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Comment by dcposch | Hacker News Reader

That just means we should treat low level criminals humanely. Four years is plenty.

The thing where decade plus sentences are fairly common is unique in the first world: only in America. It’s barbaric and embarrassing.

The science is pretty unambiguous—a high likelihood of being caught and punished is a better deterrent than a low-probability but larger punishment.

So I don’t want to see this doctor get a 40-year sentence. I’d rather see lots of doctors who accepted gifts from opioid manufacturers get one-year sentences. Most important is that the pharma executives go to jail, too.

Criminal justice should never be about retribution. In this case, the purpose is to keep future patients safe.

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The deterrent and long term way to keep patients safe is not just the 4 years in prison, it is losing his medical license in perpetuity throughout the USA. Not sure if his sentence includes this but it should be in public records. My PCP in MA was busted for a different charge and lost his ability to practice medicine FOREVER throughout the USA. Way to throw all those years of med school in the dustbin!

He did lose his medical license but he's also 63. After he's out, he's most likely going to retire.

If he saved enough, ha. You'd be surprised at how many doctors making $300k+/yr have less than a couple years' worth of expenses saved up :/

any source for that claim?

Alan Reynolds' book "Income and Wealth".

I mean doctors in particular, but other high income earners in professional areas as well.

Football players for one.

Don't forget parachute pants enthusiasts. https://en.wikipedia.org/wiki/MC_Hammer#Bankruptcy,_lawsuits...

The longer he’s in prison, he’ll be closer to full retirement age, meaning he’ll collect a higher social security benefit (62 is the bare minimum, waiting until 70 gives you the highest monthly amount).

He’s essentially already retired now.

True, I merely mean that he may be used to a much higher annual expense than he'll be able to afford in retirement. Which is fine, he ain't gonna starve if he worked that long as a doctor.

I imagine that the $800,000 in restitution and any other legal fees probably wiped all that out.

>>but he's also 63.

It sounds so foolish when people so close to retirement take undue risks and ruin it all at the end.

Greed can be a dangerous bait at times.

> That just means we should treat low level criminals humanely. Four years is plenty.

And the street dealers’ customers know full well that they’re buying a very addictive substance which is not medically indicated.

> And the street dealers’ customers know full well that they’re buying a very addictive substance

You're forgetting the large number of non-addictive substances that carry long sentences.

I was thinking of dealers selling heroin in particular, since that feels like the appropriate thing to compare fentanyl-pushing MDs to, but in a broader sense, your point is if course correct.

Ironically, fentanyl is more dangerous than heroin and a large amount of heroin overdose have supposedly been because fentanyl was mixed in with the heroin unbeknownst to the user.

It’s more dangerous because you don’t know how much you’re getting on the streets. In a prescription, it’s a regulated medicine that is exactly the amount the label says.

I’m not defending the doctor but the point being made doesn’t apply.

It's more dangerous in street drugs because it is potent at extremely low doses, so poorly mixed drugs can contain fatal doses very easily.

In a controlled setting, where the dose is precisely known, that is not an issue. I did some reading of fentanyl vs. morphine a while ago, and found that fentanyl is often preferred for acute pain due to faster onset, shorter duration (which may make controlling adverse reactions/overdoses easier), fewer side-effects and less histamine release. Specifically:

> When adverse event rates were counted across both the out-of-hospital and ED phases, morphine's and fentanyl's safety levels were extremely close, erasing even the suggestion of a trend toward safety in one drug or the other. Our data do not suggest that further work should be done to try to determine which drug is safer: The low absolute rates and small difference between the two drugs make it unlikely that this difference would become either clinically or statistically significant, even with a larger sample size.

I don't believe the notion that fentanyl is per se more dangerous, rather than being dangerous when misused/poorly handled, is supported.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924527/

Fentanyl is also far more addictive due to its rapid onset and short duration of effect. Not that they give that stuff to anybody other than cancer patients and those undergoing anesthesia. But in theory it’s more dangerous.

It’s really not. Four years is hardly a deterrent. It’s barely a slap on the wrist considering the number of lives destroyed by that plague.

What’s makes this particularly heinous is the trust we place as a society in medical providers. The vast majority of people will take whatever medicine a doctor prescribes. No questions asked. Abusing that position of power is sickening.

