It’s pretty wild that everyone acknowledges that the Sacklers engaged in a “milking program” going from 15% to 70% distributions after the first lawsuits in order to strip the company of assets and then hide behind the company to shield liability. This alone should allow claimants to pierce the corporate veil and go after the family directly.
> allow claimants to pierce the corporate veil and go after the family directly.
This decision is a win both for that cause, and also forestalling precedent that would allow future wrongdoing corporations from 'shielding the veil' so to speak through bankruptcy. A win-win indeed.
At least initially, I'm glad to see this verdict if it means such behavior can't hide behind the corporate veil. However, it's important to acknowledge it's not necessarily a win-win-win. By reading Justice Kavanaugh's dissenting opinion, this decision seems to delay opioid victims the settlement they previously won.
>"As a result, opioid victims are now deprived of the substantial monetary recovery that they long fought for and finally secured after years of litigation...virtually all of the opioid victims and creditors in this case fervently support approval of Purdue’s bankruptcy reorganization plan."
Time will tell if this ruling gives enough preventative pressure to future cases to make it worth the additional pain to the present claimants.
But now that the ruling potentially exposes the Sacklers directly, they have much more incentive to negotiate a new settlement. If the plaintiff's attorneys are clever, they will leverage this to come to a quick settlement of approximately the same amount, with the threat that delays will bring demands for higher amounts.
> By reading Justice Kavanaugh's dissenting opinion, this decision seems to delay opioid victims the settlement they previously won.
The problem is that this sets an ugly precedent. The bankruptcy settlement is basically "I can make a deal with A that takes away your ability to sue B, even though I wasn't suing B and you are". It makes no sense. The dissenting opinion is the epitome of "fuck you, I got mine."
Suppose we discover next year that one of the RNA covid vaccines causes cancer with 100% probability. The vaccine maker, on the hook for trillions of dollars of damages with no possible way to pay, declares bankruptcy (victims get approximately nothing). Elon Musk steps in and offers to contribute 20 billion dollars to help compensate the victims who would otherwise get nothing. All he asks is that the bankruptcy court dismiss all claims related to his pay package, stock manipulation and libel on twitter. The victims overwhelmingly approve the settlement and the judge oks it. After all, bankruptcy judges have wide discretion and $20 billion is better than $0.
Is that ok?
In my analogy, Elon Musk (and most of the people suing him) are not related to the vaccine maker (but there could be overlap among some of the plaintiffs and Musk could own some shares of the vaccine maker). But, technically, the same is true with Purdue Pharma, the Sackler family and plaintiffs. Yes, the Sacklers are more closely related to Purdue than Musk and the hypothetical vaccine company, but that's just a matter of degree.
In the Purdue bankruptcy, the victims of Purdue voted (and the court agreed) to take the Sackler's money and in exchange prevent anyone at all in the United States from suing the Sacklers about anything at all related to opioids. Even people who are not eligible to be members of the Purdue bankruptcy settlement cannot sue the Sacklers!
If the Sackler settlement was allowed to stand, it effectively allows billionaires to buy their way out of liability for unrelated things if they donate some money to sympathetic victims. All they would need to do is create some degree of nexus between themselves and the entity declaring bankruptcy, sufficient for a bankruptcy judge to ok the settlement.
I don't disagree with any of this. That's the main reason why I said I think we'll have to wait and see if this ultimately leads to better outcomes. However, I think it's been shown that the very human idea of "fairness" can create spiteful, sub-optimal outcomes. Remember, "nobody gets anything" is also fair amongst victims, but certainly not optimal.
I could see shielding from future civil liability as an option, but only after a true bankruptcy has occurred. Liquidate everything, and by that I mean everything, and then you can move on with your life. Definitely no shielding money in offshore accounts.
If you're not willing to do that ... well, see you in court. Over and over, because every individual you hurt should have a chance to come at you with a liability claim.
One problem of which I was unaware is that the Sackler family has largely fled the United States.
Pursuing their assets introduces vast complexities of international law.
"In a brief filed on behalf of the relatives of Mortimer Sackler, most of whom are based overseas, lawyers warned of “significant litigation costs and risks” in seeking to enforce any foreign court judgments against the family if the settlement were thrown out."
> "In a brief filed on behalf of the relatives of Mortimer Sackler, most of whom are based overseas, lawyers warned of “significant litigation costs and risks” in seeking to enforce any foreign court judgments against the family if the settlement were thrown out."
I understand your point, but basically they are saying: "We hid all our assets to evade the law. Give us immunity from criminal money laundering evasion and we will only pay part of what we likely would have owed."
Can you imagine a member of Congress or the President saying this? Forgoing immunity is a scorched earth tactic, but it is also one that will dissuade future abusers. We have those overseas money reporting laws that make it difficult for Americans to get bank accounts overseas. Let's use them!
> "We hid all our assets to evade the law. Give us immunity from criminal money laundering evasion and we will only pay part of what we likely would have owed."
> Can you imagine a member of Congress or the President saying this?
Well, we haven't gotten to that part just yet. Right now, we're still in the stage of deny deny deny even in the face of evidence and convictions. They are still in the deny stage.
It generally demands deterrence. Helping the victims out is great, and the proceedings should do that as best they can, but the largest benefit that can be brought to society as a whole is showing that doing these kinds of things will be bad for you.
That's basically the argument made in the dissenting opinion. I find the split among the justices here very interesting as it is not along party lines, as such splits usually are.
> Can you imagine a member of Congress or the President saying this?
definitely. The 2012 STOCK Act is routinely violated by members of congress who insider trade on information from congressional committees before laws are enacted. that money the openly argued about the legitimacy of in congress and Pelosi, for one, and Tommy Tuberville, for another argued that it should be allowed. Pelosi later changed her stance, but continues insider trading. you can find datasets for all this at (no relation...just interesting data) https://quiverquant.com
> "We hid all our assets to evade the law. Give us immunity from criminal money laundering evasion and we will only pay part of what we likely would have owed."
> We have those overseas money reporting laws that make it difficult for Americans to get bank accounts overseas. Let's use them!
This is conflating two things.
It is not criminal to move money offshore, and nothing suggested any money laundering occurred, because it is not necessary to launder money to move it offshore. And it is also not money laundering to obfuscate money's origin or destination. Money laundering requires a criminal origin and then obfuscation.
Despite how much the US has convinced its entire culture to stigmatize the concept of moving money, the US is operating in its own bubble of hubris to suggest money has to stay within its ecosystem. It doesn't make any sense at all when you say it out loud does it?
To your second point, the US has reporting laws on money held offshore legally, for US citizens. For banks, this is merely an additional compliance burden that disincentivizes them from dealing with small accounts because its not worth it. But at Sackler money, it is worth it. It is not hard to find someone to bank you as an American. And at Sackler levels of money you don't have to remain a US citizen, hence absolving the reporting requirements if they went that direction.
Or when you have a second citizenship, you can just not tell the US about it, and you can just not tell the foreign bank about your US citizenship. Prosecute that on its own, if you find out.
and finally, there are gaps in this reporting framework. FATCA treaty was a broad expansion of a country's power, to the limit of our global society in the continuum of history. And its not completely as omnipresent as the American psyche imagined. Just like the global sanctions attempt on Russia showed, its a nice try but now everyone can see how much is hubris in plain sight.
> And at Sackler levels of money you don't have to remain a US citizen, hence absolving the reporting requirements if they went that direction.
Renouncing your citizenship because you owe the US government money is generally not seen as a valid reason by the US government to renounce your citizenship.
Nor should it be. These people are leeches whose very existence is antithetical to a healthy and just society. They've done immeasurable damage and then hide behind the courts to avoid any repercussions. Disgusting, the lot of them.
> and you can just not tell the foreign bank about your US citizenship
Holding foreign assets that you did not report on an FBAR is a crime. Lying about it to the bank that asks if you are a US citizen wod be obfuscation to support a crime. I'm not sure why you are trying to argue that nothing criminal is being done in these scenarios.
Considering the patience the US has with getting justice against other individuals who have fled our jurisdiction, we could do the same here. We also have an enormous amount of influence in the financial sector in other western nations, so we could at least make their lives less lavish and comfortable.
Throwing up our hands and declaring it an unsolvable issue just encourages others to misbehave and then escape the same way.
Nit: the assets were frozen, not seized. There was recently hand wringing in the EU over using the principle or interest to fund Ukraine, and they settled on interest because seizing assets scares any foreign investors who might someday disagree with a government.
The question is whether to allow a smaller settlement immediately, or pursue a less-likely and possibly larger set of judgements in the future. It's not clear that it is possible to get more money out of them.
The EPA values one human life at $10M. A conservative estimate of the number of people killed by the Sackler family's companies (testified in court) was ~~245,000~~ Edit: probably at least 100,000, see below. So if opiates were environmental pollutants, the Sacklers would be on the hook for $1T in damages. Their immediate settlement was $6B.
The number of opioid overdoses between 1999 and 2021 was 645,000, according to CDC. Purdue Pharma brought in $35B in OxyContin revenue from 1995 to 2017. OxyContin was prescribed to 6.2 million people in 2002.
I'll edit the number above to ~100,000 as an estimate of the number of victims, since it looks like I misremembered 645,000 as the number of Purdue-related deaths. Still, that's assuming only 1.6% of those 6.2 million people taking OxyContin in 2002 developed an addiction, which seems low.
Come to think of it, it's mind blowing when you compare the slap on the wrist of a punishment the Sacklers have received against what Julian Assange had to endure. One is responsible for the deaths of more than half a million people while the other is responsible for zero. The justice system really needs to get its shit together.
The US are proud of getting some terrorist in the middle of Pakistan or putting pressure on whistleblowers internationally but when big money is involved getting a criminal scumbag responsible for ~1m deaths is suddenly a huge problem.
Matt Levine has covered this several times in the past, worth reading. From memory, the Purdue family had put away their money in legally sheltered arrangements, so even an unfavorable decision (to the Sacklers) would likely not be able to claw back much money. The previous deal traded the risk of trial for a perceived as decent compensation. My read is that the majority in the supreme court disagreed that you can always financial-engineer your way out of trials
They were (apparently) sheltering money specifically to pay for personal legal damages, and they voluntarily offered it back during the bankruptcy proceedings in exchange for giving up their liability.
The court ruling is not about the legality of their financial shenanigans, but the authority of the bankruptcy court on deciding such matters.
Lawyers are fixated on the money for obvious reasons, but the money will never really fix what the Sacklers did (particularly for the many victims who are now dead.) Restitution is largely a farce and we should be focusing on retribution.
I'm really not sure what other retribution you're suggesting. There's always public lynching if that's what you're after, but we've kind of decided that is not a good idea in modern society
Because car manufacturers exist, and this isn't theoretical or a jab at cars themselves. We are 100% certain that people will die while using cars, and by cars. Vehicular manslaughter even has a high bar for real punishment precisely because driving a car has an inherent risk of killing others and that risk is legal to take on.
Knowing that some people using your product will die, and even that selling more of your product increases the deaths is something we're okay with. It's true of guns, red meat, skateboards, alcohol, lawn mowers, and industrial equipment — all sold for profit.
I very much dislike cases like this because while yes, opioids were overprescribed and Purdue sales people did go out and sell often times not in legal ways, doctors still prescribed them and we knew that people dying was necessarily an outcome. So while the crime they actually committed was about kickbacks, not doing the DEAs job enough for them, and lying with statistics they get blamed for the actual deaths which is silly. I take stimulants that double my risk of heart attack and are also known to be addictive, neither outcome is the maker's fault if those happen. It's the tobacco settlement all over again where when bad thing happens the proximate deepest pockets get blamed. I couldn't care less about the government taking money from rich people because reasons, have at it, but I think they're the scapegoat.
Except Purdue clearly stated that addiction was not an issue with their product. Car manufactures never say that death is no longer possible with their product. They blatantly misrepresented the dangers of their product in ways none of the other examples you listed come close.
They didn't though, they cited a medical journal article where an unaffiliated doctor reported the extremely low addiction rate. Which was true and misleading because short term opioid use addiction rates don't predict long term addiction rates — lying with statistics. And they should be charged and convicted for this, in fact they already were. However, since 2001 every bottle of oxy has made no claim that it's less addictive than other opioids. And we still prescribed them like candy.
I understand people who think the Sacklers are villains who destroyed lives, Purdue should be shut down, and we should transform the legal regime around opioids.
I understand people who think Purdue should continue, the status quo is OK, and the Sacklers are not [simply] villainous.
I don't understand people who think the Sacklers are villains who destroyed lives, but Purdue should continue operating more-or-less as-is. Which is, I think, the conclusion from this settlement. If this is you, can you help me understand? Do you think there is/was a realistic way to prescribe opioids routinely and safely?
I think there's a misunderstanding in what the settlement is about. As part of Purdue's bankruptcy, the Sackler family is voluntarily providing 6 billion dollars to help settle claims opioid victims have brought against Purdue Pharma.
As a condition to provide the 6 billion dollars, the Sackler family has asked the bankruptcy judge to not even allow any new suits against the Sacklers related to the Opioid epidemic. This is something bankruptcy courts do regular for the company Purdue Pharma, but it is irregular when it comes to the Sackler family (this is not the entity going bankrupt!)
This is the issue that went up to the Supreme Court, and the Supreme Court ruled that the protection given to the Sackler family is not something that can be given by a bankruptcy judge during the bankruptcy of Purdue Pharma.
To try to illustrate the (bad) principle with a starker hypothetical:
1. Scrooge McDuck owns a thousand different corporations that are restaurants and eateries.
2. A one-taco-stand company is in bankruptcy court, after recklessly inflicting severe food-poisoning on a dozen customers.
3. Scrooge McDuck says: "Out of the goodness of my heart, I will charitably donate $X of my personal funds to help these poor unfortunates... If you give me personal immunity to any lawsuits somehow involving recent food-poisoning problems anywhere."
4. The dozen hospitalized taco-eaters are puzzled but OK with this, since they'll at least get something. The judge shrugs and things move forward.
5. Meanwhile a million other customers of other restaurants see the news on their phones, which they have out because they're stuck on their toilets with raging diarrhea. Plus maybe a few whistleblowers that can't get work anywhere because Scrooge blacklisted them.
6. All of them are justifiably outraged that their rights to seek justice/compensation have been (partly) signed-away in the bankruptcy of some unrelated tiny taco stand case that they didn't--couldn't--participate in.
I don't understand why your analogy requires multiple taco trucks. So if I'm missing something please explain.
Otherwise, I find your analogy helpful and illustrative of my confusion. Here is the simplified analogy:
1. Scrooge owns a nasty taco truck that makes everyone sick. He runs to the bahamas and is gone.
2. A dozen customers take it to bankruptcy court and get ownership of the taco truck and Scrooge's "charitable" donation, but Scrooge would get immunity, and so would the taco truck.
3. Meanwhile, the victims that weren't in the settlement are outraged that Scrooge might be immune. Not everyone was a part of the first suit -- plus, the taco truck is still selling tacos, and people are still getting sick!
This illustrates my confusion.
To me it seems like we should shut down the taco truck, and not give it immunity. I'm kind of a utilitarian and I don't much care about Scrooge, though I wish I could take his money away and put him in jail.
But it seems like most of the people who are mad about the diarrhea are not talking about the taco truck's continued operations and immunity??? And they are chiefly concerned about Scrooge, who is no longer involved with the taco truck??? What gives?
Trucks? The lawsuit involves one discrete corporation, and its small size is underscored by how it's just one stand/kiosk. (I suppose it could be mobile, but that's not what I was thinking of.)
However same owner/investor happens to be involved in many un-enumerated companies, some of which might easily be guilty of the same problems, including ones that would normally "pierce the corporate veil" and affect investors directly.
> but Scrooge would get immunity, and so would the taco truck.
The taco-stand corporation isn't immune, it's going bankrupt paying judgements. CEO/Owner Scrooge is coming in from the sidelines to preempt a personal lawsuit, and also trying to get someone in authority to (wrongly) grant him immunity from other potential lawsuits from other claimants.
> plus, the taco truck is still selling tacos
Oh, I think I see: No, this isn't a duck-ified version of the entire national controversy, I'm just trying to illustrate the how an "immunity" grant can be bogus.
In other words, the taco-stand is not a 1:1 analogy placeholder for Purdue Pharma, you can assume it's been bankrupted into Chapter 7 and broken up and sold off.
Matt Levine is a treasure. He is tied only with Derek Lowe for being a fantastic writer who makes complex topics understandable, interesting, and enjoyable.
My question is not about the settlement; it's a question about moral judgements people have around Sacklers/Purdue, including judgements I see on this comment page. I already understand the mechanical details you've explained and they don't answer my question.
>I don't understand people who think the Sacklers are villains who destroyed lives, but Purdue should continue operating more-or-less as-is. Which is, I think, the conclusion from this settlement. If this is you, can you help me understand? Do you think there is/was a realistic way to prescribe opioids routinely and safely?
As GP noted, that is not the conclusion of the settlement - not even close. If you want to better understand comments on this page, perhaps reply to them asking for clarity?
Yes of course there are realistic ways to prescribe opioids routine and safely. Purdue did not invent opioids, what they did is patent a particularly strong formulation, and then work to undermine the cultural taboo in medicine around their use. That last thing was their crime.
There isn't, at this time, any other way to treat serious pain (in all cases). Opioid prescriptions will continue to be an unfortunately necessary feature of our medical system until we invent painkillers strong/good enough to replace them. I say this as someone who was personally addicted to opioids in general and Oxycontin in particular and feel very lucky to have only one dead friend as a result.
Opioids can't be banned until we can replace them with something equally generally effective. But what we should do is reinstate the taboo around prescribing them, and probably stop offering take home fentanyl prescriptions at all (it's still useful for anaesthesia, in hospitals). Perhaps more importantly, I think the cat is kind of out of the bag on prescriptions. I haven't been around that world for a long time, but it seems to me like pharmaceuticals aren't the primary entrypoint to opioid addiction anymore - people just start with fentanyl.
