How the Sacklers shifted $10.8B of an opioid fortune built on OxyContin • Hacker News Board

Re: How the Sacklers shifted $10.8B of an opioid fortune built on OxyContin

#141

Post by mmm_grayons » Wed, Aug 26, 2020, 5:06 PM UTC

smolder wrote: post #138

mmm_grayons wrote: post #73

Earlier quoted context omitted.

Is all that money tainted? While oxycontin holds a huge potential for abuse I know plenty of people who have taken it for real pain, been helped by it, and moved on. "Just take it all" doesn't sound like justice either.

Taking it all seems fair to me. When someone steals from a retailer, we don't just make them pay for it and send them on their way, because that doesn't disincentivize stealing in the first place. The Sacklers/Purdue would need to be punished for the predatory, antisocial scheme to prevent others like it.

While an additional fine might be fair, again, just "taking it all" isn't. The Sacklers, while they might have played a small part, are being unfairly scapegoated for the whole of the opioid epidemic. This ignores the responsibility borne by states, physicians, and most importantly, those who choose to take the pills. This was also done with FDA approval.

More importantly, this is a part of the larger narrative that everything has been caused by overprescribed opioids. However, there's no correlation between increased prescriptions and increased illicit usage [0]. Rather, it seems there's been a large growth over time of illicit opioid use [1]. The only place this sort of thing has been effectively combated is in Portugal due to its decriminalization and attempts to make things safer. Politicians caused this with their stupid "war on drugs". They are now pointing and saying, "Look, the big bad Sacklers did it!" so their own failures are ignored. Stop scapegoating one family for a political and societal issue.

0: https://www.researchgate.net/publication/330922982_Today%27s...

1: https://www.sciencedaily.com/releases/2018/09/180920161028.h...

Re: How the Sacklers shifted $10.8B of an opioid fortune built on OxyContin

#142

Post by at_a_remove » Wed, Aug 26, 2020, 5:08 PM UTC

boomboomsubban wrote: post #133

at_a_remove wrote: post #69

Earlier quoted context omitted.

I think a casual understanding of history has numerous examples of opioids that were prescribed as being safe, and that people then got addicted to, and then we all moved on to the next one. Heroin was one, after all. I find it hard to imagine too many doctors who are unaware of the history. How they have chosen to view that history (psychiatry's triumphant " this time we got it right!" or perhaps simply shrinking aw…

Asking doctors to decide which research they should and should not trust based on their understanding of history seems like a more dangerous situation.

I dunno, "The history of all opioids we have ever encountered has always been associated with addiction" is not a particularly difficult concept to grasp, nor can I see it taking an inordinate amount of time to cram into their education.

Re: How the Sacklers shifted $10.8B of an opioid fortune built on OxyContin

#143

Post by gameswithgo » Wed, Aug 26, 2020, 5:14 PM UTC

JumpCrisscross wrote: post #23

TL; DR The Sacklers extracted about $6.1bn after taxes but before capital gains or losses and propose to pay $3bn in their settlement. To my knowledge, none of them have been arrested yet, though the wheels of criminal justice turn slower than those of civil law.

criminal justice turns slow for the wealthy. for the poor you are often accelerated straight to being dead.

Re: How the Sacklers shifted $10.8B of an opioid fortune built on OxyContin

#144

Post by IMTDb » Wed, Aug 26, 2020, 5:15 PM UTC

civilized wrote: post #119

IMTDb wrote: post #114

The US right now: "Some doctors told us the negative effects of opioids are not that dangerous compared to the short term benefits on physical pain. We sell that in pharmacies. This is a billion dollar industry. This was definitely a bad choice, we should have listened to the people talking about the danger of that addiction. Let's burn the skarks that were responsible for that". Also the US right now : "Some doctors…

It's a good point to raise - at the same time, I think it's generally accepted that THC is on the safer side of the "problematic drug" spectrum, while opioids are on the riskier side?

I agree that opiods are definitely on the riskier side of the spectrum, while THC definitely seem on the safer side - at least for adults. But we know that: that's why opioids are mainly sold after a prescription by a doctor and in a pharmacy. At least we are trying to limit access to opioids.

On the other hand THC is currently almost advertised as being "good for you" (see all the papers/studies around it), and a socially acceptable/fun thing to do. While I don't really see anyone posting on social media a picture of themselves crushing some oxy pills. Overall we can expect the number of people negatively impacted by a THC addiction to be significantly higher in the next few years than for opioids. Even if at the individual level, the effects are lower.

At the macro level this makes THC widespread use worrying - just like the opioids use is worrying. The really interesting thing is the difference in narrative. We know want to lock down one as much as possible, while we want to open the other as much as possible.

PR wise, it's incredible. The arguments used in this article against opioids (it was a great business making lots of money !), are exactly the argument used in favour of THC (it is going a great business making lots of [tax] money !).

Re: How the Sacklers shifted $10.8B of an opioid fortune built on OxyContin

#145

Post by wmeredith » Wed, Aug 26, 2020, 5:15 PM UTC

rrrrrrrrrrrryan wrote: post #136

songshu wrote: post #13

I never understand why doctors are not blamed for prescribing these. Are doctors not supposed to be responsible for prescriptions? If they are not, should we stop allowing them to prescribe? Why don’t doctors unions throw out members who would claim to have been hoodwinked by pharmaceutical companies?

It's because doctors and hospitals are increasingly evaluated based on patient satisfaction instead of patient outcomes. It's why you'll walk into a medical plaza lobby that looks like a 4-star hotel, with fountains and art on the wall, and why the doctor will write you a prescription for an absurd dose of narcotics after surgery. After you've been cut open, it's normal to be in some pain for a while, but if the doct…

HealthGrades.com and RateMDs.com is already a thing.

