You’ve Never Seen the Opioid Crisis Like This Before: A Review of Empire of Pain | Hacker News Reader

You’ve Never Seen the Opioid Crisis Like This Before: A Review of Empire of Pain

nursingclio.org

92 pointsbenbreen117 comments

PSA: The much larger crisis is the much larger number of folks who are no longer able to get effective pain relief, thanks to opioid hysteria.

Thank you. That is all.

The crackdown 10 years ago drove a bunch of people from Vicodin/Percocet to heroin.

Bravo with your moral panic, turned a bad situation in to a nightmare. (This second part is a comment in general, not a direct reply to the parent comment)

PSA: People in other countries seem to be doing just fine with NSAIDs for pain relief.

If pain can only be managed with opioids, you should get them in a hospital under supervision, since they are too dangerous for home use.

Are they, though? Do you know many people with chronic pain?

For those who read the comments before the article, here's the punchline: read this book if you want to understand how profit in medicine corrupts medical professionals to the point that they can become perfectly willing to kill their patients, for the right price.

it is the punchline at the end of the article. i found it confusing though, and to be honest, lurid---the article deals with the Sackler family, their greed, lies and ambition.

There’s a few Youtube channels doing a kind of street journalism recording the effects of the crisis in different cities. Some channels do interviews with the addicts when they’re sober. It’s hard to see what the “best” way forward is but i think its not that difficult to identify some things we do today that aren’t helping at all.

https://m.youtube.com/channel/UCOuf_kStlWnhuauw4ce8l-w/video...

https://m.youtube.com/channel/UCyWpRDBBb84ogtALVskwciw

I think the north star regarding addiction are people like https://twitter.com/Twolfrecovery who was addicted and is now sober and campaigning hard to stop the San Francisco/California co dependent state enabling of addiction with safe consumption sites, free needles and paraphenalia and no questions asked hotel rooms to live and die in.

The Sacklers products are now illegally mass produced, most of the bay area fentanyl is run by Honduran drug dealers who are allowed to operate openly due to relaxation of California laws and a'restorative justice' SF DA.

Add in stealing up to $950 a day with no legal consequence and we have a massive problem. The solution is to surely cut off the drugs at source. The Sacklers are wealthy scum but they have enabled a vast underworld of deeply evil people and our politicians are just not addressing this.

I respect that person's perspective, but more failed drug war is the completely wrong answer. It has solved nothing and has exacerbated many of the complaints mentioned on the twitter feed.

Comparing pill mills and online sales of drugs to safe injection sites is a bad take. The staff at the safe injection site make no additional money for getting more people addicted. Being under professional supervision all but eliminates the risk of overdose.

The real answer is prevention: strengthening communities, increasing opportunity, and mitigating hopeless situtations for everyone, so they don't get ensnared in addiction in the first place. For those who are already addicted, harm reduction while exploring paths to recovery is the most effective way to help people.

If you've been anywhere near California recently you will have seen we are facing a rapidly building tsunamai of street addiction and deaths. there would be even more dead were it not for endless od revivals with narcan buddys. https://www.economist.com/united-states/2021/05/15/last-year...

That's the dilemma of the drug war, isn't it? It is not exactly going to become easier over time to keep street drugs out of the hands of people who really want them. We can let people ruin their own lives through addiction and self-harm... or we can ruin their lives for them by throwing (some of) them in prison.

I prefer the first strategy, but it sounds like you prefer the second. It sounds like a false dichotomy, but it really isn't. No one has come up with any other solutions that scale. Supervised usage is probably the only workable compromise in the long run.

The binary idea of living and dying on the streets OR going to jail is equally hopeless, but allowing open drug scenes in places like SF is a disaster whichever way you look at it. Places like Amsterdam, Lisbon have liberal drug law but are v strict on public consumption and drug dealing.

I believe the answer is rural sobriety camps far from the dealers with rewards for those who have achieved sobriety. California spent 13 billion on homeless services in the last 3 years with even more spent since then. the result has been an explosion of homeless and drug usage. We are headed very rapidly in the wrong direction.

I tend to agree, in that physical separation or exile is ideal, but (a) they won't be "sobriety camps," considering we can't even keep drugs out of secure prison facilities; and (b) putting people in camps comes with a LOT of well-earned baggage. It would arguably cost us what little moral authority we have left.

https://www.fs.fed.us/psw/publications/documents/psw_gtr233/...

