DOJ: Billionaire pharma owner fueled the opioid epidemic with bribery scheme
arstechnica.com
arstechnica.com
Usually it's the taker of bribes that is the biggest criminal. Any doctor who can be shown to have given addictive opioids to people that aren't terminally ill should be investigated.
This is completely regardless of whether it was the "standard practice" at the time, or whether some pharmaceutical sales rep told them it was a good idea.
If just a couple of hundred doctors would lose their license and a few dozen end up in jail, that would make some headlines and perhaps make other doctors think twice before prescribing oxycodone to someone with normal back pain. Doing that is like amputating someone at the hip for toenail fungus.
This is a terrible idea. All opioids are theoretically addictive. They're also the most effective painkillers. Even cocodamol is an opiate. Escalating the War on Drugs like this is just going to leave a whole load more people in treatable pain.
It's a complex problem, but I think this Vice article is a good summary of how the UK has avoided a comparable crisis: https://www.vice.com/en_uk/article/ppm5eg/the-truth-about-ox...
Well, you're not wrong. However, this isn't limited to opioids. If a doctor is not following the standard of care, according to their peers, and a patient has an adverse outcome then the Doctor is subject to board review and they may have their license revoked and/or be prosecuted. This is already in place and has been for some time. This is why most Doctors are generally extremely conservative in the treatments and interventions they recommend for their patients.
My understanding is that a doctor isn't going to be making more money because they're prescribing you opiods or not. But they do it anyways because it can help you through pain. Just like you can get stuff to help with your cold, even if it's not necessary
Airlines aren't the same as pillow manufacturers just because they lend you one on a flight.
Meanwhile one doctor had 23 Lamborghinis, many beach front condos and 2 doctors prescribed 1/3 of the total prescriptions in the world. Both serving 20+ years sentenced last year, NPs who pushed all this got 3 years, almost every executive has been charged and trial 2018
Do they err in the direction of over-prescribing? Probably. But to say that opioids should never be given to anyone who is not terminally ill would be to err in the opposite direction.
This seems to work pretty well.
EDIT: added "exceptional cases" - this can be other cases than just cancer, see e.g reply
Because of the intense back pain leading up to the surgery she was already taking high opiate doses. After the surgery she was taking doses of hydromorphone (5x as strong as morphine) that would kill you or me with a single dose.
I would appreciate it if the HN peanut gallery would take a moment to stop and consider others before spouting off. Take this opportunity to do some research into the humiliating procedures the war on drugs has visited upon patients and doctors, then ask yourself if we really need more of the same.
For example: did you know my wife had to hobble into the pain management office and pee in a cup on several occasions? Just to make sure she was taking the drugs (the torso-length scar on her back being insufficient). The fact that someone selling the pills could have simply taken some the morning of the test made the farce even more absurd.
Why can doctors not prescribe something like 3 pills a month to someone? Its not nearly enough to get addicted on, but can help someone experiencing severe but temporary pain. Is it something in our legal framework that only allows doctors to prescribe a months worth at a time with the assumption that its taken every day? Is it some pressure from insurance companies who don't want to deal with paying out small claims like for 3 pills?
The second issue is deliberate overprescription. Most insurance companies have rules on the amount of medication which can be dispensed -- 100 days is a common limit, but some limits are as low as 30 days. The justification for this is that they don't want you to end up with lots of unneeded medication if your needs change; but usually the real reason is that they don't want to end up covering costs which can be offloaded to your next insurance company if you change insurers. In response, some doctors will deliberately inflate prescriptions -- e.g., if your doctor thinks you need one pill/day and trusts you not to abuse the medication, he might write a prescription for 3 pills/day so that your insurance company will approve an amount which will last you for longer.
The scar really isn't sufficient. There have been many cases of relatives (usually spouses, but sometimes children or parents) stealing pain medication which was prescribed for post-operative pain, and then coercing their victim into not reporting the theft. As horrible as it is, the drug testing was there to protect your wife.
The industry term for this is "drug diversion," and it happens pretty frequently and is very under reported. The patient may not even be aware it's happening because a health care employee, real estate agent, teenager child, nanny, guest, etc may be stealing the medicine. It even happens in a hospital setting, with deadly results - https://www.medscape.com/viewarticle/825801
That's why if you have drugs someone may want to steal it's recommend you keep them locked up.
Not even dying in hospice care stops family: https://www.washingtonpost.com/national/health-science/dying...
As I don't know your story, you don't know mine. Get off your high horse before you lecture the peanut gallery.
With great sympathy to your wife, to those who've had lives taken and families destroyed by an addiction which started with a doctors over prescription, maybe hobbling to pee in a cup doesn't sound so bad.
I edited that my post above (sorry if your reply looks odd after the edit)
Use of opioids in an IV in a hospital after a major surgery isn't what's discussed. That happens everywhere and doesn't seem to cause addiction problems.
Opioids are a good choice for end of life care, but they're also useful in other situations, such as acute (short term) pain - post operative pain for example.
