts here that 99.9% of doctors and pharmacists already know attests to the paucity of Purdue's argument. As I said elsewhere, the true tragedy of this saga is that both the FDA and much of medical profession pretended they didn't know these well-known facts or ignored what was happening for self-serving, ulterior motives (I find it very hard to believe it was incompetence or lack of knowledge on their behalf).
> "What about all the people who were diagnosed with terminal cancer and were suffering from unimaginable pain?"
I don't think anyone would disagree here. But they weren't just prescribing it to terminal cancer patients, were they?
"With the launch of OxyContin, in 1995, Purdue unleashed an unprecedented marketing blitz, pushing the use of powerful opioids for a huge range of ailments and asserting that its product led to addiction in “fewer than one percent” of patients."
Oxycontin has its uses and benefits. No doubt. The problem is that the manufacturers thought that's not enough profit. So they expanded their target market and pushed it on people for whom it was a harmful choice. To do this they lied about the necessary doses perfectly knowing that this was a lie. It's the same playbook the tobacco industry used (still does?). Lie about known problems with your product while at the same going all out on sales.
> The drug may well have made bearable the last months of millions of people.
If you think that is a fair trade-off, how many deaths would you consider acceptable to gain the pain relief benefit? As an exercise, try calculating an exact number and then comparing that to actual deaths from the opioid epidemic.
Says a lot about our ruling institutions that the headline is this and not "The Sackler family's plan to ride out the next 30 years in federal prison."
What I find interesting is how the story is framed. In particular why do articles about corruption in the US (and other first world countries), never feature the word "corruption" explicitly? It is implied that there is corruption but it is never explicitly stated.
If this article was about some less developed country, the word would appear endlessly throughout the text.
Seems like western journalists have bias when it comes to using that word.
My guess is to avoid risk of defamation lawsuits. I know in the states a lot of publications are careful how the phrase things to avoid even the risk of a lawsuit regardless of if it would be a legitimate claim.
Ruling institutions collude with the powerful and the uber wealthy. The way this happens in through layers of indirection: ex-DOJ prosecutors as partners at big law firms, revolving door, etc.
I've never had debilitating, long-term pain. Have you? I think it's remarkably sadder that people have to deal with pain like this. And you jump right to wanting to lock up people and take your revenge. Isn't that a rather sad state of affairs?
I've been in the presence of people who need pain medicines like OxyContin and who are not able to continue living without it. Not because they're addicts, but because they have horrendous medical conditions caused by all sorts of things, ranging from US armed conflict all the way to cooking accidents while on the job at a restaurant.
For however many people you think are addicted and killed by drugs like OxyContin, there are far more people that are in need of drugs like these through no fault of their own, and often times, directly due to the very same politicians who are now celebrating this "takedown" of Purdue.
The difficulty one of these individuals had in obtaining their necessary Oxycodone during the COVID-19 lockdowns resulted in him attempting suicide. This person is not alone in this dilemma. The ridiculous scapegoating and guilt-tripping of this drug has led to the ruination of countless lives as well. Many people are suffering right now because some people think it's a corporation's fault when they choose to put a highly effective narcotic into their system.
We can't send people to foolish overseas conflicts, require people to engage in dangerous jobs like oil rigging and construction work, and then not give them medicine to make their on-the-job injuries livable. Doctors are the ones who make decisions about what to prescribe - they are the ones who commit the fraud of prescribing unnecessary medicines. If you're truly so eager to throw someone into a cage for their terrible crimes against humanity, you may want to start with the doctors and politicians before the wealthy, greedy Sacklers. I know that doesn't fit into the neat little boxes on top of which people love to grandstand these days, but the truth is a lot more valuable than filthy, emotionally-driven platitudes.
You've missed the point. There would be precious few who would deny narcotics to those who really need them. They are often the only effective line of pain relief for severe pain and they are on WHO's list of essential drugs!
You seem to have not considered these points:
(a) The intrinsic nature of narcotics requires them to be managed with great care. This means the dose has to be accurately titrated sufficient to kill pain and no more or addiction results. These facts have been known by the medical and pharmaceutical industries for over 100 years, also the FDA knew this but seems to have forgotten when it was lobbied. (I'm oversimplifying the facts here but it'll have to do.)
