Supreme Court blocks controversial Purdue Pharma opioid settlement • Hacker News Board

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#411

Post by thegrimmest » Thu, Jun 27, 2024, 9:42 PM UTC

feoren wrote: post #319

shawndrost wrote: post #280

I understand people who think the Sacklers are villains who destroyed lives, Purdue should be shut down, and we should transform the legal regime around opioids. I understand people who think Purdue should continue, the status quo is OK, and the Sacklers are not [simply] villainous. I don't understand people who think the Sacklers are villains who destroyed lives, but Purdue should continue operating more-or-less as-…

Loaning money at 8% interest to informed parties is OK. Loaning money at 200% interest to vulnerable people is usury and should be illegal. Where in the middle is the right line to draw, legally? Does the intent of the lender matter? Does it matter if the lender is intentionally trying to keep people uninformed and vulnerable? These are hard questions, but that doesn't change the basic facts at the extreme ends of th…

> Loaning money at 200% interest to vulnerable people is usury and should be illegal

Stop with the patronizing. Any transaction between consenting parties (backed by bankruptcy protection) should be allowed. We're all grown ups, let people make their own decisions.

Setting upper limits on interest rates simply makes it so that high-risk borrowers are unable to access credit. This harms those borrowers more than anyone else, by limiting their opportunities.

Regarding the Sacklers, they never prescribed any drugs to anyone. Doctors did. Why aren't we holding them responsible? It is doctors who have a duty of care to their patients, not pharmaceutical companies.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#412

Post by philipkglass » Thu, Jun 27, 2024, 9:42 PM UTC

michael_vo wrote: post #403

suslik wrote: post #386

Earlier quoted context omitted.

Why is this question important? The primary purpose of pain medication is not to facilitate recovery, but to reduce suffering and increase quality of life.

Exactly! Opioids increase suffering and ruin the quality of life for hundreds of thousands of Americans. 80k+ yearly overdose deaths, plus a percentage of those using opioids for recovery become addicted to it. Is that a worthy tradeoff? I presume (could be wrong) but we did fine recovering with surgical operations 80 years ago without opioids.

Morphine was commonly administered for post-surgical pain 100 years ago:

"The after-treatment of surgical patients, by Willard Bartlett and collaborators." (1925)

https://babel.hathitrust.org/cgi/pt?id=mdp.39015071056918&se...

One of the first complaints made by the postoperative patient on returning to consciousness is pain. This if due to the actual operative procedure should be at once relieved. William J. Mayo taught us long ago to give morphine during the first twenty-four hours for the pain which we make; viz., by cutting, retracting, suturing, etc. The discomfort caused by such procedures is relieved best by this drug and it is given by us if there be no contraindications for its use, regardless of the amount until full relief is experienced or its physiologic effects obtained.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#413

Post by doctorpangloss » Thu, Jun 27, 2024, 9:42 PM UTC

shawndrost wrote: post #401

doublet00th wrote: post #308

Earlier quoted context omitted.

I think there's a misunderstanding in what the settlement is about. As part of Purdue's bankruptcy, the Sackler family is voluntarily providing 6 billion dollars to help settle claims opioid victims have brought against Purdue Pharma. As a condition to provide the 6 billion dollars, the Sackler family has asked the bankruptcy judge to not even allow any new suits against the Sacklers related to the Opioid epidemic. T…

My question is not about the settlement; it's a question about moral judgements people have around Sacklers/Purdue, including judgements I see on this comment page. I already understand the mechanical details you've explained and they don't answer my question.

> Do you think there is/was a realistic way to prescribe opioids routinely and safely?

Oxycodone is routinely and safely administered right now, to tens of thousands of people, every day. But this is kind of like, an FDA question, no?

