Elixir Sulfanilamide
en.wikipedia.org
en.wikipedia.org
Could be a statement made by a drug company owner in the late 1930s, or an autocratic-government-friendly exploit broker in the early 2020s. Plus ça change.
https://www.cnn.com/2021/08/20/us/purdue-pharma-richard-sack...
Any consumer who took opiates and got addicted has exactly one person to blame - themselves for being uninformed.
I love recreational drugs, and I've had back problems that required more than NSAID's alone, but I've never taken opiates, and I never will until I'm ready to die, because I know just how awesome they are.
Blaming the manufacturer for opiate deaths is like blaming manufacturers for firearm deaths, rather than the shooters.
You greatly overestimate the reasoning abilities of suffering humans.
Manufacturer promotes, doctor prescribes, patient ingests.
Doctors should know better than to assume that the mfr is motivated only by the patients' well-being, but the patient should be able to trust their doctor.
In some cases, the medical team does not ask you whether you want opioids. Are you going to get "NoOps" tattooed on your forearms and butt where the IVs might be placed during your unconsciousness?
This has nothing to do with firearms.
Way to completely miss the point. That's an analogy that explains that manufacturers can't reasonably be held responsible for the actions of independent consumers. The manufacturer didn't make that decision, the consumer did.
Now you can argue that the manufacturer was manipulative in effort to achieve greater profit, and thus has partial liability, but do we collectively feel as angry at Facebook for all the suicides that were influenced from deliberate psychological manipulation campaigns the company performed to shift people's feelings? If so, where's the outrage?
Sacklers are an easy target because people hold bias against "old rich white conservatives". I hear more people complaining about this than I hear complaining about 3M & DuPont, who have managed to put small amounts of a known carcinogen in the bloodstream of about 99.9% of the population of the entire planet with PFOA/PFOS in Teflon & related chemicals, and then proceeded to basically change 1 atom in the molecule and create an entirely new product that thus far appears to be identically harmful (GenX) after PFOA was banned - and spun off a holding company to sell that product to completely shield themselves from legal culpability.
Where's the outrage at that? Statistically speaking, DuPont harmed you, the Sacklers didn't. Why the popular anger at one and popular indifference towards the other?
Answer: people are stupid. Stupid doctors trusted an untrustworthy company. Stupid patients trusted their stupid doctors. They're mad at themselves for falling for something that dumb. Also so stupid that many who were harmed by DuPont but not harmed by the Sacklers don't even realize that fact.
The rest of your follow up comment is also tangential, although much more interesting than the firearms junk.
This is the fundamental question behind drugs and firearms. It all boils down to how stupid, informed, impulsive, and gullible people are at various layers of the sales, distribution, and usage stack.
For firearms city dwellers generally believe the buck stops with manufacturers because if they didn't exist then nobody would shoot each other anymore (sic).
For drugs many believe the buck stops with doctors because they are the patient's advocate and authority figures perpetually repeat that doctors always know best because they are educated in the matter and the average person isn't. Americans have generally internalized this propaganda.
https://www.rutgers.edu/news/expertise-liability-experts-may...
Also, people are not stupid for trusting doctors. Are you not supposed to listen to professionals with usually more than a decade more of education in a specific field than you?
You are about eight times more likely to be killed by a doctor than by an automobile accident, and only about 10% of such deaths are reported (https://pubmed.ncbi.nlm.nih.gov/28186008/).
People are, empirically, objectively, and measurably stupid for trusting doctors more than they trust the safety of being in an automobile.
Isn't that like the perfect example of comparing apples to oranges? Wouldn't the danger of trusting a doctor require comparing the outcome of trusting a doctor to the outcome of not trusting a doctor?
This is a reprehensible point of view. Consumers can't be expected to place their personal medical judgements above that of their doctors and their government's regulatory agencies. We in fact attack them 24 hours a day if they do, and call them stupid selfish traitors under the mind control of foreign powers whose only goal is to foment strife and destroy our unity and world leadership through the corruption of our soul, the science, and the facts.
Besides that, people have to work and they don't have time to independently determine if their cellphones will give them brain cancer. They rely on experts and authorities to tell them, on the morning news, as they run out of the door on the way to work.
You might attack people for having a healthy skepticism of both doctors and deeply corrupt government regulatory agencies that have a revolving door with big business - I encourage it.
Most people work 8-10 hours and sleep about 8 hours. That leaves a lot of time to perform a perfunctory reading of the Wikipedia article on the drug you were just prescribed before taking it.