Back to the future. Well paid for clearing forestry fuels, a path out of addiction.

Is there any good de-clickbaiting (/de-spammy-buzzfeed-esque-naming) extension? Stripping certain patterns (such as anything starting with 'You') out of headlines, or hiding matches?

It probably wouldn't be that hard to build one. I trained the world's dumbest clickbait classifier a few years ago if you want some ideas https://github.com/peterldowns/clickbait-classifier

Be careful with that... that's the sort of thing that might be dangerous to run backwards... your program might produce clickbait so clickbaity that you can't help but try to click on it... but... oh no, there's no actual article there....

(hat tip https://slatestarcodex.com/2018/10/30/sort-by-controversial/ )

This is great! I liked the "know it when I see it" comment :).

Not a bad problem to solve .. how to identify clickbait

But how will you advertise your clickbait bot?

* Clickbait writers hate this Firefox extension!

Are you looking to penalize the headline or the article itself? I.e. a good article can have a click-baity headline, but if your extension removes that based solely on its headline, you'd never get to read it.

Ideally toggle-able (or site-based) I think. On HN I'd be happy to trust the points, and just improve the title for my own sanity. For general browsing, just get rid of it, it probably indicates the contents fairly reliably.

And these people are the ones who also have singlehandedly made legitimate access to opiates for things like surgery and after-care.

Now, any opiates being prescribed have to go through stupid levels of approvals including the actual doctor/surgeon, the insurance company, the hospital (if the doc is there), and the pharmacist.

At least cannabis works to dull the pain. But I've considered finding a local (illicit) drug dealer for getting proper pain pills and paying the appropriate markup. But that's what I think of this whole situation.

> But I've considered finding a local (illicit) drug dealer for getting proper pain pills and paying the appropriate markup. But that's what I think of this whole situation.

If you enjoy being alive, I wouldn’t recommend it.. there’s a lot of fake pills with fentanyl in them

Edit: Apparently people think my comment isn’t correct? Well, here’s some links that support my claim:

https://www.dea.gov/sites/default/files/2018-07/BUL-167-17%2...

https://www.justice.gov/usao-id/pr/acting-us-attorney-addres...

https://www.justice.gov/usao-de/pr/claymont-man-sentenced-ov...

https://coloradosun.com/2021/04/26/fentanyl-death-conviction...

https://www.santacruzhealth.org/Portals/7/Pdfs/Alerts/Fentan...

https://www.insidenova.com/headlines/dea-pills-laced-with-fe...

I could post more, or you could Google “fake oxy fentanyl” and see the thousands of results yourself

Crazy you are being downvoted. fentanyl fakes probably outnumber real painkillers 100-1 at this point.

No idea why this is being downvoted. It is totally accurate. 50,000 people died from synthetic opioids in the US last year, and fentanyl in illicit pain pills are common. Stick to cannabis if the medical system is failing to give you a legitimate prescription.

> But I've considered finding a local (illicit) drug dealer for getting proper pain pills and paying the appropriate markup

If you're really considering that for the love of god test everything you get. https://dancesafe.org/product/fentanyl-test-strips-single-st...

It was interesting seeing this play out as a patient, as I had the same injury and surgery last year as I'd had during the height of the epidemic but was prescribed only 20% of the pain meds I'd received the first time. The second prescription was a lot more reasonable, to be honest, but I did have to fight with my insurance company as they wanted me to revisit the pharmacy every few days instead of giving me my full prescription at once. That was a little impracticable when I was on crutches.

> The second prescription was a lot more reasonable

No it wasn't. Fewer than 1% of post-surgical patients given opioids develop any sort of abuse whatsoever.[1] Under treating pain is in no way medically responsible.

It is true that there's a (very weak) association between high opioid prescription rates and society wide abuse. But that's entirely due to outright fraud and diversion. Just because some crooked doctor is fabricating prescriptions on dead patients to supply the mob with Oxycontin does not mean that legitimate patients shouldn't have their pain adequately managed.

Narcotic analgesics are literally a medical miracle. The force of Neo-Puritanism are forcing millions to suffer needlessly.

[1]https://www.bmj.com/content/360/bmj.j5790

To clarify I meant "more reasonable" in terms of getting the number of painkillers I actually needed to comfortably heal from my surgery. I don't find them habit-forming, fortunately, and agree that the anti-narcotic backlash is making life miserable for chronic pain sufferers.

