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

#151

Post by gknoy » Wed, Aug 26, 2020, 5:44 PM UTC

at_a_remove wrote: post #142

boomboomsubban wrote: post #133

Earlier quoted context omitted.

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.

A huge part of most doctors' jobs is balancing the risk of bad things with the benefits of procedures, medications, etc. One of the main reasons we have doctors is so that we can trust their educated judgment. For example, mine noted that guidance had changed on when we should test for some cancers (not as early), because the risk of false positive is higher than the risk of actually having the cancer.

In the case of opioids, doctors know they are addictive. They also unfortunately happen to be _extremely effective_ (for most people) at treating severe pains, and have to balance the benefits of pain relief (both in terms of patient happiness and the healing process) versus the risk of harm. I've definitely seen a shift in doctors' prescribing habits in the past fifteen years, in favor of starting with Ibuprofen or other NSAIDs, with the option to ask for a stronger prescription if pain is too much.

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

#152

Post by GordonS » Wed, Aug 26, 2020, 5:44 PM UTC

blendergeek wrote: post #19

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?

> Why don’t doctors unions throw out members who would claim to have been hoodwinked by pharmaceutical companies? If the companies are lying about safety, how are the doctors supposed to know? The only ones with the data necessary to know the dangers of these drugs are the manufacturers and the manufacturers were lying and covering up the dangers.

Consider OxyContin, which the makers claimed worked for 12 hours. 2 things should be red flags here: firstly, I haven't seen an extended release formulation of anything that would work over that period; I'm not even sure if it's physically possible given the human digestion system. Secondly, the many, many patients who complained that it only worked for 6-8 hours.

Any doctor with a basic understanding of pharmacology, and basic bedside manner, should have known something was up there.

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

#153

Post by TAForObvReasons » Wed, Aug 26, 2020, 5:47 PM UTC

GordonS wrote: post #152

blendergeek wrote: post #19

Earlier quoted context omitted.

> Why don’t doctors unions throw out members who would claim to have been hoodwinked by pharmaceutical companies? If the companies are lying about safety, how are the doctors supposed to know? The only ones with the data necessary to know the dangers of these drugs are the manufacturers and the manufacturers were lying and covering up the dangers.

Consider OxyContin, which the makers claimed worked for 12 hours. 2 things should be red flags here: firstly, I haven't seen an extended release formulation of anything that would work over that period; I'm not even sure if it's physically possible given the human digestion system. Secondly, the many, many patients who complained that it only worked for 6-8 hours. Any doctor with a basic understanding of pharmacology…

"doctors should have known the manufacturers' claims were bogus" is shifting the blame. The real blame should be focused on the manufacturers making false claims in the first place.

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

#154

Post by GordonS » Wed, Aug 26, 2020, 5:50 PM UTC

brandonmenc wrote: post #146

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…

I'm on regular opioids for chronic pain, and they have possibly saved my life. But I tried many, many alternatives. For the majority of chronic pain sufferers, there will be a better alternative to opioids.

Part of the problem in the US is that doctors were reaching for opioids as first or second line drugs, when they should be further down the line.

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

#155

Post by rscho » Wed, Aug 26, 2020, 5:52 PM UTC

All-around-tech-bro-knowledge is strong in this thread.

Doctors prescribe opiates all over the world, including oxycontin. Nowhere else is it a problem as big as in the US. Before wanting to withdraw prescription rights and sue MDs on a personal basis, perhaps people could think about the american exception?

The US opiate problem is cultural and the responsibility is on both sides of the doctor-patient fence. The more people will be able and willing to sue MDs, the bigger the problem. Legal action on a personal basis is _so_ the wrong path. This is depressing.

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

#156

Post by boomboomsubban » Wed, Aug 26, 2020, 5:55 PM UTC

at_a_remove wrote: post #142

boomboomsubban wrote: post #133

Earlier quoted context omitted.

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.

If doctors only prescribed opioids it would be simple, but they deal in all sorts of constantly evolving drugs where new research may overturn previous assumptions. Trusting the research and heavily punishing those who falsify data seems a lot more sane.

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

#157

Post by GordonS » Wed, Aug 26, 2020, 5:56 PM UTC

TAForObvReasons wrote: post #153

GordonS wrote: post #152

Earlier quoted context omitted.

Consider OxyContin, which the makers claimed worked for 12 hours. 2 things should be red flags here: firstly, I haven't seen an extended release formulation of anything that would work over that period; I'm not even sure if it's physically possible given the human digestion system. Secondly, the many, many patients who complained that it only worked for 6-8 hours. Any doctor with a basic understanding of pharmacology…

"doctors should have known the manufacturers' claims were bogus" is shifting the blame. The real blame should be focused on the manufacturers making false claims in the first place.

It wasn't my intention to shift the blame - clearly the manufacturers should be strung up for making the false claims they did. Absolutely no argument there.

My point is though, that doctors shouldn't blindly trust whatever a manufacturer tells them, if the evidence right in front of their eyes says different.

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

#158

Post by nickff » Wed, Aug 26, 2020, 6:00 PM UTC

rscho wrote: post #155

All-around-tech-bro-knowledge is strong in this thread. Doctors prescribe opiates all over the world, including oxycontin. Nowhere else is it a problem as big as in the US. Before wanting to withdraw prescription rights and sue MDs on a personal basis, perhaps people could think about the american exception? The US opiate problem is cultural and the responsibility is on both sides of the doctor-patient fence. The mor…

There are huge problems with opiods in many countries, but the USA has the most data. Canada has major issues, but only some provinces are tracking it.[1]

[1] https://www.cbc.ca/news/canada/british-columbia/bc-overdose-...

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

#159

Post by rscho » Wed, Aug 26, 2020, 6:01 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…

As an MD, I strongly agree. However, you forgot to mention the other side of this: a rating lower than two stars is combined with an immediate threat to sue.

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

#160

Post by chimeracoder » Wed, Aug 26, 2020, 6:03 PM UTC

GordonS wrote: post #157

TAForObvReasons wrote: post #153

Earlier quoted context omitted.

"doctors should have known the manufacturers' claims were bogus" is shifting the blame. The real blame should be focused on the manufacturers making false claims in the first place.

It wasn't my intention to shift the blame - clearly the manufacturers should be strung up for making the false claims they did. Absolutely no argument there. My point is though, that doctors shouldn't blindly trust whatever a manufacturer tells them, if the evidence right in front of their eyes says different.

> My point is though, that doctors shouldn't blindly trust whatever a manufacturer tells them, if the evidence right in front of their eyes says different.

Just to be clear, you're advocating doctors eschewing published clinical data (including data from published trials and the FDA approval) on the basis of nonrandomized anecdotal data?

The issue here is that the manufacturers committed fraud - falsifying and/or misrepresenting clinical data. The courts confirmed this, finding them guilty of fraud, bribery, and more.

Unlike courts, a doctor is in no better position to such sophisticated identify fraud at that scale than a patient is. The pharmaceutical companies and manufacturers absolutely should be held accountable for that, but doctors by and large are not to blame for the fraud committed by pharmaceutical companies.