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

#191

Post by R0b0t1 » Wed, Aug 26, 2020, 7:38 PM UTC

wmeredith wrote: post #145

rrrrrrrrrrrryan wrote: post #136

Earlier quoted context omitted.

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.

I see these as a consequence to having no real way to remove bad doctors through the legal system. They all protect each other. There's some idiots looking for narcotics, but that isn't all of it.

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

#192

Post by rscho » Wed, Aug 26, 2020, 7:47 PM UTC

nickff wrote: post #190

rscho wrote: post #177

Earlier quoted context omitted.

By culture and attitude, I do not mean the objective criteria defining the healthcare system. I mean how things go when you have a patient encounter. American patients are perceived as far more legally agressive and vindicative. True or not, this results in an overly defensive response from american MDs. Unfortunately, medicine has that in common with war that a dead patient is less problematic than an injured patien…

The USA is definitely very litigious, but I am not sure that Canada is similar. Cultural explanations are interesting, but they can be molded to explain almost anything. I could for instance say that US doctors are motivated to prevent overdoses, as their patients are a source of recurring revenue, whereas Canadian and European doctors and systems see their patients as cost centres.

Yes, of course my assertions are subjective and based upon personal experience. However, here is a very objective thing: you're a US doc and your patient is in pain. Very simple, you prescribe oxycodone and it solves the immediate problem. Then, your patient dies of overdose. But most of the time, you won't even be aware of the cause of death and simply archive the file. And, most important of all: _the patient did not overdose on your prescription, but on self-medication/street drugs_.

So in fact the difference is how MDs solve the immediate pain problem. In the US, they would try to suppress the pain (and legal threats with it). In Europe, they would try to make it bearable while keeping the patient functional, because they are not afraid of their patient.

Everyone benefits from a less tense relationship.

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

#193

Post by xsmasher » Wed, Aug 26, 2020, 7:51 PM UTC

refurb wrote: post #109

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.

Lying about safety? These are opioids which have been around for more than 100 years. And pharma companies are one of many sources of information about drugs. Doctors aren’t forced to only listen to them.

Purdue specifically claimed that oxy was safer; that it had a smaller chance of addiction.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/#__sec2...

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

#194

Post by rscho » Wed, Aug 26, 2020, 7:59 PM UTC

R0b0t1 wrote: post #191

wmeredith wrote: post #145

Earlier quoted context omitted.

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

I see these as a consequence to having no real way to remove bad doctors through the legal system. They all protect each other. There's some idiots looking for narcotics, but that isn't all of it.

The more you'll sue doctors, the more MDs will practice defensive medicine and you'll end up with shit quality overly invasive care. The way to go is to sue the institutions, but not the practitioners themselves. Then the institution punishes the doc if warranted.

In opposition to what you think, doctors are highly egoistical individuals and absolutely do not cover for one another.

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

#195

Post by s5300 » Wed, Aug 26, 2020, 8:20 PM UTC

refurb wrote: post #148

s5300 wrote: post #147

Earlier quoted context omitted.

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

Huh. Call me crazy, but it almost seems as if guidelines and codes haven't meant much for a while. Like, real life "air quotes" oh yes, we won't send them to resorts.

Well, if I had to make an educated guess, they really did cross their fingers and nobody seems to be investigating/enforcing otherwise and they're getting away with it - because I'm telling you, first hand... it's happening, quite frequently, at least on the West Coast.

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

#196

Post by triceratops » Wed, Aug 26, 2020, 8:27 PM UTC

geodel wrote: post #42

dvduval wrote: post #31

Earlier quoted context omitted.

Me either. Imagine a world where the poor have no news access, and instead depend on Facebook for news.

I am trying to imagine a world where everyone think they should get for free other persons' labor. I wonder what that thing is called.

Open source software?

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

#197

Post by Nasrudith » Wed, Aug 26, 2020, 8:36 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?

Because doctors are supposed to provide it to people in pain who approved it and it would rapidly turn arbitrary and Kafkaesque if they started punishing doctors for doing their job while obligating them to do so at the same time. If you punish a surgeon for having a patient die good luck ensuring access to surgeons.

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

#198

Post by Nasrudith » Wed, Aug 26, 2020, 9:01 PM UTC

Retric wrote: post #122

murbard2 wrote: post #101

Earlier quoted context omitted.

Bastiat is specifically referring to rent seeking, occupational licensing, protectionism, etc. The Bastiat quote is on point if your criticism of Purdue Pharma is that it profited from the medical licensing laws and drug prohibition laws that unfairly proscribes teenagers from buying madak cigarettes on the free market. If the criticism is merely that they made money selling addictive drugs, this really isn't what th…

a legal system that authorizes it They did not make billions from selling yet another opioid of which there are dozens available cheaply. They made billions by subverting the medical system largely though completely legal means. Essentially they sold yet another synthetic street drug through Doctors rather than on street corners. And this worked because they jumped through the correct hoops and advertised in the corr…

That mischaracterizes street drugs in production quality, goal, and financial model. Viagra is closer to the model of endorsed recreational usage.

If they went and produced 'Oxycotin gets you high and it is legal!' like a head shop the operation would have not reached multimillion dollar size before it got cracked down.

Jumping through the hoops is the part the system understands as important though.

Those two differences although irrelevant to end outcome being bad and condemnable are pretty damn big distinctions akin to claiming you "unleashed a savage wolf to attack unsuspecting children" when you sold out a pit bull puppy who was sourced from a dog fighting ring and the dog mauled a kid who yanked on his tail.

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

#199

Post by Nasrudith » Wed, Aug 26, 2020, 9:12 PM UTC

autisticcurio wrote: post #61

casraso wrote: post #4

Earlier quoted context omitted.

This is why I am puzzled when people say 'you should fight your battles in the courts, not through protests'. It has always been about who can afford better lawyers, who can win the war of attrition, and a whole lot of luck along the way. Quite a few articles have showed up on HN the past week that reinforce this.

If the system was honest, everyone would be taught at least the basics about law, medicine and finance, but you dont, you get taught enough to be a slave.

They are taught - they just don't pay attention or remember the "boring stuff we will never use" and then after going with the flow for decades with no forward thinking look for somebody to blame for their own failures.

Seriously, all of those who goofed off in home ec and math complaining years later that they don't know how to cook or balance a checkbook.

The immediate resources were often subpar I will admit but don't say you weren't taught.

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

#200

Post by Retric » Wed, Aug 26, 2020, 9:14 PM UTC

Nasrudith wrote: post #198

Retric wrote: post #122

Earlier quoted context omitted.

a legal system that authorizes it They did not make billions from selling yet another opioid of which there are dozens available cheaply. They made billions by subverting the medical system largely though completely legal means. Essentially they sold yet another synthetic street drug through Doctors rather than on street corners. And this worked because they jumped through the correct hoops and advertised in the corr…

That mischaracterizes street drugs in production quality, goal, and financial model. Viagra is closer to the model of endorsed recreational usage. If they went and produced 'Oxycotin gets you high and it is legal!' like a head shop the operation would have not reached multimillion dollar size before it got cracked down. Jumping through the hoops is the part the system understands as important though. Those two differ…

OxyContin was a massive street drug as it is and was literally sold on the street in massive quantities. The additional legal channel for the identical substance from the same manufacturer is both a legal and illegal at the same time. Which is why Bastiat‘s quote is so interesting in this context.