People in physical or psychological pain deserve access to effective treatments. Outside of overdose, which is very rare if used as perscribed opioids are benign to the body compared to nicotine or alcohol. Where the problem comes from is they work so good people want more and they develop addiction and society restricts access due to moral stigma. Pharamceutical opioids perscribed by a doctor or methadone or buprenorphine maintenance is far better than using street drugs and yet access is difficult to get unless you already are into using street drugs. I find it curious how the same NPR set that hates pharmaceutical opioids supports abortion, euthansia and physical sex changing. Seems really inconsistent. During the heyday of open access to opioids in 19th century overdose was rare. Thomas de Quincy, who wrote "Confessions of an Opium Eater" functioned for I think about 20 years on the drug. Then he quit voluntarily. It is prohibition and restriction of access that is the problem. That said some habitual opioid users may be lazy and self centered. Not unlike some marijuana users or alcoholics or people in general.

Whatever pharmaceutical companies have done, the drug war is what is directly responsible. Stigma, limiting options for treating addiction, and favoring extremely potent drugs are the big culprits here. Blaming a specific family or industry is a convenient cop out

I'm assuming you're not some kind of shill, as it should be, and I do think your point has merit. At the same time I can't help myself from thinking this sort of deflective take has at least some roots in the PR efforts of "a specific family" and the industry. All it takes is a few convincing arguments to be made by real shills and taken up by others that "no, we shouldn't blame the Sacklers, because..." That's how PR does its work. That aside, I think it's clear their family got away with profiting off of wrongdoing, even after the fines. Profiting off of wrongdoing is much too common for big businesses. In some sense they can afford not to be held to account.

Thanks for not accusing them of being a shill, but the problem with this sort of wariness is that you can’t make certain arguments, or even ask certain questions, without people thinking you might be a shill.

You can’t figure out what’s really going on in the world by making meta-arguments about who benefits. Meta-arguments aren’t evidence.

(It is true, though, that in a forum where we don’t know each other, there is a lack of trust for good reasons. Which is why it’s good to post links to more trustworthy sources.)

Blaming the owners of Oxycodone for oxycodone overdoses due to overmedication fraudulently prompted by said owners seems to me overly just. Fair. Honest. Exact. Correct.

You name it.

Haven’t most opioid overdoses of the past 5-10 years been fentanyl (or carfentanyl) overdoses?

> Haven’t most opioid overdoses of the past 5-10 years been fentanyl (or carfentanyl) overdoses?

Well, the data [1] is really mixed depending on the year. It looks like fetanyl deaths really exploded in 2016, exceeding the prescription opioid deaths then.

We'd probably have to examine the source data [2], and go back more in time to get a good feel for it.

[1] https://www.drugabuse.gov/drug-topics/trends-statistics/over...

[2] https://www.drugabuse.gov/sites/default/files/Overdose_data_...

It's interesting to note that sharp increases in overdose deaths coincide with increasing restrictions on opioid prescriptions and decreased legal supply.

Exactly. It all comes down to fentanyl and fentanyl derivatives. Moving opiates to the black market heavily incentivizes suppliers to substitute relatively safe traditional opiates for highly dangerous fentanyl concentrates. Because fentanyl can deliver so many more effective doses per unit of mass than traditional opiates, it's far cheaper on the supply side.

Think of it this way. Would you rather smuggle a shipping container filled with heroin or a briefcase filled with carfentanil? You keep wholesale supply as potent and concentrated as possible. Don't dilute until the very last point in the supply chain, at which point you try to pass it off as heroin. The problem is a trap house is not a pharmaceutical grade lab, and unless the product is homogenized perfectly some poor bastard gets an unbroken clump of carfentanil in his hotshot and dies.

The simple solution is to legalize heroin, and make sure the supply is regulated for purity and consistency.

> some poor bastard gets an unbroken clump of carfentanil in his hotshot and dies. The simple solution is

Every problem has simple and easy to understand incorrect solution. I don't understand why society has to carry a burden of preventing an individual from harming oneself.

Imagine if we were making chocolate chip cookies and rat poison in the same factory. Periodically a family would drop dead after buying a bad batch at the grocery store. Reformers loudly cry out "Can we please stop making chocolate chip cookies next to rat poison!"

