5 ms·

I think what's facile is to discuss the properties of the drug as though the drug itself is representative of the damage that Purdue/Sacklers have done. They b

by ak217 6y ago

I think what's facile is to discuss the properties of the drug as though the drug itself is representative of the damage that Purdue/Sacklers have done. They bribed physicians at scale to boost the sales of their drug. That's the crux of the problem. I am fully prepared to believe it helped a lot of people - I've had family members get oxy prescribed for serious pain - but their physician should not be getting paid to prescribe more of it.

hilbert42 6y ago
'They bribed physicians at scale to boost the sales of their drug. That's the crux of the problem.' Exactly, not only has Purdue's irresponsible pushing up sales of OxyContin led to more people consuming the narcotic but also and more importantly—as we've seen from the opioid epidemic—it means that thousands of patients who are not terminally ill have already become seriously addicted to the drug when otherwise they likely would not have been had they had proper medical care/pain management. I mention terminally ill patents here both because others have done so and the fact that it's necessity to classify them separately from those who are not terminally ill because essentially both groups have very different opioid regimens to each other. For obvious reasons, concern about addiction in terminally ill patients is not as an acute a problem as it is for those who are not terminally ill whereas it is an extremely serious matter for the latter group. The issue of discriminating between pain relief for terminally ill patients and for others who are NOT terminally ill has long historical roots—a fact that many, especially the regulators, (FDA et al) including those within the medical profession who have either seemed to have forgotten the facts or who never learned them in the first instance. Excuse me for not having the exact details to hand, but when international treaties that were concerned with illicit narcotics and the illicit narcotic trade were being signed some 80 years ago, they included provisions that permitted the use of morphine for medical purposes but banned heroin (aka, diamorphine or diacetylmorphine) outright, as then it was considered too dangerous (and unmanageable) for said purpose. This was despite the fact, which was already well known at the time, that heroin is significantly better at suppressing very severe pain than is any increased amount of morphine. Thus, the inclusion of this clause in the treaty meant that heroin became illicit for any purpose. Nevertheless, one country refused to sign the treaty in its entirety. The United Kingdom became the stand-out exception in that whilst it still signed the treaty it had clauses that banned heroin per se struck out and or had them altered to allow heroin to be used in cases of very severe pain that were unable to be adequately controlled with any quantity of morphine. Typically, these were terminally ill patients with cancer. Whilst this enlightened and humane view put British doctors (or at least those ones who controlled policy and regulations) at odds with doctors in other countries, it meant that doctors throughout the UK could [continue] to use heroin in cases where pain was otherwise intractable (note: heroin had been in use before the treaties came into effect). Not only did UK doctors acknowledge that heroin was essential to their pain-relieving arsenal for terminally ill patients but also they went even further in that they continued to use a combination of both heroin and cocaine (and sometimes also in combination with other drugs) in a mixture that became known as Brompton cocktail (named after the UK hospital of the same name). This combination of drugs acted synergistically to not only relieve a cancer sufferer's severe pain but it also made the patient feel substantially better and more comfortable during his or her remaining days. That doctors in other counties did not adopt this approach is, in my opinion, heartless. Whilst concoctions such as Brompton cocktail are not as relevant these days for various reasons too involved to mention here, there's still a longstanding problem with pain management that's not necessarily directly connected with opioid addiction problems. It's as if these bastards have adopted the attitude that too much pain relief is not good for one even if it has nothing to do with increasing addiction. https://en.wikipedia.org/wiki/Brompton_cocktail https://en.wikipedia.org/wiki/Brompton_cocktail Comment on my various posts to this news article: If you read my other/earlier posts here, you'll notice that I'm not only vehemently opposed to the proposed leniency that's likely to be extended to the Sacklers but also you'll see that my anger almost surges to zealot-like proportions over what both they and Purdue have done. My reason for reacting to the extent that I have is that this Sackler/Purdue scandal is not just another instance of corporate corruption caused by the nefarious actions of bad and greedy players—rather; it goes much, much further than that. Those of us who actually understand the true extent of what has happened in this horrible saga know that the issues it crosses are those that are fundamental to underlying integrity of modern medicine. The matter is truly that significant and the fact that so many people do not really care about it is truly tragic. Like so many other things that have gone wrong these days, it almost seems that people have willingly parted with their long-held ethical values for good. The matter of opioid regulations was about as high as it got