The Sackler family’s plan to keep its billions

https://www.newyorker.com/news/news-desk/the-sackler-familys-plan-to-keep-its-billions

by hhs • 6 years ago

129 112 6 years ago

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."

Upvoter33• 6 years ago

It's so sad that we have had so little ability to put people behind bars for how they have profiteered off of addicting and killing people.

vmception• 6 years ago

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.

sokoloff• 6 years ago

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”?

AndrewUnmuted5• 6 years ago

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.

raincom• 6 years ago

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.

The rule of law is for everyone else.

lumberjack• 6 years ago

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.

fedorareis• 6 years ago

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.

arrosenberg• 6 years ago

The oligarchs who own the media companies don't want to offend their friends.

throwaway7281• 6 years ago

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?

wilde• 6 years ago

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.

malandrew• 6 years ago

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.

https://en.wikipedia.org/wiki/Hanlon%27s_razor

gooseus• 6 years ago

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...".

[1] https://www.edge.org/response-detail/11513

iamdbtoo• 6 years ago

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.

d4mi3n• 6 years ago

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.

brandonmenc• 6 years ago

more good than harm comes of it

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.

yread• 6 years ago

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

digitaltrees• 6 years ago

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.

klyrs• 6 years ago

Top article right now is about ants decorating their homes with the heads of their enemies. Plenty of fun speculation about "human nature" there.

shadykiller• 6 years ago

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.

Link: https://peterattiamd.com/caroltavris-elliotaronson/

loxs• 6 years ago

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.

Edit: proof... https://en.wikipedia.org/wiki/The_Third_Wave_(experiment)

sneak2• 6 years ago

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.

Klinky• 6 years ago

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?

ves4• 6 years ago

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.

ramraj07• 6 years ago

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?

snarf212• 6 years ago

“It is difficult to get a man to understand something, when his salary depends on his not understanding it.”

― Upton Sinclair, I, Candidate for Governor: And How I Got Licked

danans• 6 years ago

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.

hnracer2• 6 years ago

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.

ves4• 6 years ago

This comment is obviously not an endorsement of these beliefs, for the down voters.

rebuilder• 6 years ago

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?

snarf212• 6 years ago

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?

Supermancho2• 6 years ago

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.

LatteLazy• 6 years ago

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.

justinclift• 6 years ago

https://archive.vn/PwCLw

Igelau3• 6 years ago

What is a 'white-shoe fixer'? I've never heard this term before and it sounds strangely racially charged.

ForHackernews2• 6 years ago

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.

[0] https://en.wikipedia.org/wiki/White-shoe_firm

kevin_thibedeau• 6 years ago

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.

Igelau3• 6 years ago

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!

His 'Wind of Change' podcast was good stuff.

Supermancho2• 6 years ago

it sounds strangely racially charged.

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.

Igelau3• 6 years ago

Two things I've learned not to worry about: how others view my questions and fake internet points.

kevmo• 6 years ago

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.

ffggvv2• 6 years ago

how can one think both of these things:

1. drugs should be legal

2. the sacklers are evil

pdeffebach• 6 years ago

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.

sneak2• 6 years ago

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.

abtom• 6 years ago

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?

Udik• 6 years ago

shady corporation conspiring with the system

Was "the system" also put on trial? Or it's just Purdue?

SpicyLemonZest• 6 years ago

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.

ffggvv2• 6 years ago

you don’t think of heroin is legalized, there will be corporations conspiring to do the same?

typon• 6 years ago

If you don't actually examine the situation's complexity, then yes things can look pretty black and white, and wrong.

whiddershins2• 6 years ago

Furthermore I’ve heard it is worse than this, that some very large percentage of opioid addicts were not previously prescribed opioids.

That the path to addiction in many cases was purely extralegal.

This was on a single Reddit thread with either one or zero citations, so I’m unsure about it.

But I wish I knew the truth of this, because it would be one of those things where the common narrative is upside down.

DanBC2• 6 years ago

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.

curiousgal• 6 years ago

1. You chose to take that drug willingly knowing the full effects.

2. You had a drug recommended to you by your physician.

bzb6• 6 years ago

1 is false for almost every person and drug, including alcohol and tobacco.

MaxBarraclough• 6 years ago

Sackler are accused of misleading both doctors and the general public, regarding the addictive nature of opioids.

https://www.theguardian.com/society/2019/feb/01/oxycontin-sa...

CameronNemo• 6 years ago

Do you have an example of someone thinking both of those things? Where drugs == opiates (which are already legal in many forms)?

Different drugs have different risk profiles. Most people I have heard from want to decriminalize heroin, not legalize it.

scythe• 6 years ago

"Legal" is not a synonym for "prescribed unnecessarily".

rstuart41332• 6 years ago

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.

golemotron3• 6 years ago

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.

cainxinth• 6 years ago

We can do both

blackflame7000• 6 years ago

No we can't because their medication also helped a lot of people in addition to the abusers that make it difficult for everyone else to get treatment.

ves4• 6 years ago

Well, getting mad at the Sacklers may not be productive, but it’s certainly merited.

golemotron3• 6 years ago

But inconsequential compared to changing the law.

alextheparrot• 6 years ago

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.

golemotron3• 6 years ago

It's fine to get angry. Just do something too.

hilbert427• 6 years ago

'The answer isn't "get mad at the Sacklers", it's change the law.'

In fact it's both. It's a shame your internal ethics aren't shouting that fact out loudly to you.

rstuart41332• 6 years ago

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.

eigenvalue• 6 years ago

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.

bombela• 6 years ago

Yes. But do you need to market that to anybody with a headache?

GordonS2• 6 years ago

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.

AndrewUnmuted5• 6 years ago

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.

Balgair• 6 years ago

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.

https://en.wikipedia.org/wiki/List_of_To_Kill_a_Mockingbird_...

ves4• 6 years ago

OxyContin isn’t an unmitigated evil, but the Sacklers are quite a bit closer.

aikah• 6 years ago

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.

AndrewUnmuted5• 6 years ago

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.

bryan0• 6 years ago

Problem is that it was pushed on people...

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 ."

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140023/

hhs• 6 years ago

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.)”

candiodari• 6 years ago

I don't get this reasoning.

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.

spaetzleesser2• 6 years ago

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.

ak2172• 6 years ago

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.

hilbert427• 6 years ago

'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.

akamaka• 6 years ago

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.

mensetmanusman• 6 years ago

This is analogous to point out that ‘guns don’t kill people, people do’

It is true, but there is a point at which giving it out like candy might change the stakes.

Reason077• 6 years ago

"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."

hilbert427• 6 years ago

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.

ncmncm• 6 years ago

Title should have said "scheme".

tinktank• 6 years ago

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.

The Sackler family’s plan to keep its billions

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