Dealing with fentanyl seems to me to be basically impossible. One kilogram of pure fentanyl is ~2,000,000 doses, for someone without a tolerance. This is impossible to interdict at the border. It is also fully synthetic, with no great choke point on synthesis routes. I have heard that there are other, even more dangerous, compounds like https://en.wikipedia.org/wiki/Etonitazene that are also even easier to synthesize. I don't really know if there is a good way out of this other than doing the slightly less impossible thing, which is curing addiction.
Thank you for the reply! I am honestly not informed about this stuff and not asking to covertly push an agenda.
Follow-up Q for you. What is the realistic way to prescribe opioids routinely and safely? Are there certain formulations that have been or should be removed from the market? How do we reinstate the taboo on prescribing them?
For EG: I got a vasectomy recently and was told to expect a day or two of pain. I was prescribed a month's supply of opioids without a single comment from the doctor on their addictive nature. My understanding is that this is how people get introduced to opioids; the pathway goes "legal scrip -> addiction -> illegal supply -> fentanyl -> death" and that's the engine of the epidemic.
Should it be legal for the doctor to prescribe pain meds like this? (Or, should it be legal but discouraged? Is there a well-understood way to do this?) If it should be legal, should we expect the epidemic to continue? And if so, is post-bankruptcy Purdue a good thing or a bad thing?
(My instinctive answers here are that we should make opioids illegal for much of their current use pattern, and that post-bankruptcy Purdue is approximately as gross as Sackler-era Purdue, for what it's worth.)
> I was prescribed a month's supply of opioids without a single comment from the doctor on their addictive nature.
Is this really what the question was about? Reflections on a personal experience? Those are perfectly valid concerns. Nobody is stopping you from asking any of the professionals you interacted with about addiction, if you are worried, go and ask!
Correcting in the other direction is way worse. I had a huge surgery last year in Germany and 8 days later when released from the hospital, bones still not yet fused, I was given no industrial-grade painkillers whatsoever.
I had to cop on the black market to keep from going insane from insomnia and screaming, until I could check myself into an inpatient clinic that would dispense them legally.
There is more harm in making them difficult to get.
I just wonder why random people would know better about this than your highly educated providers. Go ahead and ask. You can say those exact words. They will give better answers!
If you want a poll, this court case was a poll. A majority of victims who had ample time to participate in litigation agreed to the settlement terms. They told you that addiction is bad, the new Purdue would help, and that money from its owners was sufficient justice. That some agitator basically played the Yogg-Sauron of this meta, the Supreme Court, and cast 5 fireballs against his opponent versus 4 fireballs on himself, isn't super material to the seeming success of the hard political work of this bankruptcy judge.
Oxycontin was, and still is, a prescription drug. I'm not sure if you're aware, but at least in the United States (where this court judgment was), it is doctors that write prescriptions. Listening to them is how the first opioid crisis happened. McKinsey dangled some shiny slides in front of Purdue, Purdue dangled them in front of doctors, and then doctors prescribed them en masse. This has, arguably, not gone well.
> I just wonder why random people would know better about this than your highly educated providers. Go ahead and ask. You can say those exact words. They will give better answers!
Are you sure they'll give "better answers" when they're the ones prescribing like that?
its easier to ask random people from home then go to a provider when I have no such problem or need to physically introduce myself to a highly educated provider. it's like a google search.
What I wonder is why someone like you wouldn't know this?
My question is specifically about the judgements that uninvolved people have formed. I can't learn about this from my doctor, or from the victims' decision in the context of a highly-constrained kabuki dance.
It seems most commenters here are fine with a settlement that clears Purdue to sell opioids (for the benefit of victims), but not with a settlement that lets the Sacklers off with a fine. That is exactly the opposite of my moral intuitions. What gives?
> Follow-up Q for you. What is the realistic way to prescribe opioids routinely and safely?
The simple answer is "less and with better monitoring". The first half of that was the equilibrium that Purdue intentionally shifted in the medical establishment. The cascading effects of that are what caused the modern day opioid crisis. Unfortunately, the modern-day opioid crisis as I understand it is mostly no longer related to pharmaceutical availability. So, while we should improve and lock down that supply chain route, unfortunately I don't expect it to make a large dent in the overall problem.
> Are there certain formulations that have been or should be removed from the market?
Take-home fentanyl is probably unnecessary, but again, I wouldn't really expect this to be a silver bullet. The DEA/FDA has gotten much tighter on their prescribing rules for powerful opioids, but their doing so has largely coincided with the expansion of the illegal heroin, and then fentanyl markets. It is now too late to fix by choking off supply, because the market has mostly moved outside of the regulatory regime (though we should still do that, to the extent we can).
> How do we reinstate the taboo on prescribing them?
These answers keep getting worse but we largely already have. We could probably do more, but if you are an MD and you are not "opioids are dangerous actually"-pilled, I think you need to go back to medical school. There was a short period in the mid 2000s where doctors were convinced otherwise by Purdue among others. Doctors who "think otherwise" today are almost without exception just outright criminals.
> For EG: I got a vasectomy recently and was told to expect a day or two of pain. I was prescribed a month's supply of opioids without a single comment from the doctor on their addictive nature. My understanding is that this is how people get introduced to opioids; the pathway goes "legal scrip -> addiction -> illegal supply -> fentanyl -> death" and that's the engine of the epidemic.
Overprescription like that (which that definitely is) is bad and unfortunately common. It's hard to say exactly how much addiction is caused by that variety, though. Most serious opioid addictions that I am aware of didn't get that way from a one time moderate overprescription of things like Vicodin or Percocet. It is possible to get "mildly" addicted from a month's supply of that and when you run out you might have a slightly unpleasant day or two, but not worse than that. If the illicit market wasn't there, that 30 day supply would be the end of any binge, and that would be "mostly fine", as such. That is not an endorsement or to say that it is at all a safe thing to do, but the risk comes primarily from not wanting to quit when you run out, and having other options available.
Two things changed with the introduction of Oxycontin:
1. It started being prescribed for chronic, not acute pain. This meant that people had permanent, ongoing prescriptions for them. Which meant that people built up a very large tolerance, which led to..
2. Oxycontin is pure oxycodone, it is not formulated with an NSAID (like Percocet is). The presence of an NSAID limits the amount you can take before you get sick, and prevents you from (straightforwardly) consuming it via non-oral routes of administration, which is exponentially more addictive.
> Should it be legal for the doctor to prescribe pain meds like this? (Or, should it be legal but discouraged? Is there a well-understood way to do this?) If it should be legal, should we expect the epidemic to continue? And if so, is post-bankruptcy Purdue a good thing or a bad thing?
Legal but discouraged, definitely. They are an important tool in the treatment of acute pain. They can, more rarely, be an important tool in the treatment of chronic pain (cancer / chemotherapy being a good example of a sufficiently serious condition). And finally, they are absolutely worthwhile for palliative care. For these reasons and what is now the magnitude of the illicit market, I don't think there is a lot of value in a total restriction.
Nah, a friend and colleague needed fentanyl lollipops at one point. You'd be at lunch and he's like "Oh I can't eat food, they had to remove my entire stomach" sucking on the lollipop, and he'd calmly explain that you mustn't touch his weird lollipop because while he can suck on it for a normal person the dose from doing so would be fatal, he'd just used so many strong painkillers for so long that it was now necessary because the painkillers they give regular people did nothing.
Weaned himself off eventually too. Amazing willpower, probably related to why he's not dead.
Fentanyl lollipops/patches are useful in rare circumstances where someone can't swallow pills for some reason, like this one. There are other ways of achieving similar effects but its possible fentanyl is the best way to go in this situation. It is a fairly rare situation though.
I don't know if it is genetic, a side effect of chronic or acute pain, or just plain luck but I've seen family wind up not addicted at all despite heavier doses. If it is genetic it might be linked to not finding painkillers enjoyable at all.
I know from my wisdom teeth removal getting a few days of oxycontin while it helped with the pain it mostly made me feel weak not only while taking it but for about a week or so after discontinuing it. And this is from someone with a low pain tolerance.
> Opioids can't be banned until we can replace them with something equally generally effective.
Opioids should not be banned
Opioid addiction (I have seen a lot of it, not had it) is a social problem and is best managed with, opioids
The problems stem from putting unreasonable obstacles between adicts amd their appropriate treatment. Practical legal and financial obstacles, sadistic legal obstacles, and bizarre moral obstacles
Great Britain for many y4ars managed Opioid addiction with opioids, principally methadone and heroin
Nineteenth century society managed it with laudinum
We westerners in the twenty first century are failing to manage it with cruelty
The Sacklers are, were, parasites profiting from that social malaise and bad things will finally happen to them. But the cause of the malaise is our irrational attitude to drugs
> Opioid addiction (I have seen a lot of it, not had it) is a social problem and is best managed with, opioids
I don't entirely disagree with you, but I have also seen enough people stop, who probably wouldn't have if that were the typical treatment, to be pretty cautious about that. There are a number of promising addiction treatments in the wings at the moment, in particular Ozempic and the general GLP-1 agonist class.
Transitional opioids like Buprenorphine are fine as a detox strategy, and maybe even fine for the medium term, but committing to them for life I think is a mistake (in most cases).
> The problems stem from putting unreasonable obstacles between adicts amd their appropriate treatment. Practical legal and financial obstacles, sadistic legal obstacles, and bizarre moral obstacles
There is a lot of truth to this. It is, in fact, what I used to say when I used them. And it is and remains true. It is also true that prolonged opioid use is mostly physiologically harmless (overdoses notwithstanding). However, there are psychological elements that come with long term use that these measures do not capture, and are not fully internalized by the transaction costs (or literal costs) associated with obtaining them.
> Nineteenth century society managed it with laudinum
Ask China why they fought that opium war, and how they feel about such things lately. They are still mad about it.
> The Sacklers are, were, parasites profiting from that social malaise and bad things will finally happen to them. But the cause of the malaise is our irrational attitude to drugs
Agree on the Sacklers although personally I'd place more blame on the McKinsey consultants that wrote the original deck that proposed the strategy. I don't know how much the Sackler individuals personally made these decisions, but those people certainly did.
Re: irrational attitudes to drugs, I agree, but the situation is substantially more nuanced than it might superficially appear. Laudanum did used to be over the counter, as did cocaine among other things. However, these things were not criminalized for no reason - heroin wasn't criminalized in the 60s/70s anti-hippie craze, or for racist reasons in the 1930s (like marijuana).
Heroin was first criminalized for over the counter sale in 1910 - 15 years after Bayer first marketed it. Easily the fastest criminalization of a novel pharmaceutical compound in the history of the world. This is not an accident or a product of some temporary social hysteria. And unfortunately, it was also not criminalized because all of its harms were due to its being illegal.
If criminality were the problem we would expect things to get better, not worse, with the introduction of fentanyl which is far cheaper and more readily available. I could be misreading the data, but that does not seem to be working out.
> Ask China why they fought that opium war, and how they feel about such things lately. They are still mad about it.
Was this meant to be ironic? Most of the illicit fent precursors comes from China now, I would guess it’s only a matter of time until Chinese producers look inward rather than just at export, which is why I’m surprised the Chinese government isn’t taking a harder line stance on illicit fent production and export.
I'll quibble on two points. "used as a wedge issue by foreigners", while perhaps true in some moral sense, it does not really make much sense, on closer scrutiny. To reduce things down to being some foreign imposition is to suggest that it could have been any product. But it couldn't - only opium has the special properties necessary to become this kind of product. Nobody fought a war over tobacco, or even cocaine.
It is also true that Arabia, and even the ancient Greeks ('land of the lotus eaters') were aware of and could obtain Opium. However, I'd inquire as to how it is that the primary opium growing regions of Arabia are doing lately, or say, ever.
It is true that Opium has been available to varying degrees, at various times, in various places without a total social breakdown. However, widespread, sustained, cheap availability of pure Opium without total social breakdown is, as far as I know, unheard of. The over the counter stuff in Europe and the early US were mixed with other things, as in Laudanum. Almost all of high society at the time was addicted anyway, and this was the mild form.
The Chinese discovered that they could smoke it, and changing ROA from oral to smoking is a radical step change in addictiveness. I'm not entirely sure why this didn't catch on elsewhere at the time, but the fact of the matter is it didn't, and the difference between these things is a difference in kind, not degree.
> It is not a choice between continued sadism or free reign herion and cocaine dealing
I hope you're right! But I don't observe anything in the world that would support it, unfortunately. I quit because I was arrested, for instance. I want to be careful about causal meaning here, I didn't stay off because I was arrested, but it was the excipient that proximately caused and also facilitated it. It was a structural break that allowed other things to change around it.
That's not to say that the judicial system is a good way to deal with things - it's not. But the credible threat of the judicial system cannot really be done away with here without courting disaster. When dealing with highly physically addictive substances, shaping short term behavior by force is often a necessary ingredient in having any hope of shaping medium or long term behavior via therapy, life circumstance changes, or anything else.
Causality is hard to tease out here, but more importantly, all they're doing is decriminalizing it and offering methadone/buprenorphine maintenance treatments. And the effect on number of addicts has not been good:
> Coca in Bolivia (I am on thin ice, I know too little, but they elected a coca grower as president)
Coca is really not anything. If you've ever chewed coca leaves, they're mildly stimulating. They're nothing like cocaine.
> I think there is plenty of evidence that a considered thoughtful approach to drugs is better
Considered, thoughtful approaches are always better! The question is, what are you considering and being thoughtful about. And the fact of the matter is that the most drug-liberal cities in the US have the worst drug problems, and so do the most drug liberal countries (like Portugal).
The countries that have the fewest problems with addiction are the harshest: Singapore, China, Japan. These things are not an accident. I'm not necessarily advocating adopting policies that harsh, just pointing out that they do actually work, whereas the liberal policies fail disastrously everywhere they're implemented. I'm in favor of criminalization, but only as a tool to force people into deferral/treatment programs. I don't want to see anyone actually put in jail for using drugs, unless they fail to complete their deferral program.
“Opioids can't be banned until we can replace them with something equally generally effective.”
If only doctors took this advice! When the CDC made its first recommendation against using opioids there was a chilling effect and thousands of chronic pain patients who desperately in need of opioids to function were cut off. There were suicides.
It wasn’t until 2022 that the CDC loosened its recommendations and, in my experience, only a few doctors have caught up.
I could not agree more. Fentanyl enforcement is obviously not feasible to anyone that has been, or known, an addict. Its incredibly cheap to buy, and you can store enough to kill 1000 people in a bag in your pocket.
You might as well have cops trying to arrest the pollen in the air.
Taboos are bullshit. Either something is a clearly articulated, written, rule with an enforcement mechanism, or it's fair game.
Prescribing doctors are responsible for the opioid epidemic. Doctors failed in their duty of care to patients. Doctors massively overprescribed, failed to track their patient's medication usage, and failed to spot addictive behaviour. Why aren't we holding them responsible? Simply because that's hard to do?
Purdue aggressively marketed OxyContin as having a very small rate of addiction to doctors who weren't pain specialists and thus had little experience with controlled medications, while providing a dosing regime that was almost designed to cause addiction. (It's sole advantage was as a timed-release medication; if pain returned before time for the next dose, doctors were instructed (strongly) to raise the dosage rather than increase the number of doses per day.)
> . (It's sole advantage was as a timed-release medication; if pain returned before time for the next dose, doctors were instructed (strongly) to raise the dosage rather than increase the number of doses per day.)
The same thing happens with ADHD medications, the timed release dosages are supposed to last 12+ hours, but in reality they vary from 8 to 16.
Thankfully most doctors will willingly prescribe a small after lunch short acting dose.
There is a large delta between the average response curve and an individual's response curve!
> The same thing happens with ADHD medications, the timed release dosages are supposed to last 12+ hours, but in reality they vary from 8 to 16.
Modern ADHD meds are really not comparable to powerful opioids. They are both dopaminergic, but they are night and day in terms of addictiveness. Even weak opioids vs strong opioids is night and day.
> There is a large delta between the average response curve and an individual's response curve!
True! But the word "average" is actually not, itself, precise. It has at least three typical meanings: mean, median, mode. These all have quite large deltas to each other when talking about dose-response curves, and since they are curves, you would also have to pick a norm first.
There are a lot of sources of variability, but variation does not actually make it very difficult to detect improper opioid prescribing behavior. Just like the variation in people's weights would not tell you much about the strength of asphalt roads. These things are not measured in the same scale.
The majority of the pharmaceutical problem came from a very small number of people who churned out prescriptions like a literal mill. Like 5 minute appointments all day every day - not random doctors overprescribing their patients by accident. What is true is that the random doctors overprescribing provided a certain amount of cover for the corrupt doctors, for a while.
> Modern ADHD meds are really not comparable to powerful opioids. They are both dopaminergic, but they are night and day in terms of addictiveness. Even weak opioids vs strong opioids is night and day.
True, my point more was that false advertising about "duration of extended release action" is a problem across multiple types of prescription drugs.
> True! But the word "average" is actually not, itself, precise. It has at least three typical meanings: mean, median, mode. These all have quite large deltas to each other when talking about dose-response curves, and since they are curves, you would also have to pick a norm first.
The marketing material doesn't care. "All day", "24 hour", "12 hour" are the phrases that get used.
Meanwhile reality is that every person who takes a drug is different and doctors need to be aware of this and just ask the patient how well things are working out.
> The majority of the pharmaceutical problem came from a very small number of people who churned out prescriptions like a literal mill. Like 5 minute appointments all day every day - not random doctors overprescribing their patients by accident. What is true is that the random doctors overprescribing provided a certain amount of cover for the corrupt doctors, for a while.
Yeah it got out of hand, but I'd imagine that this wasn't happening from day 1.