in international treaties. The fact that Sacklers and Purdue have completely undermined that 100-year understanding between nations is just staggering. Moreover, as I've shown, it is not only the medical profession that was convinced of the absolute necessity to tightly control the distribution of opiates. As we can see from the universal actions of governments around the world some 80 or so years ago, in that they were all of similar minds and convinced to the extent that they were prepared to enter into international treaties that bound both them and their citizens to this effect. In addition, each government then enacted strict local drug law legislation with draconian penalties to back said treaties. Essentially, that for the better part of a century, the regulated control and distribution of narcotic opioids and other drugs of addiction has not only been of prime concern to the medical profession worldwide but also to every government on the planet for the very reason that the unregulated distribution of these drugs would have a devastating negative affect on their citizens. Stated another way: that if the world's citizens were given unregulated and unfretted access to drugs of addiction then many of them would suffer irreparable harm and damage to themselves from having access to said drugs—is a notion upon which both the medical profession and governments almost universally agree—and they have so agreed to this notion for most of the 20th Century and they continue do so into the 21st Century. That long-winded statement is to emphasize the universality of this position. What you have to understand is that the Sacklers and Purdue have deliberately undermined that almost universal covenant on drugs of addiction and they have done so in the most despicable, reprehensible and nefarious way possible. The family/company combo of Sackler/Purdue, whose ethics are as equally bad as the large illegal drug cartel barons, acted outrageously and in an irresponsible manner by deliberately co-opting and undermining the ethics of many doctors by bribing them. Many of who have since acted in a greedy and disingenuous towards their patients, not to mention also having breached their Hippocratic Oath towards them. In summary, the Sacklers and Purdue along with their complicit doctors including the irresponsible FDA have completely undermined the very foundations of present day medical 'law', in essence they've torn away the ethical fabric from asunder, and in so doing they have effectively destroyed the universal consensus that's been built up over the past one hundred years or so between the medical profession, the regulators such as the FDA and those countries that signed the otherwise irrevocable drug treaties. The fact that Sacklers/Purdue can wield this much power is, in my view, terrifying.
- ak217 6y ago
  Hey, thanks for your reply, it's clear that you're passionate about the topic and that we're on the same page. Your writing on the topic is lucid and convincing, I would only point out that it's liable to get lost in the noise here on HN. I would encourage you to write essays on this and post on a personal blog and link to it on social media, or similar - or contact journalists who you see writing on this topic.
  - hilbert42 6y ago
    Thanks for your comments. First, I must admit to having a bad case of prolix disease so this reply will have to appear over two posts. ;-) My main concern is driven by the fact that corporate memory seems to have deserted so many important institutions these days, matters once long settled have been forgotten or depreciated in importance by the very institutions that are supposed to be upholding those ideas. Rigor, ethics and ideals have seemingly flown out the window. It seems very strange to me to chuck out ideas that have long since been proven to work but I accept it's part and parcel of the current zeitgeist to devalue ideas from the past without first evaluating them as to whether they're worthwhile or not. This wasn't the case until perhaps the late 1970s or early '80s, that's when postmodernist ideas began to take hold in a big way. I'm not against all postmodernist ideas per se but some have had a devastating effect on science and engineering: once facts were just that—facts—not just 'possible maybes' as so many people consider them to be nowadays. Reason, logic and logical argument just aren't fashionable these days. Now the public's faith in science seems badly mauled and I reckon that's a bad thing. Whilst cultural changes outside of science have largely contributed to its fall from grace, there's also little doubt that science has shot itself in the foot far too many times in recent decades for it not to have had a significant negative effect on public perception. There's been too many major scientific scandals that should never have happened, some scientists have much to answer for, and scientists generally have a great deal of PR work to do to clean up the mess: https://en.wikipedia.org/wiki/List_of_scientific_misconduct_incidents https://en.wikipedia.org/wiki/List_of_scientific_misconduct_.... Nevertheless, I strongly believe that science is still the best discipline we have to prevent us from returning to the dark ages. If you want to get an appreciation of how significantly the public's attitude to science has changed for the worse since the mid 1950s then it's worth looking at this short 1955 doco for school kids titled Why Study Science?. It's a bit trite and clichéd but there's no hiding the fact that back then the public held science in very high regard, it also shows that science and engineering held absolutely prominent and unquestionable places in society at that