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

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#561

Post by pembrook » Fri, Jun 28, 2024, 3:21 AM UTC

api wrote: post #427

janalsncm wrote: post #398

Pound for pound, the Sacklers probably did more damage to America than any other drug dealers in history. More damage than any serial killer or mass shooter. In my mind they should be considered public enemies 1 through N. I sincerely hope they face civil and criminal liabilities for what they’ve done.

Don't forget McKinsey: https://www.nytimes.com/2021/02/03/business/mckinsey-opioids...

I always cringe whenever I see people giving McKinsey credit for stuff (good or bad). It's a powerpoint factory of 20-somethings with zero experience executing anything.

To suggest the virtuous, humble Purdue management could never have figured out how to sell oxycontin and bend regulators--without the insight of a few powerpoint slides--gives me a chuckle.

It's not like Purdue, a drug company, had any experience marketing drugs and dealing with regulators before, right? I mean, it must have been a super hard problem for them to solve. How do you sell an instant painkiller thats wildly addictive, while getting corrupt regulators to be corrupted? Impossible!

Too bad they got duped by those evil 22-year old powerpoint geniuses at McKinsey, who are clearly the real villains of the story.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#562

Post by com2kid » Fri, Jun 28, 2024, 3:28 AM UTC

anigbrowl wrote: post #498

beaeglebeachedd wrote: post #462

Earlier quoted context omitted.

You didn't learn about the opium wars? I'm not talking about dare which was obvious bullshit, I'm talking of learning from history. There was no weed war, that a drug caused a couple wars lasting decades should at least raise an eyebrow of any thinking person.

I think this has more to do with the general lack of curiosity about the world beyond the US borders that prevails in most of American society. It's not as if US high schoolers get a comprehensive education in world history except for a few select omissions. I agree with you that this is something they ought to be aware of but I think you've kinda stretched the causality here.

>I think this has more to do with the general lack of curiosity about the world beyond the US borders that prevails in most of American society.

Just learning about all the countries the British messed up would take at least another 5 or 6 years on top of whatever schooling is already done.

If you wanted to add everything America has done, well, people wouldn't be graduating high school until they are in their 30s.

We did learn about the Anglo-Zulu War and the East India Company, but a decision has to be made on what list of British atrocities to include in a history curriculum.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#563

Post by smartbit » Fri, Jun 28, 2024, 3:30 AM UTC

api wrote: post #427

janalsncm wrote: post #398

Pound for pound, the Sacklers probably did more damage to America than any other drug dealers in history. More damage than any serial killer or mass shooter. In my mind they should be considered public enemies 1 through N. I sincerely hope they face civil and criminal liabilities for what they’ve done.

Don't forget McKinsey: https://www.nytimes.com/2021/02/03/business/mckinsey-opioids...

https://archive.is/Gc1Lh

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#564

Post by com2kid » Fri, Jun 28, 2024, 3:31 AM UTC

darawk wrote: post #509

com2kid wrote: post #460

Earlier quoted context omitted.

> . (It's sole advantage was as a timed-release medication; if pain returned before time for the next dose, doctors were instructed (strongly) to raise the dosage rather than increase the number of doses per day.) The same thing happens with ADHD medications, the timed release dosages are supposed to last 12+ hours, but in reality they vary from 8 to 16. Thankfully most doctors will willingly prescribe a small after…

> The same thing happens with ADHD medications, the timed release dosages are supposed to last 12+ hours, but in reality they vary from 8 to 16. Modern ADHD meds are really not comparable to powerful opioids. They are both dopaminergic, but they are night and day in terms of addictiveness. Even weak opioids vs strong opioids is night and day. > There is a large delta between the average response curve and an individu…

> Modern ADHD meds are really not comparable to powerful opioids. They are both dopaminergic, but they are night and day in terms of addictiveness. Even weak opioids vs strong opioids is night and day.

True, my point more was that false advertising about "duration of extended release action" is a problem across multiple types of prescription drugs.

> True! But the word "average" is actually not, itself, precise. It has at least three typical meanings: mean, median, mode. These all have quite large deltas to each other when talking about dose-response curves, and since they are curves, you would also have to pick a norm first.

The marketing material doesn't care. "All day", "24 hour", "12 hour" are the phrases that get used.

Meanwhile reality is that every person who takes a drug is different and doctors need to be aware of this and just ask the patient how well things are working out.

> The majority of the pharmaceutical problem came from a very small number of people who churned out prescriptions like a literal mill. Like 5 minute appointments all day every day - not random doctors overprescribing their patients by accident. What is true is that the random doctors overprescribing provided a certain amount of cover for the corrupt doctors, for a while.

Yeah it got out of hand, but I'd imagine that this wasn't happening from day 1.

Also when we talk about preventative measures, people going to a pill mill doctors to get a refill are already addicted, but what can have a long term impact is putting in the effort to prevent people from becoming addicted in the first place, which means understanding how so many people who did not want to get addicted to opioids ended up that way.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#565

Post by EVa5I7bHFq9mnYK » Fri, Jun 28, 2024, 3:37 AM UTC

janalsncm wrote: post #398

Pound for pound, the Sacklers probably did more damage to America than any other drug dealers in history. More damage than any serial killer or mass shooter. In my mind they should be considered public enemies 1 through N. I sincerely hope they face civil and criminal liabilities for what they’ve done.

