The Off Topic Topic

[Monoriu]

The other side of the story is that the drug companies bribe doctors to prescribe more of their drugs.

That's an obvious conflict of interest that should be regulated, and people involved in the bribery should be prosecuted. 

[Admiral Yi]

That's an obvious conflict of interest that should be regulated, and people involved in the bribery should be prosecuted.

They did it in a manner that was legal at the time, I think.  They would pay doctors who prescribed a lot big honorariums to give de facto sales speeches.  I think they recently outlawed this.

[Maladict]

There are so many things that I don't understand about this whole opioid crisis. 

How come I have never heard of this problem in this side of the world? 

I guess opium has never really caught on in China.

[Duque de Bragança]

Of course not. It was forced upon China by the English White Devils. 

We need a Mandarin emoticon.

[crazy canuck]

Yeah mono, that's one side of the argument.  Most drugs have side effects and it's the FDA's job to make sure those side effects aren't too great, and that everybody is aware of them.  And it's the prescribing doctor's job to make sure people don't get addicted.

The other side of the story is that the drug companies bribe doctors to prescribe more of their drugs.

The first side, your side, is one you don't hear a lot these days.

You are mischaracterizing the case against them.  The issue is the risks of addiction were known by the company but they dishonesty marketed and represented that the drug was not addictive. 

[Josephus]

The many Sacklers of Sackler Gallery:

https://www.sacklergallery.com/

is that site down?

[Malthus]

The opioid crisis has many parts. Some of those parts are the proverbial road to hell paved with good intentions; others were not. Suffice it to say that while there were villains, their villainy was not alone responsible.

In no particular order:

1. Pain management among physicians underwent a significant shift, in which much more emphasis was put on relieving pain than had been the case before: "pain as the fifth vital sign" became the medical standard promoted in the 1990s. While there are various medicines used to control pain, by far the most effective are various opiates. So regardless of promotional practices by manufacturers, the prescription of opiates was bound to increase significantly. In the past, patients were more likely to be expected to simply deal with a certain amount of pain, unless it was truly unbearable. 

2. All opiates carry a risk of addiction. Why some succumb to that risk and others do not is not well understood. Nor is it easy to control.

3. Purdue (and others) who manufactured various opiate-derived medicines systematically "over-promoted" the drugs, including underplaying or denying altogether their potential to cause addiction - this together with the aforementioned shift in pain management - sent sales skyrocketing.

4. Social attitudes towards addiction in the US especially but also elsewhere: it's a personal, moral failure plus a criminal offence to indulge. A strict divide exists in people's minds between medical use (prescribed by a doctor) and "recreational" use (bought from a pusher). This makes dealing rationally with addiction as a medical issue impossible. It became easy for someone suffering some ailment to fall into addiction and ruin. They go to a doctor, get prescribed an opiate, get hooked, shop around for increasingly sketchy docs to prescribe them the drugs they now crave, go to pushers when the docs fail them ... end up dead or in prison.

5. Cheap opiates flood in, mainly from China (Fentanyl). Very potent and very easy to overdose with. Now addicts find opiates are cheaper than ever, but with a much increased risk of dropping dead if bought from a pusher. 

See for example:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993682/

[Syt]

The many Sacklers of Sackler Gallery:

https://www.sacklergallery.com/

is that site down?

It's up for me.

In case people wonder where it comes from, it was set up by Last Week Tonight: https://www.youtube.com/watch?v=-qCKR6wy94U

[The Brain]

If doctors had been less opiate-happy then we would have won the Battle of Britain.

[Valmy]

If doctors had been less opiate-happy then we would have won the Battle of Britain.

Whose side are you on Brain? 

[The Brain]

If doctors had been less opiate-happy then we would have won the Battle of Britain.

Whose side are you on Brain? 

The underdogs.

[Duque de Bragança]

A classic! Foreigners mixing up Frankfurts. How they managed to go the small, far away Frankfurt instead of the far closer Frankfurt is beyond me. Not the brightest Benfica fans, but I remember similar cases in 2006 during the World Cup in Germany.

https://www.givemesport.com/1469319-a-group-of-benfica-fans-have-gone-viral-for-travelling-to-the-wrong-frankfurt

[Maladict]

A classic! Foreigners mixing up Frankfurts. How they managed to go the small, far away Frankfurt instead of the far closer Frankfurt is beyond me. Not the brightest Benfica fans, but I remember similar cases in 2006 during the World Cup in Germany.

https://www.givemesport.com/1469319-a-group-of-benfica-fans-have-gone-viral-for-travelling-to-the-wrong-frankfurt

He was driving, probably just put Frankfurt in the satnav and followed directions.

[dps]

The opioid crisis has many parts. Some of those parts are the proverbial road to hell paved with good intentions; others were not. Suffice it to say that while there were villains, their villainy was not alone responsible.

In no particular order:

1. Pain management among physicians underwent a significant shift, in which much more emphasis was put on relieving pain than had been the case before: “pain as the fifth vital sign” became the medical standard promoted in the 1990s. While there are various medicines used to control pain, by far the most effective are various opiates. So regardless of promotional practices by manufacturers, the prescription of opiates was bound to increase significantly. In the past, patients were more likely to be expected to simply deal with a certain amount of pain, unless it was truly unbearable. 

2. All opiates carry a risk of addiction. Why some succumb to that risk and others do not is not well understood. Nor is it easy to control.

3. Purdue (and others) who manufactured various opiate-derived medicines systematically "over-promoted" the drugs, including underplaying or denying altogether their potential to cause addiction - this together with the aforementioned shift in pain management - sent sales skyrocketing.

4. Social attitudes towards addiction in the US especially but also elsewhere: it's a personal, moral failure plus a criminal offence to indulge. A strict divide exists in people's minds between medical use (prescribed by a doctor) and "recreational" use (bought from a pusher). This makes dealing rationally with addiction as a medical issue impossible. It became easy for someone suffering some ailment to fall into addiction and ruin. They go to a doctor, get prescribed an opiate, get hooked, shop around for increasingly sketchy docs to prescribe them the drugs they now crave, go to pushers when the docs fail them ... end up dead or in prison.

5. Cheap opiates flood in, mainly from China (Fentanyl). Very potent and very easy to overdose with. Now addicts find opiates are cheaper than ever, but with a much increased risk of dropping dead if bought from a pusher. 

See for example:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993682/

Another thing which I think is a factor is that I believe that there's been a fundamental shift in the doctor-patient relationship, possibly at least partly because we rely way less on general practitioners and more on specialists nowadays.  I think the family doctors we went to 40 years ago knew us well enough as people that they would have noticed and cared if we were overusing painkillers.  I'm not sure that the doctors we go to now would notice--as long as we aren't complaining about pain, they figure we're OK on that front, but if we are complaining, they feel obligated to give us a prescription for it, instead of digging deeper or just telling us to take a couple of aspirin.

[Duque de Bragança]

A classic! Foreigners mixing up Frankfurts. How they managed to go the small, far away Frankfurt instead of the far closer Frankfurt is beyond me. Not the brightest Benfica fans, but I remember similar cases in 2006 during the World Cup in Germany.

https://www.givemesport.com/1469319-a-group-of-benfica-fans-have-gone-viral-for-travelling-to-the-wrong-frankfurt

He was driving, probably just put Frankfurt in the satnav and followed directions.

He typed Frankfurt on his GPS. He should have paid attention to the river after Frankfurt. Main or Oder?