time: https://archive.org/details/WhyStudy1955_2 https://archive.org/details/WhyStudy1955_2. My, my how times have changed, it's a shame this doco doesn't get more of an airing by scientists (and in fact by everyone), as it seems to me to be a good reference point for comparison; moreover most scientist will be too young to have experienced how the public perceived their profession during its halcyon days, which alone is a good enough reason for them to view it. What is so damn annoying to me about this opioid crisis is that many of those who are implicated in its creation were trained in scientific disciplines, what they did was the antithesis of what science stands for. I would further add that I don't believe doctors and scientists would have been implicated to such a degree back half a century ago (that's not to say they were above reproach, far from it). Reading the above, I must appear to be an apologist for a past era but I'd insist it's not so. I haven't the time to expand and justify the last sentence in detail but I'll add this much. Whilst I was too young to be one of the targets of that 1955 doco, I did grow up somewhat later whilst that ethos was still current (as mentioned, things changed in the '80s and onwards). This meant that I not only learned science within that earlier culture but also I'm inculcated to think that way. Furthermore, as I'm writing this in October 2020, it means that I've witnessed the public's change in attitude towards science over these decades and, in my opinion, it's been nothing short of dramatic in the negative sense. It's not as if back then people were slaves to the scientific elite, that's definitely not so as that was the time of the Cold War and the Bomb so there was much criticism of those who developed and tested it. The disparity between then and now is that in those days most people had a much better understanding of the difference between scientific progress for the betterment of society and science that is used for nefarious purposes and I believe that the media had much do with this more positive attitude, as reporting was much more objective and balanced back then. Furthermore, we didn't have the internet full of millions of self-styled experts to criticize science (and for that matter criticize just about everything else, both good and bad). Unfortunately, internet's 'noise' now drowns out much worthwhile stuff. As I alluded to at the outset, there are many reasons for the opioid crisis, but I return to the fact that these days institutions such as the FDA simply do not have structures in place to remember the importance of why certain decisions were made in the past. The fact that opioid addiction has been high on the medical agenda for ≈150 years and very high on the agenda of both local and international politics for about a century and the fact that it has been effectively forgotten by the FDA says not only a great deal about said institution but also much about modern culture. [If all goes well, I'll provide you with some examples in a reply below.]

by ak217 6y ago

hilbert42 6y ago

'They bribed physicians at scale to boost the sales of their drug. That's the crux of the problem.' Exactly, not only has Purdue's irresponsible pushing up sales of OxyContin led to more people consuming the narcotic but also and more importantly—as we've seen from the opioid epidemic—it means that thousands of patients who are not terminally ill have already become seriously addicted to the drug when otherwise they likely would not have been had they had proper medical care/pain management. I mention terminally ill patents here both because others have done so and the fact that it's necessity to classify them separately from those who are not terminally ill because essentially both groups have very different opioid regimens to each other. For obvious reasons, concern about addiction in terminally ill patients is not as an acute a problem as it is for those who are not terminally ill whereas it is an extremely serious matter for the latter group. The issue of discriminating between pain relief for terminally ill patients and for others who are NOT terminally ill has long historical roots—a fact that many, especially the regulators, (FDA et al) including those within the medical profession who have either seemed to have forgotten the facts or who never learned them in the first instance. Excuse me for not having the exact details to hand, but when international treaties that were concerned with illicit narcotics and the illicit narcotic trade were being signed some 80 years ago, they included provisions that permitted the use of morphine for medical purposes but banned heroin (aka, diamorphine or diacetylmorphine) outright, as then it was considered too dangerous (and unmanageable) for said purpose. This was despite the fact, which was already well known at the time, that heroin is significantly better at suppressing very severe pain than is any increased amount of morphine. Thus, the inclusion of this clause in the treaty meant that heroin became illicit for any purpose. Nevertheless, one country refused to sign the treaty in its entirety. The United Kingdom became the stand-out exception in that whilst it still signed the treaty it had clauses that banned heroin per se struck out and or had them altered to allow heroin to be used in cases of very severe pain that were unable to be adequately controlled with any quantity of morphine. Typically, these were terminally ill patients with cancer. Whilst this enlightened and humane view put British doctors (or at least those ones who controlled policy and regulations) at odds with doctors in other countries, it meant that doctors