(b) Sacklers/Purdue were fully aware that intrinsic nature of narcotics requires them to be managed with great care. As this info is in almost every medical text on the planet that deals with the subject, similarly every pharmacopeia text on the subject. (Check for yourself.)
(c) Sacklers/Purdue deliberately ignored these well established medical facts about narcotic addiction so as to proffer from drug sales. They willfully pushed OxyContin use to levels well in excess of that recommended by medical best practice. Thus, it hugely increased the numbers of opiate addicts than there would otherwise have been.
(d) As I've said above, many medicos were complicit with Purdue and deserve to lose their license to practice.
(e) As I also said above 'before OxyContin, there were any number of narcotic painkilling drugs from those that have to be injected to ones that can be swallowed as a tablet or capsule that are made by more reputable drug companies (and have been for decades). OxyContin didn't offer anything over these earlier drugs.' Doctors, pharmacists and the FDA knew this too, yet they deliberately threw away their Hippocratic Oath and 'mistreated' their patients for a few cheap shekels.
One of several reasons this happens is because debilitating the company is like completely skipping an antitrust hearing and granting the remaining companies closer to a monopoly.
The government feels like reining in the remaining company's behavior in the future will be that much harder, while the service for customers and society will degrade to that much worse and egregious.
Yes, the concept is stretched when half a million people are dead, and many of the others are now addicted to fentanyl as the country has devolved into a narcostate with poisoned supply chains. If you want to understand how we get here, you have to understand the psychology of the governments instead of oversimplifying it with "corruption" because such a simplified view will cause the wrong and ineffective public policy changes to occur, making those dead and dying people's lives be in vain.
Where on the line ranging from opioids through tobacco through sugar through fast food through alcohol through 1970s food pyramid through steak through salads should we place the point representing “everyone who profited from items to the left of here shall be sent to jail”?
This should not be a surprise to anyone who understands the purpose of the corporation. It is to create a legal entity that shields owners from liability.
See _The Corporation_ by Joel Bakan for details.
The answer isn't "get mad at the Sacklers", it's change the law.
This monotheistic appeal to the altar of legalism is frightening. Just because my government or even peers have determined that raining down hellfire on villages in the Middle East or has accepted that some of the state's population should be subject to capital punishment does not mean I think it is 'good'. Moreover, I can be angry because I think it is bad. It is not simply irrational either - in my framework of moral logic I see someone doing something 'bad' and naturally react negatively towards that behavior.
> This should not be a surprise to anyone who understands the purpose of the corporation. It is to create a legal entity that shields owners from liability.
True. But the owners are the shareholders. The bargain is if they limit their involvement to providing capital, their liability is limited to what they provided.
But the Slackers didn't limit their involvement to just buying shares, they ran the place. There are not just on the line for criminal activity, the banks could have made them personally responsible for money borrowed, companies made them responsible for NDA's, governments hold them personally responsible for things they sign like tax submissions.
Roughly half a million Americans have died from opioid overdoses since 1998 [1]. I don’t know how many can be directly attributed to OxyContin, but other drugs are pulled from the market over a tiny fraction of that number of deaths or less serious side effects.
Dang, I know you like to run a tight ship, but being critical is not the same thing as trying to instigate a flamewar. I’m stating harsh realities and we need to be grown-ups and deal with them if we ever want to solve them. You’re clearly a person of enough mental fortitude to moderate subjective material but sometimes I think passionate discussion is necessary. Everyone on this forum is an adult (From an intelligence pov) who should be able to handle critical questions with admittedly poor tone and not become emotionally blinded. See that’s what im trying to do; I’m trying to see if they will fight reason with better reason or subjective emotion. If you limit conversation on the grounds of hurting someones feelings, then you’re stifling the ability to express an idea to people more who might be more receptive.
Can someone enlighten me on the psychological wiring of people like these? Do you even think a moment about anything else than you very own well-being, no matter the (societal) costs? Is your relation to the world a purely instrumental one? Where does this destructive energy comes from?
Few people play the villain in their own story. More likely they thought they were helping people with chronic pain and justified it by thinking that “more good than harm comes of it”.
Plenty of people on this site are employed in work with large negative externalities with similar justifications. We just haven’t had the 20 years to see the outcomes yet.
