The Family Making Billions from the Opioid Crisis

I'm always astonised when I'm in the US at the medical ads on TV. It seems bizarre that companies target advertising at the consumer for products that should really be selected on their behalf by a medical professional.

And those disclaimer/warning crack me up.

Otherwise they'd only target doctors, in their offices, trade mags and all. http://www.businessinsider.com/infographic-america-is-over-m...

I don't really know anyone who thinks "Remember the good old days when cigarette ads were on TV?" (that was a thing). Prescription ads on TV are a relatively recent thing anyway (really 1995 in the US), one in which a powerful lobbying group used their money and influence to help write the rules.

* 58% of respondents "agreed strongly that DTC ads make the drugs seem better than they really are"

* 78% of physicians believed patients understood possible benefits, however, only 40% believe patients understood the risks involved.

* 75% of "physicians surveyed believed that DTC ads cause patients to think that the drug works better than it does"

* "physicians felt some pressure to prescribe something when patients mentioned DTC ads."

So, patients are getting more involved and asking questions, which is great, but they don't understand the risks involved, the patient misrepresents how well the drug is working for them, and the physician feels pressure to give them what they ask for.

That sort of bias is a problem, especially with on-going therapy. If a patient is being misled by DTC ads about how well they are being treated, they can't raise questions that would allow them to get even better treatment. If a physician is feeling pressured to give a drug when asked, they can't try other, sometimes more effective, therapies.

http://killercoke.org/

However.

Coca Cola started as a sugary drink laced with cocaine. Much like how beer has alcohol in it to keep you buying more, Coca Cola had that magically addictive cocaine in it to keep customers coming back for more.

The name 'Coca Cola' is a celebration of this history, really there is no more insane an idea than getting a nation hooked on class A drugs in liquid form. The name and the connotations would make a right minded person want to be disassociated from that.

In theory a 'crack pipe' could be re-purposed as a nice little vase suitable for a small child to play with. But that would make you shudder. So why is it that we are happy to have this denatured liquid cocaine drink as something we give to children? We could at least change the branding, drop the 'coke' and 'coca-' drug references. With allusions to it being the real thing?

When original Coca Cola got closed down and they had to reformulate their marketing they realised that they could do just as well getting people hooked to sugary drinks laced with caffeine and salt, the cocaine wasn't actually needed to shift product. Or even the sugar, fake sweeteners work too, perhaps even more addictively. Maybe it is the marketing that is the problem and not the product ingredients. They can even get the water hooked into buying plain bottled water, something that was never bought back in the days when tap water was a luxury.

Advertising isn't hypnosis. People know not to take claims at face value and if they don't, US medical ads are full of disclaimers and warnings. And once you see an ad for a treatment, you have many opportunities to research it, including by discussing it with your doctor.

Do you really think doctors alone should decide your treatment?

My mother in law had terminal brain cancer. She could not eat due nausea from her chemotherapy. I accompanied her on a visit to her doctor. We told him the anti-nausea prescription wasn't working, and I asked why he didn't prescribe her medicinal marijuana. He angrily rejected it as a viable treatment and huffily said he'd change her prescription to a different anti-nausea medication. Shortly later she went on the last trip of her life, to Arizona for some sun and relaxation, but her nausea was so bad that she threw up in the airport and had to return home, where she died in bed a few months later, a 60 lb bundle of bones from barely eating for months on end.

If you want to be protected from "advertising", change the channel. I don't, so stop trying to "protect" me by restricting my right to listen to other viewpoints.

The evil here isn't that the drug is addictive but that doctors and pharmaceutical companies prescribe it despite the known side effects. It's almost unheard of outside the US.

As for a citation, well nobody has done a study on that specific point, I'm talking from my experience of 500 or so patients.

http://www.phoenixnewtimes.com/news/sheila-polk-anti-prop-20...

$500k is a huge amount in Arizona politics.

Medicare and Medicaid HMOs pay for “results”, not visits. So you need to either get admitted or get the hell out and don’t come back to the ERir they lose revenue.

Do these museums have a responsibility to disclose the source of the Sackler family's wealth?

"If anything, taxes for the lower and middle class and maybe even the upper middle class should even probably be cut further. But I think that people at the high end - people like myself - should be paying a lot more in taxes. We have it better than we've ever had it." - Warren Buffett

Warren Buffett is just a guy who believed in the power of compounding from an early age, lived below his means so he could invest every dime possible, and became the world's best at investing in businesses.