Go look at the very first (2002) version of the wikipedia page for Oxycodone, for crying out loud. This drug was publicly known as dangerous and addictive on what is probably the most accessible source of information for common people since 2002 - https://en.m.wikipedia.org/w/index.php?title=Oxycodone&oldid...
Reading the info from Wikipedia is difficult if you have no chemistry education. For complex cases I read Wikipedia and also obscures sites of Internet with a huge bag of salt on the side of the screen, but it's difficult.
My recommendation is to get a second opinion (from a real medical doctor) and perhaps a third, and sometimes more.
For normal people a pill looks innocuous enough to take the medical advice at face value. Anyway, opioids have a long history to get my spider sense is tingling, even before the recent 10 year events.
100% agreed that people should seek second and third opinions from medical "professionals" - from whom medical malpractice is one of the top 10 leading causes of death in the USA.
Anyway, they are doing very complicated stuff, like cutting people in half and messing with the internal plumbing. In same cases it's hard to hide mistakes under the carpet like with git --amend. It's like plane pilots, any mistake can be fatal.
For some reason plane pilots have checklist for everything, and very regulated maximal time without rest. Anyway, IIRC surgeons at least count the number of gauze they put and remove inside the patient, but are against checklists. And they still have some weird long shifts in some positions, like 12, 16 or 24 hours https://en.wikipedia.org/wiki/Residency_(medicine)#Adoption_...
Columbian cartels whole-heartedly agree. They're just manufacturing and shipping the stuff, they don't make you buy and use it! Stop the war on drugs, legalize over-the-counter opiates, inform the consumers, and in five years you won't recognize the society — that's how drastically it will improve^!
^ "improve" here means "change", and may include both positive and negative improvement. Void where applicable.
Of course the modern regime somehow manages to combine the worst outcomes of both permissiveness and prohibition. We now have junkies overrunning our public spaces while a draconian enforcement regime manages to trample our civil rights without providing any social benefit.
It's not that drug abuse is good or that we ought to encourage it, it's that criminalizing it only makes the situation worse without solving the original problem. Criminalization is an entirely unnecessary added harm, while simultaneously failing to deliver on the premise of the justification for it.
I don’t propose any kind of one size fits all solution because I don’t think any such thing exists. I do think that if there is a policy solution, it will necessarily involve demand reduction[1], social services, and yes in some cases putting addicts into some kind of custodial managed living environment. All of that being tailored to the needs and resources of each particular locale. Practically speaking those treatment centers be a jail or an involuntary hospital, but ideally it would look a lot more like a nice rehab facility with incentives for fostering recovery.
Edit: [1] I intentionally left out supply reduction, because I think we have sufficient evidence that it is impracticable.
If that's your argument, it's a miracle these people didn't die earlier from drinking bleach, thinking it was a tasty beverage.
In the early aughts I was prescribed vicodin (which I didn't take) and made a joke "I hope I don't get addicted to these" and my doctor laughed and said "These aren't like opium or heroin. They're non-habit forming if used as directed"
I suspect the "if used as directed" was doing a lot of work.
I will say that you should try some only if you're desperate, but I wasted over a decade of my life suffering and thinking illegal stimulants like meth and amphetamine will make me a retarded addict... But they didn't.
I quit drinking and fixed anxiety and depression with GHB and pregabalin. I can quit them in several days. Zero problems Afterwards (except bring back to my old self).
I fixed my attention/energy problems with aPVP, methamphetamine and amphetamine. Now using the latter because it's super cheap and available and the former two have too many side effects. But they're all useful in a pinch.
Heroin? GHB feels better! I also hate cannabis which most people love.
All I'm saying is the effects are actually different by person and dosage. But falling into a binge is easy and I know many people can't get out of it.
This was bad medicine, implemented by oblivious (or complicit) docs, pushed by bad practices by drug companies. Don't blame the patient.
Let's see how you feel after you've been in a serious car accident, then.
Heaven forfend such a thing should happen, but I'm prepared to bet you'd be hitting the fentanyl as hard as you possibly could.
I've had many dozens of procedures where afterward I need an opiate prescription. I try to only take them for as long as necessary, usually no more than 2 days, because I know an extra 12-24 hours does start to get into mild withdrawal for me. The fearful scenario you're painting more sounds like when someone shoots up an opiate directly into their veins.
More recently however I've had different procedures, surgeries, the prior being stem cell treatments - and I've needed to take opiates up to 4-5 days due to post surgery pain. But these surgeries reduced my pain so much that the mild withdrawal was the same or less than when I was used to just taking them for 2 days.
