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I hate regulatory capture as much as anyone, but this makes for a more damning-sounding headline than it actually is. To steal a comment from Reddit[1] user New

I hate regulatory capture as much as anyone, but this makes for a more damning-sounding headline than it actually is. To steal a comment from Reddit[1] user NewInThe1AC: > It's a lot less concerning if you actually think about what he specifically did, and what information he would've had access to at the time > He was 23 and working on an early career project. Given how consulting teams are structured, he was not an architect of any grand scheme or plan, and was just executing the work ahead of him. Based on the evidence cited in the article, this was run of the mill business research -- interviewing experts about how pharma sales works and how to segment doctors, summarizing and framing to get to recommendations, and editing PowerPoints > It's only bad when you consider that the product was opioids, but keep in mind that the scientific literature he would've had access to at the time would not have suggested they were especially harmful. If anything, there were compelling reasons for a 3rd party at the time to actually believe that more widespread use of these products would improve wellbeing. If it was so obvious to everyone how bad these things were, we wouldn't have ended up with the crisis we did [1] https://old.reddit.com/r/sanfrancisco/comments/1ipgwcm/sfs_new_public_health_chief_tasked_with_fighting/mcs0a53/ https://old.reddit.com/r/sanfrancisco/comments/1ipgwcm/sfs_n...