I think this is exactly it, the stories we tell ourselves (and each other) about ourselves allow for every kind of justification for any kind of action. It reminds me of studies in confabulation in split-brains:
>> Some of the most famous examples of confabulation come "split-brain" patients, whose left and right brain hemispheres have been surgically disconnected for medical treatment. Neuroscientists have devised clever experiments in which information is provided to the right hemisphere (for instance, pictures of naked people), causing a change in behavior (embarrassed giggling). Split-brain individuals are then asked to explain their behavior verbally, which relies on the left hemisphere. Realizing that their body is laughing, but unaware of the nude images, the left hemisphere will confabulate an excuse for the body's behavior ("I keep laughing because you ask such funny questions, Doc!").[1]
People are driven by one part of their brain to consume and acquire pleasure/status/money and simultaneously convinced by another part of their brain to believe they are good, deserving, and entitled to everything they enjoy. I see this with all sorts of people who are caught doing something they know is wrong and immediately respond with "well, everyone else does even worse..." or "yeah, but I do X, so it evens out...".
I would also argue that we've noralized the idea that if you achieve massive wealth that is the real success and you shouldn't be held responsible for the bad things you had to do to get there.
Most people can't achieve that level of wealth without sacraficing some morality along the way, but when very few of them are held accountable it's just the cost of making billions of dollars.
There is also the idea that wealth is a reasonable measure of one's contribution to society. This way, any personal wealth that is acquired by legal means is not just morally acceptable, but good for all.
I am not sure if you typo'd "moralized" or "normalized". I think the latter, but it might be good to edit your comment with the intended version (if you see this before the edit period ends).
I don’t know if that’s absolutely true. Google was successful simply because they built a better mousetrap in search and selling ads around it. The more shady things I’d argue came much later, from what I can gather about the publicly available information on the company and what it’s been like to work there through the years.
I’m actually far more worried about what these people and companies do to maintain their wealth and status. That tends to be where things go much much more sideways and ends up more often than not being very harmful historically
Furthermore, there are many layers between them and where much of the wrongdoing took place, so they may or may not have had any involvement in the "villainy". Perverse unintentional incentives at one more places in the stack are more than sufficient to create the appearance of villainy without any intentional malice. Hanlon's Razor is far more common than people want to admit.
In this story, doctors are looking for easy solutions they can prescribe in 5-15 minute appointments so they can see as many patients in a day. Management is looking to increase sales. Account managers are trying to get doctor's to prescribe. The only "villainy" at the board/shareholder level could be as simple as tasking management with finding other legitimate well meaning use cases for opioids. That incentive alone is enough to create pressure all the way down the stack and when people in the stack are presented with the challenge of meeting goals, all of them in concert making small compromises within their role are enough to produce the illusion of villainy.
> Furthermore, there are many layers between them and where much of the wrongdoing took place, so they may or may not have had any involvement in the "villainy".
Or perhaps they had involvement, but it was too abstract to register as obviously "villainy" in their conscience.
I sometimes quip that the only thing necessary for the triumph of evil is for good men to be separated from it by enough layers of indirection. Perhaps that's one of those cases.
I have yet to see any compelling argument that opioids do not provide a net good to society.
A cursory glance at the statistics re: opioid abuse suggests that it negatively affects us at about the same level as alcohol, which has absolutely zero therapeutic use.
This sounds true until you hear the Sackler family speak, after that it’s clear they fundamentally detest other people and don’t care about the harm they cause. They wanted money that’s where the analysis stops.
There's also a cruel irony in the fact that addiction has very negative impacts on folk's self esteem. One of the negative cycles in addiction is when someone does become the villain in their own story.
It's heart breaking to talk to a loved one suffering from addiction and hearing that they think they deserve to have it due to some self-perceived failing.
I really wish the U.S. would get it's act together culturally around how addicts are perceived, treated, and helped.
Very true. Also it's difficult to judge whether “more good than harm comes of it”. I mean: I work in cancer research but maybe it would be better for the world if I didn't and somebody smarter would take my place
The fundamental flaw in human nature is the universality of the thought "I'm a nice person, I'll never do what they did!"
Yet, few of us forego our comforts and vacations when that could measurably help many with basic life necessities. If you contribute 20% of your salary to charity, you're already in the significant minority, leave alone higher ratios.
