When half a million Americans died and nobody noticed (2012) | Hacker News Reader

When half a million Americans died and nobody noticed (2012)

theweek.com

135 pointscempaka94 comments

The article concerns allegations made by Ron Unz (https://en.wikipedia.org/wiki/Ron_Unz), who currently runs The Unz Review (https://www.unz.com/). The Unz Review currently has the following article at the top of its page: The Protocols Revisited by Karl Haemers, which is a review of Protocols of the Elders of Zion: The Definitive English Edition, Edited and Translated by Thomas Dalton PhD.

"Thomas Dalton, PhD has achieved the high claim of his title, Protocols of the Elders of Zion: The Definitive English Edition. While such reading cannot be considered “entertainment,” given the urgent and alarming subject matter, I found the variety of writing styles, viewpoints and analyses among the many chapters compelling in counter-point and also in consensus. I struggle to think of any adult and youth today who would not gain crucial perspective on history and current events that they can apply to their own protection and the defense of the world. Along with bringing this knowledge to our attention once again in this new form, Dalton’s greatest contribution is the simple, clear and effective solutions he offers at the end. I am left with a persistent peal of passion:

We must do this!"

The rest of the page is taken by links to anti-semitic articles, anti-black articles, anti-feminist articles, neo-confederate articles, and various conspiracy theories.

Consider your sources.

While I understand you’re trying to add some color to the claims so as to inform us to take them with a grain of salt, you’re also committing a logical fallacy.

So what if the devil himself made the claim? Unless it’s verifiably absurd, you have to respond to the substance. It seems from reading other threads that it’s not an absurd claim, so it would be helpful if you brought some substance of your own to the discussion. Otherwise we risk throwing the baby out with the bathwater.

We all have a limited number of heartbeats in our lives. There are far more claims made than we have time to individually assess ourselves. Someone making repeated false claims is a good metric to use when deciding whether analysis of certain claims are worth our time to evaluate.

Exactly. People and society having to deal with certain individuals "making repeated false claims" has resulted in this having a name: "bad reputation".

My point is not that reputation is a useless metric. It is that it’s only part of the equation and in this case probably misleading.

The difference is that this guy has a history of unpalatable opinions, not refutable claims. For someone who makes consistent, provable errors, I completely agree not to waste the effort. But I don't agree in the first case, especially because this is a more or less a provable article, not an opinion piece.

Out of curiosity, are the Protocols of the Elders of Zion an "unpalatable opinion" or a "refutable claim"?

https://en.wikipedia.org/wiki/The_Protocols_of_the_Elders_of...

https://www.brandeis.edu/now/2020/september/whitfield-conver...

If 10 out of 10 claims a person makes are verifiably absurd, is that not empirical evidence of something?

See Derick Lowe's response to this claim.

(by the way archive link for the article https://archive.ph/LgsbB)

I am in awe of this article. It has two verifiable pieces of information - a FDA study indicated that Vioxx was responsible for 55,000 deaths and that Merck had known about lethal side effects before launching the drug.

The key point in the article? A magazine publisher with no background in epidemical studies does a "quick study" of the CDC website and says that "perhaps" 500,000 deaths resulted from Vioxx.

Then there's about 10 paragraphs of hand writing and alarmism before we get to the befuddling conclusion that "in today's world and in the opinion of our own media, American lives are quite cheap, unlike those in China. "

I hardly know how to unravel that.

Looking at the Wikipedia page, it’s being returned to the market albeit for a different disease/condition.

https://en.m.wikipedia.org/wiki/Rofecoxib

Topical is a completely different animal than a systemic pill.

Glancing at a few graphs of death rates/year, they show, if anything, the opposite of what he claims. And note the effect he's claiming would be huge, the drug was on a market for a few years, so 500k would be on the order of 100k/year. Total cardiovascular deaths /year in the US run around 500k a year, so you'd be seeing a jump of 20% and then a similar decline a few years later. Its hard to imagine that would go unnoticed.

It's not got much to do with America, it's a human problem where we don't accurately assess risks, especially when there is a level of abstraction, or when emotions are involved. For instance, if there were three, highly-publicized cases of teenagers dying—somehow—from eating too much toothpaste, there would be a hundred news articles about it ("what you need to know about the toothpaste eating epidemic", "7 safe alternatives to toothpaste for your child"), and cities would pass laws limiting the size of toothpaste tubes you can legally sell, and the toothpaste would be moved behind locked ballistic glass in stores, and you'd have to show ID to buy it. Meanwhile, air pollution kills 7 million people a year, and has for decades, and it's like "meh, price of doin' business". Humans are dumb about this stuff, and there is very little rhyme or reason to the proportionality of their responses to different risks.