anigbrowl 2y ago
It's been widely understood since the 1970s, if not longer, that opioids have a high potential for addiction and that long term use tends to be harmful. Sure, he seems to have been quite a junior employee, but I knew opioids were a high risk category of drugs when I was in high school. I don't think he's the worst guy in the world, but I do think McKinsey style consulting and this experience in particular is a net negative.
- asdff 2y ago
  Potential for addiction yes but we are looking at it from the lens of a post Purdue media bias. People abuse plenty of drugs that aren't opioids and we aren't say seeing a big push against Xanax for example because that wasn't in any crosshairs of media spectacle. People die on Xanax but it doesn't seem to matter because people write them off as combining with alcohol or that they were addicts. And indeed most drugs of this sort are not particularly harmful if they are used within recommendations. At a certain point a doctor can't control what you chose to do at home with your prescription and that doesn't mean you shouldn't have people who would use it responsibly not receive it even if it means some will abuse it.
  - sepositus 2y ago
    > At a certain point a doctor can't control what you chose to do at home with your prescription and that doesn't mean you shouldn't have people who would use it responsibly not receive it even if it means some will abuse it I'd like to think that most of those decisions are coming from datasets that suggest, on average, certain medications tend to lead to abuse, including from people with no prior history of abuse. I'm quite libertarian in a lot of my views, but this particular one on lax drug controls I've never really been able to buy into.
    - skippyboxedhero 2y ago
      I can't remember the exact stats but something like 5% of doctors were writing 75% of the sales for these products. It isn't that they lead to abuse, it is that people who are using heroin will abuse them, and will go to doctors who facilitate that.
      - wlesieutre 2y ago
        Dentists were handing opioid prescriptions out like candy to teenagers getting their wisdom teeth out. How many of those kids were previously on heroin and were picking dentists who would hook them up? It's a massively common procedure and defaulting to "here's some addictive painkillers just in case you want them" was an insane thing to do, even if only 1% of cases turn out badly.
        zoklet-enjoyer 2y ago
        I got my wisdom teeth out at 16 or 17 and was given a prescription for oxycodone. I was really excited because I had read about oxy online and wanted to try it. But also I knew it was referred to as hillbilly heroin because of how addictive it was, so I had to be careful. I didn't take any of the oxy after the surgery and just took ibuprofen, so I could save the oxy for later on. I got high off it a few times and loved it. Later on I got a chance to try some hydrocodone and I thought that was even better, because the oxycodone was a little too much for me. I didn't nod off on the hydros. Anyway, opiates are great, that's why I haven't used them since high school.
- SmellTheGlove 2y ago
  When I was in my mid to late 20s I was at a consulting firm and later in government directly. I wasn’t assigned to anything particularly objectionable or anything, but I’ve looked back on it a lot and it’s heavily influenced how I operate in the tech industry now, 20 years later. In government and in consulting I saw a lot of misaligned incentives that led to empire building, duplicative efforts, and treatment of individuals that I didn’t really find to be effective. And today, I’m really good at spotting that and stopping it quickly, because I think much of that was not the best way to operate. But I didn’t immediately get into it and realize it wasn’t how I would run things - and experiencing being part of the machine for a bit first taught me lessons that I would not have learned as an outside observer. If you made the same assumptions about me based on what I did in my 20s, you’d actually be assuming the direct opposite of what I believe in and how I work today. We’re all shaped by our experiences, but that shaping doesn’t always mean we grow into the behaviors that we experienced during our formative early career. Maybe this guy looks on that experience and knows exactly what he doesn’t want to see happen.
- Mistletoe 2y ago
  I’d say it goes back considerably further than the 1970s. https://en.wikipedia.org/wiki/Opium_den https://en.wikipedia.org/wiki/Opium_den https://en.wikipedia.org/wiki/Opium_Wars https://en.wikipedia.org/wiki/Opium_Wars I’m still struck by how deeply immoral it is to start a war and say “You WILL allow us to sell you opium!”
- khana 2y ago
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rgrieselhuber 2y ago
Yeah he was just an innocent marketing consultant: “ In a March 2008 PowerPoint presentation, Tsai outlined a marketing strategy for the drug that included guidance on targeting “specific physician segments to grow high-prescriber group (i.e., physicians more sensitive to patient needs)” and an idea to introduce “coupons” for the drug as part of a pilot program.”
- asdff 2y ago
  Are you trying to say this quote is painting him as not innocent? That really doesn't seem so sinister. Sinister would be buying billboard space in west virginia like something out of newport cigarettes playbook.
  - skippyboxedhero 2y ago
    Yes, it is fairly obvious that he wasn't innocent based on that quote. The high-prescribers were people operating out of strip malls, often with unclear credentials, and whose main clientele were opioid addicts. Many of these people (I am choosing not to use the word doctors) ended up in prison...consultants who were advising them, not so much. There are a large number of people who could do this job, it is reasonable to ask whether the person you want doing this job is someone who, at best, was unaware that these people were breaking the law. And, to be clear, he was Partner of their Healthcare practice whilst this was going on...he wasn't just making Powerpoints. The revolving door between consultancies and government must continue. No-one is more skilled than running government than lawyers and consultants who have lots of experience in...advising other people how to run things.
    - asdff 2y ago
      > The high-prescribers were people operating out of strip malls, often with unclear credentials, and whose main clientele were opioid addicts. I think this is an assumption. May be right but for all doctors who “listen to patients needs” to be pill pushers deserving prison time seems a little too inconvenient. At the end of the day he is asked to optimize a business in a consultancy not to play to his moral principles and get replaced on the project for someone who will optimize it for business needs. At least he is potentially seeing all the inputs with these relationships and a side of the healthcare industry a lot of people wouldn’t have any experience with without holding these positions themselves to be able to be in these rooms where these conversations are held.
noah_buddy 2y ago
To be frank, the issue is that our society is not more damning of people involved in the low-level actioning of great injustices.
- Spooky23 2y ago
  That’s worked really well in other areas of criminal justice. /s
- lolinder 2y ago
  A far bigger issue with our society is our willingness to brand someone forever based on what they did decades prior—we (as a society) pay lip service to the idea that people change, but we don't truly believe it. It's the same punitive impulse that causes the permanent second-class citizenship bestowed upon anyone who finishes a prison term.
  - noah_buddy 2y ago
    Generally, that problem is separate. The impact of little Eichmanns everywhere is greater than the loss of productivity from people convicted of crimes who can’t get a job later imo. Our society is very forgiving if you propagate “faceless” evil. It’s unforgiving if there’s a human face to it. Part of this ties into the power of monetary capital over social capital.
    - lolinder 2y ago
      > Our society is very forgiving if you propagate “faceless” evil. It’s unforgiving if there’s a human face to it. How does this track with your assertion that "the issue is that our society is not more damning of people involved in the low-level actioning of great injustices"? Isn't your impulse to damn now that there's a low-level face to the faceless evil the exact same impulse as the one people have to condemn a low-level drug runner for the rest of their life?
      - noah_buddy 2y ago
joe_the_user 2y ago
I hate regulatory capture as much as anyone, but... Others have talked about the question of innocence but I think your comment illustrates not getting the dynamic of regulatory capture. The situation of regulatory capture is about there being "revolving door" between industry and regulators, so that the regulators use same criteria as companies for regulatory decisions. This dynamic results in broad regulatory capture regardless of the individual bad deeds.
kyleblarson 2y ago
"I was just doing my job."
morpheos137 2y ago
Opioids are not a particularly harmful to most people. The harm is in the addiction not the chemical. Opioids are useful for treating acute pain, such as after surgery. They are less useful for chronic pain but if the doctor and patient are able to responsibly manage dose escalation as tolerance develops they are also useful for chronic pain.
zoklet-enjoyer 2y ago
Only a complete moron wouldn't know about the addictive potential of opiates in 2007-2015
- zoklet-enjoyer 2y ago
  Seeing that comment at -1 makes me chuckle. Imagine not knowing opiates are addictive anytime past the 1800s
dimal 2y ago
The banality of evil. He was just doing his job.
tengbretson 2y ago
I don't live there, so I wouldn't know, but did they run out of other candidates that haven't shilled tramadol?
ekianjo 2y ago
> scientific literature he would've had access to at the time would not have suggested they were especially harmful. Only if you pretend to be blind. McKinsey knew exactly the effects of opioids which is why they were condemned as well
khana 2y ago
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anigbrowl 2y ago

