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Comment by rscho | Hacker News Reader

All-around-tech-bro-knowledge is strong in this thread.

Doctors prescribe opiates all over the world, including oxycontin. Nowhere else is it a problem as big as in the US. Before wanting to withdraw prescription rights and sue MDs on a personal basis, perhaps people could think about the american exception?

The US opiate problem is cultural and the responsibility is on both sides of the doctor-patient fence. The more people will be able and willing to sue MDs, the bigger the problem. Legal action on a personal basis is _so_ the wrong path. This is depressing.

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Opiates are a huge problem everywhere.

But the US and NZ are the only two countries that allow DTC drug marketing. And Purdue in particular was monstrous (in size and as an evil creature) in their direct to healthcare provider marketing.

I would argue this a MUCH larger contributing factor than any cultural differences, and actually causing some 'cultural' differences.

Where else is a drug pusher allowed to legally access a database of all scripts written by which doctors in order to target the top 1% of script writers who make up a large % of the profit. Then pay HUGE commissions to pushy non-educated salespeople - armed with criminally false 'research' funded by shell 'non-profits' - to bribe doctors to write even more.

Not to mention Purdue actively incentivizing pill mill Doctors, actively reaching out to obvious criminal MDs to get them to sell more drugs!!!!

It's disgusting and they need to be held accountable for manslaughter. all ill-gotten gains should be reposed and used for treatment.

If this were any other drug dealer their cash/cars/etc would be seized immediately and the accused would have to prove the money was not ill-gotten to get it back.

Put the Sackler's on the treasury sanctions list just like we do with Cartel leaders. Maybe them museums will start chiseling their names off of the buildings.

There are huge problems with opiods in many countries, but the USA has the most data. Canada has major issues, but only some provinces are tracking it.[1]

[1] https://www.cbc.ca/news/canada/british-columbia/bc-overdose-...

Yes, Canada... a country with a similar healthcare culture.

What about Europe, Asia? They also have oxycontin. How about Germany, for example? How do they manage?

I've practiced both in Europe and in the US. I wouldn't go back to care for americans even for a million bucks. Healthcare culture in the US is incredibly toxic.

What? Canada has a similar healthcare culture? Canada is one of very few single-payer-only systems. Canada and the USA have polar opposite healthcare systems.

Yep, completely different system. Same attitude, though.

I really don't understand what you mean by 'culture' and 'attitude'; please explain.

By culture and attitude, I do not mean the objective criteria defining the healthcare system. I mean how things go when you have a patient encounter. American patients are perceived as far more legally agressive and vindicative. True or not, this results in an overly defensive response from american MDs. Unfortunately, medicine has that in common with war that a dead patient is less problematic than an injured patient. Hence, the opiate crisis.

This is purely cultural. European patients and MDs are much less aggressive.

The USA is definitely very litigious, but I am not sure that Canada is similar. Cultural explanations are interesting, but they can be molded to explain almost anything. I could for instance say that US doctors are motivated to prevent overdoses, as their patients are a source of recurring revenue, whereas Canadian and European doctors and systems see their patients as cost centres.

Yes, of course my assertions are subjective and based upon personal experience. However, here is a very objective thing: you're a US doc and your patient is in pain. Very simple, you prescribe oxycodone and it solves the immediate problem. Then, your patient dies of overdose. But most of the time, you won't even be aware of the cause of death and simply archive the file. And, most important of all: _the patient did not overdose on your prescription, but on self-medication/street drugs_.

So in fact the difference is how MDs solve the immediate pain problem. In the US, they would try to suppress the pain (and legal threats with it). In Europe, they would try to make it bearable while keeping the patient functional, because they are not afraid of their patient.

Everyone benefits from a less tense relationship.

I understand that you think it's an incentive problem, and I agree that opiod issues are probably driven by incentive issues, but I am not sure we have the data to support your explanation. I also don't think most doctors keep track of patient fatalities at all, let alone the causes of death.

For example: am Canadian, had to get stitches for a nerve-damaged lacerated finger. Doctor tried to prescribe me Oxy — which was absolutely ridiculous for such a small injury, so I refused it. I'm pretty certain that I'd be an opioid addict had I accepted that prescription, knowing myself.

Canadian healthcare is great, and dissimilar to American, in that it's treated as a public good.

Canadian healthcare is not great, and similar to American, in that a lot of prescription decisions are made from a similar cultural perspective as in the US, ie drugs are handed out like candy.

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