Skeptics chime in "Well... It's really not that simple. Even without rat poison, chocolate chip cookies are pretty unhealthy. Do we really want to be sending a message that it's okay to eat cookies by not poisoning them. Wouldn't that just encourage more people to try them. These people knew the risk of rat poison when they choose to eat the cookies, why is it our job to protect them?"

> "These people knew the risk of rat poison when they choose to eat the cookies, why is it our job to protect them?"

That is my question. What is the answer?

Compassion for other people? We've evolved to have a society for a reason, stepping over dead or desperate people on our way to work isn't good for us either, even if you don't care about them. There are solutions, specifically access to treatment and "clean" drugs that have a much lower chance of killing, that can actually help people.

Inpatient detox will take up to two weeks. After that there is nothing that will make a person to continue except deliberate choice to do so. So access to treatment is OK. "Clean drugs" and "substitute therapy" is already beyond compassion.

Why not blame both? Pharmaceutical companies did in fact knowingly take actions to increase abuse potential because it made them more money.

Also, the pharmaceutical companies have been lobbying against marijuana legalization. Even if the drug war were entirely at fault, the companies are partially responsible for the drug war.

https://www.google.com/search?q=pharmaceutical+companies+lob...

This is specifically relevant because studies have shown lower opioid use in states with medical marijuana. For example:

https://journals.lww.com/jaaos/Fulltext/2021/02150/State_Med...

The Sacklers have caused more pain in more people because of the "abuse". And the med establishment has only fed onto those fears.

Now, everyone in med is 'deeply concerned' with abuse, that many people with legitimate pain are being denied access. The Sacklers lied about addictivity - seriously, how did the FDA allow a morphine derivative to say 'non-addicting'??? But it's also the whole medical establishment's fault in thinking that all pain should be extremely restricted.

Seems to me the USAs opium problem got a lot bigger while the military were present in Afghanistan, it will be interesting to see if the opium habit is some what curtailed by the swift exit.

> opium problem got a lot bigger while the military were present in Afghanistan

Is there any credible evidence that Afghan opium made it to the U.S., much less to its pharmaceutical companies?

I mean, basically every trend of the past 20 years got a lot better while the military were present in Afghanistan, by definition. Internet use and smartphone use exploded during the Afghanistan war, Netflix use got much higher, social division got much worse, and asset prices got much higher. I doubt many of those had much to do with the Afghan war (except possibly the last, with low interest rates to finance government war spending inflating asset prices).

> So, take it from me, a historian of opioids: if you want to learn how one family and their company caused arguably the biggest ongoing public health crisis in the US, but you only have the time to read one book on the subject, it should be Empire of Pain: The Secret History of the Sackler Dynasty.

To say that Perdue Pharma caused the crisis seems too strong. The crisis was caused by people making bad decisions against a background of economic and social disintegration.

> But more importantly, read this book if you want to understand how profit in medicine corrupts medical professionals to the point that they can become perfectly willing to kill their patients, for the right price

This last sentence seems disjoint from the bulk of the article, which singles out the family's guilt, how they dodged and lied to the FDA etc. Who are those murderous medical professionals, or does this refer to the MDs of the family?

By far the worst part of this is the Sackler family gets to keep the money. They were just given immunity from additional lawsuits:

https://www.npr.org/2021/09/01/1031053251/sackler-family-imm...

"The deal grants "releases" from liability for harm caused by OxyContin and other opioids to the Sacklers, hundreds of their associates, as well as their remaining empire of companies and trusts.

In return, they have agreed to pay roughly $4.3 billion, while also forfeiting ownership of Purdue Pharma."

They pay $4.3B and lose their empire. More lawsuits would be for.. what purpose exactly? Put them behind bars? Who does that benefit exactly? Just some sort of vengeance?

If I tell someone a glass is full of water when it's actually strychnine, that's murder. If I convince a doctor a medicine isn't dangerous when it is, that's murder. The punishment for half a million murders should not be a line item in a checkbook. My vote's for scaphism.

Was Perdue actually convincing doctors Oxy isn't addictive or dangerous? Most of the documentaries I have watched about the Opioid Crisis and Perdue fairly clearly lay out that Doctors are not as innocent as "being convinced". They were being paid to look the other way.

https://www.theguardian.com/us-news/2019/apr/10/purdue-opioi...

https://www.ctpost.com/local/article/Less-CT-doctors-report-...