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#414

Post by shawndrost » Thu, Jun 27, 2024, 9:42 PM UTC

darawk wrote: post #389

shawndrost wrote: post #280

I understand people who think the Sacklers are villains who destroyed lives, Purdue should be shut down, and we should transform the legal regime around opioids. I understand people who think Purdue should continue, the status quo is OK, and the Sacklers are not [simply] villainous. I don't understand people who think the Sacklers are villains who destroyed lives, but Purdue should continue operating more-or-less as-…

Yes of course there are realistic ways to prescribe opioids routine and safely. Purdue did not invent opioids, what they did is patent a particularly strong formulation, and then work to undermine the cultural taboo in medicine around their use. That last thing was their crime. There isn't, at this time, any other way to treat serious pain (in all cases). Opioid prescriptions will continue to be an unfortunately nece…

Thank you for the reply! I am honestly not informed about this stuff and not asking to covertly push an agenda.

Follow-up Q for you. What is the realistic way to prescribe opioids routinely and safely? Are there certain formulations that have been or should be removed from the market? How do we reinstate the taboo on prescribing them?

For EG: I got a vasectomy recently and was told to expect a day or two of pain. I was prescribed a month's supply of opioids without a single comment from the doctor on their addictive nature. My understanding is that this is how people get introduced to opioids; the pathway goes "legal scrip -> addiction -> illegal supply -> fentanyl -> death" and that's the engine of the epidemic.

Should it be legal for the doctor to prescribe pain meds like this? (Or, should it be legal but discouraged? Is there a well-understood way to do this?) If it should be legal, should we expect the epidemic to continue? And if so, is post-bankruptcy Purdue a good thing or a bad thing?

(My instinctive answers here are that we should make opioids illegal for much of their current use pattern, and that post-bankruptcy Purdue is approximately as gross as Sackler-era Purdue, for what it's worth.)

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#415

Post by legitster » Thu, Jun 27, 2024, 9:43 PM UTC

wing-_-nuts wrote: post #377

nonethewiser wrote: post #351

Earlier quoted context omitted.

Liberal vs. conservative has always been the wrong take. The stronger dividing line is textualism vs pragmatism. In fact Scalia famously said this coming from a textualist perspective which I think most people can agree with even if they hate him: “ If you’re going to be a good and faithful judge, you have to resign yourself to the fact that you’re not always going to like the conclusions you reach.” This seems absol…

>The stronger dividing line is textualism vs pragmatism. They should be doing what is right for the American people . There are clearly laws on the books today which infringe on individual freedoms (abortion), harm society as a whole (citizens united), etc. The 'justice system' is supposed to be the government branch protecting the little guy from powerful elites. I've not often seen that. I see the opposite. If the…

Strong but respectful disagree from me. Justice is supposed to be blind. And if right and wrong were so clear cut there would no need for democracy at all.

The court is not a democratic institution and exists to uphold the textual rule of law as determined by lawmakers. If a pragmatic ruling by the court can circumvent a politically logjammed congress, so be it. But the courts deciding what is right or wrong for the American people is a very slippery slope that leads to disaster. And a court that just rules against the (existing) elite every time is a junta.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#416

Post by relaxing » Thu, Jun 27, 2024, 9:45 PM UTC

rayiner wrote: post #408

relaxing wrote: post #358

Earlier quoted context omitted.

[flagged]

I'm trying to convey how legal conservatives think, as someone who is one. I am, on many policy issues, quite liberal. I think rich people should pay more taxes, people should drive EVs, etc. But ultimately I care more about the rules--especially the rules about who makes decisions and where power is allocated--than I do about what people or outcomes. I'd rather see 3C of global warming than administrative agencies o…

> I'd rather see 3C of global warming than administrative agencies operating contrary to the tripartite system of government the Founders designed.

You want to see millions dead to support your political philosophy?

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#417

Post by doctorpangloss » Thu, Jun 27, 2024, 9:46 PM UTC

thegrimmest wrote: post #405

darawk wrote: post #389

Earlier quoted context omitted.