> It's not got much to do with America

The executives responsible were at no meaningful risk of being charged. They retained all the cash they were paid for maximizing elderly-killing drug sales.

It's got much to do with America.

This is one of those problems caused/aggravated by America’s adversarial system, which is basically enforcement by lawsuit.

Very motivated individuals can get powerful results by filing suits. On the other hand class actions are notoriously difficult, look at the Oxycontin ones.

A complete lack of the precautionary principle and quality assurance. It's not even quality control and using the general public as "canaries" without even bothering to notice when people are dying because of institutional and systemic ageism. My (late) grandmother and mother experienced a pattern of dismissive and disrespectful treatment from doctors and healthcare providers in the US.

And if a reader were to believe this to be "just an old people problem", they ought to reexamine their understanding of The Golden Rule and realize they will get old too when they live long enough.

This number is likely too high by a factor of 10, and there are more reliable sources.

Derek Lowe's rebuttal to the article is here: https://www.science.org/content/blog-post/500-000-excess-dea...

and a medical press article from 2019 estimates 60,000 excess deaths: https://www.statnews.com/2019/10/09/vioxx-relaunched-treat-h...

From Lowe's article:

"I do not see the effects that Unz is talking about. Not at all. A single-cause change in the death rate of the magnitude that he's proposing should most certainly show up in these figures (particularly the latter chart), but it isn't there. I see no reason to take this claim seriously."

Note that Derek Lowe has been more than willing to be critical of big pharmaceutical companies when they deserve it, on other issues, and he's a professional with decades of experience in the field.

> "We find the largest rise in American mortality rates occurred in 1999, the year Vioxx was introduced, while the largest drop occurred in 2004, the year it was withdrawn," says Unz. "Vioxx was almost entirely marketed to the elderly, and these substantial changes in the national death-rate were completely concentrated within the 65-plus population.

I want to believe there were other factors at the time, but I can't see it. It was widely used, in that age group, and the company already knew of the risks. I wonder if this will lead to more people buying Chinese drugs, given the more harsh reaction by the government during their own drug crises.

> I wonder if this will lead to more people buying Chinese drugs, given the more harsh reaction by the government during their own drug crises.

I doubt it, baby formula importing didn't seem to die down in China as a result.

I haven't been following the developments there recently, but I am skeptical this changed even after the US' chaos over allowing a near monopoly to become too big to shut off, too unsafe not to, and naturally above criminal consequences for fraudulent paperwork.

Derek Lowe (https://www.science.org/content/blog-post/500-000-excess-dea...):

""We find the largest rise in American mortality rates occurred in 1999, the year Vioxx was introduced, while the largest drop occurred in 2004, the year it was withdrawn," says Unz. "Vioxx was almost entirely marketed to the elderly, and these substantial changes in the national death-rate were completely concentrated within the 65-plus population."

I found this claim very hard to believe. (For one thing, how could all those patients and lawyers suing Merck have let this get past them?) Looking at the statistics themselves, I can see no evidence for Unz's claim. Here, for example, is the death rate in the US, crude and age-adjusted, over this time span: And to get more specific, here are the numbers for cardiovascular deaths for people 65 and over. (They're in a chart comparing them to cancer death rates as well):*

I do not see the effects that Unz is talking about. Not at all. A single-cause change in the death rate of the magnitude that he's proposing should most certainly show up in these figures (particularly the latter chart), but it isn't there. I see no reason to take this claim seriously."

I’m really unsure about the Chinese milk scandal analogy. While the Vioxx incident is definitely terrible on its own and may indicate the US government and merchants do not take enough responsibility, the comparison to the melamine is awkward at best; one is a new drug with possible negative health implications (for whatever reason), while the other is a food product with an already illegal additive. It’s not particularly useful to compare the reactions toward the two.

Merck was aware of the danger of the drug[0] but pushed the studies under the rug. It may have been a more effective and less likely to be caught scheme than using a chemical which people outside the company would have known was poisonous, but it retains the essence, which is knowingly causing deaths to sell something.

[0] https://theweek.com/us/46535/when-half-million-americans-die...

So the math seems to be that for the 25 million people prescribed this drug...

FDA claims: 1/5th of a percent died (55k)

TFA claims: 2 percent died (500k)

That's a huge difference of opinion.

I mean, 55k excess deaths is still a pretty massive number.