throughout the UK could [continue] to use heroin in cases where pain was otherwise intractable (note: heroin had been in use before the treaties came into effect). Not only did UK doctors acknowledge that heroin was essential to their pain-relieving arsenal for terminally ill patients but also they went even further in that they continued to use a combination of both heroin and cocaine (and sometimes also in combination with other drugs) in a mixture that became known as Brompton cocktail (named after the UK hospital of the same name). This combination of drugs acted synergistically to not only relieve a cancer sufferer's severe pain but it also made the patient feel substantially better and more comfortable during his or her remaining days. That doctors in other counties did not adopt this approach is, in my opinion, heartless. Whilst concoctions such as Brompton cocktail are not as relevant these days for various reasons too involved to mention here, there's still a longstanding problem with pain management that's not necessarily directly connected with opioid addiction problems. It's as if these bastards have adopted the attitude that too much pain relief is not good for one even if it has nothing to do with increasing addiction. https://en.wikipedia.org/wiki/Brompton_cocktail https://en.wikipedia.org/wiki/Brompton_cocktail Comment on my various posts to this news article: If you read my other/earlier posts here, you'll notice that I'm not only vehemently opposed to the proposed leniency that's likely to be extended to the Sacklers but also you'll see that my anger almost surges to zealot-like proportions over what both they and Purdue have done. My reason for reacting to the extent that I have is that this Sackler/Purdue scandal is not just another instance of corporate corruption caused by the nefarious actions of bad and greedy players—rather; it goes much, much further than that. Those of us who actually understand the true extent of what has happened in this horrible saga know that the issues it crosses are those that are fundamental to underlying integrity of modern medicine. The matter is truly that significant and the fact that so many people do not really care about it is truly tragic. Like so many other things that have gone wrong these days, it almost seems that people have willingly parted with their long-held ethical values for good. The matter of opioid regulations was about as high as it got in international treaties. The fact that Sacklers and Purdue have completely undermined that 100-year understanding between nations is just staggering. Moreover, as I've shown, it is not only the medical profession that was convinced of the absolute necessity to tightly control the distribution of opiates. As we can see from the universal actions of governments around the world some 80 or so years ago, in that they were all of similar minds and convinced to the extent that they were prepared to enter into international treaties that bound both them and their citizens to this effect. In addition, each government then enacted strict local drug law legislation with draconian penalties to back said treaties. Essentially, that for the better part of a century, the regulated control and distribution of narcotic opioids and other drugs of addiction has not only been of prime concern to the medical profession worldwide but also to every government on the planet for the very reason that the unregulated distribution of these drugs would have a devastating negative affect on their citizens. Stated another way: that if the world's citizens were given unregulated and unfretted access to drugs of addiction then many of them would suffer irreparable harm and damage to themselves from having access to said drugs—is a notion upon which both the medical profession and governments almost universally agree—and they have so agreed to this notion for most of the 20th Century and they continue do so into the 21st Century. That long-winded statement is to emphasize the universality of this position. What you have to understand is that the Sacklers and Purdue have deliberately undermined that almost universal covenant on drugs of addiction and they have done so in the most despicable, reprehensible and nefarious way possible. The family/company combo of Sackler/Purdue, whose ethics are as equally bad as the large illegal drug cartel barons, acted outrageously and in an irresponsible manner by deliberately co-opting and undermining the ethics of many doctors by bribing them. Many of who have since acted in a greedy and disingenuous towards their patients, not to mention also having breached their Hippocratic Oath towards them. In summary, the Sacklers and Purdue along with their complicit doctors including the irresponsible FDA have completely undermined the very foundations of present day medical 'law', in essence they've torn away the ethical fabric from asunder, and in so doing they have effectively destroyed the universal consensus that's been built up over the past one hundred years or so between the medical profession, the regulators such as the FDA and those countries that signed the otherwise irrevocable drug treaties. The fact that Sacklers/Purdue can wield this much power is, in my view, terrifying.

ak217 6y ago
Hey, thanks for your reply, it's clear that you're passionate about the topic and that we're on the same page. Your writing on the topic is lucid and convincing, I would only point out that it's liable to get lost in the noise here on HN. I would encourage you to write essays on this and post on a personal blog and link to it on social media, or similar - or contact journalists who you see writing on this topic.