Four years is hardly a deterrent

What do you know? Do tell.

Honestly, if you could make $10M as a mid-level distributor, squirrel most of it away tax-free, with the downside risk being only four years in the pen, that would be a massive rational win for most people.

Of course, the only reason you can make millions of dollars illegally at this racket is because it's illegal in the first place, so never mind. Drug laws cause far more harm to society than the drugs themselves ever could. Any argument to the contrary can trivially be resolved to a special-pleading fallacy.

There's a famous paper about drug gang economics:

http://pricetheory.uchicago.edu/levitt/Papers/LevittVenkates...

It suggests that $10 million of profit would be quite the success.

For reference, the doctor in the story "pleaded guilty to taking more than $188,000 in kickbacks disguised as speaker fees." As a result, he "lost his medical license and was ousted from his post as a Brown University professor, … the judge sentenced him to 51 months and ordered restitution of $754,000," and I'm sure he's gotten a heap of public shame and humiliation.

Is it possible he has enough cash hidden away to make this all worthwhile? Yes, but I'd bet against it.

Couldn’t the same be said of, “Four years is plenty.”?

2 different opinions, neither sourced nor backed by data.

> Four years is hardly a deterrent. It’s barely a slap on the wrist considering the number of lives destroyed by that plague.

This is the exact kind of emotional thinking that makes it so easy to jack up sentencing to an unreasonable degree. It's why we spent so many millennia of human history insensitive to the torture and abuse of our fellow man so long as he could be labeled a criminal.

First, you're comparing a single doctor's sentence to the entirety of the misery caused by a crisis caused by many, many people and systems.

Second, what makes you think four years isn't a deterrent? Maybe it is, maybe it isn't, but we should be using evidence to decide that, not knee-jerk emotional reactions.

I have to agree. It's not "a slap on the wrist" at all. A criminal record is a massive hurdle to overcome in finding work or keeping standing with any professional association. Not to mention the damage to reputation, personal relationships, finances, and family dependencies. Purely emotional thinking does not help the problem.

This. Deterrent effectiveness is quantifiable and repeated psychological studies show that increasing the expected chance of getting caught is a much higher deterrent value than increasing the expected number of years behind bars.

One's subjective feeling of deterrence is strongly influenced by one's natural subconscious desire for mob revenge. Cultural change away from mob revenge starts with changing the dialogue.

The cost to society is roughly linear in the number of years behind bars, and the deterrent factor gets dramatically sub-linear pretty quickly as number of years behind bars increases. That money spent on guards, etc. and opportunity cost (including lost taxable income) of having a potentially productive member of society behind bars are better spent on better monitoring and other measures that increase the likelihood that offenders are prosecuted. Increasing publicity of convictions would presumably also be a pretty cheap way to reduce crime by increasing the perceived chances of getting caught.

I would really like to see it be a common thing for criminals to cut plea deals including recording public service announcements publicizing that they got caught. Though, this would also probably make it harder for reformed ex-convicts to escape their pasts.

This is absolutely correct and should not have been downvoted.

It is the abuse of a position of trust that aggravates this crime relative to that of a simple outlaw street dealer.

Commenters who are concerned with the effect on the convict's reputation and future employability are simply not in touch with reality....this was a grave breach of the basic ethics of the medical profession and seriously harmed the innocent patients involved. There is no return to work after something like this...any more than with a scientist who falsifies data, a teacher who sleeps with minor students, a lawyer who steals from escrow, etc.

I find it highly disturbing that there is more discussion in this thread as to the effect on the doctor's return on investment from his medical degree rather than on the individuals who bodies were damaged by someone they were supposed to be able to trust.

Nobody is "concerned" about the convict's reputation and future employability. You are misreading people's statements and thus misunderstanding their points. Namely, that the justice system serves a greater purpose than simply making you and me feel better and causing harm to perpetrators.

What point is there in discussing the so-obvious-it-goes-without-saying good-bad polarity of this situation? If we myopically give in to our emotions, rather than dispassionately examine the best course of action, then we'll miss an opportunity to improve the system and deter future incidents.

Stated another way, by attempting to redirect the course of this conversation, you are saying that virtue signaling by pitying current victims and demonizing the perp is more important than preventing future victims. If anything is highly disturbing, it's that.