Many here work in facebook, or Palantir, and find ways to justify how it's not that bad a company. Other tech companies too, but the point is made more clearly with these examples.
On a far simpler example, a few years back, most everyone in this forum probably used to pirate movies. Whatever Robinhood justification we all used, in the end we broke the law. Probably because we thought it didn't matter, that we somehow deserved what we took, and that we won't caught. That's the first rung in the ladder that after a very large number of steps leads to where this family has ended.
If you were ready to break a small law to just watch a movie, is it that unfathomable that these people will do dastardlier things to keep billions?
> Yet, few of us forego our comforts and vacations when that could measurably help many with basic life necessities.
Paying for those comforts helps pay for the basic life necessities of those who provide the comforts.
> If you contribute 20% of your salary to charity, you're already in the significant minority, leave alone higher ratios.
Few common workers can afford to contribute 20% to charity without living paycheck to paycheck.
This is what progressive taxation is for. The marginal utility of money for funding the basics of life diminishes as you move into the .1% of the income/wealth distribution, which is the argument for taxing those people more. The marginal utility for political power, however scales up with wealth, which is an even more compelling argument for strongly progressive taxation.
I think hardly anyone is able to really face the suffering our normal daily lives cause, to humans and animals, now and in the future. It's too much and the implications, if we were to face them, are too radical. So we tend to look at the effect we have on the people close to us and call it good.
Now imagine you're a billionaire, and your behaviour is like this. Won't you look like a monster, because of how distanced you are from most people, and the extent of your influence?
What they're doing is no different to what other people do. They're just doing it by in billions of dollars instead of thousands.
Every day, people take the easy choice, they go for the quick buck, they ignore inconvenient evidence of problems they don't want to admit, they maximise their own returns and minimise their risks, they justify and minimise their own failings.
The issue here isn't that these people were people. The issue is that they were left unsupervisored and simply "trusted" to get on with it.
The Sacklers should definitely be in jail. But everyone in the value chain is culpable. Why did insurance pay for these for almost anyone? Why did doctors prescribe it so liberally? What about the med reps that (until recently) basically all but bribed doctors to push their new drugs? What about the FDA and monitoring the quantity and velocity of these prescriptions?
It used to be that, outside of the hospital, people only got morphine at end of life. What did we think would happen when we started handling them out like Skittles?
> What about the FDA and monitoring the quantity and velocity of these prescriptions?
Why would you think it should? It had to have a warning as a schedule 2, nothing more. The hindsight that the FDA should have monitored it or that it should have been classified higher, was the responsibility of the universally corrupt idiots that are elected to the US Congress.
Reminds of this podcast below which sheds light on the theory of cognitive dissonance. About how people justify their actions to reduce cognitive dissonance - basically sleep at night.
I think a lot of it is perhaps fundamental attribution error, which is ridiculously common in people.
I actually tend toward the idea that people that manufacture and sell potentially harmful, but inanimate things are in no way responsible for their final use (or misuse). They're not forcing anyone to take these drugs, nor is the prescriber, nor is the pharmacist, nor is the truck driver who drove it to the corner store.
That said, I also recognize that while the person who put the opiates into a human body is the ultimately 100% responsible party for any harm caused by those opiates, the fact remains that many people would choose such self-harm in various circumstances (such as massively addictive drugs being prescribed by their doctor), and that we must consider the effects of circumstances on people and their decisionmaking.
Treating people as sheep that are entirely dependent upon their circumstances to determine whether or not they make good (in your and my view) choices is the wrong move, however.
Ultimately though, it's simply not the fault of the manufacturer or vendor if adults misuse their products.
There seems to be a lot of support for ending the drug war in the United States. (I'm one of those people.) If that happens, opiate addiction seems to become much more likely, as opiates will be cheaper, safer, and more plentiful/available. I guess I'm just not sure where the outrage at this manufacturer comes from, given the disaster that the drug war's been. What they're doing is (mostly) legal, and the parts that they're trying to hang criminal charges on shouldn't be crimes.
> I actually tend toward the idea that people that manufacture and sell potentially harmful, but inanimate things are in no way responsible for their final use (or misuse). They're not forcing anyone to take these drugs, nor is the prescriber, nor is the pharmacist, nor is the truck driver who drove it to the corner store.