Also when we talk about preventative measures, people going to a pill mill doctors to get a refill are already addicted, but what can have a long term impact is putting in the effort to prevent people from becoming addicted in the first place, which means understanding how so many people who did not want to get addicted to opioids ended up that way.
> Also when we talk about preventative measures, people going to a pill mill doctors to get a refill are already addicted, but what can have a long term impact is putting in the effort to prevent people from becoming addicted in the first place, which means understanding how so many people who did not want to get addicted to opioids ended up that way.
This has changed over time. At first it was the pharmaceutical route, largely due to the shift in medical norms to prescribe opioids for chronic, not just acute, pain. Prescribing them for chronic pain is a near guaranteed recipe for addiction. However, I think things have changed in the past decade or so, with people largely moving straight to fentanyl and/or other illicit opioids. I don't think the pipeline is largely pharmaceutical in nature anymore.
Blindly listening to a company trying to sell you something has never been a good idea. Doctors doing just that despite the clear, obvious, conflict of interest is their failure, not Purdue's.
Thinking that an individual or organization with a vested interest will not bullshit you at every turn is absurdly naive. This is why third-party testing, accreditation, certification, and audits are a thing.
> doctors who weren't pain specialists
Then they should have insisted on third party, board approved, usage guidelines; especially when it became obvious that OxyContin is highly addictive. It doesn't take that long. Doctors have not however been held responsible for their abject failure towards their patients, and continue to prescribe a month's worth of Oxy for minor issues. This will continue until doctors start losing their licenses.
Everyone in every industry that I know about relies on true information from their suppliers, from software to produce. They're the ones who know about the products, after all. In fact, pharmaceuticals are the one industry most likely to treat suppliers at adversaries, with FDA regulations continually attacked as too stringent.
Purdue was actively lying about their drugs.
"Purdue trained its sales representatives to carry the message that the risk of addiction was “less than one percent.”50(p99) The company cited studies by Porter and Jick,51 who found iatrogenic addiction in only 4 of 11 882 patients using opioids and by Perry and Heidrich,52 who found no addiction among 10 000 burn patients treated with opioids. Both of these studies, although shedding some light on the risk of addiction for acute pain, do not help establish the risk of iatrogenic addiction when opioids are used daily for a prolonged time in treating chronic pain. There are a number of studies, however, that demonstrate that in the treatment of chronic non–cancer-related pain with opioids, there is a high incidence of prescription drug abuse. Prescription drug abuse in a substantial minority of chronic-pain patients has been demonstrated in studies by Fishbain et al. (3%–18% of patients),53 Hoffman et al. (23%),54 Kouyanou et al. (12%),55 Chabal et al. (34%),56 Katz et al. (43%),57 Reid et al. (24%–31%),58 and Michna et al. (45%).59 A recent literature review showed that the prevalence of addiction in patients with long-term opioid treatment for chronic non–cancer-related pain varied from 0% to 50%, depending on the criteria used and the subpopulation studied.60"
"Purdue has known about the problem for decades. Even before OxyContin went on the market, clinical trials showed many patients weren’t getting 12 hours of relief. Since the drug’s debut in 1996, the company has been confronted with additional evidence, including complaints from doctors, reports from its own sales reps and independent research.
"When many doctors began prescribing OxyContin at shorter intervals in the late 1990s, Purdue executives mobilized hundreds of sales reps to “refocus” physicians on 12-hour dosing. Anything shorter “needs to be nipped in the bud. NOW!!” one manager wrote to her staff."
From what I've seen (women sent home days after a c-section with Ibuprofen as the only pain medication; all of the doctors near me displaying signs saying they will not treat chronic pain), pain medication may well be under-prescribed at this point.
> Prescribing doctors are responsible for the opioid epidemic. Doctors failed in their duty of care to patients. Doctors failed to track their patient's medication usage, and failed to spot addictive behaviour. Why aren't we holding them responsible? Simply because that's hard to do?
This is a nice idea, but most Oxycontin is not prescribed by someone's doctor (it is prescribed by a doctor, but it is power-law distributed, most of it is sold by dealers). There are a small number of doctors in the country at any given time that prescribe almost all of the supply. This is not something you can readily fix with responsibility at the doctor level. It may seem like you can, because you could just prosecute "those doctors", but the problem is that the incentives are too concentrated.
That isn't to absolve these individuals of responsibility. They are responsible, and we should prosecute them legally. The problem is that we already do and always have. We should keep doing it, but I don't expect it to fix anything.
EDIT: To be clear I'm not necessarily for or against this settlement. There was a time that we might have stopped the opioid crisis at the corporate or pharmaceutical level, but that time has long since past. We could criminalize all opioids tomorrow and it would make almost no difference. Most opioid addicts use fentanyl now, and most fentanyl is produced/sold illegally. Heroin, for instance, has been Schedule I forever - the only thing that reduced its popularity was a cheaper substitute in fentanyl.
If we are going to bother prosecuting or civilly charging Purdue or its principals, it would have to be for purely punitive reasons. Corporate behavior unfortunately does not matter anymore.
The on-ramp from minor pain or surgery; to a massive, blindly-renewed, over-prescription of Oxy; to an opioid addiction that spirals into street drugs is still mediated by doctors. Until these doctors start losing their licenses for their clear and obvious breaches in their duty of care, this on-ramp will remain open.
> a small number of doctors in the country at any given time that prescribe almost all of the supply
The fact that medical boards allow these doctors to retain their licenses is the core of the issue.
> we already do and always have
I am only aware of a handful of the most obvious, blatant, and egregious pill mill operators being prosecuted. Regular doctors who simply cannot be fucked to care for their patients, and prescribe them pills so they leave their office, have yet to be held accountable.
> The on-ramp from minor pain or surgery to a massive, blindly-renewed, over-prescription of Oxy to an opioid addiction that spirals into street drugs
This is mostly not a thing. I have known hundreds of current and former opioid addicts. I don't think I know a single one that was "on-ramped" from Vicodin or Percocet in any truly meaningful sense. It is the case that people almost always use these first. But it is relatively rare to become an opioid addict as the result of a one-off, acute vicodin prescription, per se.
> is still mediated by doctors. Until these doctors start losing their licenses for their clear and obvious breaches in their duty of care, this on-ramp will remain open.
I hope that is true! It doesn't seem like that to me, but I admit to not having carefully studied the data. Casually, there are 1.6 million opioid addictions currently in the US [1]. There were ~50,000 overdose deaths in 2019. That is, 1/1600 opioid addicts died in 2019 alone. To a first approximation, 0 people overdose annually from vicodin/percocet and other short term acute pain treatments.
It would be fairly surprising to me if (much) more than 1/1000 strong opioid users (per year) dies from an overdose. If the numbers were substantially higher than this, the epidemic would burn itself out in the population rather quickly. We can infer from this that most active opioid addicts are users of strong opioids, which are basically never prescribed for acute use. Hence, the overwhelming majority of current addicts are users of strong, non-acute opioids.
This doesn't mean there can't be some gateway effect (I do in fact think there is), but it does mean that "the problem" is mostly the presence of the strong opioids, not the Vicodin prescription for your wisdom teeth.
I'd be open to contrary data on the matter, though.
> The fact that medical boards allow these doctors to retain their licenses is the core of the issue
It is an issue, and we should absolutely try to improve it. It's just unlikely to materially dent the larger issue.
> I am only aware of a handful of the most obvious, blatant, and egregious pill mill operators being prosecuted. Regular doctors who simply cannot be fucked to care for their patients, and prescribe them pills so they leave their office, have yet to be held accountable.
I can personally attest to this being false. It was really quite annoying - I had to find new doctors on a number of occasions as a result, and that was ~15 years ago. Things have gotten much, much tighter on the pharmaceutical side since then. Every doctor who wrote me something was in prison
or dead (from suicide, in prison) within 2-3 years of the last time I saw them, and I didn't even turn them in.
It is true that at any given time the Oxycontin prescriptions are power-law distributed, with most of the scripts being written by a small number of doctors. But this is a little bit like looking at the profits in the high frequency trading industry, or the cartels in Mexico (not to morally equate these things). Yes, there are a small number of them and they seem to make a lot of excess profits, but that does not mean you can knock them off and change anything. Nature abhors a vacuum, as they say.
Taboos are part of how a society functions. Taboos can prevent the 'tragedy of the commons' in a way that rules and laws cannot. Think about it - people break the law all the time. They rarely break taboos.
Taboos are not simply undesirable things, they are rules which carry severe penalties if you break them. The difference is that rather than going through the effort of getting society on the same page and agreeing what is okay and what isn't, you instead leave ambiguity that harms the well meaning and benefits the malicious. If something is bad enough that it should be banned by an unwritten rule, it's bad enough to be banned by a written rule. If you aren't willing to ban something by law, then it ought to be permissible.
I am not a lawyer. I am from a legal family (three generations) and I understand jurisprudence
> you instead leave ambiguity that harms the well meaning and benefits the malicious.
Two points
1. Law advantages those with access, and often benefits the malicious and harms the good. Case in point: Drug law. Another is IP law
2. Law is not objective. The words that form it are in black and white, but there are courts and judges because the application of the law is subjective. The boundary cases are numerous and important
More generally....
> If something is bad enough that it should be banned by an unwritten rule, it's bad enough to be banned by a written rule.
Sotp, just stop! This is the idea that we must punish and scantion people into being good.
I think of things that are good (like treating drug addicts as ill, not criminal or imoral). I think not of "bans". They accomplish little.
Permissible, impermissible, these are blunt concepts that are not very useful. We can be, and should be, aspirational and collegial not judgemental and competitive
> Sotp, just stop! This is the idea that we must punish and scantion people into being good.
You're not understanding what this conversation is about. Taboos punish and sanction people into being good. We are in full agreement that this is undesirable. There are some things that should be banned, and if they should be banned, they should be banned explicitly. There are many other things that should not be banned, and if it should not be banned it should not be a taboo, which is a form of ban.
You give a perfect example for my argument - treating drug addiction as an illness that should be treated instead of a moral failure to be punished. Where drug use is a taboo, you can't treat it; eliminating the taboo and accepting that these are people in need of help is, in my and many other people's opinion, the correct course of action. Most would agree that making drug use legal but ostracizing drug users would be an absurd strategy.
Taboos are fundamentally about what is permissible and impermissible, there is no other framework in which to talk about them.
I would argue that fiduciary responsibility mandates that corporate leaders do everything right up to the legal boundary in pursuit of their shareholders interests. In fact profitably violating regulations would also be the right thing to do in this case. Certainly most shareholders seem to appoint executives that do exactly that.
Sociopaths and other dark triad types have been the driving force in unifying and leading people since prehistory. It takes exactly that kind of person to unite tribes of strangers in order to go conquer, subjugate, and murder your neighbours.
"Evil" is immaterial. Markets and society are ecosystems, and the optimal patterns of behaviour in ecosystems are as ruthless as they are predictable.
The ruling was only about whether or not a bankruptcy court has the legal authority to declare that the individual members of the Sackler family are immune to being sued directly, which is an agreed-upon condition of the bankruptcy settlement. SCOTUS ruled that it did not, so the settlement as it stands is dead.
Purdue is not going to be operating in any capacity regardless of this ruling (except as a bank account holding the settlement funds).
1) I don’t think this is an accurate read of the situation but others discuss that
2) a company is a set of processes and infrastructure, with some legal rights to employ people etc. The decisions of a driver of a car are the drivers fault not the cars. The car itself may be unsafe and should be adjusted if it’s possible. But there is no point in destroying the car if it has utility with different drivers and safety. Revenge isn’t a good reason to dismantle infrastructure. Revenge can only be taken on humans.
3) yes if you know people with chronic pain opioids are the difference between a full life and an early suicide. The consequence of all this is all opioid use is treated as potentially criminal by everyone involved from pharmacies to doctors to patients. This isn’t a feature this is a flaw. And the lack of legal opioid access is leading chronic sufferers into fentanyl from the street.
Loaning money at 8% interest to informed parties is OK. Loaning money at 200% interest to vulnerable people is usury and should be illegal. Where in the middle is the right line to draw, legally? Does the intent of the lender matter? Does it matter if the lender is intentionally trying to keep people uninformed and vulnerable? These are hard questions, but that doesn't change the basic facts at the extreme ends of the spectrum.
Clearly the Sacklers' behavior was in the realm of exploiting vulnerable people as much as possible in order to create a cycle of dependence. I think they're villains who destroyed lives. I don't think that means no pharmaceutical companies should be allowed to sell opioids, or that Purdue should be shut down for that reason. Clearly giving birthing women access to epidurals (fentanyl!) is OK. Clearly bribing doctors to over-prescribe addictive opioids to vulnerable people is villainous and should be illegal. It's a hard problem to find the exact right line in the middle, but it's a problem worth attempting. Obviously it involves a lot of regulatory oversight.
> Loaning money at 200% interest to vulnerable people is usury and should be illegal
Stop with the patronizing. Any transaction between consenting parties (backed by bankruptcy protection) should be allowed. We're all grown ups, let people make their own decisions.
Setting upper limits on interest rates simply makes it so that high-risk borrowers are unable to access credit. This harms those borrowers more than anyone else, by limiting their opportunities.
Regarding the Sacklers, they never prescribed any drugs to anyone. Doctors did. Why aren't we holding them responsible? It is doctors who have a duty of care to their patients, not pharmaceutical companies.
> Stop with the patronizing. Any transaction between consenting parties (backed by bankruptcy protection) should be allowed.
Any? Can I sell my kidney?
You are arguing an extreme minority opinion, consumer protection laws exist because it is not possible for an average consumer to understand all safety implications of vehicle design, house construction or a medical procedure.
> it is not possible for an average consumer to understand all safety implications of vehicle design
and that is why there is and must be independent regulation. The consumer doesn't need to understand vehicle design, they just need to understand safety _ratings_ that must be assessed via third parties (typically, a gov't institution).
So why did the FDA fail to assess the drug properly?
I don't see why not. Me saying you can't would imply that I have a stronger claim to your own kidney than you do. This is a pretty hard claim to substantiate. The majority can be, and often is, wrong.
> So I should be able to sell myself into slavery.
No, because that would imply that a person can own another person. Free, morally equal, people cannot own each other. It would also imply that present-you can obligate future-you in a way that fundamentally compromises future-you's freedom.
Present-you can however terminate his own existence, since present-you has the strongest claim on it.
Interactions must be consensual with the possibility to opt-out backed by bankruptcy protection. If you agree to donate your organs in return for compensation (presumably to your estate), but change your mind on the operating table, you should be perfectly entitled to do so. You may incur a bankruptcy protected obligation if you signed an agreement to that effect
Consent should be the fundamental principle guiding all interactions. It also conveniently precludes slavery.
> Interactions must be consensual with the possibility to opt-out backed by bankruptcy protection
So student loans, as they are not discharge able in bankruptcy, are a form of debt bondage / slavery?
Also in UK you have to pay to declare yourself bankrupt, which is also questionable.
Also you can’t back-out of an organ sale, you are under Anastasia and then you are dead. The idea that it’s better than still being alive seems morally myopic to me.
Student loans are not dischargeable by bankruptcy because an education is not an asset that can be seized and sold during the process. There should be (and are) pretty strict limits on how your wages can be garnished to repay this debt. However I do agree that student loans are a form of debt bondage, and are questionably ethical for that reason. I would much prefer student loans not be given special protection. That would at least help us stop subsidizing educations that do not lead to productive careers.
I would not be opposed to licensed professions (eg. doctors, lawyers) adopting policies that would revoke licenses for members defaulting on their student loans via bankruptcy. I don't imagine any intervention would be required for such policies to arise if the special status of student loans were to be reconsidered.
> Also you can’t back-out of an organ sale
Yes of course you can only back out up until the point you are rendered unconscious. You have to reconsider before then. The idea that "life" and "death" are somehow morally important states is what has been "hammered into us from a young age". Morality is a relationship between (free and equal) moral agents. The important concept is therefore agency and its expression via consent.
You have just spent four paragraphs outlining how it must be important to be able to backout of any agreement, how freedom is important, and now you propose semi-facist system!
> licensed professions (eg. doctors, lawyers) adopting policies that would revoke licenses for members defaulting on their student loans via bankruptcy.
Let's consider the meaning of this, and why it smells of fascism:
* An unrelated third party is recruited to use it's power to enforce government policy (if it's taxpayer money) or protect someone else's private investment. This is no longer an agreement between two parties, the loan is now backed by threat of force. The lender no longer has to ask themselves "well if we raise interest rate too much, people will default and we will suffer"
* The revoked license cannot be sold, like a house would be, it is of no use to the bank, the only effect is punitive and moral police
* If i am the doctor's employer, you have just inflicted loses upon me, to protect your investment that I have nothing to do with.
* If I am a customer or patient, and paid for a service, you have also inflicted loses upon me, it's now a crime for me to receive treatment from this doctor, despite the fact that they are qualified.
* It is affected by government policy and macroeconomics that even professional fund managers cannot predict, let alone an 18-year old student. You get high inflation due to war in Ukraine, and suddenly half of your doctors have their license revoked! Great result!
> an education is not an asset that can be seized and sold during the process
As any unsecured loan, you can take out a loan and spend it all on hookers and drugs.
I think this entire attitude is driven by the fact that in the English speaking west there is great contempt for the younger generation and they are okay to exploit. They are subject of derision and almost seen as sub-human. Why don't we treat pensioners this way, make them do some mandatory community service in the nursery to get their state pension! There would be riots in the streets!
There's no force here, and hence no fascism. Having your license revoked, while harmful to your career, is not violence. Professional licensing boards and private lenders are also free agents, and can come to any sort of agreements they please. I would oppose any government intervention, as I already mentioned.
I don't however agree with any laws that bar anyone from practicing their profession without a license. If all you can afford is to get your tooth extracted with a rusty tool by a street dentist (as is common for lower classes in places like India), there should be no law preventing that from happening. It represents a consensual exchange. Making it illegal harms exactly the people who cannot afford anything else.