- hilbert42 6y ago
  Thanks for your comments. First, I must admit to having a bad case of prolix disease so this reply will have to appear over two posts. ;-) My main concern is driven by the fact that corporate memory seems to have deserted so many important institutions these days, matters once long settled have been forgotten or depreciated in importance by the very institutions that are supposed to be upholding those ideas. Rigor, ethics and ideals have seemingly flown out the window. It seems very strange to me to chuck out ideas that have long since been proven to work but I accept it's part and parcel of the current zeitgeist to devalue ideas from the past without first evaluating them as to whether they're worthwhile or not. This wasn't the case until perhaps the late 1970s or early '80s, that's when postmodernist ideas began to take hold in a big way. I'm not against all postmodernist ideas per se but some have had a devastating effect on science and engineering: once facts were just that—facts—not just 'possible maybes' as so many people consider them to be nowadays. Reason, logic and logical argument just aren't fashionable these days. Now the public's faith in science seems badly mauled and I reckon that's a bad thing. Whilst cultural changes outside of science have largely contributed to its fall from grace, there's also little doubt that science has shot itself in the foot far too many times in recent decades for it not to have had a significant negative effect on public perception. There's been too many major scientific scandals that should never have happened, some scientists have much to answer for, and scientists generally have a great deal of PR work to do to clean up the mess: https://en.wikipedia.org/wiki/List_of_scientific_misconduct_incidents https://en.wikipedia.org/wiki/List_of_scientific_misconduct_.... Nevertheless, I strongly believe that science is still the best discipline we have to prevent us from returning to the dark ages. If you want to get an appreciation of how significantly the public's attitude to science has changed for the worse since the mid 1950s then it's worth looking at this short 1955 doco for school kids titled Why Study Science?. It's a bit trite and clichéd but there's no hiding the fact that back then the public held science in very high regard, it also shows that science and engineering held absolutely prominent and unquestionable places in society at that time: https://archive.org/details/WhyStudy1955_2 https://archive.org/details/WhyStudy1955_2. My, my how times have changed, it's a shame this doco doesn't get more of an airing by scientists (and in fact by everyone), as it seems to me to be a good reference point for comparison; moreover most scientist will be too young to have experienced how the public perceived their profession during its halcyon days, which alone is a good enough reason for them to view it. What is so damn annoying to me about this opioid crisis is that many of those who are implicated in its creation were trained in scientific disciplines, what they did was the antithesis of what science stands for. I would further add that I don't believe doctors and scientists would have been implicated to such a degree back half a century ago (that's not to say they were above reproach, far from it). Reading the above, I must appear to be an apologist for a past era but I'd insist it's not so. I haven't the time to expand and justify the last sentence in detail but I'll add this much. Whilst I was too young to be one of the targets of that 1955 doco, I did grow up somewhat later whilst that ethos was still current (as mentioned, things changed in the '80s and onwards). This meant that I not only learned science within that earlier culture but also I'm inculcated to think that way. Furthermore, as I'm writing this in October 2020, it means that I've witnessed the public's change in attitude towards science over these decades and, in my opinion, it's been nothing short of dramatic in the negative sense. It's not as if back then people were slaves to the scientific elite, that's definitely not so as that was the time of the Cold War and the Bomb so there was much criticism of those who developed and tested it. The disparity between then and now is that in those days most people had a much better understanding of the difference between scientific progress for the betterment of society and science that is used for nefarious purposes and I believe that the media had much do with this more positive attitude, as reporting was much more objective and balanced back then. Furthermore, we didn't have the internet full of millions of self-styled experts to criticize science (and for that matter criticize just about everything else, both good and bad). Unfortunately, internet's 'noise' now drowns out much worthwhile stuff. As I alluded to at the outset, there are many reasons for the opioid crisis, but I return to the fact that these days institutions such as the FDA simply do not have structures in place to remember the importance of why certain decisions were made in the past. The fact that opioid addiction has been high on the medical agenda for ≈150 years and very high on the agenda of both local and international politics for about a century and the fact that it has been effectively forgotten by the FDA says not only a great deal about said institution but also much about modern culture. [If all goes well, I'll provide you with some examples in a reply below.]