This might be admissible in the case of the sacklers if all they did was create the drug and make it available, but they did much more than that: they marketed opiates heavily, they aggressively downplayed the negative affects, and they incentivized doctors to prescribe (which of course apportions some of the blame to the doctors as well).
And even the prescribing doctors share in the blame through their deliberate actions: first, when a doctor prescribes opiates, they’re not prescribing some other treatment, but you (the patient) still have the issue, so you can’t really not take the opiates, ie forego treatment, especially since you’re also out the money and using up your insurance (if you even have that!); second, not behaving in line with your doctor’s wishes can have its own set of consequences, ranging from ticking your doctor off (which is bad, since you need them to help you with your condition, and finding new doctors takes time and money, and you’re ill all the while) to getting sent to the psychiatrist.
So much to say, I think this attitude is incorrect in the case of the Sacklers, as it doesn’t comport with the evidence, and in the general case it’s naive.
You certainly should be liable if your product is highly dangerous and addictive, and you've purposefully created an environment that incentivizes over proscribing of your dangerous addictive product. If you actively encourage the misuse, you are the problem.
You could make similar arguments against Wells Fargo account fraud or Boeing 737 MAX. Both involve executives creating environments that resulted in abuse or "misuse" by employees or customers. Did these policies cause harm? Were there safeguards in place to reduce abuse/misuse, or were those ignored because they would have stopped the gravy train?
They are protecting their property from theft by force by the state. They view themselves as the moral owners of that earned private property, and the state as the thug hired by the masses which is attempting literal theft (in the moral, not legal sense) at figurative gunpoint (don't obey - go to prison). They view their wealth as the fruits of value adding voluntary exchanges that is theirs and only theirs to reap, distribute, horde, burn, spend, etc.
That is the libertarian philosophy that undergirds these kind of actions.
I am a libertarian although you're right that that comment wasn't supposed to be an endorsement, just an explanation of the mindset of its more stringent adherents
Chances are, almost everyone, including me and you will act exactly the same given the right circumstances. At this point I don't even think of it as something "bad". It's just the way it is.
How can this possibly happen unless the administration of justice is totally corrupt? It can't and the system is corrupt in more ways than one. The Sacklers and their company Purdue are parasites on our society.
The trouble is that government administrations around the world have been complicit or Sacklers couldn't have gotten away with doing what they have done. The fact is that modern medicine has known about the true dangers of narcotics in a reasonably extensive way since the 1860s Civil War, as this was the first time that both 'refined' narcotics and the hypodermic needle were used in combination in a big way. The consequence was that thousands of injured Civil War veterans became severely addicted to the over administrations of laudanum/morphine (it's the classic case historically).
By the turn of the 20th Century the narcotics problem was well known around the world and by the end of the first half of the 20th C. international treaties on narcotics were in place and they'd been revised many times. Not remembering the details I've just checked and I offer this quote from Encyclopaedia Britannica on its page on the History of Drug Control:
'In 1909 U.S. Pres. Theodore Roosevelt proposed an international investigation of the opium problem; a meeting of 13 nations held in Shanghai in the same year resulted in recommendations that formed the basis of the first opium convention held at The Hague in 1912. Ratification of the Hague Convention occurred during the meetings of 1913 and 1914. Although further regulatory activity was suspended during the course of World War I, ratification of the Versailles peace treaties of 1919–20 also constituted a ratification of the Hague Convention of 1912. The League of Nations was then given responsibility to supervise agreements with regard to the traffic in opium and other dangerous drugs.'https://www.britannica.com/topic/drug-use/History-of-drug-co...
If you read on, you'll see there were many revisions of the drug treaties between WWI and 1950. You don't have to be a medico or in drug regulation to know narcotics are regulated by international treaty for a very good reason, yet in recent years governments around the world have acted as if these treaties (and their own narcotics laws) never existed.
Funny isn't it, if I or any of we individuals had smuggled heroin across almost any border of any country and we were caught then we'd be locked up for decades, or in some countries, we'd even be executed as they've death penalty for smuggling narcotics.
So how in fucking Hell's name did various governments let these corporate 'pharmaceutical'—drug-peddling corporate cowboys/sleazebags even operate given the history of drug regulation and past and present law—let alone push so much dope to so many for so long?