The amazing thing about Warren is that if he had wanted to be worth far more than he is, he easily could have been. He ran an investment partnership for 13 years where he earned 25% of the profits, and averaged 40% per year just investing in the stock market. Then he switched to running Berkshire Hathaway, where anyone can call up their broker and buy shares in to have Warren manage your money nearly for free (his salary is $100,000 per year. No. Really). If he had kept his profit share arrangement (and easily could have) he'd easily be worth over $200B today.

In the case of Wells Fargo, Warren invested nearly 30 years ago, because it was a great business. 10% shareholders don't get to hire and fire management, or even pick board members. He's been very critical publicly of management and the board, going so far as to suggesting directors return 5 years of pay as recompense for their failures. He's also sold shares, which he almost never does in existing investments.

Maybe Davita is a loser, if so it won't be his first. He's been great at detecting management bullshit during his career, but he's not perfect, he has no supernatural lie detector. Guaranteed he didn't pick Davita because he thought they were misleading patients. Aside from the ethics, that's a horrible investment, you can't build a lasting business on fraud.

As far whether Buffett can ethically deploy the amount of capital Berkshire Hathaway has, it's a hugely silly question. BRK has $250 Billion in net capital. The S&P 500 comprises the largest 500 companies on the NYSE & NASDAQ exchanges, which have a total market value of over $20 Trillion. There are nearly 6,000 more public companies on those two exchanges alone, and that doesn't count thousands of companies on foreign exchanges, and tens of thousands of private companies Berkshire could purchase. Or the thousands of bonds and other fixed income investments that have billion dollar capacities.

In total his universe of possible investments is likely close to $100 Trillion, having capital comprising 1/4000th of that universe doesn't require making any ethical shortcuts. Buffet's large capital base is a hindrance to his returns but he doesn't care and never has. He no longer can achieve the 40% annualized returns of the Buffett Partnerships, or the 25% annualized returns of Berkshire when it was far smaller. But he's still beating the market by a substantial amount, and that's all he cares about.

Go read Barbarians at the Gate. Buffett was quoted about what a great business tobacco companies were. "It costs a penny to make. Sell it for a dollar. It's addictive. And there's fantastic brand loyalty." But he passed on an opportunity to make a bunch of money off the RJR Nabisco takeover. "I'm wealthy enough where I don't need to own a tobacco company and deal with the consequences of public ownership".

And that was the 80s. He's far wealthier now. Some Buffett quotes.

"It takes 20 years to build a reputation and five minutes to ruin it. If you think about that, you'll do things differently."

"It's better to hang out with people better than you. Pick out associates whose behavior is better than yours and you'll drift in that direction."

"The smarter the journalists are, the better off society is. For to a degree, people read the press to inform themselves - and the better the teacher, the better the student body"

The secular quip raises the same questions about human motivations without the other baggage.

It's called being humble.

No, I’m not. I constructed extreme upper and lower bounds as a baseline for comparing axioms. That was the purpose of my reference to the apocryphal, “now we’re just haggling over price” quote.

So we have a few possibilities:

- Is demanding attribution in philanthropy bad? If it’s bad, how does it decrease the concrete “goodness” of the philanthropy?

- Is it not bad? Then why is it undesirable?

- Is it neither bad nor undesirable? Then why is it relevant?

People have (normative) reasons for personal admiration, and they can’t really be right or wrong. I’m interested in digging at the normatives.

Generalizing this further, we can say that people are easily offended by grandiosity and vanity, or at the very least find it distasteful. As a philosophical question I consider it interesting to wonder why that is the case, in a scenario where that person is not doing anything “bad” from a consequentialist perspective. As it turns out, anonymity and attribution in philanthopy seem to be a good real-world setting for this question, because narcissism appears to become invalid as a signalling heuristic.

The fallacy in your comment isn't that you're wrong about addictions, it's that you're assuming two population samples are the same: 'HN users who complain about drug addiction' and 'HN users who create addictive technology'. Those are two different values of 'we'. (I worry about being in the latter group. HN is pretty addictive.)

This article isn't about Purdue, it's about the Sackler's that influence Purdue, MundiPhrama, and a number of other global pharmaceutical companies to increase their wealth while also "braiding their name" into high society.

Unsafe assumption. Why not go the self-education route before taking the "angry preacher" role so seriously?

Except there are actually studies and data that do show a link between prior prescription opioid use amongst heroin users, along with a demographic shift:

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...

And the second part of that comment "This is much like the argument, popular among drug warriors, that marijuana is a gateway drug ..." is a total strawman.

In a country of 350 million people this right here is all the evidence you need: it's obvious that US opioid prescribing is abusive.