But, like most of these stats, it probably lies somewhere between the minimum and maximum, unless one of the parties was outright lying.

The problem with that line of reasoning is that if I put a blog post together that looks believable and claims there were 5 million deaths, many reasonable people will assume the truth is somewhere in between.

You're not an authority nor do you have any data to back it up.

It's appealing to the two authorities of research on the topic, not the FDA versus JoeRogan592's blogspot. So it's not quite equivalent, but your point about fake news is taken.

> I mean, 55k excess deaths is still a pretty massive number.

So is 25 million. :)

I don't mean to be callous by saying this, but it's often stated that even one death is unacceptable, but we also expect products to infinitely scale. At some point you will have a death from anything including breathing or drinking water.

What would be even worse is if we found that threshold of "one death" and limited the number of prescriptions below that. I think most people who need certain medications would prefer to roll the dice than be rejected the treatment.

I've always thought it would be a good compromise if the risk of death for the recommended dosage is required to be printed on the label along with doctors and pharmacists warning the patient ahead of time even for trivial stuff like ibuprofen.

Even more generally, a culture shift towards realistic expectations is sorely needed these days.

> So is 25 million. :)

Cool. I don't agree with any gradient of unnecessary/negligent deaths.

Derek Lowe (https://www.science.org/content/blog-post/500-000-excess-dea...):

The issue is that 55k deaths is the known known. The known unknown is the multiplier due to the lackadaisical handling of geriatric deaths by overworked/under-skilled coroners (large number aren't MEs or MDs). I imagine it could be 1.5-2x (say 80% confidence) but not 550k (10x) without a mountain of evidence.

I'll note you can find past Hacker News discussions full of people suggesting the FDA's approval processes are overly burdensome.

An approval process can be at once burdensome and vulnerable to the fraud Merck committed.

Theoretically, but I don't think the people making those comments would be happy with the "fixed" more fraud resistant system either.

Some of them expressed that people should be able to take unproven drugs (Libertarian philosophy). They're just okay with this happening from time to time.

I'm not here to tell anyone else their morals, but I do think telling doctors, "here's a chemical we figured out how to manufacture, let us know if you want more of it for some reason," would be ethically better than cooking the books to get FDA approval on that same chemical while knowing the side effects. In the former case doctors may commit an ethical violation themselves by presenting the drug as safe, but what did in fact happen was Merck did that, saving them the question.

In the second case, you can hold the people who "cook[ed] the books to get FDA approval ... while knowing the side effects" responsible. In the first you cannot.

> but I don't think the people making those comments would be happy with the "fixed" more fraud resistant system either

Why do you assume this? Do you expect to fix fraudulent study results by mandating more studies?

Any way to add flexibility to drug certification must necessarily include some ongoing procedure to verify it works. So, it's even hard to come out with a faster process that doesn't reduce this problem (but yeah, if you make an effort, you can make one).

By "fixed", I believe the parent poster meant mandating fewer studies, as in zero.

AFAIK nobody ever came out demanding the number of studies to be zero. Not even lunatic groups. The OP's strawman is is so obviously out of the cultural norm that it is screaming bad-faith construction.

And if he wants to claim that merely reducing the number of studies run by the people interested on a positive result to a non-zero amount will increase the odds of fraud, well, I'd be interested on honest arguments, because it's a revolutionary finding on either system or game theory.

My friend, I've seen people here, on HN, writing that they would be happy with a medical doctor trained by YouTube videos. There are people here who have expressed the opinion that any form of regulation is a positive evil.

And you can't have fraud if you don't have tests to pass fraudulently.

How exactly would ""fixed" more fraud resistant system" imply doing zero studies?

Fraud is a pretty light word. An overt act that results in someone’s death goes by some more serious words, and without a convenient statute of limitations pass.

“The COVID vaccine was ready after 3 days, FDA must be abolished!” - Otherwise reasonably intelligent people

My buddy made a COVID vax, a cure for Alzheimer’s, and an age reversal suppository in his garage in less than a week. He pinky promises that they work ¯\_(ツ)_/¯

(FWIW the other commenter is right, it is possible the process is both excessively burdensome and vulnerable, but in general people leveling this “too burdensome” critique actually have no clue how drug development works and why it’s so hard)

In many contexts, the way we deal with potential problems is allowing people to do things and punishing them when they fuck up.

For example, it's relatively easy to get a drivers license, but if you run someone over, even by accident, you're held responsible.

Maybe this is how we should deal with pharmacies as well.

No. Absolutely not. It's being given a drivers licence and allowed to kill 20,000 people on your commute to work before being stopped.

