The Pain Hustlers | Hacker News Reader

The Pain Hustlers

nytimes.com

79 pointsfarseer20 comments

This piece briefly mentions Purdue Pharma, the maker of OxyContin and the subject of a fantastic and horrifying article in the New Yorker[1]. The scale and reach of these drugs is unbelievable and the lengths the pharmas go to in order to market them is truly terrifying — speaking as a doctor who does prescribe these drugs not infrequently.

[1] https://www.newyorker.com/magazine/2017/10/30/the-family-tha...

If you’re aware of their miscreance but still prescribe, you must believe that the drugs are valuable?

It seems you are implying the parent comment is hypocritical. Unfortunately, the current reality we live in means complicity isn't necessarily a choice. The whistleblower is always a part of the machine he is exposing.

I’m trying to figure out whether Purdue Pharmaceuticals is unalloyed evil or whether they are defensible.

Neither?

I don't even know how it is possible for a corporation to be 'unalloyed evil'. At least above some threshold size, you're going to mishire and get someone who fails to kick all the puppies or twirls their mustache at an inappropriate time.

More seriously, strong drugs with high addiction potential are medically necessary for those who need them (my understanding is that there are no substitutes in some situations, and a lot of the substitutes for other situations are substantially worse along some dimensions). That shouldn't mean you do whatever you can to push volume, but, well.

So, in my view, they're producing important product. They're also run by awful, greedy human beings who should be snubbed by non-awful humans.

It is just another reminder that win-at-all-costs capitalism has... costs.

People do have legitimate chronic and/or acute pain, often severe. So there's a need for the painkillers in the market.

The problem is that Purdue's marketing went way beyond what was justified, leading to widespread overprescribing where that strength of painkiller wasn't necessary.

It isn't binary. Neither is there a binary choice between ending the company, and letting them do whatever.

(If true as reported that...)

Given that they knew that their formula didn't last for 12 hours, and their response to each doctor was "increase the dosage and keep the 12 hour interval" which of course means a greater risk of addiction, I'd go with unalloyed evil.

I should give a little context: I rarely prescribe opioids to opioid-naive patients — a more common scenario is patients who are already on a regimen that I then continue when they come into the hospital. And certainly not all opioids are the same, and some have less abuse potential, etc.

But it’s a good question. I feel the miscreance is often unrelated to whether there is value, simply because of the widespread nature of miscreance in drug and device marketing. And I do think the drugs in question have some value. I don’t know about Subsys in particular, but its FDA-approved indication, breakthrough cancer pain, is unfortunately quite real and quite horrible, and not fully understood as to why it doesn’t act like “normal” pain and respond to “normal” therapy the same way.

I think the challenge (and the concern) for me is that — in the U.S. at least — the drug you take, the artificial knee you have implanted, even the suture you get stitched up with — these are all sold to doctors with varying levels of aggression on the part of the manufacturers, because the doctor is the decision-maker and his/her buy-in is worth everything. (Thus, “Ask your doctor about...”) It doesn’t necessarily mean the drugs or devices or therapies aren’t the right choice... it just means doctors have this bizarre other force (money) to contend with in our decision-making. And subconsciously or consciously or (worst of all!) in bad conscience, as in this article, doctors choose the drugs they prescribe because they’ve been marketed to.

One issue is how drug reps push off-label prescribing. In order to increase sales. That was the core issue with Neuronin (gabapentin), for example.

Although off-label marketing is inappropriate and possibly illegal, in this case I believe patients probably benefited from it.

Off label prescribing is perfectly legal; off label marketing, however, is illegal.

The Times has some great multimedia/hypermedia designers on their staff and their reporting is incredible

You're right. (And the linked article is from The New Yorker.)

I was surprised to learn recently—and the article notes this—that most overdoses are now from illegally manufactured fentanyl, not legally prescribed pain medication.

Yes because after allowing the handing out of prescribed opioid pain medication like it was candy the authority turned 180deg and instantly cutoff all those addicted. What did they think was going to happen - the addicted were just going to stop being addicted because the legal supply was stopped?

I actually hold those that changed the rules with near zero support for those addicted far more responsible for this debacle and all the deaths than Purdue.

As a Boilermaker alum, let's not shorten it to "Purdue".

A big reason for this is because other street drugs like cocaine and benzodiazepines are increasingly being laced with fentanyl. Plus other opiods are being laced with fentanyl as well.

https://www.theatlantic.com/health/archive/2018/05/americas-...

This is good to see. Finally great reporting on of our the most pressing issues of our time.

This industry has so far played so far outside of the regulatory world. The piecewise lawsuits are reactionary and in a way useless. Unless someone actually starts regulating these scummy companies we won't get anywhere.

They are regulated - that's why the government is going after them. They violated regulations.

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