Furthermore, what were all those doctors who prescribed the drugs doing? What on earth was going on in their minds? I am not a medico and even I (as do most of us) know the scripts these doctors were issuing like confetti would lead to serious addiction.
As I see it, our governments and their regulating authorities like the FDA are so fucked-up by corporate influence and lobbying that nothing works in the interest of the citizenry anymore, essentially our democracies are stuffed!
There cannot be any other possible reason, especially so when even the doctors are deliberately ignoring a central and fundamental tenet of their medical training.
We ought to be out on the streets demonstrating over this. There's no way the Sackler family and Purdue should get any concessions over this matter whatsoever—nor should any deal be done with them. Their actions of deliberately pushing their narcotic OxyContin to the extent that patient addition was inevitable makes them fully culpable.
Nothing short of them being locked up ought to suffice.
Because there's a difference between consuming something willingly and a shady corporation conspiring with the system to get unsuspecting people hooked onto their drug of choice for personal benefit?
Not if it's legal for the addict (because mental health issue not criminal), but a crime for the pusher/distributor (because you're taking advantage of those w/ addiction tendencies).
Is there? Everything you see on the store shelves is there because some corporation manipulated the store to put it there, and because that corporation expects to personally benefit from lots of people buying it.
Notions of consent are different. You do what the doctor tells you, and its an enormous ethical violation to recommend drugs without revealing the way you personally gain from it, or to encourage people to recommend drugs that are not medically necessary.
With legalized drugs there isn't this trusted arbiter telling you what to do, so you can consent easier when you buy and take them.
I agree that it's fraught and there are tons of ethical parallels that need to be worked out but that's one reason.
It's sort of amazing that the reason we have these licensed people who are supposed to be "trusted" to give good instructions is because of the system of prohibition on the sale of drugs by the unlicensed.
The argument is, of course, that by restricting the distribution to licensed professionals, the abuse of dangerous drugs would be curbed because the trade would be restricted to to those trained in their safe use.
We have the worst of both worlds. This is all a result of prohibition.
> how can one think both of these things: drugs should be legal
Easy. In Australia cigarettes are legal. But advertising or indeed any form of promotion (including attractive packaging) is not. If Oxytocin were legal was legal in Australia in the same way tobacco is, the Slackers would have had their arses hauled off to jail ages ago.
Granted, the USA doesn't seem to have reached the same common sense compromise when it comes to legalising cannabis. You seem to go from mandatory jail terms for anyone who touches the stuff, to full on "government get out of my way so I seduce every sucker I can find into full on addiction".
There are some aspects of the USA I fear I will never understand.
> that some very large percentage of opioid addicts were not previously prescribed opioids.
Doctors massively over-prescribed opioids. This meant American homes were awash with prescription meds, and lots of these were not needed by the person they were prescribed for.
So people started giving away their meds to relatives or neighbours, or selling them. Or people started stealing meds from their relatives to distribute.
The underlying cause is the same: massive over-prescribing of opioids.
I think I've linked to the right table, but just in case it's "Table 6.47B – Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past Year Users Aged 12 or Older, by Age Group: Percentages, Annual Averages Based on 2011-2012 and 2013-2014", but there's a lot of information in this link.
It's not racially tinged (except inasmuch as all forms of elite society have been historically closed to racial minorities until quite recently), but a "white-shoe"[0] law or accountancy firm refers to the companies that make up the very crème de la crème of those industries.
These are firms staffed by wealthy and well-connected Ivy League graduates who provide services to help even wealthier and better-connected Ivy League graduates get what they want and make and keep enormous amounts of money.
The name comes from a certain style of shoes that used to be fashionable among a certain class.
The term specifically indicates members of firms so privileged that they never have to negotiate city streets filled with mud and horse shit so they can wear white shoes or spats that are always clean.
Thanks. A google search for "white shoe fixer" was only returning glue and polish for shoes.
Given the derogatory Ivy League sense of the term, it's a funny one for the author to use. Keefe attended Columbia, Cambridge, London School of Economics, and got a JD from Yale. Those white shoes you can see from space!
Good grief. Can you please stop posting ideological (and worse, race war) flamebait to HN? It's not what this site is for. Worse, it wrecks what it is for, so we have to ban accounts that keep doing it.
I have never heard this term, and a google search does not provide an accurate context. Your comment is very much contributing, as an earnest question, despite the downvotes.