They're not a great choice for chronic (long term) pain, but even then they can be used carefully.
Aren't you a little bit concerned that he might be guilty yet go unpunished? Or that he's innocent but goes down anyway?
There's a lot of money involved here, and a lot of political prestige as well. The opioid crisis is pretty big, and there's huge interest in both outcomes.
Plus the justice everyone deserves is swift and not expensive. What's the chance this doesn't get stretched out to years and years, with huge legal fees racked up?
No, they should have their license revoked. Those people are not doctors, they are opportunistic capitalists in the medical sector that should have no right to practise medicine.
In fact, this scheme could only work if doctors complied. I would say what they did was much worse than what the billionaire did. They're bad actors.
http://edition.cnn.com/2016/08/25/health/us-surgeon-general-...
This makes you wonder how many professors at medical schools also go on nice holidays paid for by pharma companies or lobbyists.
You can’t change these incentives without moving the US to a nationalized health care system, including public financing of education for doctors and much harsher regulation of the pharma industry. As long as you have doctors going into massive amounts of debt to finance their education and a drug industry with obscene wealth and power, you’re always going to arrive at this outcome. Capitalism is fundamentally opportunistic, which is why it has no business in healthcare.
About ten years ago I had two teeth removed. The next day I received a phone call from the dentist office. They wanted to know how I felt. I felt fine and I was curious why they would call me about it. They told me that often after a tooth removal, patients were complaining about pain. Again I told her I was fine and that was it.
I can understand that sometimes people complain about pain, but that's the thing : they are supposed to complain about it, I mean they must be actively demanding treatment.
Never ever had I received a phone call from a doctor or her staff. I can't help thinking that they wanted me to complain about pain so that they could prescribe me pain relief medication.
Am I being paranoid?
Usually a dentist prescribes painkillers without finding out if you'll need them. Most people go "Oh, hey, vicodin", and take it because they have the prescription.
This dentist was, by the sounds of it, actually taking an opt-in route - you have to say "Yes, I am in pain" to receive painkillers. Seems more responsible to me.
That would be absolutely unacceptable, imho.
And I thought being in pain was not enough to be prescribed opiods anyway? Isn't the pain supposed to be chronic or the patient incurable?
Episodic pain should not be treated at all, imho.
No, the solution is not putting doctors in jail. No, the solution is not piling regulations on top of more regulations. Only thing that's needed is educating people and providing less addictive alternatives. If the pack of pills has "Warning: this is highly addictive! Use only in emergency!" in big bold letters, then people will think twice about taking them.
I say "pretend" because it was no great revelation in the 1960s that smoking was bad for you. My father said they were called "coffin nails" back in the 1930s, and the first thing doctors routinely advised their patients was to quit smoking.
And, of course, the black, scarred lung of a smoker was ridiculously obvious to any person who did an autopsy or operation on a smoker.
That is until you buy a larger pack and have some.left over the next day that is.
Making sure teachers in medical schools don't tell their students that opioids aren't addictive is another.
Information to the public about what pain and pain treatment is, and what treatments are effective compared to their side effects is yet another.
I get that it's a compromise, but it is still a morally reprehensible position to believe only terminally ill patients should be allowed the choice to put opiates in their body.
The real problem is a mixture of Big Pharma propaganda, kickbacks, lack of proper education, deep socio-economic troubles, depression, and need for escapism. The solution is not to limit the freedoms of responsible citizens but to address each of those concerns in turn.
Yep. Investigate all of us. High quality understanding of medicine right here..
I assume, definition of this phrase would be the point of contention .
So I think it's fair to say that the doctors office is one of the offices where government is very present.
Sure it will. Put a 50% net-wealth bail on him (500 mil). Accept shares if he doesn't have cash.
You will say it's not reasonable.
But then it is reasonable to put a $50k bail on a poor person, which doesn't even have that money? In this case the bail is >100% net worth.
And if the shares lose value while he's out on bail? Our defendant just lost their incentive to reclaim them.
If he actually flees, the US government could easily seize most of his assets.
$1 million is a fairly high bail, generally in the ADW/manslaughter/sexual assault neighborhood. A court is not set up to handle a $1 billion bail, as you’re suggesting. That sort of money isn’t just moved around like that ($1 million is difficult enough), and the court would almost certainly mishandle it.
How about setting it at $100m? That doesn't sound unreasonable given the situation.
Not mishandling is easy: you put it in a locked escrow account and don't touch it. It the depositor had to borrow against assets to secure the deposit, then let reasonable interest accrue against the principal and deduct.
There are tons of poor people stuck in jail awaiting trial for relatively minor crimes because they can't afford what would be a trivial bail amount to most HN readers. A rich person who commits a much more severe crime gets to sleep at home, or can flee if they think they don't have a good chance of winning without a big financial impact. Is that just?