Re: How the Sacklers shifted $10.8B of an opioid fortune built on OxyContin

#146

Post by brandonmenc » Wed, Aug 26, 2020, 5:18 PM UTC

adolph wrote: post #129

SlateStarCodex's "Against Against Pseudoaddiction" is an enlightening read for some of the complexity involved. https://slatestarcodex.com/2019/09/16/against-against-pseudo...

In a similar vein, this video titled, "OxyContin patients, then and now" [0] is worth a watch.

The music suggests the drug is horrible, but of the five patient cases: two are doing well on the drug and require it to function normally, one did well but died of a (not determined to be related) heart attack, one got off the drug with some difficulty, and one died after falling asleep while driving.

Opioids are a miracle drug for people living with chronic pain. More people die every year from alcohol - which has absolutely zero therapeutic benefit.

[0] https://www.youtube.com/watch?v=pkeQifzvSNE

Re: How the Sacklers shifted $10.8B of an opioid fortune built on OxyContin

#147

Post by s5300 » Wed, Aug 26, 2020, 5:23 PM UTC

refurb wrote: post #111

sacred_numbers wrote: post #76

Earlier quoted context omitted.

Not typically in money, but in gifts, lunches, and attention paid by young, attractive pharmaceutical sales people. For opioids, specifically, there is also the factor that doctors prescribing opioids will have higher customer satisfaction in the short term because opioids are better than almost anything for pain relief. Higher customer satisfaction (not necessarily the same as better patient outcomes) usually means…

Gifts from pharma hasn’t been true for a couple decades. They don’t even give pens now. Sure they can get a free lunch, but it’s usually brought to their office and it’s fast food. Customer satisfaction is relevant, but only because hospitals have put so much emphasis on it. But regardless, nobody can get these drugs without a doctor writing a script, so there is plenty of blame to go around.

Huh. I'd love to know where you're getting that idea from.

Through a strange series of events (extreme sports hobbies) I became friends with a group of doctors, none of them participating in anything very special or that could be seen as a career height. Most really just starting out after the hell that is med school.

They spoke of pretty regular outreach of gifts from pharma. Mainly in the form of fancy retreats (like to Hawaii - note, we were based in SoCal at the time) with pretty extravagant dinners and fancy boating stuff. These were, according to them, always filled with the brim with others like them to the point it got to be quite frankly boring, annoying, and a nuisance. No matter how hard they tried to ignore the unsolicited outreach, it wouldn't stop coming.

Just some anecdata tho.

Re: How the Sacklers shifted $10.8B of an opioid fortune built on OxyContin

#148

Post by refurb » Wed, Aug 26, 2020, 5:26 PM UTC

s5300 wrote: post #147

refurb wrote: post #111

Earlier quoted context omitted.

Gifts from pharma hasn’t been true for a couple decades. They don’t even give pens now. Sure they can get a free lunch, but it’s usually brought to their office and it’s fast food. Customer satisfaction is relevant, but only because hospitals have put so much emphasis on it. But regardless, nobody can get these drugs without a doctor writing a script, so there is plenty of blame to go around.

Huh. I'd love to know where you're getting that idea from. Through a strange series of events (extreme sports hobbies) I became friends with a group of doctors, none of them participating in anything very special or that could be seen as a career height. Most really just starting out after the hell that is med school. They spoke of pretty regular outreach of gifts from pharma. Mainly in the form of fancy retreats (li…

The guidelines also reiterate the group’s 2002 code, which prohibited more expensive goods and services like tickets to professional sports games and junkets to resorts. And it asks companies that finance medical courses, conferences or scholarships to leave the selection of study material and scholarship recipients to outside program coordinators.

[1]https://www.nytimes.com/2008/12/31/business/31drug.html

Re: How the Sacklers shifted $10.8B of an opioid fortune built on OxyContin

#149

Post by eagsalazar2 » Wed, Aug 26, 2020, 5:27 PM UTC

songshu wrote: post #13

I never understand why doctors are not blamed for prescribing these. Are doctors not supposed to be responsible for prescriptions? If they are not, should we stop allowing them to prescribe? Why don’t doctors unions throw out members who would claim to have been hoodwinked by pharmaceutical companies?

Doctors as a group are not that dissimilar to police unions in that their primary function is to actually shield doctors from responsibility or accountability. Both are extremely hostile to criticism of any kind. This focus on their own outcomes results in zero virtuous feedback and being dysfunctional and failing to serve their customers consistently, with frequent gross failures.

Re: How the Sacklers shifted $10.8B of an opioid fortune built on OxyContin

#150

Post by TT3351 » Wed, Aug 26, 2020, 5:37 PM UTC

bluntfang wrote: post #75

shrubble wrote: post #9

Earlier quoted context omitted.

When plunder becomes a way of life for a group of men in a society, over the course of time they create for themselves a legal system that authorizes it and a moral code that glorifies it. Frédéric Bastiat

I've been thinking about this a lot, and really believe America was founded on "breaking the rules" and has had really great successes, but really awful consequences. Specific to the pandemic, no one wants to wear a mask. We've been conditioned to believe that breaking the rules (ie disruption) is a good way to move forward. Outside the pandemic, we see oil companies and other manufactures move their operations overs…

Wilding of America by Charles Derber is one text on this subject. It's an interesting theory. In another interpretation, the end of the frontier has also meant that the barbarism and roguery once relegated to the periphery of the country is now omnipresent.