It's been widely understood since the 1970s, if not longer, that opioids have a high potential for addiction and that long term use tends to be harmful. Sure, he seems to have been quite a junior employee, but I knew opioids were a high risk category of drugs when I was in high school. I don't think he's the worst guy in the world, but I do think McKinsey style consulting and this experience in particular is a net negative.

asdff 2y ago
Potential for addiction yes but we are looking at it from the lens of a post Purdue media bias. People abuse plenty of drugs that aren't opioids and we aren't say seeing a big push against Xanax for example because that wasn't in any crosshairs of media spectacle. People die on Xanax but it doesn't seem to matter because people write them off as combining with alcohol or that they were addicts. And indeed most drugs of this sort are not particularly harmful if they are used within recommendations. At a certain point a doctor can't control what you chose to do at home with your prescription and that doesn't mean you shouldn't have people who would use it responsibly not receive it even if it means some will abuse it.
- sepositus 2y ago
  > At a certain point a doctor can't control what you chose to do at home with your prescription and that doesn't mean you shouldn't have people who would use it responsibly not receive it even if it means some will abuse it I'd like to think that most of those decisions are coming from datasets that suggest, on average, certain medications tend to lead to abuse, including from people with no prior history of abuse. I'm quite libertarian in a lot of my views, but this particular one on lax drug controls I've never really been able to buy into.
  - skippyboxedhero 2y ago
    I can't remember the exact stats but something like 5% of doctors were writing 75% of the sales for these products. It isn't that they lead to abuse, it is that people who are using heroin will abuse them, and will go to doctors who facilitate that.
    - wlesieutre 2y ago
      Dentists were handing opioid prescriptions out like candy to teenagers getting their wisdom teeth out. How many of those kids were previously on heroin and were picking dentists who would hook them up? It's a massively common procedure and defaulting to "here's some addictive painkillers just in case you want them" was an insane thing to do, even if only 1% of cases turn out badly.
      - zoklet-enjoyer 2y ago
        I got my wisdom teeth out at 16 or 17 and was given a prescription for oxycodone. I was really excited because I had read about oxy online and wanted to try it. But also I knew it was referred to as hillbilly heroin because of how addictive it was, so I had to be careful. I didn't take any of the oxy after the surgery and just took ibuprofen, so I could save the oxy for later on. I got high off it a few times and loved it. Later on I got a chance to try some hydrocodone and I thought that was even better, because the oxycodone was a little too much for me. I didn't nod off on the hydros. Anyway, opiates are great, that's why I haven't used them since high school.
SmellTheGlove 2y ago
When I was in my mid to late 20s I was at a consulting firm and later in government directly. I wasn’t assigned to anything particularly objectionable or anything, but I’ve looked back on it a lot and it’s heavily influenced how I operate in the tech industry now, 20 years later. In government and in consulting I saw a lot of misaligned incentives that led to empire building, duplicative efforts, and treatment of individuals that I didn’t really find to be effective. And today, I’m really good at spotting that and stopping it quickly, because I think much of that was not the best way to operate. But I didn’t immediately get into it and realize it wasn’t how I would run things - and experiencing being part of the machine for a bit first taught me lessons that I would not have learned as an outside observer. If you made the same assumptions about me based on what I did in my 20s, you’d actually be assuming the direct opposite of what I believe in and how I work today. We’re all shaped by our experiences, but that shaping doesn’t always mean we grow into the behaviors that we experienced during our formative early career. Maybe this guy looks on that experience and knows exactly what he doesn’t want to see happen.
Mistletoe 2y ago
I’d say it goes back considerably further than the 1970s. https://en.wikipedia.org/wiki/Opium_den https://en.wikipedia.org/wiki/Opium_den https://en.wikipedia.org/wiki/Opium_Wars https://en.wikipedia.org/wiki/Opium_Wars I’m still struck by how deeply immoral it is to start a war and say “You WILL allow us to sell you opium!”
khana 2y ago
[dead]

rgrieselhuber 2y ago

Yeah he was just an innocent marketing consultant: “ In a March 2008 PowerPoint presentation, Tsai outlined a marketing strategy for the drug that included guidance on targeting “specific physician segments to grow high-prescriber group (i.e., physicians more sensitive to patient needs)” and an idea to introduce “coupons” for the drug as part of a pilot program.”