You're missing the point because you don't understand the gravity of the crime.

A minimum wage fast food worker is constantly observed by a phalanx of cameras that will incriminate her should she attempt to steal five dollars from the till, but a surgeon in an operating room performs an infinitely more consequential task with nary a recording device in sight. Why? The immense trust and responsibility invested by society in medical doctors.

There is a common misconception that a medical license is basically just a reward for a demonstration of technical mastery, much as a developer job flows from passing a coding interview. But in reality the technical aspect is only secondary; the primary purpose of all those years of training is to ensure that the student understands the fullness of the obligations associated with the profession and is properly disposed to accept them.

In a case like this, the person understood and accepted those grave obligations, as well as all the privileges that came with them, only to toss them out the window when the opportunity arose to make a few extra dollars. That is what is being punished here. Four years is hardly too long, or cruelly retributive.

I'm just not sure what you're responding to. Is anyone here saying or even implying that four years is cruel? Is anyone feeling sorry for the doctor?

Well you yourself said it reflected the same kind of "emotional thinking" that led to millennia of "torture and abuse". What I am trying to show is that there are plenty of good reasons for this kind of punishment (whether or not one accepts a retributive component to justice). It is not simply a knee jerk insensitive reaction.

I never complained about the punishment, nor did I equate the punishment itself to emotional thinking. What I called emotional and dangerous was the unsupported claim that the punishment wasn't enough to be an effective deterrent and should therefore be increased.

And that is the claim I was contesting. You seem to have an odd intuition that a line of argument that does not reduce to a computing problem is "emotional". Even if one does not believe in retributive justice at all, an adequate deterrent is still going to be in proportion to the seriousness of the crime. It's not something that admits of a resolution by facts and figures alone.

What you are saying here is an order of magnitude milder in its certitude than koolba's assertion that the given punishment was "hardly a deterrent" and "barely a slap on the wrist." In addition, you are comparing this doctor's punishment to the seriousness of this doctor's crime, whereas the koolba unreasonably compared this doctor's punishment to the sum total of the harm caused by an entire epidemic of which this doctor played only a negligible part.

So yes, I stand by my claim that the original poster's point was an emotional reaction.

Had koolba instead said something like, "An adequate deterrent should be in proportion to the crime committed, and I believe 4 years in prison falls below that standard for reasons X, Y, and Z," then I would not have called that a knee-jerk emotional reaction. But he didn't.

Street dealers, "low level" or not, do actually kill their clients.

Prison sentences for dealing hard drugs should be in line with prison sentences for murder, otherwise the implication is that the lives of drug users are much less valuable than the lives of regular people.

Manslaughter is different from murder.. selling someone something that they use to kill themselves, is different from selling something stronger than they anticipated, is also different from pulling the trigger yourself. Intent matters in the eye of the law.

and so do doctors prescribing unnessisary opiates.

> Street dealers, "low level" or not, do actually kill their clients.

In much the same sense as people who sell cigarettes do; perhaps we should, therefore, have life without parole for convenience store clerks.

If I buy drugs from a street dealer I know what I'm getting into. If I get prescribed opioids from a supposedly trained professional whom I'm supposed to be able to trust I don't. So as far as I'm concerned adults should be allowed to take whatever drugs they want. However, it should be illegal to bullshit them into taking them. Especially as a medical professional.

Don't worry, we've so over-corrected this thing as a society due to our knee-jerk emotional reactions and mob mentality, you won't be getting any opioids prescribed.

Fourth stage cancer patients are now having a hard time getting them. Chronic pain patients that have been stable for decades are being heartlessly dropped by doctors that now fear the DEA. We are turning our backs as a society on the most vulnerable among us.

Oy! What I really want is all drugs to be legal and people being properly educated about them. Starting in school.

Totally agree. After decades of drug wars and putting people in cages, I think it's time to admit prohibition doesn't work (I thought we learned that in the 1920s, but I guess not). I tend to believe that education is the answer. I'd love to see us give that a try.

>people being properly educated about them

As if the US government agencies would ever let that happen. They seem to favor a "shock 'em straight" approach that's utterly ineffective.

Chances are you won't die unless you overdose on the opioids and stop breathing with nobody there to assist you.

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