4 ms·

we would be better served looking at boring things like medicares 3 million pages of medical claim guidelines, clearing house operations and conflicts of intere

we would be better served looking at boring things like medicares 3 million pages of medical claim guidelines, clearing house operations and conflicts of interest, better incentives for state level responsibility, antitrust litigation, lots of practical things that don't make click bait headlines. It would also be nice to reform the FDA and the clinical trial system: https://bessstillman.substack.com/p/please-be-dying-but-not-too-quickly https://bessstillman.substack.com/p/please-be-dying-but-not-... "Antitrust litigation" covers this, but to spell it out, the increasing monopolization of many local healthcare systems is a huge problem.

duffpkg 3y ago
My opinion about the FDA is that it suffers from two major faults, it is always regulating the "last war" and it has the standard federal government incentive structure for policy making which is "do not do anything that according to civil service regulations can get me fired". In defense of the FDA, which I promise is not an instituion I have much affection for, they are asked to strike an impossible balance. More or less the same regulatory impulse that allowed Richard Sackler to build an empire on the killing of millions of americans is the same one that allows very sick people to access very, at times dubious, drugs and trials that sometimes save their lives. Most of medicine is very centrally built around the "first do no harm" approach, even at the cost of lives by non-intervention sometimes. With the FDA most people want a "do some harm, some of the time for the greater good" approach which is a really difficult thing for a federal agency to put into practice. I think they do an especially awful job with it but I appreaciate that it is a really hard balance to strike.
- sneak 3y ago
  Tobacco kills 7x as many people each hour, day, and month as opioids in the USA, and it’s available everywhere without a prescription. The Sacklers aren’t the problem here, corruption is.
  - polygamous_bat 3y ago
    > The Sacklers aren’t the problem here, corruption is. Why not both?
  - manquer 3y ago
    This is not really a good argument, there are many things that kill a lot of people , The manner and type of lives lost is important also the nature of impact. People aren’t dying very young with tobacco addiction for the most part. There is cancer in youth sure , but tobacco is not the leading cause of that . People who die of tobacco related illnesses are functioning adults and contributing members of society for the vast majority of their lives . The disruption to the lives of drug addicts and their friends and family far exceeds those faced by tobacco addicts. Not everything is a conspiracy or corruption people only react to what they see, the impact of drugs is far more visceral and immediate than tobacco or say obesity which kills even more, so pressure for legislation is higher If tobacco killed because the of one wrongly cut cigarette you smoked , it would require prescription too
    - 221qqwe 3y ago
      Do people die from prescription opioids that often? I assumed that most of the deaths occur when people who are addicted lose access to legal sources and are forced to buy illegally (so risk of overdose and other complications is much higher)?
      - trimethylpurine 3y ago
        Interesting theory. I would guess that's rare and that more often than not, people are overdosing on prescriptions that they lied to obtain and then abused, or purchased on the street from someone who received the prescriptions but didn't need them. I'm speaking from personal experiences, but of course, it's anecdotal.
      - manquer 3y ago
        That is exactly why legal sources which are prescription exists, because it is easy to kill oneself by taking a illegal pill of unknown quality, such risks are not common with tobacco. The regulation is a function of that, not how many people are killed by one item or other, it is merely just how easy is it die of OD with a poorly sourced drug, is why we have FDA and regulations etc is my point.

duffpkg 3y ago

My opinion about the FDA is that it suffers from two major faults, it is always regulating the "last war" and it has the standard federal government incentive structure for policy making which is "do not do anything that according to civil service regulations can get me fired". In defense of the FDA, which I promise is not an instituion I have much affection for, they are asked to strike an impossible balance. More or less the same regulatory impulse that allowed Richard Sackler to build an empire on the killing of millions of americans is the same one that allows very sick people to access very, at times dubious, drugs and trials that sometimes save their lives. Most of medicine is very centrally built around the "first do no harm" approach, even at the cost of lives by non-intervention sometimes. With the FDA most people want a "do some harm, some of the time for the greater good" approach which is a really difficult thing for a federal agency to put into practice. I think they do an especially awful job with it but I appreaciate that it is a really hard balance to strike.

sneak 3y ago
Tobacco kills 7x as many people each hour, day, and month as opioids in the USA, and it’s available everywhere without a prescription. The Sacklers aren’t the problem here, corruption is.
- polygamous_bat 3y ago
  > The Sacklers aren’t the problem here, corruption is. Why not both?
- manquer 3y ago
  This is not really a good argument, there are many things that kill a lot of people , The manner and type of lives lost is important also the nature of impact. People aren’t dying very young with tobacco addiction for the most part. There is cancer in youth sure , but tobacco is not the leading cause of that . People who die of tobacco related illnesses are functioning adults and contributing members of society for the vast majority of their lives . The disruption to the lives of drug addicts and their friends and family far exceeds those faced by tobacco addicts. Not everything is a conspiracy or corruption people only react to what they see, the impact of drugs is far more visceral and immediate than tobacco or say obesity which kills even more, so pressure for legislation is higher If tobacco killed because the of one wrongly cut cigarette you smoked , it would require prescription too
  - 221qqwe 3y ago
    Do people die from prescription opioids that often? I assumed that most of the deaths occur when people who are addicted lose access to legal sources and are forced to buy illegally (so risk of overdose and other complications is much higher)?
    - trimethylpurine 3y ago
      Interesting theory. I would guess that's rare and that more often than not, people are overdosing on prescriptions that they lied to obtain and then abused, or purchased on the street from someone who received the prescriptions but didn't need them. I'm speaking from personal experiences, but of course, it's anecdotal.
    - manquer 3y ago
      That is exactly why legal sources which are prescription exists, because it is easy to kill oneself by taking a illegal pill of unknown quality, such risks are not common with tobacco. The regulation is a function of that, not how many people are killed by one item or other, it is merely just how easy is it die of OD with a poorly sourced drug, is why we have FDA and regulations etc is my point.