Where was the FDA? Were the doctors all innocent? Is stupidity a good criminal defense? They should be all in the same cell.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#566

Post by returningfory2 » Fri, Jun 28, 2024, 3:46 AM UTC

harry8 wrote: post #560

Matt Levine at Bloomberg gives an excellent explanation of what happened, the ruling, why etc without telling you what you should think is the right thing or right outcome. His explanations from first principles covering ground you already know are just excellent. Worthwhile reading for anyone who has to explain detailed, complex & technical subject matter. https://www.bloomberg.com/opinion/articles/2024-06-27/purdue…

The truly awesome thing about Matt Levine is how in complicated situations like this he doesn't try to pick the "right" side but instead leans in to how both sides have good points of view. In today's newsletter he quotes the majority opinion and says it's reasonable, and then quotes the contradicting dissent and says that's reasonable too. And they both are! A really difficult case with really difficult trade offs.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#567

Post by beaeglebeachedd » Fri, Jun 28, 2024, 3:46 AM UTC

0x00_NULL wrote: post #537

addicted wrote: post #425

Earlier quoted context omitted.

I’d argue it’s the opposite. Look at what’s happened since Oxycontin was heavily regulated. Opioid deaths in America have exploded by an order of magnitude. There’s a direct correlation between higher regulation of OxyContin and opioid deaths in the U.S. The Sacklers have done illegal stuff. Misrepresenting the addictiveness of their drugs (well, it was immoral and wrong…it’s not clear how illegal it was). But it’s q…

What are you talking about? Where was America getting their opioids before The Sacklers? Go ahead and pull a chart of heroin deaths vs. years and draw a vertical bar on where Purdue launched their widespread marketing misinformation and disinformation. This is the largest and most deadly episode of addictiveness since the tobacco companies were marketing cigarettes as healthy. If this were a fire, you’d be arguing: “…

Didn't we also invade the religious nutsos stopping Afghanistan from producing poppies and then prop up a fake regime that let it flourish, massively increasing the supply of natural opiates? If I recall, the timing works out pretty good with illegal opiate use ramping up.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#568

Post by Retric » Fri, Jun 28, 2024, 3:52 AM UTC

zer00eyz wrote: post #557

Retric wrote: post #543

Earlier quoted context omitted.

> Dr where involved too! The actions of individual Doctors acting on their own simply don’t explain trends. Doctors and the FDA etc were straight up lied to. I don’t think it’s reasonable to hold Doctors accountable for when some pharmaceutical company commits fraud. That doesn’t mean every doctor was blameless, but individual Doctors have always behaved poorly it was true before the opioid epidemic and it’s still tr…

> Doctors and the FDA etc were straight up lied to Oh please. Doctors, did not believe the preponderance of evidence that ulcers were caused by bacteria. The reason, the person who discovered it was a vet. They had to give the man a Nobel Prize to get Dr's to pry their heads out of their self aggrandizing asses and pay attention to reality. Opioids were addictive. They never stoped being that. Dr's were fiscally moti…

> Doctors, did not .. The reason, the person who discovered it was a vet.

You’re wildly incorrect, nobody involved was a vet.

Barry Marshall shared that Nobel and is a Doctor. https://en.wikipedia.org/wiki/Barry_Marshall

Robin Warren received his M.B.B.S. an undergraduate degree focused on medical research. https://en.wikipedia.org/wiki/Robin_Warren He worked at: “SA Pathology, (formerly the Institute of Medical and Veterinary Science (IMVS)), is an organisation providing diagnostic and clinical pathology services throughout South Australia for the public health sector.” https://en.wikipedia.org/wiki/SA_Pathology

So whatever source you read that misinformation from is not trustworthy.

> Opioids where addictive

Hindsight bias here. We don’t want medical professionals to discard new information in favor of older treatments. There’s no way doctors can on their own replicate the medical research linking Ulcers with a bacterial infection and independently judge oxycodone’s effectiveness, and a dozen other drugs etc. Extended-release (ER) oxycodone was literally a new drug and described as not having the same issues associated with other Opioids on labeling approved by the FDA.

The crazy thing is how effective this all was. Medical schools were teaching students to hand out more opioids.

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#569

Post by [deleted] » Fri, Jun 28, 2024, 3:53 AM UTC

RIMR wrote: post #443

sailingparrot wrote: post #431

Earlier quoted context omitted.

Sure, OxyContin is better than Fentanyl, and banning Oxy can push people to way more dangerous opioids. But before painting Purdue as a hero of the people, let’s remember that million of people were pushed to opioids through Oxy when they shouldn’t have in the first place. Purdue played a big part in creating the epidemic in the first place. People that are now pushed to harder drugs because of an addiction they got…

Exactly. If it wasn't for the existing demand for cheap powerful opioids, Fentanyl would never have been a problem to begin with.

[deleted]

Re: Supreme Court blocks controversial Purdue Pharma opioid settlement

#570

Post by Retric » Fri, Jun 28, 2024, 4:11 AM UTC

EVa5I7bHFq9mnYK wrote: post #565

janalsncm wrote: post #398

Pound for pound, the Sacklers probably did more damage to America than any other drug dealers in history. More damage than any serial killer or mass shooter. In my mind they should be considered public enemies 1 through N. I sincerely hope they face civil and criminal liabilities for what they’ve done.

Where was the FDA? Were the doctors all innocent? Is stupidity a good criminal defense? They should be all in the same cell.

FDA has some culpability, but the fraud was so effective Medical Schools where teaching students to prescribe more opioids.

Perdue Pharma effectively hacked the medical system. I think the real takeaway is there’s likely more of this going on than we realize. The common decongestant phenylephrine being no more effective than placebo comes to mind. Without the mass deaths there’s apparently little to stop modern snake oil salesman.

Perhaps the FDA needs to conduct direct hands on oversight of medical trials? I mean if there’s billions to be made and little chance of prison the incentives get crazy.