The Family Making Billions from the Opioid Crisis

http://www.esquire.com/news-politics/a12775932/sackler-family-oxycontin/?src=longreads

by traek • 9 years ago

325 248 9 years ago

refurb17• 9 years ago

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.

QAPereo4• 9 years ago

How many people on heroin or fentanyl started on Rx Oxy?

refurb17• 9 years ago

Good question! I don't know and I assume others don't as well.

But we need a scapegoat right? Purdue will suffice.

rdtsc2• 9 years ago

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.

vasilipupkin3• 9 years ago

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.

sillysaurus3• 9 years ago

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.

loeg• 9 years ago

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.

beisner• 9 years ago

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.

iaw5• 9 years ago

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.

refurb17• 9 years ago

I used to work in the industry on the research side. It's amazing how wrong the media can get about these things.

ada19812• 9 years ago

Astroturfing?

dyeje• 9 years ago

What do you mean by switching? All of the drugs you listed are opioids. It's not clever, it's a fact.

refurb17• 9 years ago

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.

mcguire3• 9 years ago

"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.

iaw5• 9 years ago

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.

wozniacki• 9 years ago

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

yourapostasy• 9 years ago

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.

appleflaxen2• 9 years ago

which part bothers you?

iaw5• 9 years ago

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.

ithinkinstereo2• 9 years ago

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.

contingencies• 9 years ago

Brilliant. Who says lawyers aren't worth the money?

brucelidl2• 9 years ago

"Behind every great fortune there is a crime." —Balzac (apocryphal)

pdog2• 9 years ago

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.

brucelidl2• 9 years ago

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.

sumedh2• 9 years ago

Is Warren Buffett's fortune a crime as well?

triangleman3• 9 years ago

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.

seem_2211• 9 years ago

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.

valuearb15• 9 years ago

What was Steve Wozniak's crime?

herodotus2• 9 years ago

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.

craftyguy2• 9 years ago

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.

username223• 9 years ago

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.

joemag2• 9 years ago

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.

QAPereo4• 9 years ago

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.

pstuart• 9 years ago

And it went well beyond the names, to financial gain as well as "personal favors".

ryuuchin• 9 years ago

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...

ygaf• 9 years ago

The Bible teaches this too.

Veedrac4• 9 years ago

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.

klenwell• 9 years ago

Of course, when Larry David is involved, things can get a little more complicated:

https://www.youtube.com/watch?v=De90ozOOquY

dsacco4• 9 years ago

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.

herodotus2• 9 years ago

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.

burntwater2• 9 years ago

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.

rhizome4• 9 years ago

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.

paulsutter• 9 years ago

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.

specialist• 9 years ago

I agree. For example, the consequence of the Koch brother’s philathropy is the normalization of their radical (belligerently anti-democratic) political agenda.

air7• 9 years ago

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.

matt4077• 9 years ago

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.

wavefunction3• 9 years ago

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.

zappo2938• 9 years ago

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.

tehlike2• 9 years ago

I believe this is true for most religions. It should also be part of "common decency", for lack of a better word.

mcguire3• 9 years ago

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/)

WalterBright2• 9 years ago

People who donate anonymously still get a reward - they feel good about it.

nsedlet2• 9 years ago

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)

Findeton• 9 years ago

Thank the government for granting them monopoly rights.

throwaway2048• 9 years ago

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.

joering2• 9 years ago

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.

fmihaila• 9 years ago

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).

enraged_camel2• 9 years ago

>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.

nate_meurer• 9 years ago

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...

nsedlet2• 9 years ago

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.

Nomentatus2• 9 years ago

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.

semperdark3• 9 years ago

Except that score is calculated on factors such as your loyalty to the government.

adventured• 9 years ago

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?

rapind• 9 years ago

Meh. Don't like your reputation? Just sift through the Equifax dump and pick a new one.

maskedSlacker2• 9 years ago

They achieved what Escobar couldn't: respectability on a mountain of skulls.

cwyers4• 9 years ago

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?

wyager• 9 years ago

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.

trendia• 9 years ago

That reminds me of an old joke:

Q: How do you make $1 million in aerospace?