I'm not saying that getting a license to sell a pharmacy should be just as easy as getting a drivers license, just that there's no contradiction between wanting licensing to be easier, and wanting people held responsible for damage.

This is just one that was noticed and trackable. How many other quiet half-a-percent-contributors-to-mortality are going unnoticed? I don't think the epidemiological surveys for detecting these kinds of thing are well funded, to say the least.

There's some sort of Drake equation you can do here: prescription rate times chance of side effect divided by detectable effect size, if the number is below the threshold, it's invisible.

It would be interesting to establish something like a holdout group longitudinal study where no new drugs are allowed for 5 years or something and see if their mortality rate differed substantially from the baseline.

Here is another eye-popping medical number that goes completely unnoticed:

250,000. [1]

This is roughly the number of deaths per year from medical accidents (and/or malpractice) each year. Some claim the number is closer to 400,000.

[1] https://www.hopkinsmedicine.org/news/media/releases/study_su...

I’ve never heard of this until seeing it here. I’m dumbfounded.

Vioxx was handled terribly by Merck and the FDA. But if you talk to practicing physicians who actually prescribed it to their patients, many think it shouldn't have been withdrawn from the market. For certain patients it was very effective and worth the risks. We have other drugs on the market today with equally severe side effects. It would have been better to just add a prominent "black box" warning to the label.

My grandmother hoarded her pills after Vioxx was taken off the market because it was the only thing available at the time that helped her.

Idk, a $4.85B settlement seems like they really extracted their pound of flesh. In the thesis statement where they question if Chinese lives are worth more than American lives, I wonder if they’re specifically looking for capital punishment similar to what China administered to the highest-tier offenders.

I interpreted it more as a "when is it okay to pierce the corporate veil with criminal charges," question, which is usually answered in the affirmative for fraud.

That’s fair, if they can prove negligence (which it sounds like they have a shot at) I’d be down to see some criminal charges.

They won the class action by proving willful negligence or whatever the right term for it would be, and although civil suits are often used as springboards for criminal charges, it has been a decade and the government has shown no interest.

Leaving aside whether the number of deaths claimed by the article is correct, it is incorrect to directly compare deaths of infants with those of the elderly.

It should be done using Life-years lost [0] or Quality-adjusted life years [1].

[0]: https://en.wikipedia.org/wiki/Life-years_lost

[1]: https://en.wikipedia.org/wiki/Quality-adjusted_life_year

>It soon turned out Merck had known of potential lethal side effects even before launching Vioxx in 1999, but had brushed all such disturbing tests under the rug.

I don't trust this line.

I suspect that preliminary tests show all kinds of extreme possibilities. Positive and negative.

How many dangerous side effects never came to be?

How many supposed benefits never came to be?

Why should they have paid particular attention to this dangerous side effect? The article doesn't make it clear.

And for the record, I believe drug companies don't have our best interests at heart and that the FDA is captured by industry.

When you're doing preliminary studies, you get a sense of how common the side effects are, and if a rare one shows up you know your statistical power on bounding its likelihood. Multiplying by your expected market will tell you how well you've bounded total deaths. Consequently, you'll know when you need to extend the study to get a better detection - but to tell you the truth, for the issue to have been bad enough for them to choose to hide it entirely instead of disclosing it a list of terrible rare side effects that all medicines have, it must have been common enough in their sample for the large number of total deaths to have been predicted.

>>It soon turned out Merck had known of potential lethal side effects even before launching Vioxx in 1999, but had brushed all such disturbing tests under the rug.

>I don't trust this line.

If I recollect there were 'whistle blowers' from Merck who said this at one point. For those who have followed similar situations/drugs (like Prozac) it is well know that cherry picking studies or results by pharma is common place.

This is fascinating because the effect size is so large and so discontinuous.

That the US government has become so detached from actual law enforcement makes me wonder if there's anyone thinking about reforms to the political system itself. I'm not talking about politically charged stuff like redistricting or ranked choice that just shifts the party in power.

I mean ways to create more citizen power over their representatives. What would today's equivalent to "direct election of senators" be?

For starters, there's the national popular vote interstate compact, which would remove the influence that district and state boundaries have over the presidential election.

Which will unfortunately never happen due to the machinations of said influence. Ever since the Citizen's United decision we've just been kidding ourselves that normal political action will get us anywhere.

If you look at the map below they've made great progress

[1]:https://en.wikipedia.org/wiki/National_Popular_Vote_Intersta...