> You can take out a loan and spend it all on hookers and drugs
Lenders don't typically offer unsecured loans, for exactly this reason.
> the younger generation
This has nothing to do with the younger generation. It stems from from a definition of liberty that rejects implicit obligation, and emphasizes consent. We are all born into this world with nothing, and all must negotiate with the people already here for everything.
> Why don't we treat pensioners this way
I would be all for entirely abolishing taxpayer-funded old age security, which represents a quarter of the federal budget in the US. There is no consent, nor any ability to opt-out of this mandatory insurance scheme. Preparing for your old age is an individual responsibility, not a collective one.
I like this analogy. How does it apply to the status quo of opioids? What rate of interest is the present-day Purdue business charging? This year I was prescribed 30 days of opioids for post-vasectomy use and guided to expect low-grade pain for 1-2 days. Is this like 8% interest or 200%? Does anyone here feel like they know the answers to these questions?
It seems to me like the emergent answer I get is that the old Purdue was charging 200% interest and the new Purdue is charging 8%. But why does anyone think that? It seems like the core doom loop (dumb opioid scrips -> addiction -> fentanyl) is still in place, from what I can tell.
> I don't understand people who think the Sacklers are villains who destroyed lives, but Purdue should continue operating more-or-less as-is. Which is, I think, the conclusion from this settlement. If this is you, can you help me understand? Do you think there is/was a realistic way to prescribe opioids routinely and safely?
This is an extremely easy answer that doesn’t require any details of the case.
The supreme court clarifies what the law is, not if the Sacklers are villains and if Purdue should continue.
So the people who think the the Sacklers are Villains and that Pursue should continue are people who believe the settlement is not legal and dont believe in legislating from the bench.
That's not the settlement. The settlement is that purdue pays 8+ bn and shuts down, but the sacklers are immune personally. The supreme court threw out that deal saying that the sacklers can't be given immunity as a part of the deal.
The settlement was not at all about Purdue operating as is. Purdue was going to be turned into a legal fund and treatment provider as part of the settlement agreement.
Under the bankruptcy settlement, Purdue will continue to sell opioids. The ownership will change (profits will be used to fund the causes you listed) but the operations will not. Right?
You know I can't actually find a lot of details about what the "new" Purdue was supposed to operate like - my understanding was that it was going to turn into a receivership under the court.
But that's kind of the weirdness of all of this - at no point was OxyContin itself banned or been made illegal.
The only way is if it is done without a profit driven system incentivizing their overprescription. But this requires a gigantic systemic overhaul of healthcare to a nationalized system. And there seems to be a lot of peer reviewed evidence in favor of such a system, and there seems to be broad popular support for such a system. Yet we never manage to get there. It's almost like there's a group of people who simultaneously benefit from its existence and have the capital to influence legislation in their favor. Feels almost undemocratic.
Here is a good resource on it [1]. My understanding is that Purdue pushed hard for marketing, including paying doctors to market for them. This paragraph sums up most of it.
> “Purdue admitted that it marketed and sold its dangerous opioid products to healthcare providers, even though it had reason to believe those providers were diverting them to abusers,” said Rachael A. Honig, First Assistant U.S. Attorney for the District of New Jersey. “The company lied to the Drug Enforcement Administration about steps it had taken to prevent such diversion, fraudulently increasing the amount of its products it was permitted to sell. Purdue also paid kickbacks to providers to encourage them to prescribe even more of its products.”
Is purdue solely at fault here? Absolutely not. Does it seem that Purdue likely knew what was happening, but put profits above public health? In my opinion, yes.
I understand the contents of the link; that judgement prompts my question rather than answering it.
The DOJ found that old Purdue's problem was illgal marketing, kickbacks, etc. I understand that as a legalistic thing.
But as far as human judgement goes: I thought the problem here was opioid addiction, which is continuing to rise in the "new Purdue" regime. We all think old Purdue should not have been doing the illegal stuff. But was the illegal stuff the real problem here? It seems like the "new Purdue" reforms are not affecting the growth of the opioid epidemic.
> I don't understand people who think the Sacklers are villains who destroyed lives, but Purdue should continue operating more-or-less as-is
I’ve got a friend that’s the same in Afghanistan - he thinks it was right to go in, and it was right to abandon it - which to me sounds like moral myopia. Surely it was either wrong to begin with, or you have to stick around.
Here's a way to help you understand. Let's say I gave you 1 million dollars to help you understand. Then would you understand? That's likely how other people started understanding the situation. Something along those lines. Something this obviously wrong, some sort of coercion or bribery or some other shady thing has got to be a part of it.
I understand there's fraud and bribes and such, but it seems to me that in the end it is doctors and the medical system, with a bit of help from government regulators, that decide prescriptions, dosages, limitations and such. Purdue could have been making pure poison, but they don't prescribe anything.
Is it fraud if the pharmaceutical company falsely claims that the addiction rate is very low? If the company aggressively pushes a dose regimen that is almost designed to produce addiction?
I mean I have been prescribed opioids many times and I just take them as prescribed and they help the pain of the surgery or whatever. I don’t even take the whole bottle. What will replace the opioids if we don’t allow them to be prescribed?
I don't think it s a black or white on opioids. But more of a being honest in the marketing and recommended dosages. For instance, Morphine is an opioid that often gets used in end-of-life care, this is a 90 year old on hospice actively dying from terminal cancer, so morphine to ease the suffering. No reason to not give them opioids. However, before the opioid crisis became a known crisis, my dad who is a disabled vet would get like 300 pills mailed to him a month, at the time to be indefinite, from the VA. This was when marketing was telling everyone percocet and vicoden were safe and non-addictive.
These heavy hitters do have a purpose. But it should as narrow as necessary.
1. Nothing will replace the opioids, but we should make most routine use illegal anyway, because the usage you described causes addiction, abuse, and death in some cases, which overrules your QOL improvements.
2. Nothing could replace the opioids, so we should keep the status quo. The addiction, abuse, and death are a relatively minor downside to an important bundle of benefits. The Sacklers marketed them illegally, but we've course-corrected as best as possible, and the new status quo is uncomfortable but OK.
These are, I think, the first two buckets of people I listed. I understand them both. I think you're in the second camp. I'm in the first. But I think most commenters here are in neither camp???
Could you have recovered without pain killers? Or maybe used a pain killer that is much weaker that doesn't kill all the pain but is much safer like marijuana?
Are there scientific studies that shows that opioids help patients recover quicker?
Why is this question important? The primary purpose of pain medication is not to facilitate recovery, but to reduce suffering and increase quality of life.
Exactly! Opioids increase suffering and ruin the quality of life for hundreds of thousands of Americans. 80k+ yearly overdose deaths, plus a percentage of those using opioids for recovery become addicted to it.
Is that a worthy tradeoff? I presume (could be wrong) but we did fine recovering with surgical operations 80 years ago without opioids.
One of the first complaints made by the postoperative patient on returning to consciousness is pain. This if due to the actual operative procedure should be at once relieved. William J. Mayo taught us long ago to give morphine during the first twenty-four hours for the pain which we make; viz., by cutting, retracting, suturing, etc. The discomfort caused by such procedures is relieved best by this drug and it is given by us if there be no contraindications for its use, regardless of the amount until full relief is experienced or its physiologic effects obtained.
24 hours post operation is fine. But giving them for weeks after an operation seems unnecessary. I've also heard that oxycontin in the USA is given to pregnant women to deal with pain.
Most countries do without them now and have always done without them except in special cases such as palliative cures. You get opioids during recovery in the hospital, but not once you're discharged. You might get codeine rarely, but that's it.
One thinks you have never had a really damaging surgery. For obstructive sleep apnea I had the back of my tongue microwaved, my deviated septum repaired, and my uvula and back of throat removed. Ibuprofen and Tylenol would not have been sufficient for recovery from that. And that is even nothing compared to other more damaging surgeries.
The article I linked explains that you can still get opioids during recovery in the hospital in other countries, it's only once you're discharged that they're a lot more careful.
There must be something intermediate between "Tylenol and ibuprofen for everything" and "Vicodin before and after canal therapy".
Basically, the original judge did a good job - the settlement plan was reasonable and widely popular. And the Sackler family being released from liability by putting billions of personal dollars into the payment fund meant more victims would get more money immediately.
With this ruling, the Sacklers are personally legally liable again - which may make you or I more happy, but this means that victims have to pursue a much harder and more expensive set of lawsuits to get money from the Sackler family. It also means the victims of the deal don't get a voice in the proceedings, and it may also make future payouts and bankruptcies harder if there is no reason to cooperate with the state.
I disagree. The dissent focused way too much on emotional appeals. It shouldn’t matter if the remedy was popular amongst the primary parties if the law doesn’t allow for such a remedy, “it was popular” is not a solid legal footing.
If we want to make sure that the victims of people like the Sacklers can get some justice then let’s actually write some laws for that purpose. Let’s remove the loopholes that let them make a ton of money at the expense of a nation, and them take it all offshore. Let’s add transparency to corporate structuring. Let’s fully pierce the corporate veil for egregious situations such as this.
What we shouldn’t do is allow the powerful yet another tool to escape consequences. Whether or not this particular deal was a net-positive for victims is besides the point. It gives too much power to bankruptcy judges and is a ripe avenue for corruption. Go to a “friendly” judge and have them absolve you of any personal liability, then send them a nice gift basket full of Benjamins, now fully legally (Thanks Supreme Court!).
> If we want to make sure that the victims of people like the Sacklers can get some justice
This isn't just about the Sacklers either, this could potentially impact a lot of other important cases in the future once the law is more well defined.
> victims have to pursue a much harder and more expensive set of lawsuits to get money from the Sackler family
They also have to litigate away a 2004 indemnification agreement extended by Purdue to the Sacklers in 2004, which could result in litigation and liability draining the pot before pay-outs can begin.
Definitely more complicated than I first appreciated.
What's the point of "restitution" if it came from the victims anyways? The Sacklers would have kept all of their ill-gotten gains under this settlement. The amount they'd be paying is practically just the interest from their earnings.
I have a hard time with the concept of retribution alone, but I think if it is phrased in terms of modeling societal standards and demonstrating to others that this behavior is unacceptable, it is still valuable to society. I guess you can mark that under "deterrence", but it's less about sending a signal to future would-be criminals, and more about communicating and demonstrating societal standards to the entire society at large.
justice from whom? Just because they got a prescription doesn't mean they lost complete body autonomy. The lack of personal responsibility regarding drugs around here is insane.
The whole basis of this suit is that a Purdue subsidiary went out of their way to market these pills as non-addicting. "Personal responsibility" in this case clearly lies on those actors, not the addicts.
I'm not sure about the justice aspect, but I wouldn't underestimate how powerfully addicting some of these drugs can be to the point where it can override your "personal responsibility". Same thing with any substance like alcohol or cigarettes, gambling, over-eating, etc. It's very easy to slip into abuse and an addictive response and susceptibility isn't universal.
Opioids are highly addictive. If you're vulnerable and your doctor eagerly prescribes them because it feeds their wallet, you can easily loose control.
Expecting some personal agency is now victim blaming? Detoxing from opioids is not fatal. It sucks. But it's doable. You don't need to take your entire prescription. Take it while you're in pain.
If you were prescribed heroin and proceeded to take it, you would end up addicted and unable to quit. Full stop. It is exceedingly rare to overcome opiates, you underestimate them greatly.
why would it be harder? wouldn't it just be the next family that tries to get away with crap like this will be scolded sooner?
it seeem like if you want people stop doing bad things you can't let them get away with bad things. here, the family was trying to get away with billions. The bankruptcy court said, "yay, ok". The Supreme Court said "no, not ok"
I don't understand the dissent. unless the dissent is friends of the family trying to spin.
If you want money from the Purdue bankruptcy entity: you just file a claim while they still have money.
If you want money from the Sackler family: you need to lawyer up, prove a bunch of personal liability claims (which are very, very hard cases to win), and wait a long time. And hope they still have money.
While it may feel nice to eventually, maybe, be able to throw the Sackler family in jail, it basically just blows up the ability to do mass tort arbitration.
From the dissent, which even includes Sotomayor and Kagan:
"As a result of the Court’s decision, each victim and creditor receives the essential equivalent of a lottery ticket for a possible future recovery for (at most) a few of them. And as the Bankruptcy Court explained, without the non-debtor releases, there is no good reason to believe that any of the victims or state or local governments will ever recover anything."
> If you want money from the Purdue bankruptcy entity: you just file a claim while they still have money
And as the dissent notes, this class includes the Sacklers per their 2004 indemnification agreement. So we first need to nullify that to avoid draining.
It’s harder because it requires piercing the veil of protection of an LLC, a legal construct that is explicitly designed to limit liabilities. There are simply more legal hurdles to this.
Though I do agree with the conclusion that the bankruptcy court should not be able to grant immunity to the Sackler family. It feels deeply, deeply immoral
> harder because it requires piercing the veil of protection of an LLC
Source?
It’s harder because they’re indemnified by Purdue, and their individual liability is far from established. (The opinion and dissent both refer to a monolithic “Sacklers,” but they’re individuals and trusts and whatever.)
I think the argument is against the Sacklers personally and their actions, not based on their ownership stake of the LLC. So this wouldn’t involve piercing the veil.
Only if suitors were going against Sackler assets to pay off Purdue corporate stuff.
An important but frequently overlooked aspect of the law is that by the time the courts are involve it is often too late for there to truly be justice. Things have often happened that cannot be undone. Often parties that are at fault do not have the resources to pay their share of damages.
No matter what the court does in those situations someone is getting screwed.
The idea of the rule of law + the state's monopoly on violence is that you WILL cooperate with the state if the law says you should. It may even be worth some losses to keep that up.
It's really not that complex. The question is NOT whether the plan was a good idea or reasonable. The question was whether the Bankruptcy Code authorized the bankruptcy judge to approve the plan. It doesn't. It's really not more complex than that.
Courts cannot legislate from the bench. Why not? Because the Constitution says so; i.e., Congress gets to say what the statutes say, while the Judiciary gets to say what the Constitutions says. That's the balance of power under the Constitution.
To me...the waaaaaaay bigger and more intriguing thing is: the story underlying this split 5-4 decision.
I mean this spit the "right" justices and the "left" justices. J Jackson came out of nowhere and sided with four "right" justices. Like, what?
Also, I can't for the life of me understand how J Sotomayor and J Kagan could ever come to the conclusion that this sweetheart deal for rich billionaires, who made their money killing $247k humans, was a good idea and totally fine. Again, what? But no the efficacy of the deal doesn't legally matter and is irrelevant.
Nevertheless, we don't know that the victims will be harmed by this decision. However, we DO KNOW that the rich billionaires would have benefited if this decision went the other way.
Remember that.
There's gotta be a Pulitzer worthy story behind this split.
Are you talking about the Sacklers as individuals, a family unit, or in their capacity as decision-makers for Purdue? There seem to be a relatively complex set of incentives and options in each of these capacities.
And they'll get it - they stashed a lot of their gains overseas, and they'll keep those gains while continuing to live a lavish life amongst the elites of the world.
I lost a very close friend to opoid addiction, and Purdue was based one town over from where I grew up. I hope the entire Sackler family gets fined and taxed to the point of genuine destitute poverty, and then some. Genuine scum.
I think this is where the settlement went wrong. The Sacklers were going to remain billionaires after the $6B payout. In all real respects they were going to feel no pain. They already have way more money than any of them could hope to spend in their remaining years, and that really rubbed people the wrong way. With the immunity removed they will at least spend some of their retirement in court room after court room instead of sipping drinks on the deck of one of their many megayachts.
It sucks for the victims who are realistically not going to get any help before they die, but it does send a message that you can't kill thousands (probably millions) and get off scot free.
Matt Levine at Bloomberg gives an excellent explanation of what happened, the ruling, why etc without telling you what you should think is the right thing or right outcome.
His explanations from first principles covering ground you already know are just excellent. Worthwhile reading for anyone who has to explain detailed, complex & technical subject matter.
The truly awesome thing about Matt Levine is how in complicated situations like this he doesn't try to pick the "right" side but instead leans in to how both sides have good points of view. In today's newsletter he quotes the majority opinion and says it's reasonable, and then quotes the contradicting dissent and says that's reasonable too. And they both are! A really difficult case with really difficult trade offs.
As a layman, I find the dissenting opinion strange -- for a judge. Sure it might be more pragmatic and beneficial for the victims of this particular case to take the deal. But a supreme court can't possibly cover all cases, so IMHO it must deal with the law on a higher more principled level. The argument that the bankruptcy court did ok in this case and should be allowed to do this in general is iffy because it fails to take into account various realities of life, e.g. corruption. Limitless authority is for me not a good idea, and I think the decision of the majority makes more sense.
> A bankruptcy court’s powers are not limitless and do not endow it with the power to extinguish without their consent claims held by nondebtors (here, the opioid victims) against other nondebtors (here, the Sacklers).
But again, this is my regular Joe view on the matter. And it's true that the majority of victims in this case might be in the end worse off, but the decisions of a supreme court are relevant for a long long time.
> WASHINGTON — The Supreme Court on Thursday blew up the massive bankruptcy reorganization of opioid maker Purdue Pharma, finding that the settlement inappropriately included legal protections for the Sackler family, meaning that billions of dollars secured for victims is now threatened.
Does anyone find it strange that this is described as a loss for the victims?
Well, it is. The victims had a settlement agreement worth billions of dollars, which the Sackler family was going to willingly provide in exchange for legal protections.
Now that legal protections are off the table, it is very unlikely that any new settlement will be as generous, and in fact quite unlikely that any settlement will be achieved at all.
Even if that's the result (which is questionable), the Sacklers are almost all overseas and their assets are "hidden" in complex schemes. So, collection is as big a hurdle as coming to a reasonable judgement.