It seems like there could be a lot of unexpected drawbacks to such an approach, since on the other end it’s harder to justify a high bond for a destitute, transient murderer, for example. If you’re okay with $100 million for this guy, it follows that you’d also have to be okay with $10 for him. Otherwise justice is partial and biased, even more so than it is now. Ignoring net worth seems safer, but again, I don’t know.
Assuming that $10 is high enough to ensure that the destitute, transient murderer will show up for trial, why shouldn't I be OK with it?
What you allege, that people happily plead out while innocent, does not happen. It just doesn’t, and it’s something I’ve heard repeated a lot by people who haven’t been inside. I was in a position to advise dozens of inmates on their cases during my time, and not once did that ever happen.
The truly innocent folks (and it’s hard to tell) were happy to sit to get their day to prove it or wait for the charges to get dropped. I’ve seen inmates rip up a plea bargain and throw it in the prosecutor’s face after sitting in county three years. Inmates are not dumb cattle looking for the first door. They understand what signing a plea bargain does. Even beyond that, innocent people are almost never arrested in the first place. There are very, very, very few innocent people in jail. I hate to break it to you, because I know it undermines liberal sensitivity and view on the world (which I know because I’m liberal, I’m not critiquing). You’re also coming at this from the perspective that assumes everyone should be able to bail out, which isn’t true. Would you revisit total bail denials, too?
Re: $10, how can you make that assumption? It’s disappointing that I’m being downvoted so heavily for pointing out that a seemingly minor change which is reactionary to one case could have implications far beyond intention. Being upset and changing things because of one billionaire is the very definition of mob-style reactionary grievance. There’s more to consider than just him, and I agree it sucks. This is a complicated issue and the easy engineering fix is very likely not the right one.
Oh, I see. Guess this conversation is pointless, then.
(Edit: I’m out of posting quota for today, but I at no point said what you’re claiming I’m trying to tell you in even the most uncharitable interpretation.)
The felony conviction rate in the US is around 70%. That doesn't sound to me like "innocent people are almost never arrested in the first place."
The rate of false convictions for people on death row is about 4%. That's for by far the most scrutinized cases out there.
According to this article, it's believed that somewhere between 2% and 8% of convicted felons are innocent people who pled guilty: http://www.nybooks.com/articles/2014/11/20/why-innocent-peop...
Maybe we have a disagreement over what number constitutes "almost never"?
I'm trying to talk about the real problems bail causes in the justice system, and you're trying to tell me that it doesn't matter because basically everyone who gets arrested is guilty anyway. That's not substantive, and it's only superficially civil.
Just like if you always fine people $100 for speeding, then average folk will generally adjust their behaviour and millionaires will be able to race around and not give a f*.
ETA: Well, we can't necessarily write the rules however we want; there are Constitutional restrictions. In this case, the case could be made that increasing bail for wealthy suspects violates the guarantee of equal protection under the law. That's a different argument from the one you're raising, however.
One millionaire got a $54,000 speeding fine commensurate with his income and another got approximately $200,000 fine based on memory of exchange rates.
That's a life sentence there so in theory he could try to make a run near the end of his trial...a year or two in hiding. What does he have to lose, his good name? But then he has so much money that even if he was left with $10mil he could in theory start Spanish lessons. The judges should make the super rich to pay for Marshals /FBI to watch them while in bail.
I doubt any judge will show mercy to him and common sense (not always right but..) says there's a LOT of paper trail incriminating him. It's a huge company and lots of salespeople, lots of payoffs. Not done with a wink and a nod.
> You’re aware America is under siege, fighting an opioid crisis that has exploded into a public-health emergency. You’ve heard of OxyContin, the pain medication to which countless patients have become addicted. But do you know that the company that makes Oxy and reaps the billions of dollars in profits it generates is owned by one family?
There's big money in opioid addiction.
(Yes, I know, someone will find such a video on youtube to prove me wrong).
Not condoning it, just suggesting that's the real reason why.
But it is just more salt on the wounds for me because the monthly insurance premium I pay is huge, and people (after I asked around) consider my health insurance scheme to be very good. And yet every doctor visit, test etc means more bills to pay.
It forces me to conclude thus: The healthcare system in the US is totally unfair to hardworking people of America, and the blame is not on the doctors/physicians. It lies squarely on this Pharmaceutical/Insurance Industry complex of creating more sick people, keeping costs artificially high to fleece more money as premiums from hardworking people, while making it easy to get prescriptions for such drugs.
EOD, it feels like my money is feeding this drug addiction epidemic. And politicians on the left, right and center in US are doing zilch to fix this.
w.r.t this article, I hope this owner gets a fair trial, and if convicted, I hope that he drags down every single person who was part of this scam, with him.
Also, if a doctor is writing an inappropriate script based on a kickback are their licenses getting suspended?
So almost certainly not.
With cannabis up in 1, though, I guess those scheduling guidelines don't actually mean a damned thing.
The problem is when it's used for different purposes- and the drug rep was caught lying to the insurance company to imply the prescription was for breakthrough cancer pain.