That doesn't affect Perdue's guilt.

How? If Perdue said “this is basically a miracle pain killer. It carries risks.” and doctors said “k, my patients hate pain, I’ll prescribe it heavily!” that doesn’t sound like Perdue’s fault

Perdue paid them to look the other way. I'm equally guilty whether I trick someone into poisoning someone else or pay them to do it.

I'm inclined to agree that it doesn't affect Perdue's guilt. Though, what people are bothered by is that ~$5B doesn't align with the outcome, which I'm also inclined to agree with. I think if you accept my rationalization above then that could leave open a remaining $5B that is owed by participating physicians.

Certainly. Those doctors should be in prison.

> Who does that benefit exactly? Just some sort of vengeance?

The rule of law, for one.

And everyone, for another. The precedent this sets for other pharmaceutical companies is horrible. Lie about the downsides of your drug, aggressively extract profits, stash the money overseas and discharge your liabilities through bankruptcy is an awful playbook.

Whose playbook involves taking a $4B bath?

Considering the scope and breadth of their involvement in the deaths of hundreds of thousands, I don't think losing their money and "empire" is adequate. Prison time is well-deserved considering the outcome of their lies and fraud: https://www.youtube.com/watch?v=zGcKURD_osM

So 2 years of house arrest would make you happy?

In the same article it clearly states they earned over $10B. So yes they got to keep a majority of the money.

> vengeance?

'justice', when executed by the state

They murdered untold thousands of people and ruined millions of lives. They are criminals and should be treated as such. Basic justice is not 'vengeance', it's simple justice.

Also there is no deterrent for future criminals. There is no dissuading jail time; our society just says, hey can you ruin some lives and make some money? You'll get to stay rich and out of jail!

It's not sustainable - future criminals will see the royal treatment that the Sacklers' got and be unworried about hurting more people while they get richer.

Does anyone have a link to a specific text or advertisement written and promoted by Purdue Pharma that is uncontrovertibly false?

I'm curious.

Does this count as uncontrovertibly false? It was good enough for convictions.

"OxyContin is a Schedule II prescription pain relief medication, classified as having the highest potential for abuse of legally available drugs. The Purdue Frederick Company, Inc., and the three executives have admitted that Purdue fraudulently marketed OxyContin by falsely claiming that OxyContin was less addictive, less subject to abuse, and less likely to cause withdrawal symptoms than other pain medications when there was no medical research to support these claims and without Food and Drug Administration approval of these claims."

https://media.defense.gov/2007/May/10/2001711223/-1/-1/1/pur...

You'd probably have to look at the case for evidence, rather than the AG's statement for the actual text.

I'm confused lately by articles like this and the comments on them.

Is the war on drugs OK now again? There should be more people in prison for selling drugs now instead of less? Or is it OK to sell addictive drugs but only if you don't get rich doing it?

What's the new conventional wisdom?

> Is the war on drugs OK now again? There should be more people in prison for selling drugs now instead of less?

You don’t see shades of grey between years in prison for marijuana possession and no jail time for causing a nationwide opioid epidemic?

Very few people are going to prison for possession. At the federal level, virtually all of the people in prison for drug offenses are traffickers.

That's been the war on drugs, busting small time traffickers to go after big time traffickers. Is that cool now again?

I don't see the connection between the war on drugs and big pharma pushing drugs. I think you're looking for an angle on this topic that does not exist. The war on drugs and big pharma murdering people by selling addictive drugs are not related.

What do you mean? It has always been OK. It is a massive jobs creation program that benefit a number of enforcement agencies, law enforcement companies and private prisons, while destroying underprivileged poor communities (by primarily targeting those communities). It is as American as Apple Pie. Up there with spending 20 years fighting and loosing a war that (again) only benefitted private companies and politicians who ended up working for those companies as a reward for giving large contracts to those companies. It is the American way. What’s not to like?

> Is the war on drugs OK now again?

It was always OK.

> What's the new conventional wisdom?

You're allowed to have your own opinion on issues. You don't have to follow the herd, trust me.

Marijuana is cool, opium is evil. That's what the media says anyway.

C'mon. Anyone in the last fifty years believing that this time they have made opiods non-addictive? I mean, let me know if those people truly exist because I have one bridge to sell to quite a lot of them.