Victory is not guaranteed, and even if the victims do win, going to court takes a lot of time and costs a lot of money. The victims agreed to the settlement because they preferred that option to going to court.
OK - but the individual payouts are going to be small and do little to compensate for the harm caused.
The primary goal for the suit is to punish the wrongdoing and disincentivize similar future behavior by others. Higher costs and uncertainty does that.
And to people whose lives were wrecked by addiction. Tens of thousands of dollars would be a welcome windfall to people on HN, but to these families it could even be life changing amounts of money. Sucks that their payout is now delayed indefinitely.
Not really, it will be played out in a number of separate cases and each case is in a weaker position separately simply due to scale and resources. The Sacklers have an estimated $1bn liquid available to fight these things.
The $6bn ruling was significant and not an amazing outcome for either side (so, a compromise).
Additionally most of the Sacklers are well into old age, so they'll probably die before losing $6bn.
It's a loss of ~1/2 of their net worth. That's significant.
They are now likely to pay much less by settling smaller individual cases, which will take significantly longer and cost claimants significantly more to pursue.
When they die (which will be soon, most of them are 75+) it'll become even more difficult to get anything.
The deal that was overruled was certainly not justice, but reality will likely be worse. There's no outcome that will render them not billionaires within their lifetimes.
> It's a loss of ~1/2 of their net worth. That's significant.
It's a gain of billions of dollars that everyone agrees they should not have had in the first place. That's really much more significant.
It's pretty telling that literally nobody says that the Sackler family should actually have this money, just varying degrees of it being hard to claw back from them.
If someone walks into my house, stabs me with a knife, and steals the money on my dresser, keeping half of the money they took from me is the exact opposite of a loss for them.
There's no strong legal structure to allow it, the US justice system strongly favors the rich and corporations. Loose consensus isn't enough if there's no legal mechanism to do so.
The deal was pragmatic in the absence of a clear path for actual consequences.
It would be easier to rally an angry mob at this point.
It sounds like you agree with me, since this is exactly a variation of it being hard to claw back, which is annoyingly analogous to letting rich people get away with whatever they want including theft and murder because trying is hard.
predictably of asset distribution, the end of a long campaign of bad pr, and government pressure (which is now fairly deflated)
the settlement was also in the interest of the government, which may now end up with tens of thousands of separate suits to manage and $6bn less to help manage the crisis unfolding in the meantime
don't get me wrong, the sacklers could end up worse off... but it's a big if and will take much much longer
> Does anyone find it strange that this is described as a loss for the victims?
As the dissent notes, this decision means the victims won’t get money now. When is an open question, as well as whether it will be similar, more or less after litigation costs, and to whom it will be paid.
What is certain is the Sacklers will be hurt more. (Unless a couple bizarre legal maneuvres pay off, e.g. the Sacklers extinguishing liability by way of a 2004 indemnification agreement.) So in a sense, this is deterrence and retribution winning over restitution [1].
They never gave up any cash to my knowledge. The plan was a promise.
We can conclude the Sacklers are worse off right now given they (and the creditors) accepted the deal. They may be materially better off in the future. But the rest of their lives will be about this.
The Supreme court case was specifically about the $6 billion dollars the Sacklers committed to the bankruptcy fund. And this ruling says they are not allowed to contribute to it.
> Does anyone find it strange that this is described as a loss for the victims?
I can see it going both ways, yes: this means that 6 billion dollars are not immediately available for compensation.
On the other hand, certain states (Washington was one, if I recall) argued that 6 billion dollars was such a pitifully small amount (relative to the damage done) that they declined to accept compensation in hopes that future lawsuits would yield more.
I view this decision as rejecting the immediate compensation, but opening up possibility for greater compensation in the future (with obvious risks and delays).
> certain states (Washington was one, if I recall) argued that 6 billion dollars was such a pitifully small amount (relative to the damage done) that they declined to accept compensation
As the dissent notes, “all 50 state Attorneys General have signed on to this plan.” The holdouts were “a small group of Canadian creditors and one lone individual.”
I always thought of the Sackler carve-out as a scam. But the dissent gives me pause. This ruling trades restitution for retribution. In all likelihood, many classes of victims—such as small victims, small states and local governments—won’t see a penny, at least for years.
IMO the money is a pittance, sounds like a lot but it's just a fraction of what the federal government spends on any given day. We can afford to carve out the financial resources to help victims. The retribution is totally worth it, because it needs to be understood that behavior like this will get punished. It should be painful, not just the cost of doing business.
You may find the money a pittance, but the victims decided otherwise.
It seems the case that the interests of the victims/plaintiffs (e.g. compensation) may be different than the public at large (e.g. punishment).
If so, perhaps the interests of the public should be pursued by a different avenue than the civil case of the victims, which requires superseding the agency of the victims.
> You may find the money a pittance, but the victims decided otherwise.
When you say 'the victims' are you implying they all agreed to this? So they are all okay with giving up their individual right to sue for damages? You make several points which imply that this is some kind of consensus position that everyone is okay with. That's the root of the problem, though -- this settlement in no way addresses the damage to all the victims.
Perhaps renegotiate the agreement so that it only immunizes Purdue/Sacklers from further civil action from
In any case, when I say pittance, I was clearly talking about relative to the financial resources of the US. This is a national problem, we can afford to solve it at a societal level without being forced into accepting an unjust settlement.
The case and settlement has almost nothing to do with solving the problem at a societal level, with either outcome being negligible.
Real progress would involve systemic changes to the treatment and causes of drug addiction, as well as medical treatment philosophy.
To hang the opioid epidemic on perdue is a gross oversimplification, essentially a scapegoating of a multifactorial problem. Perdue sold the same pills in Europe, but the US has an overdose rate 2,000% higher.
> To hang the opioid epidemic on perdue is a gross oversimplification
The only sane comment here. It's laughably ridiculous to call for retribution against a single family as if they were personally responsible for every overdose the country has seen.
I don't excuse their unethical and potentially criminal behavior, but I do think they way people talk about it is detached from reality. The corporate choices likely had some effect on the margin, but I dont think the appropriate disclosure around addiction potential and would have moved the needle much.
I think that was because they could more effectively market their "pain is bad mkay" strategy in the culturally and politically more homogeneous market that is the US.
The European healthcare market is completely different for each country in multiple dimensions. Be it political, the way insurance is structured, laws are setup and governmental agencies handle them. That means while it is entirely possible to sell the pills in Europe they won't be prescribed in the amounts necessary to jump start the "vibrant free market" for them the US has. So they are just an opioid that is prescribed in extreme cases.
I dont think the idea that patient pain is bad was unique to perdue and their drugs. Many European countries have private health insurance, with reimbursement quite similar to the US.
Like I said above, I think it would be extremely shallow thinking to claim that there is a single reason.
If I were to pick a leading difference, I would say that the US has embraced trained consumerism to a greater degree than most European countries. As such, the idea that a simple pill/product will make a problem go away has more traction, both with prescribers, patients, and abusers.
You see this difference manifest in many cultural and social forms, where people in the US are especially prone to "quick fix" marketing and products that offer escape and excitement through consumption.
This is one thing that leads into higher rates of substance abuse in the US than Europe. For example, the US has a higher rate of alcohol use disorder than most European countries, despite most of the countries having more permissive laws around alcohol and more consumption of it on average.
I agree, but absent John Stewart taking it up [1] were not paying out the victims, and I’m not a victim, so it’s easy to discount their desire for the $3,500 to $48k.
> As the dissent notes, “all 50 state Attorneys General have signed on to this plan.”
Thanks for the correction! I must have read about Washington States objection a while ago, and been unaware of a change in their position (since I first read about it)
"is now threatened" is not characterizing this as a loss for the victims. It's characterizing this as opening up the possibility of a loss for the victims, relative to what had been settled. That characterization seems accurate and relevant.
(This ruling also brings a certainty of delay for compensation, since negotiations for a settlement have to start anew, and with lower chances of success.)
Well, not a loss for the legal profession for sure :D
Will the victims come out with more in their pockets than they would have from this settlement? I guess we'll find out...
>The court on a 5-4 vote ruled that the bankruptcy court did not have the authority to release the Sackler family members from legal claims made by opioid victims. As part of the deal, the family, which controlled the company, had agreed to pay $6 billion that could be used to settle opioid-related claims, but only in return for a complete release from any liability in future cases.
Is this actually a positive outcome or a kick-the-can?
If you wanted the outcome of the case to be at least some money going towards opioid treatment, then this decision could jeopardize that outcome.
However, if you thought that the Sackler family being able to escape any personal liability despite the myriad of evidence of many of their involvement in stoking the opioid epidemic— and they still got to keep a very sizeable amount of the family fortune— is morally repugnant and legally dubious, then this court decision is a positive.
I would personally prefer many of the executives and members of the Sackler family to be held liable, their assets seized, and formal charges brought against them. But that’s unlikely
> A number of trials were conducted by the Chinese government resulting in two executions, three sentences of life imprisonment, two 15-year prison sentences, and the firing or forced resignation of seven local government officials and the Director of the Administration of Quality Supervision, Inspection and Quarantine (AQSIQ). The former chairwoman of China's Sanlu dairy was sentenced to life in prison.
Many of the most high profile names involved in Purdue Pharma or the Sackler family have retired or have passed away, so garnishment wouldn’t be as impactful as asset seizure (directly or from the estate of those that died)
The number the Supreme Court used in its decision was 247,000 deaths over a twenty year period. That's the verified number and therefore almost certainly lower than reality.
It also makes sense to me. If someone didn't join the class action, they should not be bound by its settlement, and should be free to pursue damage claims on their own.
deaths of thousands is a massive understatement. Just overdose deaths is probably getting close to a million. But they are also responsible for:
The people who don't OD but have their lives destroyed by opiods.
The family and friends who suffer because someone they know is an addict.
The time, money and energy society has spent trying to help addicts.
All the crimes, victims of crime and criminal justice costs that are a result of addiction.
They didn't kill thousands of people, they killed millions, affected every single person in the country negatively and contributed to the destabilization of our society.
The settlement was really a bit insane to me - we’re giving immunity to a family that killed hundreds of thousands and destroyed who knows how many more, and the money is being paid to local governments. In my area they planned on spending their share on things like “outreach” and free-to-the-addict narcan so they could continue to run around causing local mayhem.
Speaking as a man with a deceased father and aunt as a result of the Sacklers, really it’s a spit in the face kind of outcome that was shot down. They ought to be locked up next to El Chapo in ADX Florence.
> In a 5-to-4 decision, written by Justice Neil M. Gorsuch, a majority of the justices held that the federal bankruptcy code does not authorize a liability shield for third parties in bankruptcy agreements. Justice Gorsuch was joined by Justices Clarence Thomas, Samuel A. Alito Jr., Amy Coney Barrett and Ketanji Brown Jackson.
> GORSUCH, J., delivered the opinion of the Court, in which THOMAS, ALITO, BARRETT, and JACKSON, JJ., joined. KAVANAUGH, J., filed a dissenting opinion, in which ROBERTS, C. J., and SOTOMAYOR and KAGAN, JJ., joined.
US$ 6bi to be disbursed across hundreds of local governments to use for settlements over millions of individuals is nothing compared to the damage the Sacklers inflicted. On top of that having a sweet deal to never see any future liability case is an egregious misjustice.
The minimum would be for them to be arrested, if we pushed drugs to someone who eventually dies from it we wouldn't be getting just a fine. At the scale they did it's simply inconceivable to me that paying a fine which is less than their profit is anywhere close to justice.
It really depends on what you mean by "pushed drugs". If you or I recommended that someone should get an oxycodone prescription from their doctor, and they eventually died after getting that prescription, I don't think we'd get arrested or fined. (And the Sacklers were never getting criminal immunity in the first place.)
The recipients of the settlement are mixed about this. Some raised this suit because they felt the Sacklers were not sufficiently punished. Others felt that this was likely to be the best deal that could realistically achieved and dragging out proceedings in court for years and adding uncertainty of any settlement or victorious law suit was not worth the risks and emotional turmoil.
If you rob a bank and can pay the bank off with interest from the money you stole, was justice served?
If you sell drugs and use the interest from your profits to pay a fine, it doesn’t sound like punishment.
Part of the problem with this is that much of an old money wealth is from less than reputable sources (slavery, piracy, war, crime, smuggling, opium and alcohol).
> Harrington objected to the release of additional claims against the Sacklers, saying it would be unfair to potential future plaintiffs.
> Purdue criticized Harrington’s role, saying that groups representing thousands of plaintiffs have signed on to the settlement, which could not have happened without the Sackler family contribution.
The concern is the set of current plaintiffs is incomplete and those plaintiffs who are missing are going to be hurt by this and the bankruptcy judge over this decision does not have the authority to approve this deal despite the current set of plaintiffs wanting it.
Negative outcome. Some important points that the article here did not emphasize:
1) The Sackler family was not actually a party to this litigation. They came to the table (with most of the settlement money) specifically to get these so called '3rd party releases'.
2) Purdue is basically broke. It's also an LLC. Thus, in order to go after the Sackler family's money, you basically have to claw back money that Purdue paid out to the family over the years. It's not impossible to do, but it requires a whole more litigation, the outcome of which is not at all certain.
Now, 3rd party releases are a genuinely weird thing: a court ruling that a party that's not directly involved in the case is immune from future lawsuits. Partially the reason it went all the way to the supreme court is that there was a circuit split - they were allowed in some circuits, but not others. However, (and this is according to a friend who represented the victims in the settlement), it's really unfortunate that THIS is the case where they get struck down. If the Sacklers walk away from the settlement, it makes the victims getting their payout much less certain, and certainly delays that payout by many years.
My understanding is that Piercing the Corporate Veil has gotten easier over the years. The more egregious the robber baron class has gotten the less sympathetic the courts have been.
> Thus, in order to go after the Sackler family's money, you basically have to claw back money that Purdue paid out to the family over the years.
Or you can find them personally, directly, criminally liable and their profits the result from a criminal conspiracy.
Personal crimes aren’t protected by the “veil” of LLC, so any assets of the family could be liable, after criminal conviction, for any civil claims from victims.
IANAL, but I don't think this would help the victims (and incidentally, that could have still happened even with the settlement). If there were a criminal lawsuit of the Sacklers, and if that lawsuit was successful, the seized money would just go to the justice department.
The only way the victims actually see any money is through civil litigation.
Well, I don't think civil forfeiture specifically would work, but like I mentioned above, yes, if the justice department wanted to criminally charge the Sacklers, they could possibly win and get a judgement against some of the money. But then that money doesn't really go to the victims - it's just a way to punish the Sacklers.
The bankruptcy settlement had a bunch of money going to families of the victims, and also to the states for anti-addiction programs, and also some money towards documenting the Purdue wrongdoings, so that the public would have better visibility just HOW this was allowed to happen in the first place
The next likely step to this will be how it affects the future hypothetical (but almost certain) trial of Boeing execs. Depending on what you want that to look like, then this was either positive or negative.
It seems to come down to whether the sentence "[A chapter 11 bankruptcy plan may] include any other appropriate provision not inconsistent with the applicable provisions of this title" means "A plan can contain anything anyone can imagine as reasonable as long as it isn't expressly forbidden" or "A plan can contain other types of provisions that follow the same general theme as the concrete list given just before this sentence".
The Sacklers argued that the law says they can take away other peoples rights to sue them, since the law says these bankruptcy plans can include "anything", and the majority opinion of SCOTUS was that that's not the right way to read the law.
It also seems to turn whether the Sacklers seek a third-party “release,” which is precedented, or “discharge,” which is not. (The Court also assumes Purdue’s indemnification of the Sacklers will not hold, which would allow the Sacklers to drain Purdue as they fight the various claims against them.)
Interestingly, the argument for is textual. The argument against is pragmatic. (Both argue history, in my opinion, unconvincingly. They’re talking past each other on release vs discharge, a delineation neither side bothers to delve into.) The dividing line defies easy summary. (Gorsuch, Thomas, Alito, Barrett and Jackson concurring, Kavanaugh, Roberts, Sotomayor and Kagan dissenting.)
The argument for is a mixture of textualism and moral repugnance at the idea of letting the Sacklers keeping billions in profits they made from killing a quarter of a million people. I suspect the second part was strengthened to swing Jackson's vote and aside from her, it's a fairly standard split.
> the law says we can take away other people's rights to sue us as part of a bankruptcy settlement
As the dissent notes, third-party releases are part of the law. The turn is on whether the Sacklers are having third-party liabilities discharged versus released.
The solution may be in re-drafting the Plan so it’s more clearly a release. That might mean the Sacklers can be sued for fraud, but not other things.
> If this decision was just about third-party releases, it wouldn't be before the court. And you know that.
What is the difference between a discharge and release as it relates to the §1123(b)(6) “any other appropriate provision” power this case is about? You seem to have clarity the Court’s members couldn’t find.
You, then: As the dissent notes, third-party releases are part of the law.
Gets called out for over-simplifying the case.
You, now: What is the difference between a discharge and release as it relates to the §1123(b)(6) “any other appropriate provision” power this case is about?
Indeed. Maybe next time, stop pretending there isn't more to it.
IANAL but most contested Supreme Court decisions I've read (going all the way back to AP gov class) sounded like they could have reasonably been decided either way depending on who had control over the court. The law is ambiguous and complex enough that there's just so many logical ways to approach a decision and little in the way of prioritizing or disambiguating them. Whatever their bias, judges have lots of ways of reasoning themselves to their predetermined outcome. This is true up and down the courts but most judges are at least somewhat worried about their reputation and their record with appeals courts, which at least mitigates their biases but the SCOTUS is free to do whatever it wants.
As much as each side likes to bloviate about originalism and activist judges, SCOTUS often decides at the whims of ideology and personal bias because the law gives them lots of room.