Yes of course there are realistic ways to prescribe opioids routine and safely. Purdue did not invent opioids, what they did is patent a particularly strong formulation, and then work to undermine the cultural taboo in medicine around their use. That last thing was their crime. There isn't, at this time, any other way to treat serious pain (in all cases). Opioid prescriptions will continue to be an unfortunately nece…

> That last thing was their crime Taboos are bullshit. Either something is a clearly articulated, written, rule with an enforcement mechanism, or it's fair game. Prescribing doctors are responsible for the opioid epidemic. Doctors failed in their duty of care to patients. Doctors massively overprescribed, failed to track their patient's medication usage, and failed to spot addictive behaviour. Why aren't we holding t…

Nobody is forcing you to see any doctors for any of your problems.

That's pretty reductive, right? Well so is what you are saying.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#418

Post by qarl » Thu, Jun 27, 2024, 9:46 PM UTC

micromacrofoot wrote: post #390

BugsJustFindMe wrote: post #296

Earlier quoted context omitted.

> The $6bn ruling was significant and not an amazing outcome for either side (so, a compromise). I find this framing extremely bizarre. A $6bn ruling means the family profits $5 BILLION. In no universe is that not an amazing outcome for them.

It's a loss of ~1/2 of their net worth. That's significant. They are now likely to pay much less by settling smaller individual cases, which will take significantly longer and cost claimants significantly more to pursue. When they die (which will be soon, most of them are 75+) it'll become even more difficult to get anything. The deal that was overruled was certainly not justice, but reality will likely be worse. The…

> They are now likely to pay much less...

So then why did they choose to settle? That makes no sense. The only reason a defendant settles is to minimize potential losses.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#419

Post by worik » Thu, Jun 27, 2024, 9:47 PM UTC

darawk wrote: post #389

shawndrost wrote: post #280

I understand people who think the Sacklers are villains who destroyed lives, Purdue should be shut down, and we should transform the legal regime around opioids. I understand people who think Purdue should continue, the status quo is OK, and the Sacklers are not [simply] villainous. I don't understand people who think the Sacklers are villains who destroyed lives, but Purdue should continue operating more-or-less as-…

Yes of course there are realistic ways to prescribe opioids routine and safely. Purdue did not invent opioids, what they did is patent a particularly strong formulation, and then work to undermine the cultural taboo in medicine around their use. That last thing was their crime. There isn't, at this time, any other way to treat serious pain (in all cases). Opioid prescriptions will continue to be an unfortunately nece…

> Opioids can't be banned until we can replace them with something equally generally effective.

Opioids should not be banned

Opioid addiction (I have seen a lot of it, not had it) is a social problem and is best managed with, opioids

The problems stem from putting unreasonable obstacles between adicts amd their appropriate treatment. Practical legal and financial obstacles, sadistic legal obstacles, and bizarre moral obstacles

Great Britain for many y4ars managed Opioid addiction with opioids, principally methadone and heroin

Nineteenth century society managed it with laudinum

We westerners in the twenty first century are failing to manage it with cruelty

The Sacklers are, were, parasites profiting from that social malaise and bad things will finally happen to them. But the cause of the malaise is our irrational attitude to drugs

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#420

Post by doctorpangloss » Thu, Jun 27, 2024, 9:48 PM UTC

shawndrost wrote: post #414

darawk wrote: post #389

Earlier quoted context omitted.

Yes of course there are realistic ways to prescribe opioids routine and safely. Purdue did not invent opioids, what they did is patent a particularly strong formulation, and then work to undermine the cultural taboo in medicine around their use. That last thing was their crime. There isn't, at this time, any other way to treat serious pain (in all cases). Opioid prescriptions will continue to be an unfortunately nece…

Thank you for the reply! I am honestly not informed about this stuff and not asking to covertly push an agenda. Follow-up Q for you. What is the realistic way to prescribe opioids routinely and safely? Are there certain formulations that have been or should be removed from the market? How do we reinstate the taboo on prescribing them? For EG: I got a vasectomy recently and was told to expect a day or two of pain. I w…

> I was prescribed a month's supply of opioids without a single comment from the doctor on their addictive nature.

Is this really what the question was about? Reflections on a personal experience? Those are perfectly valid concerns. Nobody is stopping you from asking any of the professionals you interacted with about addiction, if you are worried, go and ask!