What I actually wanted to is that as the pain in my body reduced (from whatever procedure I was getting done), then the withdrawal was easier, less present - arguably as there was returning into less pain in my body as the opiates wore off.
I'm talking about physical pain above, but physical and emotional pain share the same pathways - and if someone isn't actually properly grounded, connected, to their body, and its sensory, they may not realize how much pain their body is actually signalling, and then I imagine opiates could quickly become a problem for someone.
TL;DR: Opiates aren't actually that great unless you're in pain - though that's supposing you're taking the actual medicinal use level dose - and not taking 4-10x+ recommended; I can't speak to that.
“Grünenthal acted in accordance with the state of scientific knowledge and all industry standards for testing new drugs that were relevant and acknowledged in the 1950s and 1960s.”
https://en.wikipedia.org/wiki/The_Demon_Under_the_Microscope
One fascinating aspect of this is that Bayer originally tried to convince the world that their patented derivative of sulfonamide, Prontosil (note nitrogenous ring additive) was the one that worked.
https://en.wikipedia.org/wiki/Prontosil
It turned out that the non-patentable sulfanilamide was the actual active species, which Bayer probably knew but kept secret because, well, patents and market share and so on:
It's this one: "Chapter 10. Take two elements, call me in the morning"
Today if the FDA approves a drug as safe, and effective for any single specific use, doctors are allowed to prescribe it "off label" for any other use. This generally works well, and contributes to pharmaceutical innovation. We should expand this to where doctors can prescribe anything the FDA has classified as safe. Restricting advertising and other carrots to drugs that have convinced that FDA of their efficacy (as we do today for off label uses) is probably still good, though.
I'd go further, and restrict advertising to doctors to a specific format, something like the Nutrition Facts label we have for food. They'd be allowed the brand/trademark, but everything else is specified to be in effect a data sheet.
The only thing allowing advertising to consumers will do is result in a lot of them insisting on, or agreeing to, drugs they don't actually need.
I know my personal opinions about this are unusual, statistically speaking, but I think the pendulum has swung far too far in the other direction since the 1930s. It's frustrating to me that debates in the US are often framed in terms of two extremes, one resembling what we have, which is broken, and another where there's no safety oversight at all, as if those are the only options.
I personally feel like the FDA should concern itself with regulating the characterization of basic safety profiles of substances, and with product purity and truth in labeling. Outside of that, it seems like you start getting into rent-seeking.
Note that the congress.gov link is outdated: the bill unanimously passed in the senate on Sep 29.
https://www.congress.gov/bill/117th-congress/senate-bill/295...
“(1) Cell-based assays.
“(2) Organ chips and microphysiological systems.
“(3) Computer models.
“(4) Other non-animal or human biology-based test methods.
“(5) Animal tests.”.
The US FDA, as it exists today, is the single biggest hurdle to global medical progress (because other developed countries with socialized medicine are still getting about half their new drugs from the US). It costs a billion+ dollars (in FDA testing alone) and many years to push a single drug into the market. Even during an unprecedented pandemic where things are being rushed and all the world's pharmaceutical resources are poured into the drug development, it still took a solid year after vaccines were developed.
90 years ago, animal testing was often the best option. But in this specific example, the drug manufacturer didn't do any kind of testing at all, so it isn't much of a fair comparison. And as a sibling commenter mentioned, there are other effective tests that can be done before human trials, saving time and animals.
> In 1937, S.E. Massengill Co. (a Tennessee drug company), manufactured sulfanilamide dissolved with diethylene glycol, to create a liquid alternative of this drug. The company tested the new product, Elixir sulfanilamide, for viscosity, appearance and fragrance. At the time, the food and drug laws did not require toxicological analysis before releasing for sale. When 105 people died in 15 states during the months of September and October, the trail led back to the elixir, and the toxic potential of this chemical was revealed.
https://en.wikipedia.org/wiki/Diethylene_glycol#Epidemiology
If you aren't convinced that things haven't gotten better over the years, here's your proof.
https://www.youtube.com/c/PatrickKellyMedicalHistory
This is the video containing the story about Sulfaninamide: https://www.youtube.com/watch?v=Vuhi1SR8Zuk
There are cases where the solvent will react with the antibiotic, and there are corner cases of weird interactions. Some can be predicted from general chemical rules, but some are unexpected.
So instead of mixing random stuff and following advice of morons like me in the internet, it's better to ask a real medical doctor and a pharmacologist, and make some animal and clinical trial anyway.