The law surrounding Chapter 11 reorganisation plans only covers the relationships and responsibilities between debtors and creditors. It doesn't say anything about third parties.
But it does include a term saying a plan "may" also "include any other appropriate provision not inconsistent with the applicable provisions of this title" - subject to the approval of a judge.
Applying the broadest possible interpretation of this catch-all wording would produce absurd results - a bankruptcy plan would be more powerful than the constitution itself. So courts have to figure out just how broad an interpretation to apply.
> law surrounding Chapter 11 reorganisation plans only covers the relationships and responsibilities between debtors and creditors. It doesn't say anything about third parties
Yes it does. It covers third-party releases—there is ample precedent for that. The Court held this isn’t a release, but a discharge. (Idk.)
What really stuck out to me was how soft the opinions were. Especially the dissent. Rather than dry legal reasoning, it was argued much like a politician would. Maybe this happens fairly often, but usually when I read the actual decision from SCOTUS is is very specific and sober, even if I disagree with the conclusion.
Bankruptcy is a unique creature. It's created directly in the Constitution as a federal system. Bankruptcy is inherently "equitable," which means that judicial decisions are guided by case-by-case considerations of fairness rather than strict legal rules. Bankruptcy courts have wide latitude and discretion to basically do what makes sense in each context.
Here, the majority overturned something the bankrutpcy code approved, because, in its view, the remedy of a non-consensual third-party release conflicted with the structure of the Bankruptcy Code. The dissent disagreed, pointing out there were no express prohibitions on the relief the bankruptcy court had granted, and explaining that, in their view, the bankruptcy court should have been given discretion to authorize such a release if ultimately it would make the creditors better off. Basically the majority was focused on the structure of the Code, while the dissent was focused on the practical fact that the creditors would probably get more money from the Sacklers this way than if they had pursued direct lawsuits against them.
Thanks, that word helps clarify my major problem with handling this as a bankruptcy case. I don't see the destroyed lives as an issue of creditors, I see them as victims. Calling off the corporations coming after an individual for unpaid debt is a whole different issue than barring individuals from going after a corporation for actual injuries.
Chapter 11 bankruptcy law includes a "catchall" provision that “may” also “include any other appropriate provision not inconsistent with the applicable provisions of this title.”
Historically bankruptcy courts have wide discretion to make any "appropriate" provisions, and this document is an argument about what the limits of appropriate include.
Pound for pound, the Sacklers probably did more damage to America than any other drug dealers in history. More damage than any serial killer or mass shooter. In my mind they should be considered public enemies 1 through N. I sincerely hope they face civil and criminal liabilities for what they’ve done.
You're really underselling it if anything. Over a million Americans have died so far in the opioid epidemic. That more than any of their wars, including their civil war.
A good book to read regarding this topic is "Death in Mud Lick" by Eric Eyre who was a reporter for a local newspaper in WV during the early discovery phase of the epidemic.
The book details the methods used by the drug companies to pedal these drugs into small communities, the tragic victims, and lastly the refusal of drug suppliers to admit any wrong doing. There's also a slight dose (no pun intended) of WV AG's sheer incompetence on the matter due to donations and gifts by said drug suppliers.
Super depressing book, but great read nonetheless.
Painkiller is a great little short series on them too. does a great job at portraying all of what you mention in a six hour tv format. it can get a little on the nose sometimes but the meat is 100% true
Not to mention creating more homelessness, increasing crime and deteriorating our cities, strengthening Mexican drug cartels, providing business to suppliers in China.
They have objectively made the world a worst place.
Don't have to. Virtually none. People die from the street heroin they bought as a substitute for the oxy they couldn't get once the DEA cracked down.
You can see it on every fucking graph, the very week that the DEA did this, if the dates have enough resolution. This is why we don't ask "the families of the victims", because you're irrational with grief and can't process what the problem is.
In America, if I shot you in the leg and you died years later from an infection incurred because of that bullet wound I can and likely would be charged with murder because of the long string of consequence caused by my action.
So I can draw a pretty solid causal line from “my father died in a tent in the woods behind a gas station off of I-95 to the Oxy he was once on.” Maybe the pill itself didn’t directly kill him but it sure lead there.
Perhaps I’m just too emotional here, having literally dealt with the above last month. Can’t think straight?
> if I shot you in the leg and you died years later from an infection incurred because of that bullet wound I can and likely would be charged with murder because of the long string of consequence caused by my action.
Which is a useful convention, because it deters the sort of violence as "shooting people in legs".
The analogy doesn't hold. Drug warriors like yourself murdered the OD junkies. Your policy murders, and somehow you perceive yourself as the overburdened heroes. Prohibition is a bizarre policy, and we don't prosecute beer brewers for drunk driving deaths, no matter how addicted the alcoholic was. You're a bad person. You make the world more miserable than it has to be with nothing more than your evil opinions. And nothing I can say will ever convince you of the truth.
> Perhaps I’m just too emotional here, having literally dealt with the above last month.
You're not just emotional, but irrational. I and others like me could fix the things that make you hurt, but you want more of the same. It is not the sadist who screams "the beatings will continue", it is masochists like yourself who beg for it, telling all involved their morale really will improve.
I can’t respond to any of your comments about policy, because you’ve never elaborated your ideas, and you seem to be assuming a great deal about mine and the other commenters.
1) Real heroin does not exist anymore in real life. All of it is varying cuts of fentanyl and research chemicals.
2) Your original comment asked the question “how many have died from oxy vs hepatitis”, which, along with your comments about heroin, made it clear that your knowledge isn’t up to date. It strains credulity to say that more people died of hepatitis than they did of the opioid they’re injecting into themselves regularly. Do you really think hepatitis is the root cause here? Or is it the proliferation of opioids much stronger than heroin. I’m sure you’ve heard of fentanyl and carfentanil, but there are entire other classes (such as Benzimidazoles) that have been rising to prominence in the last few years that are more dangerous.
3) I’m very anti DEA as well, and agree that prohibition kills. However, this is not simply a case of holding a manufacturer for a substance responsible. It’s what the Sacklers did after learning of the addictive power of these medicines that gives them culpability. It’s like a local bar serving someone even when they’re visibly drunk, which confers criminal responsibility if that drunk person later does something while under the influence. Making opiates == legal, being negligent == not legal. I wish we didn’t have a prohibition, and drugs could be acquired safely, but that doesn’t mean that the ends justify the means, and any drug manufacturer is automatically the good guy.
I just don’t think you’re approaching this subject with the care it deserves. It’s easy to make flippant comments blaming “Drug warriors” (genuinely confused what that even means—does that mean someone who is pro-prohibition?), it’s much harder to interact with the literal decades of research about this topic, and magnitudes harder to actually experience these things yourself. If you’d like a starting point, I found this report to be pretty approachable: https://www.rand.org/pubs/research_reports/RR3117.html. However, I wouldn’t be surprised if posing questions the way you have elicits emotional reactions from those who know people who have died. I lived through the first wave of fentanyl in the US, but I know quite a few who didn’t. Based off what i’ve been able to pick up out of all the vitriol, I think we would likely agree about the policy decisions, but your approach of making simplistic comments and then calling people evil based off of their response seems like an ineffectual strategy. And maybe it isn’t, but then you’d have solved the drug crisis already, right?
Tobacco companies have paid out countless nine figure sums, smoking in public has gone from universal to mostly illegal, cig taxes have skyrocketed, etc…
Tobacco has been treated as a crisis, and I have no doubt that if cigarettes had been invented by one specific family, that family would be hated.
True, but it still shows that lobbyists have a lot of influence. Even if it means hundreds of thousands of death people every year. Same goes for Alcohol. And maybe also specific types of food.
What’s weird is that people still think tobacco smoking is about nicotine being addictive and dangerous, when it is literally everything else in the smoke that makes it extremely addictive and mortally dangerous.
The nicotine is what makes it addictive, but everything else makes it deadly.
This distinction is well known here in Sweden where we have snus, and also lower rates of lung cancer and cigarette use than the rest of Europe by a LOT.
That is not true. It is the interaction of nicotine with various monoamine oxidase inhibitors that makes tobacco smoking addictive, to an extent that it could be stated that it is the MAOIs entirely causing the addictive behaviour: the exact same MAOIs are also found in coffee, after all.
Why are nicotine pouches and vapes addictive, then? The answer lies in the flavourings, which themselves have psychoactive properties, likely also through MAO inhibition.
I'm not here to argue, but all top 5 links for me are about smoking. I've not heard of people being addicted to nicotine patches for example, especially non-smokers.
I looked into this previously, though it was a while ago so I no longer have the sources to hand. Nicotine is still addictive on it's own but when given to non-smokers in a non-tobacco form it's notably less addictive than smoking. Still addictive but far closer to coffee than cigarettes.
Some of this can be explained by different consumptions methods. For example in lozenges, gum and patches nicotine enters the bloodstream much slower than smoking or vaping so even if you consume the same overall amount the peak is lower slowing adaption. But that couldn't explain it entirely.
You will have to supply something to back up such a wild statement. Nicotine has been shown to be extremely addictive all the way from humans down to single neurons in a petri dish, for decades.
It's not known in Australia where you have to have a prescription to buy a vape but can buy cigarettes freely. Apparently they're relaxing the prescription requirement later in the year but still only pharmacies will be allowed to sell them.
Going by a quick skim of the 2022 WHO oral health numbers, Sweden[0] doesn't seem significantly worse off oral-health wise than Germany, Holland, or the UK. In fact it's oral cancer incident rates appear a bit better. Though the UK doesn't have great cancer incident rates, it's periodontal disease rate seem to be significantly lesser than the other three (perhaps due to close monitoring as a result of the "bad British teeth" stereotype).
Sweden male tobacco use percentages are slightly higher than the other three countries, which might be a function of the population additionally using non-cigarette tobacco substitutes perhaps as was mentioned by others.
Not cancer. Because it's, again, not the nicotine that causes the cancer. Snus does NOT increase cancer risk.
It decreases cavities by a lot (presumably because the bacteria doesn't like the environment anymore), but also destroys your gums. All in all, depending on your dosage it could be a wash or even positive for your oral health.
It's absolutely disgusting, but it's not dangerous :P
I always cringe whenever I see people giving McKinsey credit for stuff (good or bad). It's a powerpoint factory of 20-somethings with zero experience executing anything.
To suggest the virtuous, humble Purdue management could never have figured out how to sell oxycontin and bend regulators--without the insight of a few powerpoint slides--gives me a chuckle.
It's not like Purdue, a drug company, had any experience marketing drugs and dealing with regulators before, right? I mean, it must have been a super hard problem for them to solve. How do you sell an instant painkiller thats wildly addictive, while getting corrupt regulators to be corrupted? Impossible!
Too bad they got duped by those evil 22-year old powerpoint geniuses at McKinsey, who are clearly the real villains of the story.
You might be partially right, but McKinsey Senior Partners have a very long list of friends to call, many of them former McKinseys in positions of power. So while the shitty PowerPoint might seem as the product, the actual product might be trafficking influences and coordinating favors, getting insider information from a competitor, etc.
In this case in particular, if memory serves, they were advising the FDA in parallel, and leaking information to the Purdues. No brain-dead 24yo Harvard grad did that.
Just after the decision was announced, the victim's lawyers seemed to put out a statement decrying the decision since the victims are not going to be paid (soon?). Is this overzealousness on the part of the lawyers themselves wanting to get paid? Does any law person have a comment on the situation?
Manslaughter maybe, but not murder. They didn't want to kill people using their drugs. That wouldn't make any sense.
Also, I'd be careful about saying the judge (Robert Drain) is corrupt unless you can back that up with facts. You might be opening yourself up to a libel suit.
FDA has some culpability, but the fraud was so effective Medical Schools where teaching students to prescribe more opioids.
Perdue Pharma effectively hacked the medical system. I think the real takeaway is there’s likely more of this going on than we realize. The common decongestant phenylephrine being no more effective than placebo comes to mind. Without the mass deaths there’s apparently little to stop modern snake oil salesman.
Perhaps the FDA needs to conduct direct hands on oversight of medical trials? I mean if there’s billions to be made and little chance of prison the incentives get crazy.
It's sort of a different class of failure than with opioids, but it is a notable area of weakness. Basically, for OTC drugs that were initially approved before 1962, many are still on the market despite sometimes having weak efficacy data. While the FDA has been making some progress in reevaluating these older drugs, we're still far from where we should be.
A few quotes from the conclusion of the article (but the entire piece I linked in SA is worth a read!):
> In 2023, 16 external experts on the second Nonprescription Drug Advisory Committee looked at all the evidence compiled by FDA staff, heard manufacturers' arguments in favor of oral phenylephrine's efficacy, and heard from experts like me who argued that oral phenylephrine is ineffective. In the end, they concluded that oral phenylephrine is not GRASE. A final ruling on whether decongestants containing the drug can still be sold will take time. We hope science will prevail.
> From this experience we've learned that the monograph process for OTC drugs approved before 1962 needs to be reexamined. Systematic reviews of the available evidence indicate that other nonprescription drugs such as guaifenesin (sold in Mucinex and Robitussin), dextromethorphan (sold in Robitussin DM) and antihistamines marketed for colds (for instance, chlorpheniramine) probably don't help with coughs and colds. They are usually not dangerous, but their effects are likely to be the result of a placebo response; more modern research is needed.
> The outcome for oral phenylephrine shows that the FDA needs more funding to look at old drugs. We need public funds to support independent researchers who want to examine these products objectively. The government should be able to spend millions to save consumers billions on ineffective products. Companies that market these products have no incentive to prove they don't work. Nonprescription drugs must be effective, not just safe.
I'm surprised there aren't lots of PhD students doing modern trials on these. "I was the person disproved a widely available drug" seems like it would be a great thing to have on an academic resume. From the outside, it also seems like this would be relatively easy research since the drugs are widely available, safe, and treat common symptoms.
They appear to have left the oversight up to two individuals - ones with whom there was an obvious quid-pro-quo [1]. It's a stain on the agency and they should take responsibility and make changes.
Maybe, but its more common than this one example and more than what most people can stomach. The real problem is these people are sociopaths, and the next set of sociopaths will do it again. They don't care who they hurt because they lack empathy and if killing people drives up profits then so be it.
If you really want to show concern or right a wrong then find a way to better criminalize violations of accepted ethical norms. The best way to punish sociopaths is to take all their assets, embarrass them in public, and permanently bar them from practicing in the same industry. For example if a lawyer is disbarred they do not get a second chance.
>" better criminalize violations of accepted ethical norms"
What a load of BS. Wat's next ? Burning witches? I think we are way over our heads with criminalization already and have created big underclass of people who have no second chance because of that. So no fuck you.
P.S. Sure I'd like to see many of our masters in jail for fucking up with people's lives but that will not happen
There is no criminal underclass of convicted billionaire sociopaths. What are you talking about? Of course it won't happen if we continue to permit, excuse, and enable their behavior while crying about how hard life is.
>"There is no criminal underclass of convicted billionaire sociopaths"
To that I agree. However you can not make laws specifically criminalizing rich for "violations of accepted ethical norms". It will just open floodgates diverting regular and poor to underclass. This whole criminal background check should be made illegal with some very specific exceptions. It hunts people for the rest of their lives. Europe handles this situation much better in general from what I've heard.
My understanding is that for regular theft, there are different classes of charges depending on the amount stolen. Perhaps we could apply a similar approach at the top end? E.g. laws that only kick in when there has been more than a billion in damages or thousands of deaths?
> Pound for pound, the Sacklers probably did more damage to America than any other drug dealers in history.
That's complete horseshit. They produced a drug of known, unvarying dosage in regulated pharmaceutical manufacturing plants, overseen by pharmaceutical engineers making sure that no illegal or unsafe substances adulterated the final product.
For once, there was a drug on the street that wouldn't cause junkies to overdose. It wasn't hot with fentanyl half the time. Jackasses didn't cut it with baby formula or laxatives. Hell, it didn't even encourage druggies to reuse needles.
But if you need empirical evidence, drug overdose deaths only spike after the DEA cracks down on pill mills. They demonstrably saved lives. Any sane person who examines this at even a shallow level would concur. You've drank the kool-aid.
I cannot name another family that helped introduce a nationwide need for a completely new type of first aid, that being naloxone. It's not just ambulances; it's in police cars, pharmacies, libraries, schools, and workplaces. A complete deployment throughout the third-largest society in the world, in less than ten years, because of the frequency of overdose.
> gabapentinoids are increasingly being used for off-label conditions despite the lack of evidence. Prescription rates for off-label conditions have overtaken that for on-label use. Similarly, the use of gabapentinoids in the perioperative period is now embedded in clinical practice despite conflicting evidence. This article summarises the risks associated with this increasing use. There is increasing evidence of the potential to cause harm in vulnerable populations such as the elderly and increasing prevalence of abuse. The risk of respiratory depression in combination with opioids is of particular concern in the context of the current opioid crisis.
Look at what’s happened since Oxycontin was heavily regulated.
Opioid deaths in America have exploded by an order of magnitude.
There’s a direct correlation between higher regulation of OxyContin and opioid deaths in the U.S.
The Sacklers have done illegal stuff. Misrepresenting the addictiveness of their drugs (well, it was immoral and wrong…it’s not clear how illegal it was).
But it’s quite clear that America had a parallel opioid crisis going on. By making OxyContin easily available, ie, a slow acting opioid (it had to be crushed to be fast acting) that was produced legitimately and had a legitimate supply chain so people were able to get exactly what they wanted, Purdue Pharma helped keep the number of opioid deaths under control.
IOW, the U.S. has had an addiction crisis that is independent of prescription drugs whose cause is not clear yet because everyone has thrown the blame on Oxy instead of researching it. This is the same kind of drug crisis that hit inner cities in the 20th century but has hit rural areas in the 21st century. By providing easy access to regulated and legitimate opioids the Sacklers may have marginally worsened the addiction crisis, but they minimized the number of deaths and severe negative impacts.