It's okay, we can count of the FDA to protect us in the future. Trust the science.

Funny this shows up when I am watching this : https://www.youtube.com/watch?v=AMJWeluZ3tI

American here: here's the deal: regulation slows things down and consumes resources both for the regulator and the regulatee. The deal is: either corp X is accountable, responsible for the control they exhibit or want, or in the vacuum for lack of, a regulator does it for you. Neither happens. Why?

Institutional weakness. The top dog of shirking responsibilities is the US Congress. Whether it's outsourcing wars to the executive branch, 1990s deregulation, or failure to make any serious updates/changes to any of the big issues ongoing since the 1980s:

- immigration

- current account deficit

- debt

- guns

- tax avoidance by corps (I've been in Apple's Cupertino headquarters. How in the hell is it based in Ireland for tax purposes?)

corporations run wild. How in heck did the Sackler's not follow FDA guidelines and release a drug without criminal/civil consequences?

Why is it that if you/I commit financial fraud we're nailed to the wall, but when Wells Fargo's employees do so there's no criminal consequences? Recall, they opened credit cards in customer's names due to internal compensation and incentives. Banks launder money and are not shutout of the US banking system? In other cases, banks report suspicious transfers and the Treasury doesn't follow-up. How are corps enabled to continue to hide behind off-shore shells? How can the Sackler's divest and separate dollars as law suites work up the court appeals process, and still keep it?

The issue is not that corps are evil, or that capitalism is bad. The issue is that since 1980 the pendulum has swung too far in corp's favor, while regulators have failed to respond in kind. We need to bring it back center.

Good god: if I was a share holder at JPMorgan and saw the money they spent on internal lawyers to defend themselves against the 2008 financial company I'd be pissed.

Meanwhile people running for the Senate or the House run the same lame game during elections:

- I am an outsider (b/c Washington's rep is crap)

- I will make changes once in

- But almost all House bills die in the Senate so net nothing happens.

So the whole of Congress is always lost in the fog of the perpetual future.

Can you really blame people for being sceptical of the vaccines when you read stories like this everyday?

As a lay person, how do I know that the vaccine really is as safe as everyone says?

I mean, if you told people in 1995 that you won't take the pills that the doctor prescribed because they just want to get you addicted, people would have looked at you funny.

How do we know it's different this time?

If your attitude is "information source X has ever put out information that was false, therefore I will trust no information it ever puts out," since every possible value of X has put out false information at some point in its existence, especially multi-century institutions like "western medicine," you're left with an inability to ever believe anything. They call this "epistemic learned helplessness" and it's an extremely unfruitful way of evaluating information.

Instead, recognize that all human knowledge is probabilistic in nature. The vaccine trials were all published publicly. Review them and scrutinize the methods if you think the conclusions are likely to be wrong.

It's perfectly fair to see that studies have been entirely falsified in the past, but understand also this is why the vaccine was developed in such a way that no single vendor has a monopoly patent on it. Coordinated fraud on the part of multiple researchers funded by multiple vendors in one of the most scrutinized public processes ever conducted is a lot less likely than when all of the information is being generated by a single source.

I don't blame anyone for skeptical of the pharmaceutical industry. The US federal government and American large corporations have not earned the benefit of the doubt.

However, I only think it's only legitimate to reject the advice of the government if you actually go out and do your own research. If you do that, in a rationalist way, you will likely come to the conclusion to get the Covid vaccine, unless you 1) are willing to completely isolate, or 2) have particular blood or immune conditions. The safety of the vaccine compared to the safety of Covid has been conclusively demonstrated.

> The safety of the vaccine compared to the safety of Covid has been conclusively demonstrated.

I agree with this, but it I find it hard to find a single repository of good information on Covid. Maybe I am ignorant. Is there something you can share with me? I know many people still on the fence and I would like to offer them some evidence.

This sounds disingenuous. If you agree with it, wouldn't that mean you've seen sources of information you accept to lead you to agreeing? And then you could share those sources? This sounds like a "no offense intended, but" approach to misinformation.

You have access to the internet, yet claim you can't find good information about Covid? Please don't troll about a virus that's already killed millions of people, including my own mother.