asdff 2y ago
Are you trying to say this quote is painting him as not innocent? That really doesn't seem so sinister. Sinister would be buying billboard space in west virginia like something out of newport cigarettes playbook.
- skippyboxedhero 2y ago
  Yes, it is fairly obvious that he wasn't innocent based on that quote. The high-prescribers were people operating out of strip malls, often with unclear credentials, and whose main clientele were opioid addicts. Many of these people (I am choosing not to use the word doctors) ended up in prison...consultants who were advising them, not so much. There are a large number of people who could do this job, it is reasonable to ask whether the person you want doing this job is someone who, at best, was unaware that these people were breaking the law. And, to be clear, he was Partner of their Healthcare practice whilst this was going on...he wasn't just making Powerpoints. The revolving door between consultancies and government must continue. No-one is more skilled than running government than lawyers and consultants who have lots of experience in...advising other people how to run things.
  - asdff 2y ago
    > The high-prescribers were people operating out of strip malls, often with unclear credentials, and whose main clientele were opioid addicts. I think this is an assumption. May be right but for all doctors who “listen to patients needs” to be pill pushers deserving prison time seems a little too inconvenient. At the end of the day he is asked to optimize a business in a consultancy not to play to his moral principles and get replaced on the project for someone who will optimize it for business needs. At least he is potentially seeing all the inputs with these relationships and a side of the healthcare industry a lot of people wouldn’t have any experience with without holding these positions themselves to be able to be in these rooms where these conversations are held.

noah_buddy 2y ago

To be frank, the issue is that our society is not more damning of people involved in the low-level actioning of great injustices.

Spooky23 2y ago
That’s worked really well in other areas of criminal justice. /s
lolinder 2y ago
A far bigger issue with our society is our willingness to brand someone forever based on what they did decades prior—we (as a society) pay lip service to the idea that people change, but we don't truly believe it. It's the same punitive impulse that causes the permanent second-class citizenship bestowed upon anyone who finishes a prison term.
- noah_buddy 2y ago
  Generally, that problem is separate. The impact of little Eichmanns everywhere is greater than the loss of productivity from people convicted of crimes who can’t get a job later imo. Our society is very forgiving if you propagate “faceless” evil. It’s unforgiving if there’s a human face to it. Part of this ties into the power of monetary capital over social capital.
  - lolinder 2y ago
    > Our society is very forgiving if you propagate “faceless” evil. It’s unforgiving if there’s a human face to it. How does this track with your assertion that "the issue is that our society is not more damning of people involved in the low-level actioning of great injustices"? Isn't your impulse to damn now that there's a low-level face to the faceless evil the exact same impulse as the one people have to condemn a low-level drug runner for the rest of their life?
    - noah_buddy 2y ago

joe_the_user 2y ago

I hate regulatory capture as much as anyone, but... Others have talked about the question of innocence but I think your comment illustrates not getting the dynamic of regulatory capture. The situation of regulatory capture is about there being "revolving door" between industry and regulators, so that the regulators use same criteria as companies for regulatory decisions. This dynamic results in broad regulatory capture regardless of the individual bad deeds.

kyleblarson 2y ago

"I was just doing my job."

morpheos137 2y ago

Opioids are not a particularly harmful to most people. The harm is in the addiction not the chemical. Opioids are useful for treating acute pain, such as after surgery. They are less useful for chronic pain but if the doctor and patient are able to responsibly manage dose escalation as tolerance develops they are also useful for chronic pain.

zoklet-enjoyer 2y ago

Only a complete moron wouldn't know about the addictive potential of opiates in 2007-2015

zoklet-enjoyer 2y ago
Seeing that comment at -1 makes me chuckle. Imagine not knowing opiates are addictive anytime past the 1800s

dimal 2y ago

The banality of evil. He was just doing his job.

tengbretson 2y ago

I don't live there, so I wouldn't know, but did they run out of other candidates that haven't shilled tramadol?

ekianjo 2y ago

> scientific literature he would've had access to at the time would not have suggested they were especially harmful. Only if you pretend to be blind. McKinsey knew exactly the effects of opioids which is why they were condemned as well

khana 2y ago

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