The moment Oxy and the other opioids were made less easy to get, the underlying drug crisis hadn’t gone anywhere, so instead the people suffering from the crisis had to get their opioids from illicit sources as opposed to the pharmacy, exposing them to all sorts of unregulated drugs that had all sorts of nonsense like Fenranyl mixed in, which causes the actual negative impacts of the drug crisis to explode.
The funny thing is that when the entire country was just absolutely united at making the Sacklers the big bad evil, the actual people working on the ground trying to help those who were facing this drug crisis were predicting this exact situation and were asking authorities to not clamp down on Oxy. But they were all ignored and so we have a situation where opioid OD deaths have gone from a consistent 10-15,000/year (a rate which preceded Oxy) to about 50,000/yr now.
None of that would’ve happened if they didn’t start the flood of opiates to begin with. It wasn’t a marginally increased issue, they flooded the market with it. People with minor pain were getting massive bottles of OxyContin and selling or using it. This led to pill mills and crooked doctors. You had normal people getting hooked on high dosages. These are not the people who were using opioids before that. Pills made it seem safer. Most users don’t start with heroin, they start with pills because of exactly that. “A doctor prescribed it, must be okay.”
This is some insane logic to absolve them of responsibility. I say this as someone who also saw the problem firsthand. Was regulation handled badly? Sure but there’s no way you can say they didn’t start the problem.
Not only that, some of the problem with addiction were directly caused by the dosage guidelines for oxycontin. They really wanted it to be a 12h drug, but it really isn't and it wears off after about 8 hours. Rather than admitting this and giving a smaller dosage more frequently they doubled down by using a larger dose and trying to keep with the 12h schedule.
This combination or larger dose followed by mild withdrawal then results in a higher likelihood to become addicted to opioids. So not only they marketed it heavily and got more people on opioids than necessary, they did it in a way that maximizes the likelihood of addiction.
A bartender mocked my brother for getting Aspirin for his broken arm.
"man you got nothin', you should get some oxy for that!"
I'd been living outside the US and this in my first few hours back on US soil. A few hours later my friend (working in criminal defense) explained how opiates accounted for roughly 1/3rd of his income (other sources: drunk driving and domestic abuse). They all followed the same trajectory: minor condition -> prescribed oxy -> illegally obtained oxy -> heroin when the money ran out.
This wasn't normal. It didn't happen anywhere else in the world at the time, or at least not where I was living.
> But it’s quite clear that America had a parallel opioid crisis going on
I don’t think that’s really the case. What happened here was that peddling oxy, created the excess demand that is now met by illicit sources that cause more deaths now that oxy is regulated. But what you’re missing in your understanding is that without oxy, demand wouldn’t exist in the first place. And that’s the harm everyone is talking about.
You’re talking about the aftermath of the problem. Parent is talking about the root cause.
You’re saying “created excess demand” like the people that you’re referring to weren’t chronic pain patients.
I know some of them were drug-seekers but we decided it was OK to throw chronic pain patients under the bus so we could eliminate those drug-seekers.
Now, in addition to dealing with pain every day, I also have to “prove” that I’m not an opioid seeker if I end up in the ER for overwhelming pain. Because saying that you’re hurting is clearly a sign that you’re actually an addict trying to get a fix.
This might sound cold-hearted, but as someone who deals with chronic pain I’m fine with some street ODs in exchange for people who are in pain being cared for. Now we just torture patients by doing nothing.
Recreational drugs are a choice. My pain was not. Why we punished for others’ bad choices?
> You’re saying “created excess demand” like the people that you’re referring to weren’t chronic pain patients.
I don’t think you know the full history of how Purdue operated. They did two things: downplay how addictive oxy was & aggressively push oxy through doctors by providing kickbacks.
Chronic pain patients were actually a much smaller portion of the eventual victims. In a lot of cases, normal people would be prescribed oxy after minor procedures and they would get hooked on it and become permanent addicts. Once hooked, doctors would continue prescribing it for far longer and create a perpetual dependency. If the true effects of oxy were made public (which were known by Purdue pharma and Sackler family), oxy would’ve been prescribed with a lot more caution. And prescription of oxy for minor pain would’ve been non existent since a lot of safer alternatives existed.
I’m sorry you have a chronic condition, but not everyone who got hooked onto oxy had chronic conditions, and nor were they junkies.
You can directly count the total amount prescribed opioids through time and adjust for potency.
Purdue Pharma didn’t just manufacture a drug. They did a great deal of behind the scenes manipulating so even people who did not seek out severe pain medication were prescribed extremely high doses.
In terms of long term pain management opioids suck. People need increasing doses over time until the drugs side effects become toxic. Not such a problem in hospice or someone in an ambulance after a major accident, but handing them to people with chronic conditions guarantees a downward spiral. Perdue Pharma knew this, strait up lied about it, and even pleaded guilty to mislabeling OxyContin.
Opioids suck. And the medical profession was complicit. For a class that is supposed to be professional and well informed most Dr's are, shockingly, not that bright.
The actions of individual Doctors acting on their own simply don’t explain trends.
Doctors and the FDA etc were straight up lied to. I don’t think it’s reasonable to hold Doctors accountable for when some pharmaceutical company commits fraud. That doesn’t mean every doctor was blameless, but individual Doctors have always behaved poorly it was true before the opioid epidemic and it’s still true today.
Doctors also refused to believe the germ theory of disease because it would imply they were all incompetent before then. Lots and lots of people died from infections transmitted by unwashed hands.
Robin Warren received his M.B.B.S. an undergraduate degree focused on medical research.
https://en.wikipedia.org/wiki/Robin_Warren He worked at: “SA Pathology, (formerly the Institute of Medical and Veterinary Science (IMVS)), is an organisation providing diagnostic and clinical pathology services throughout South Australia for the public health sector.” https://en.wikipedia.org/wiki/SA_Pathology
So whatever source you read that misinformation from is not trustworthy.
> Opioids where addictive
Hindsight bias here. We don’t want medical professionals to discard new information in favor of older treatments. There’s no way doctors can on their own replicate the medical research linking Ulcers with a bacterial infection and independently judge oxycodone’s effectiveness, and a dozen other drugs etc. Extended-release (ER) oxycodone was literally a new drug and described as not having the same issues associated with other Opioids on labeling approved by the FDA.
The crazy thing is how effective this all was. Medical schools were teaching students to hand out more opioids.
Chinese emporers were controlling opiates all the way back in the 1700s and the British were tied up in war for 20 years over the wreckage to the Chinese addicts.
The doctors, all college educated, some of our most studied and intelligent citizens, they knew about the history of opiates and im not talking about the dare campaign. I knew before the epidemic even got into force when I tossed the opiates I was prescribed in the trashcan.
The oxy marketing was just the wink and the nod everybody needed to convince themselves to parrot with a straight face, but they didn't actually really believe it.
“Tied up in a war” is a funny way to say “aggressively breaking Chinese law in order to hook local populations, make tons of drug money, and collapse public order.”
The Opium Wars were a cynical prototype for the modern war on drugs, which was initiated with similar designs and outcomes.
It's a valid point. Another valid point is at that time it was known the FDA had a history of approving addictive drugs. It is not evidence based to trust FDA over hundreds of years of history countering otherwise. I knew LOTS of people who turned down or tossed opiate scripts during that time because the long history was obvious to anyone with half a brain.
> You’re saying “created excess demand” like the people that you’re referring to weren’t chronic pain patients.
When a pain patient becomes an addict, their demand tends to be in excess of their prescription. I don't think anything you're saying is a reasonable response to the comment you're responding to.
Even the chronic pain patients should not have had the amounts prescribed to them that they were. Doctors were incentivized to give as much as possible. Creating addicts in people who may otherwise would not have been.
I personally knew people getting more than a cancer patient should’ve been given for day to day chronic pain.
I’m sorry if you were personally affected by regulation but that doesn’t mean they didn’t cause the crisis.
> You’re saying “created excess demand” like the people that you’re referring to weren’t chronic pain patients.
> I know some of them were drug-seekers but we decided it was OK to throw chronic pain patients under the bus so we could eliminate those drug-seekers.
To the GPs point, the cause of the regulation was the abuse of the sale. Many deaths were caused by aggressively selling oxy to folks who weren’t managing pain.
The fallout has resulted into harm with people that have a legitimate need for pain management.
Both can be true. The Sacklers are the culprits any way you slice it.
When I was a teenager I had my wisdom teeth removed and was prescribed Oxy. My mother was smart enough to not fill that prescription and gave me some ibuprofen instead. I was fine, the OTC painkillers were completely adaquate. Taking that Oxy would have been totally unnecessary and potentially life ruining.
Sure, OxyContin is better than Fentanyl, and banning Oxy can push people to way more dangerous opioids. But before painting Purdue as a hero of the people, let’s remember that million of people were pushed to opioids through Oxy when they shouldn’t have in the first place. Purdue played a big part in creating the epidemic in the first place. People that are now pushed to harder drugs because of an addiction they got into for the sake of Purdue making more dough.
It's the same shit practically all the way back to opium wars.
Always the drug dealers fault.
I blame the patient. We've known opiates were bad since at least the 1800s, and really longer than that. What the doc said was just what they needed to hear to lie to themselves, but this is taught in every highschool.
> We've known opiates were bad since at least the 1800s, and really longer than that. What the doc said was just what they needed to hear to lie to themselves, but this is taught in every highschool.
I am not sure high schools are teaching people to be distrustful of their doctor’s advice. I think what’s being taught is about the dangers of illicit drugs, not those with a medical expert’s stamp of approval.
> I blame the patient. We've known opiates were bad since at least the 1800s, and really longer than that.
As a reminder, Oxy was heavily marketed, (to doctors!) as a "not bad" opioid. As in, not as addictive, not as problematic, and something that can be prescribed more easily and with less worries.
If a doctor comes up and tell you "don't worry about this one, it isn't addictive like the others", and you are in a ton of pain at the time, you are going to thank modern medicine for its new miracle pain drug and accept the prescription.
> but this is taught in every highschool.
And as another reminder, most schools, until recently, just taught that "drugs are bad" and kind of left it at that. They exaggerated some of the down sides, and didn't mention any of the positive experiences.
IMHO South Park actually did the world's best anti pot ad -
"Well, Stan, the truth is marijuana probably isn't gonna make you kill people, and it most likely isn't gonna fund terrorism, but… well, son, pot makes you feel fine with being bored. And it's when you're bored that you should be learning some new skill or discovering some new science or being creative. If you smoke pot you may grow up to find out that you aren't good at anything."
-
And IMHO messages like that are more useful than what kids are being told.
There is also the social contract side of things - Since around 1950s, if people worked hard they things in return from society: A stable job, a house, the opportunity to raise a family. That social contract is shot to shit, and so it should be no surprise that more and more people are choosing to drop out of society via drugs/games/apathy.
You didn't learn about the opium wars? I'm not talking about dare which was obvious bullshit, I'm talking of learning from history. There was no weed war, that a drug caused a couple wars lasting decades should at least raise an eyebrow of any thinking person.
I think this has more to do with the general lack of curiosity about the world beyond the US borders that prevails in most of American society. It's not as if US high schoolers get a comprehensive education in world history except for a few select omissions. I agree with you that this is something they ought to be aware of but I think you've kinda stretched the causality here.
>I think this has more to do with the general lack of curiosity about the world beyond the US borders that prevails in most of American society.
Just learning about all the countries the British messed up would take at least another 5 or 6 years on top of whatever schooling is already done.
If you wanted to add everything America has done, well, people wouldn't be graduating high school until they are in their 30s.
We did learn about the Anglo-Zulu War and the East India Company, but a decision has to be made on what list of British atrocities to include in a history curriculum.
We didn't study the Opium Wars in history at all throughout my education, I learned about those on my own thanks to the Internet. The entire Middle East, our influence in South America, etc, none of that was covered in school, and I went to some pretty good public schools. (E.g. in High School we edited DNA of Bacteria)
For that matter, I think China was only mentioned in passing throughout my entire education. WW1 was also only mentioned very briefly (maybe a couple weeks? Archduke is shot, shit goes down) and then we spent a fair bit of time on WW2, but less than we spent on Ancient Egypt honestly. (I think we spent an entire 2 or 3 months on Ancient Egypt).
We spent a fair amount of time on the Reformation and Renaissance, ancient Greece and Rome, and US history was mostly a ~bullshit~ censored history of the founding of the US. The Washington State history classes went into some history of the local tribes, but failed to mention any of the fun details about how Seattle was founded (prostitution, drinking, Seattle literally poisoning the wells of nearby towns to force them to join Seattle to get access to clean water)
College was better, mostly US history and World History, still nothing about the far east though.
We did an excellent segment on the US Revolution in College, including the funding source behind the revolutionary war, that was very interesting.
Edit: Sex ed was pretty comprehensive, and we ended the quarter by watching Rocky Horror Picture Show, so that was fun. (The Nerd and Goth kids formed a voting block for what movie to watch. :D) I am still surprised they talked about so much about forms of contraceptives that almost no one uses (spermicidal gels and foams), but at least they properly demonstrated how to use a condom, so that was good.
For "don't smoke" the health teacher had lots of pictures of tumors.
Alcohol wasn't really talked about, but honestly in the 90s we didn't know a much about how unhealthy it is as we do now. (Doctors knew it was bad, but just in the last few years research has come out showing that the safe amount of drinking is none)
That’s gotta be the most ignorant opinion I’ve heard on the subject. This clearly is coming from someone who has had the benefit of good health, or hasn’t had the misfortune of a critical ER visit.
When I got addicted to opioids, the doctors didn’t ask me what I wanted in the ER. I got Dilauded as they prepped the OR. I wasn’t lucid enough or cognizant enough to give informed consent. During my recovery, there wasn’t an option of alternate anything - I got a lot of morphine and then oxy. I was discharged 4 weeks later from the hospital with a 3 month prescription for 120mg of opioids per day. That would kill most people.
My story is not unique. It is so common it could be a troupe. The doctors saved my life in one way, then discharged me into a hell of addiction that it took 9 months of serious determined effort to overcome.
Then, some uninformed keyboard warrior like yourself comes along and blames people in my situation? Maybe you should have read a little less Opioid Wars and a little more Current Events. You clearly know nothing about this problem.
I've worked in the ER, held a license to work there, and spend everyday with licensed providers in addiction medicine. I assure you I have more familiarity here than even most addicts.
But you win the victim totempole height contest I guess.
That doesn’t clarify anything about your knowledge. The specialized hospital cleaning crews are in the ER every day and dozens of hours per week in the OR, but that doesn’t allow them to practice medicine or perform surgery. Proximity is not the same as practice.
The medical practice (until a few years ago) was profoundly and intentionally misinformed about the addictiveness of Oxycodone and Oxycontin. You brought up a question about why people didn't learn from the Opioid Wars, but your flippant question could just as easily be applied to the MDs who wrote the prescriptions.
Medical doctors are smart; they MUST know about the Opioid Wars and the horror the opium wrecked on Chinese society for centuries. Why would they prescribe such a dangerously addictive compound to injured and vulnerable people having the worst day of their lives?
Instead, you blame patients with little choice (or capacity to evaluate choices) in a terrible situation. And, if you talked to any addicts, you'd sure find that the top of the "victim totempole" is actually really crowded with people who got there the exact same way. That is no coincidence.
The fact of the matter is that Purdue intentionally misinformed everyone - doctors, patients, caregivers, and family. They used marketing, propaganda, bribes, recognition, and myriad other tools to convince everyone that their product was different. Doctors, knowing full well about the Opium Wars, wholeheartedly believed the propaganda. I wasn't the first patient to be discharged from the hospital with a multi-month supply of opioids. This was a common practice.
The worst part is for someone who claims to be around addicts, you think I am somehow unique in my story. My story is so mundanely typical that it should be nauseating. Medical treatment is, by far, the most common way addicts start with opioids. 75% of all heroin users whose addictions started in the 2000s reported that it began with prescriptions from their doctors.
I genuinely suggest you spend some time talking to the addicts around you rather than judging them. You'd quickly come to regret the flippancy of your statement and probably have some empathy for their situation. These were regular people with jobs, families, lives, hopes, and dreams. In a crisis, they entrusted medical doctors to make the best medical decision for them, and the price they paid was their future.
Of course, I speak from the pillar of privilege and but am a lowly untouchable on the great victimhood totempole. We should instead only listen to the high priest victims, uncontrollably fented our their minds to kill the pain.
If you want to get rocked on opiates have at it, it's your body, just don't pretend you don't know they're addictive. It's ok to be an addict if you're honest to yourself about what's happening. Might even make sense if the pain is chronically awful.
Here's the thing about what they teach you about drugs in high school: lots of it is bullshit. I don't know if it's still a thing but when I was in school there was a lot of pearl clutching about weed being a Gateway Drug. For a lot of people who smoked weed and didn't progress towards any harder drugs, weed was a prime example of how drug education was a sham. No one went crazy, none of the weed horror stories came true, everyone enjoyed the concert and woke up the next morning feeling better than if they'd been drinking alcohol the night before.
As someone who deals with chronic pain, I watched this situation develop: people lost access to their “safer” opioid and switch to whichever one they can get. Or suicide; there were many suicides around this time.
Thankfully opioids have never been an appropriate treatment for my pain so I didn’t have to deal with this, but I feel real empathy for the people who switched to street drugs at that time. OD is a risk but considering how consuming pain is many would probably rather be dead than experience that anyway. This is not hyperbole, on pain forums people talk about assisted suicide all the time.
We failed pain patients across the board.
It took 6 or 7 years for us even start to find therapies that work. To this day doctors have just shoveled handfuls of Gabapentin and muscle relaxers down our throats or sent us for very invasive and painful nerve blocks which both have a high complication rate and need to be repeated as frequently as every three months.