As a lay person, how do you know that the milk you drink, the beef that you eat, the eggs that you eat, the water you drink is safe? The answer is: you don’t. You only trust it because it hasn’t made you sick yet.

We've had cows, chickens, and water a lot longer than we've had mRNA vaccines. If milk, beef, eggs, or water caused long-term side effects, we'd know about them by now.

The cows and chicken you eat are pumped full of growth hormones, anti-biopics etc. Nobody knows what the long term effects will be.

Yes?

The opioid is not the problem. It's the way it was marketed and prescribed.

Nobody is getting addicted to vaccinations.

>It's the way it was marketed and prescribed.

Can you explain to me, a simple Brit, what you mean. Here doctors are very reluctant to prescribe anything addictive even for a short time. What are the forces behind this?

This is literally what the book being reviewed in the linked article (and summarized in the linked article) is about.

In a word: money.

This is a great concept for a near-future sci-fi short story, though.

That’s not the issue.

The issue is that it’s legitimate to distrust medicine as a whole because there are numerous good examples of it being untrustworthy at every level from public health officials, drug manufacturers, down to individual physicians.

I don’t think it’s good sensemaking to be generically anti-vax, but I think the lack of trust in medicine is a systemic problem and not one that can so easily be blamed on the people who don’t trust it.

It is exactly the issue.

The best guidance we have about these things are from the CDC. While they don't always get it right, they usually have a good explanation for their error when they don't.

It's a gigantic gulf to go from "they're wrong some of the time" to "I'm not going to get vaccinated, but if I do get sick, I'm going to go inject myself with horse paste because I trust whackjob talking heads on the internet more than licensed medical experts in the field."

The VAST majority of people who are resistant to masks and vaccinations are not doing this because they don't believe in the science. They're doing it because talking heads instructed them that to accept them as normal is an affront to their freedom.

> The best guidance we have about these things are from the CDC.

Why not the WHO?

The CDC lied to us that masks were useless when in fact they believed that masks were helpful but they wanted to keep the supply for medical professionals.

> While they don't always get it right,

That wasn’t a matter of not getting it right. It was a deliberate lie that was harmful to the health of those who followed it.

> they usually have a good explanation for their error when they don't.

It wasn’t an error, and the explanation was that they lied in order to manipulate public behavior.

> It's a gigantic gulf to go from "they're wrong some of the time" to "I'm not going to get vaccinated, but if I do get sick, I'm going to go inject myself with horse paste because I trust whackjob talking heads on the internet more than licensed medical experts in the field."

It might be for you and me who have background knowledge about vaccines and viruses, but in the absence of that, why would trust the CDC who you know for certain have been lying? Medical licenses didn’t prevent that.

Also, it’s not horse paste. That’s a lie in itself. It happens to be used in horses, but it is also approved for use in humans as are many medicines also used in animals, for example Ketamine. Do you think ketamine is ‘horse paste’.

Calling it horse paste shows contempt for those who think it’s a useful medicine. Why would anyone trust someone who is contemptuous of them?

Remember there are hundreds of licenses medical professionals who recommend ivermectin for covid. Some of them are the very people you are calling “whackjob talking heads”. Deepak Chopra has a medial license and has written 91 books! It doesn’t seem like a medical license is sufficient to tell who is a “whackjob”.

I don’t think ivermectin is effective, but that’s based on my own calculus of how to integrate the various different opinions, none of which are all that trustworthy.

Gonna be blunt here.

I don't value the opinions of those who believes that a de-wormer is useful medicine against a virus.

Not. A. One.

Know who would have the most to gain by a buying spree of ivermectin?

The manufacturer.

Merck stated that ivermectin is not effective against COVID way back in February.

C'est la vie.

> Gonna be blunt here.

What does that mean? Seems like you just stopped discussing the issue of trust and offered a bunch of opinions about people.

> I don't value the opinions of those who believes that a de-wormer is useful medicine against a virus.

Were you aware that there are new clinical trials being done now to test the hypothesis?

Do you think you know better than the scientists who are conducting them?

I know about them. I also know that they couldn't draw any conclusions about the effectiveness of ivermectin, meaning that people who are currently using it might as well be rubbing crystals for all the good it will do them. Just because a scientist tries something, doesn't mean it's a cure or a treatment. It means they're making an attempt at understanding something.

We already have treatments that work. Roundworm poison isn't going to save anybody.

