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comment by ButterflyEffect
ButterflyEffect  ·  331 days ago  ·  link  ·    ·  parent  ·  post: The Class of 2000 ‘Could Have Been Anything’

Jail everybody. Destroy these drugs companies. That's the only recourse, and it's of course what will not happen.

kleinbl00  ·  331 days ago  ·  link  ·  

You know what? I don't think so. I think the opioid crisis would be completely defeated by Medicare For All.


We're looking for a new accountant. Met with one; he mostly does dentists (birth centers are, financially, closest to dental offices from a financial perspective) but he had a naturopathic doctor client. He looked over our books and was immediately horrified by how little money we're making on supplements. 'cuz see, the basic profit model of a naturopathic doctor's office is you get 'em in, find their problem and then sell 'em supplements. One of my wife's friends watched a guy leave with $900 worth of pills for male pattern baldness once (she left that clinic).

The problem here is you either have to believe that $900 worth of supplements will help someone better than a five-year supply of Rogaine or you have to accept that you're a pill merchant, not a healthcare provider. And let's be clear: there are patients out there looking for a pill merchant. That model works for both sides of the bargain within a narrow band of experience. But my wife likes to help people and most people aren't helped by pills.

The anti-vax conspiracy nuts have come up with the idea that "big pharma" wants all their kids to pay through the nose for medications their kids don't need without recognizing that the Feds front the cost because it saves a shit-ton of money to have everybody vaccinated:

    Vaccination programs like the VFC are expensive, but they also result in significant cost savings through prevented hospitalization and doctor visits. Routine childhood vaccination among the 1994-2013 birth cohort is estimated to result in $107 billion in direct costs and $121 billion in social costs. In return, childhood vaccination results in the aversion of $402 billion in direct costs and $1.5 trillion in societal costs. This gives vaccination a net present value (net savings) of $295 billion and $1.38 trillion in direct and societal costs, respectively.

If you look at the diffusion of oxycodone through the healthcare system, it started with Purdue Pharma finding an old, unread paper that basically said "the likelihood of addiction to opioids is highly overstated" based on, effectively, nothing. Then they ran junkets to change the narrative to private doctors who then started prescribing. From there it spread down-market to the point where Medicare recipients are on Oxy.

If it went the other way it never would have gotten as far - a bunch of doctors whose prescribing recommendations come from the top down aren't going to step out of line to prescribe a drug just because the rep is nice. If your patient can't get their drugs paid for, you aren't going to prescribe them. We deal with this every day.

If Medicare For All was a reality in 1995, Purdue would have said "we think everyone should be on Oxycontin!" and Medicare would have said "do you have a generic equivalent?" and Purdue would have said "...no" and then Medicare would have said "Okay can you make a compelling case that we should cover non-generic Oxycodone?" and then Purdue would have said "...here's this shitty study from '75" and Medicare would have said "lol no" and that would have been the end of it.

ButterflyEffect  ·  331 days ago  ·  link  ·  

I don’t disagree with that. Medicare for All would be a fundamental improvement for society. I believe that’s at least a decade out for this country. It doesn’t provide justice or retribution for what has already happened. I want the profiteers at the stocks.

kleinbl00  ·  330 days ago  ·  link  ·  

Justice and retribution are fine; I was taking exception to your argument "that's the only recourse." Here's the question, though - when you say "everybody" do you mean "everybody?" From the top down, we've got the Sackler family. The buck obviously stops with them. We've got their direct reports, who were making them money. We've got the senior sales team, who probably knew something was up. But then we've got the sales reps who are spouting back what they've heard in as convincing a manner as possible. You've got the doctors who are largely doing what all their colleagues are doing. In order to get where we got there had to be a lot of people who didn't think or know they were doing anything wrong.

It's the same problem as with the 737 Max or with Vioxx - people are dead because a lot of people made some not-quite-perfect choices in an environment that rewarded imperfect decisions. The opioid crisis is obviously awful and obviously a lot more ongoing but I'm unconvinced punishment is going to prevent similar problems in the future. Martin Skreli isn't in jail for doing anything wrong, not really, and you know it. He's in jail for being an asshole and jacking prices. Heather Bresch? Woman who raised the price of the Epipen to $600? Survived the scandal, merged Myland with Upjohn, retiring with a golden parachute after seven years earning $17m a year.

Vengeance is appealing but it rarely fixes anything.

ButterflyEffect  ·  330 days ago  ·  link  ·  

All of those people should be fined heavily or in jail. Fuck the Sacklers, fuck the low level salespeople and fuck Bresch (I hate paying $250 a year for my auto injectors, it’s a racket). Being too stupid or careless to think about what you’re doing while you get your quarterly bonus doesn’t absolve you of the role you played in creating a public health crisis and ruining lives.

You’re right that it doesn’t solve much, but if it makes some of these bad actors are example then I’m all for it.

OftenBen  ·  330 days ago  ·  link  ·  

That's childish Bfx.

You should go work real hard until you sit on the board of directors for a drug firm.

Mature subversion and all that.