Assuming all pending states enact the compact then there are only two electoral college votes remaining.

I'm not holding my breath, but it would be nice. The best chance would be if democrats won the election while losing the popular vote, since that would likely get conservative states on board.

It's gone the other way for years and years, so it's not likely to be inverted now.

It wasn't so long ago that Kerry won the popular vote and lost the (contested) electoral college. The feeling seems to be that there are enough small democratic states that the advantage can go either way.

If you look at the map it really drives home how you only need a small collection of purple states to push you over. Imagine if democrats could really push hard and retain solid control over some of these states. It would make this compact foolproof. Imagine if the compact goes into effect but the red states just change their minds and don't enforce the laws on the books.

By making it so that these few purple states retain solid blue control, it help preempt this possible last pushback. that would go a long way to changing the landscape. All of a sudden it would finally sweep away all this conservative nonsense by clearly showing that it is not as popular of a position as it seems right now and the current democratic position becomes the base level conservative position. That will be the lasting legacy of this compact I so badly want to see in my lifetime.

My hunch is they need to push harder into turning PA solid blue. Maybe AZ long term? Or maybe Iowa. Maybe just pick off the small states like Iowa, NH and include PA and that should be enough votes to solify the compact.

Looks like all of the blue states are already in; not sure where the last 2 votes will come from.

Changing demographics in some of the purple states that allow democrats to take over state level government and push this compact through.

I feel like term limits would at least help prevent singular people from staying in power long enough to collect more power. It only really seems controversial with the politicians themselves, everyone else seems to be pretty for it from wherever they are on the aisle from what I've seen.

Wikipedia has a very dire list of consequences of term limits: https://en.wikipedia.org/wiki/Term_limits_in_the_United_Stat...

I'm pretty against them (and not a politician) because it takes power from voters and gives it to unelected party members. Absent term limits, voters can just vote against any politician they feel has served too long.

>Term limits have been linked to lower growth in revenues and expenditures.[105]

It's always humorous when Wikipedia editorializes. I don't think everyone would agree that this sentence belongs in the negative impacts paragraph. ;-)

It's interesting that this is all on the "term limits in the US page" and not the general "term limits" page

P.J. O'Rourke once quipped about term limits something along the lines of "do you want a dog that knows where all the bones are buried, or a dog that digs up the entire yard?"

It seems an easy fix, but like a lot of easy fixes you replace the known problems with unknown problems. Which doesn't mean it's not a good idea per se, but it also doesn't mean it will fix anything. For example, with term limits, it becomes even cheaper to buy a politician than it is now.

Term limits mean that there only inexperienced politicians, easily guided by lobbyists.

Because the current bunch aren't eager to have their fingers in the pie.

I think it has to be balanced, we definitely don't want insanely low where every 2 years all of congress is brand new, but according to https://en.wikipedia.org/wiki/List_of_members_of_the_United_... there has been 64 members with 40+ years of tenure within the house or senate, which I think is way to long.

Their voters don't seem to think so.

Last large company to be broken was in 1982, with Bell System... it's been so long and now they literally own the entirety of government.

Microsoft's acquisition of ActBlizzard is a perfect example, while I must have to admit that as a map maker for Warcraft 3 for 20 yers, I am glad that the game is out of Bobby Kotick's hands, and that's my selfish reason to support the acquisition...

In reality it's really scary how easily the US accepted it, even worse how they went and threaned Sony when Sony attempted to fight them, lol, it became painfully obvious that senators are basically just talking heads for Microsoft.

Now there are documents that they want to acquire Nintendo and Valve... this would legitimately ruin gaming as a whole.

And yes I get that there are massive differences between pharma/food companies corruption and tech, but it just shows how much power corporations hold in modern day over modern life, it is scary.

It would have to be something that increases independence from political parties. As it stands, my representative has simply voted in line with the Biden administration’s preference 100% of the time. I haven’t read every bill, but it’s hard to believe that’s what people here would really want.

(2012)

Discussion from then: https://news.ycombinator.com/item?id=3954201

There was a big drop in deaths in 2004, but I'm really curious as to what caused the big increase in 2014.

https://www.macrotrends.net/countries/USA/united-states/deat...

Fentanyl?

https://nida.nih.gov/sites/default/files/images/2023-Drug-od...

https://www.nytimes.com/2016/06/01/health/american-death-rat...

You mean the drop from 8.52/1000 in 2003 to 8.12/1000 in 2008 that roughly followed the slope of the decrease from 9.59/1000 in 1968?

Reply on news.ycombinator.com