> I know about them. I also know that they couldn't draw any conclusions about the effectiveness of ivermectin,

There are new studies being done now. We don’t know what them results will be.

> meaning that people who are currently using it might as well be rubbing crystals for all the good it will do them.

You don’t actually know that because you don’t know the results of the studies.

> Just because a scientist tries something, doesn't mean it's a cure or a treatment.

Of course, but it means they don’t think the matter is settled.

You seem to be claiming it is, I.e. that you know better than the scientists conducting the studies.

Distrust is different than "downright reject" and lumping the two together, painting it as a picture of "reasonable distrust," is being extremely favorable to those who simply have stopped engaging. Nobody who disagrees with them (that Covid is real, that masks have value, that the vaccine is worth getting...) is trustworthy by definition. That's not "distrust," that's not something that can be addressed simply by "oh I talked to some more people and now I believe that this isn't a case of the system abusing us."

Rejecting the vaccine because you don't even understand it's described mechanism and so you fall victim to nonsense claims about "viral shedding" or "gene editing" is not being skeptical, it's being gullible.

> Distrust is different than "downright reject" and lumping the two together, painting it as a picture of "reasonable distrust," is being extremely favorable to those who simply have stopped engaging.

I agree that there are level of distrust, but these are not separate categories.

> Nobody who disagrees with them (that Covid is real, that masks have value, that the vaccine is worth getting...) is trustworthy by definition.

Why is it relevant to attack people who disagree with mainstream views as ‘untrustworthy by definition’?

Being wrong or misguided doesn’t make someone untrustworthy.

> That's not "distrust," that's not something that can be addressed simply by "oh I talked to some more people and now I believe that this isn't a case of the system abusing us."

It’s not clear what point you are making here.

> Rejecting the vaccine because you don't even understand it's described mechanism and so you fall victim to nonsense claims about "viral shedding" or "gene editing" is not being skeptical, it's being gullible.

Now you are changing the goalposts. Skepticism is not the same as distrust and not something I have mentioned.

Look how many countries the vaccines have been deployed in. Are they all in some kind of conspiracy to suppress deaths and side effects, or to fabricate high efficacy numbers?

Just declare phentanyl a schedule 1 drug. There, fixed that for ya. OK not, but that is the required first step.

How will that help? The fentanyl in street ‘heroin’ is manufactured in China (and maybe Mexico) and smuggled into the US, it isn’t fentanyl from Roche or Lilly being diverted to the black market.

You could take a step towards hard reduction and reduce penalties for pure morphine. As in you get caught with a kilo of pure morphine go to jail for 6 months. Caught with a gram of fentanyl, 10 years in prison.

The consequences for drug crimes do not matter to the people who sell them, the potential profits are too big. You can make hundreds of thousands of dollars a year selling cocaine or heroin to addicts. The consequences do not deter drug sales, the evidence being that drugs are widely available.

The profit margins are too big. Fentanyl probably has a 95-99% net profit margin, that’s why people kill each other over drugs.

I just remember what happened when California decriminalized pot back in 1975. Didn't take long for ordinary pot dealers to stop selling hash. Also they stopped selling anything but buds.

So based on that I'm pretty sure if you reduced penalties for high quality morphine and slammed people selling Fentanyl, dealers wouldn't touch Fentanyl.

>Schedule II drugs, substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence

That describes Fentanyl very well. Compare that to...

>Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse

There are clear uses for Fentanyl. However, you could argue that we could phase out use of Fentanyl for any procedure in favor of other drugs and I wouldn't be opposed (which would shift it up to Schedule 1).

Thanks for the definitions. So schedule II. There is no use for it that can't readily be handled by something less dangerous and addictive. Just get it off the (legal) market.

Pharmaceutical companies are evil... who knew? The problem is a medical system that rewards bad actors. The systemic problems need to be fixed. And that won't happen so we can continue to pretend that "it's a few bad apples" and nobody else's fault.

>Pharmaceutical companies are evil

I've lost count how many institutions, governments and corporations have disappointed me over the last year.

But Moderna and Pfizer are not among them.

> But Moderna and Pfizer are not among them.

https://www.justice.gov/opa/pr/justice-department-announces-...

I suppose if the company involved in the largest health care fraud in US history doesn’t disappoint you, little would.

Or, maybe you’re just limiting it to the last year. Seems strange either way...

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