A: Start with $1 billion

cwyers4• 9 years ago

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."

appleflaxen2• 9 years ago

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.

astura2• 9 years ago

You're confusing "spending money" with "starting a business."

tiggybear• 9 years ago

it's about power

savanaly• 9 years ago

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.

cwyers4• 9 years ago

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?

stephengillie• 9 years ago

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.)

WalterBright2• 9 years ago

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.

cwyers4• 9 years ago

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.

joemag2• 9 years ago

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.

mavhc3• 9 years ago

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.

walshemj2• 9 years ago

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.

refurb17• 9 years ago

What? Even in single payer systems you can choose your doctor!

golergka• 9 years ago

If people are idiots, why deny them the possibility to realize their potential?

valuearb15• 9 years ago

Are you saying patients should not have any say in their own treatment?

lr4444lr• 9 years ago

If your doctor is making actual medical decisions based on a pharma. rep's sales pitch, find yourself another doctor pronto.

tclancy3• 9 years ago

But how would you necessarily know? And not everyone is equipped to make such a determination. Lots of people still treat doctors as infallible demigods.

jlarocco• 9 years ago

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.

feistypharit• 9 years ago

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.

walshemj2• 9 years ago

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

mgkimsal• 9 years ago

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.

robotresearcher2• 9 years ago

The signs out front are to discourage drug seekers from coming in the door. They’ll prescribe it if you need it.

alkonaut4• 9 years ago

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.

ithinkinstereo2• 9 years ago

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).

quuquuquu• 9 years ago

"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.

DanBC3• 9 years ago

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.

semperdark3• 9 years ago

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.

SmellTheGlove• 9 years ago

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.

andreasgonewild3• 9 years ago

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.

mabub24• 9 years ago

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/

andreasgonewild3• 9 years ago

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.

rattray• 9 years ago

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.

refurb17• 9 years ago

You do realize that if Purdue talked about any other dosing regimen other than 12 hours that would be illegal off-label promotion right?

spraak• 9 years ago

Also kratom

alkonaut4• 9 years ago

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.

Gatsky2• 9 years ago

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.

fencepost• 9 years ago

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.

jayess2• 9 years ago

Why not just go back to prescribing cocaine instead of Oxy?

valuearb15• 9 years ago

In Arizona big pharma was the biggest contributor to the campaign to defeat marijuana legalization.

pas2• 9 years ago

Links, sources, please.

Animats• 9 years ago

... Medical Advertising Hall of Fame...

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/

EvanAnderson• 9 years ago

Ick! This reinforces my belief that direct-to-consumer advertising of prescription drugs should be illegal.

lostlogin5• 9 years ago

It is nearly everywhere. New Zealand, USA and Brazil allow it.

hawkice• 9 years ago

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.)

robotresearcher2• 9 years ago

As it is in many if not most G7 countries.

valuearb15• 9 years ago

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?

hiyer• 9 years ago

It is illegal in India. As a result, in all my life here I cannot recall seeing ads for any medicine stronger than aspirin.

refurb17• 9 years ago

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...

rdtsc2• 9 years ago

... 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

cbanek3• 9 years ago

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.

jayess2• 9 years ago

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

neilk2• 9 years ago

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.

tclancy3• 9 years ago

This smells of whataboutism and whatever the ethics of making addictive software, it's killed far fewer people so far.

GigabyteCoin• 9 years ago

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.

neilk2• 9 years ago

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.

dirtybird04• 9 years ago

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

ChoGGi• 9 years ago

Once you get the physical addiction out of your system, you then spend the rest of your life dealing with the psychological addiction.

toephu2• 9 years ago

Wow, and this has been known for years...and yet OxyContin is still legal in the U.S. and being sold every day.

sanguy• 9 years ago

Sad. Hope the family gets what's due -- being burnt alive would be a good start.

throwaway0255• 9 years ago

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.

valuearb15• 9 years ago

The idea that the patient should be influencing their own treatment decisions is absurd?

maskedSlacker2• 9 years ago

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?

chmaynard• 9 years ago

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.

tehlike2• 9 years ago

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.

gesman• 9 years ago

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...

thr0waway187• 9 years ago

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.

chiefalchemist• 9 years ago

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?

The Family Making Billions from the Opioid Crisis

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