Or told us to get more exercise. I’ve always loved that one! I’ve been improving my fitness for three years, but advancement is very slow because if I go too fast it can trigger pain and be a huge setback.
Fuck the Sacklers, but fuck whoever decided that pain patients don’t deserve opioids at a rate of 100x. As is always our policy with the disabled in America, our suffering doesn’t matter anywhere near as much as the political moralization that gets people in office
Ok, I’ll get off my soapbox. This topic makes me so angry.
The black pill with chronic pain is it’s often better to off yourself depending on the condition. There’s no hope for some things like erythromelalgia.
Lol fentanyl is more toxic by an order or two of magnitude. People would be on prescription opioids, lose a script, get on heroin because that was 4 to 8 times cheaper and more available than black market pills. The fentanyl crisis is a phenomenon between cheap imported precursor and Cartel economics.
The synthetic opioid demand in the US was a result of a chain of events including the purposeful stimulation of demand by marketing directly to Drs, lying about abuse potential, lying about withdrawal and addiction potential, and not introducing mediating controls when evidence of abuse and sales not meeting market demographics was clearly evident. Like they imported millions of pills to small towns with over selling pharmacies. Drs would up dosage to adjust to tolerance.
But anyway it’s fentanyl that is killing people. I’d argue just let people use opium and regulate that sale.
Edit: changed and to an. Chinese precursor to imported precursor bc I honestly don’t know how many different countries are sources of a precursor. Added part about importing to small towns and upping dosage.
Opinions like this are why I’m glad I don’t live in the USA anymore. Live practically anywhere else, where there is no opioid crisis, and this line of thinking sounds insane. Copy paste for other uniquely American issues like gun violence - the answer is… more guns?
morally: providing more of something that has no societal good is not commendable.
logically: this argument isn't sound at all. looking at what happened since Oxycontin was regulated is not a proper counterfactual. you would have to look at a universe in which it was never introduced to begin with
Wasn't Oxycontin kind of the boot loader for the present opioid crisis in that it mainstreamed opioid use and got a huge number of people introduced to it?
Then it was taken away and things like illicit fentanyl filled the gap, but that came later.
Indeed. At the undergrad college I went to in New England in 2008 it wasn’t uncommon to see people at house parties doing lines of oxycontin out in the open. Was fairly socially acceptable.
Regulation helped cause the deaths by driving people to more dangerous sources. You're 'forgetting,' however, that the oxycontin and prescribed pills were the source of those addictions in the first place. The regulations didn't kill them. If the regulations had always been there, they would have been fine. They weren't tamping down on some mystical parallel crisis, however convenient that would be to shift the blame. They were creating a new one, using the legitimacy of the medical system and doctors prescriptions to get people hooked, to fatal effect when the regulations finally came down and people facing addiction turned to illicit sources.
> a slow acting opioid (it had to be crushed to be fast acting)
You seem to just skip over that point in a bit of a blasé fashion, as if OxyContin's slow release formulation is somehow a defense of the Sacklers' behavior, when the exact opposite is true.
That is, a primary argument is that Purdue pushed OxyContin because they argued it was safer due to its slow release formula. Except they knew full well that "slow release" was pretty much bullshit because people were getting addicted by simply crushing the pills.
Purdue sales people deliberately pushed Oxy with the false promise of additional safety even though they knew this wasn't true.
It's much worse than that. In order to protect the big selling point (10hrs between doses, once per nursing shift) they encouraged larger doses which were more likely to cause addiction instead of more frequent doses which were actually appropriate.
There is a lot in this post that is ...questionable in my opinion but I just have to call out as especially creative the praise for a drug that is so safe and slow-acting that it won't have harmful fast acting effects unless you... Apply a small amount of pressure with a hard object.
I would argue that it is the expected outcome of processes exhibiting: Latency... it takes a few years to actually kill their victims, and Exponential behaviour.. the most damage is done in the last few rounds of the expansion.
What are you talking about? Where was America getting their opioids before The Sacklers? Go ahead and pull a chart of heroin deaths vs. years and draw a vertical bar on where Purdue launched their widespread marketing misinformation and disinformation.
This is the largest and most deadly episode of addictiveness since the tobacco companies were marketing cigarettes as healthy. If this were a fire, you’d be arguing:
“Look, America has always had fires. Sure Purdue started fires in all 50 states that spread into the forest, but they were small when Purdue started them. Now, there is a blaze that has spread uncontrolled across the Continental US. So, obviously there were other parallel organizations starting fires.”
No. That doesn’t follow. Purdue stared the fires. They added tinder with marketing misinformation, then they inhibited any attempt at controlling it with active disinformation campaigns to confuse doctors and regulators about the root cause. Now, it’s a wild uncontrolled inferno, but they started the first fires.
Didn't we also invade the religious nutsos stopping Afghanistan from producing poppies and then prop up a fake regime that let it flourish, massively increasing the supply of natural opiates? If I recall, the timing works out pretty good with illegal opiate use ramping up.
We sure did. About 60-70% of all of the world's opium was sourced from Afghanistan until 2022. That supply was used to make actual prescriptions in non-OECD countries - like India & China - as well as sold to make heroin in the US, EU, Asia, and Africa.
But be careful about confusing cause & effect. The cause of the Afghani farmers growing opium was the insatiable demand for opium that was developed through legal means. Then, when countries like the US started to restrict access to opiates, addicts and patients alike started to seek alternatives to the scarce prescriptions.
More to the point, why didn't patients use something else? Because there is nothing. Purdue's misinformation actively discouraged the discovery of new non-addictive compounds for decades. No one was looking, and the R&D pipeline ran dry.
By the time enough doctors sounded enough alarms to cause a change in the late 2010s, research in non-addictive pain management solutions was decades behind. No one engaged in it because there was no need for it. Now that we realize it was all a lie and these drugs have killed millions, there are no alternatives. Very few potential compounds are even in Phase 2 clinical trials right now, let alone the half dozen that would be needed in Phase 3 to ensure we have a single alternate choice for pain management in the next five years.
So, the outlook looks bleak. Today, in 2024, we don't have good ways to manage pain that is non-addictive, and certainly no good way to reach the millions who are hopelessly addicted to opioids for pain management. But, very little of this is the patient's fault - and a lot of this is directly related to the monumental efforts of Purdue to misinform for profit.
This is the only reasonable outcome... you can't deny some people justice just because other people think it's fine.
The sacklers have done immeasurable damage to the country. All of their wealth should be removed. Their foundation should be dismantled and used to fund damage and mental health services for addicts of the opioid crisis that they went on to create.
And perhaps some of the individual pushers/purveyors of the drugs, too.
The Sacklers were absolved of financial liability, not criminal. A DA that thought there was a strong enough case could have brought charges this whole time irrespective of the settlement agreement.
> Their foundation should be dismantled and used to fund damage and mental health services for addicts of the opioid crisis that they went on to create.
Part of the settlement agreement was that they were going to turn Purdue into a treatment organization. But right now it's back to the drawing board and plaintiffs will have to pursue separate and much harder cases to get reparations directly from all the individual members of the Sackler family.
Last time I looked into things, the fines they were going to pay is a tiny slap on the wrist compared to the obscene money they made. They can put the billions in an account and use just some of the interest for the fines. The biggest hit to them so far was having their name removed from some museums. Let that sink in. They've lost some slight prestige with other wealthy folks.
They took in something like $11 billion and were going to fund something like $6 billion.
As far as purely pragmatic solutions go this was not a bad deal for victims. There are a lot of members of the Sackler family and a lot of them have a lot of money despite personally not being connected to the Purdue business in any way.
Even if they could all be connected to wrongdoing actually getting money from, like, the second step-grand-nephew who lives in Copenhagen is going to be really, really hard.
$6 billion dollars is a lot of money, but it's also just half of what they profited from what was effectively mass murder. Is that really something you want to let people buy their way out of for less than they profited?
Think of it this way - if you found out your great-grand-uncle was a Nazi official, and that the house you grew up in or the favorable college you got into or whatever lifestyle you had growing up was initially partly funded by his misdeeds? Could your assets be targeted by descendants of the victims and you personally be made bankrupt?
That's a bit of an exaggeration, but a lot of the wealth of the Sackler family is distributed this way. The original brothers have died, there is a huge lump of easily gotten money from the direct family, and then there is a lot of money that has been spread around 2 or 3 generations removed. At a certain point if you want the full $11 billion you are going to have to go into the weeds.
I don't think "partly funded by his misdeeds" is an accurate description.
Members of the Sackler family ran Perdue Pharma and they aren't dead. Sure, a relative of the Perdue Pharma executives should be off limit for liability. But there's still plenty of actual executives that should be held accountable.
> and that the house you grew up in or the favorable college you got into or whatever lifestyle you had growing up
Are we talking about wealth I inherited? About wealth I wrongfully inherited from the wrung necks of the dead? When in this framing do we start to consider where that money should have been vs where it is now? I presumably in this scenario did nothing wrong personally, and yet what wealth do I _deserve_? Do I _deserve_ this wealth extracted by mass destruction enacted by my relatives, granted not by myself, but that someone else would otherwise have?
645,000 people died due to opiate abuse while their company was promoting opiates, and their prescriptions peaked at 6.2 million prescription users pee year. Under EPA standards for damages they would be liable for trillions.
> The Sacklers were absolved of financial liability, not criminal
I don't understand how this changes anything; why would it make any more sense for the subset of the victims who settled to absolve the Sacklers of financial liability towards to the victims who didn't settle? The type of liability doesn't change the fact that victims not part of the settlement shouldn't be restricted by the terms of it; being able to push their own case separately is the entire reason why people are allowed to opt out of class action settlements.
As the dissent pointed out, getting voluntary concessions from parties is generally considered a good outcome in bankruptcy court and part of the reason it exists in the first place. Any time you can take a million lawsuits and turn it into one saves a lot of legal fees for everyone and frees up our court system.
Another thing the dissent pointed out is that anyone who doesn't participate in the group settlement is only going to get the money first-come/first-serve. In bankruptcy court you can split the money more or less evenly. If everyone litigates separately, only the people with more senior claims get their money before the funds run out.
Agreed, they should be made an example of. Everyone involved in the fraud of getting this medication approved and then marketed to millions of people should face a fair trial and should be made an example of if found guilty. There is no reason that this medication should have been approved or marketed the way it was, especially considering what the medical community already knew about opioids and the harm they can cause.
The immunity deal on the table here was for civil litigation, not criminal trials. The Sackler family can still declare bankruptcy on their own, they just can't use the bankruptcy of their company to extend protection to themselves- which does make sense. But nothing that was proposed would have shielded them from criminal prosecution.
The wild part is how the justices were split: Gorsuch wrote for the majority, joined by Thomas, Alito, Barrett and Jackson. You won't often see these 5 seeing eye to eye in a split decision.
This ruling breaks my usual test that the conservative majority will nearly always side with corporate intersts because this decision definitely isn't pro-corporate.
The settlement would essentially shield the Sacklers from all liability and allow them to keep the proceeds of their crimes while paying a fine over a long period of time essentially from future earnings on thse ill-gotten gains.
The dissent seemed to say this was bad for 100,000 opioid victims. That's not a reason to legally shield the crooks who profited from their death and suffering. I'm shocked that Kagan and Sotomayor, in particular, went for that line of reasoning.
In a just world, the Sacklers would die pennieless in a 6x8 cell. Fines are just the cost of doing business. Intentionally addicting hundreds of thousands (if not millions) to opioids for profit, knowingly, should lead the loss to both your freedom and every dollar you earned from that endeavour.
It's more complicated than that. They knew it was killing people and turning thousands (millions) into addicts and they kept pushing doctors to use it at all costs. I'd recommend the John Oliver special on it.
They also designed it to be more addictive. The recommended dosage and timing causes the patients to repeatedly experience minor withdrawal during normal use, which is a standard technique for conditioning someone into being an addict.
All of this is documented in emails that were presented as evidence in court.
Yes - sort of. Many of the additives found in cigarettes are designed to increase the rate of absorption of nicotine. This gives you a distinct rush within seconds of consumption, as well as a more pronounced crash that triggers intense cravings.
That's very different from the effects of (freebase?) nicotine typically found in e-cigarettes which is slower to absorb and doesn't have a noticeable crash.
It was in jest. But part of the problem with nicotine that helps to lead to addiction is its short half-life. If you are a smoker you experience several episodes of abstinence throughout the day, so you lit just another one.
Why are doctors so easy to manipulate? They learn about addiction in medical school. Why would they believe a pharmaceutical company saying "...oh but this opioid is not addictive..."
It’s easy to overlook that OxyContin was very effective. Even a doctor acting in good faith was likely to prescribe the drug— because it worked well. It really did help people struggling with pain management. The downside, of course, was that Purdue pharma was knowingly misleading doctors on the addictiveness of the drug. Also the amount of doctors that were willing to turn a blind eye to the clear signs of addiction is very worrying.
> Also the amount of doctors that were willing to turn a blind eye to the clear signs of addiction is very worrying.
No disagreement, but I think it's worth considering how stigmatized addiction is in our society. I expect many patients would hide any signs of addiction from their doctors - especially since it might result in losing their supply of OxyContin, or worse, their career.
Yes, whole heartedly agree. The social impact of addiction and the ostracism of those suffering with addiction has undoubtedly only made this situation worse. I was more leaning towards doctors/pharmacies that were operating as pill mills - I.e. the handful of regions in the Appalachias where there were more scripts for Oxy than there were people in the county
Because doctors believe studies and health system policies pushed aggressive treatment of pain.
And our unequal society forces a lot of people to damage their bodies in the pursuit of happiness (i.e. earning money). That damage becomes chronic pain.
And unfortunately, painkillers often have a euphoric effect. So people might use that effect to escape the grinding reality that they are trapped within. Consider how popular cannabis is, especially among older adults in states where recreational use is legal.
Because physicians don't get much if any training in evaluating evidence and research, they generally believe what they're told by scientists. Which is a shame, they should be taught critical evaluation of literature
They also don't have time because of the artificial limits of physicians graduating every year, combined with more bureaucracy being pushed on them day by day
Well I work at med school, grad students get far more training on research, med students can take an optional research elective. This elective isn't a formal course either, what happens is a med student comes to our lab and we put them on a small project as an assistant doing data analysis or a simple experiment. They don't get formally taught how to evaluate research
You have to remember med students are training to be clinicians not researchers. They have to diagnose and treat patients based on information taught to them by clinicians and basic scientists
This is also why it annoys me when lay people refer to the opinions of physicians on some new research that just came out, like with covid stuff. They are not research experts, they're clinicians. They treat people and make diagnoses
It is largely true. Evidence in medicine widely exists but most doctors arent keeping up with it. There has been a bit of a movement toward evidence based medicine in the last decade but most docotrs are still relying on what they learned in med school instead of keeping up with literature.
Many physicians also tend to be very conservative in terms of adopting new treatments. They tend to stick with what they know "works" and don't want to take risks to try something new
We can trust the process of science but we need to be mindful of how to critically examine a body of literature. When I see most lay people examine literature all they do is cherry pick what they like and discard the rest and ignore any analysis or methodological concerns
It's incredibly hard to do anything else, since it's pretty easy to cherry pick methodological concerns for any given conclusion you don't care for, since it's incredibly rare for a given body of work to be free of methodological flaws.
Something I have noticed is that non scientists don't understand the methods so when they do try and critique the methods those critiques don't make sense because they lack the understanding of the underlying principles
There is a lot of basic science that is quite solid and is replicable yet people tend to throw it out with nonsense complaints
Oh absolutely, science journalism is absolutely terrible for the most part. That's why I always try to find the original paper they're reporting on to see what's actually going on
Most journalists don't understand research either and I've even seen some PhD science writers get things wrong too but usually less often.
Science journalism is filled with incredible sweeping claims and jumps in logic that boggle the mind and are nothing like what's in the research being reported on, it truly makes me disappointed
I've seen a lot of research around nutrition, where the abstract/summary for the paper itself makes claims not reasonably backed in the paper itself. Then again, I think pharma, food and agriculture in particular have bent to financial forces over everything else.
A friend of mine recently died from cancer. I had looked up some particular things about it while he was still alive, and apparently some cookies got crossed and I was marked as an oncologist. I've had some ads on Facebook or Instagram telling me, the "oncologist," about particular cancer drugs. Of course, everyone in the US has probably seen regular ads for various cancer drugs.
Doctors pretty much need to be intelligent and hard working to get through med school and residency. After that, they might not necessarily keep up with things. You'd think oncologists would know the best treatments for each patient, but if that were true those ads would be worthless - and I doubt those companies like to throw money away.
>Why would they believe a pharmaceutical company saying "...oh but this opioid is not addictive..."
Because the pharma company offered them direct or indirect benefits for doing so. Doctors are just as human and just as susceptible to financial incentive as anybody else, that's why for decades there were doctors advertising the health benefits of smoking.
> whether most would think a mechanic is more or less easily manipulated into unnecessary vehicle repairs.
That's different. This is closer to a mechanic using a part from Company X in the repairs of their customer's car, because a rep told them it was more durable.
You're right, that's a better example. But wouldn't you expect the mechanic to have a more discerning eye in that case as well? The more contextual knowledge you have, the better you should be able to tell legitimate claims from BS.
To catch some BS, sure. I wouldn't expect them to fall for obvious lies. I doubt a mechanic would be significantly educated metallurgy or production techniques to spot BS in part lifespans. Or to spot pseudoscience in air filters.
I would expect them to notice their repeat customers not getting the benefits. But keep in mind that doctors saw their patients appearing pain free and high functioning.
You may be right and I may be guilty of hindsight bias, but I would probably put this in the realm of BS. It’s not like opioids were unknown to cause addiction, and when physicians witness the company continuing to up the dosage and wordsmith terms like “breakthrough pain” I would expect a cognizant doctor to be throwing red flags.
To overextend the mechanic metaphor, it would be like making a part out of aluminum and claiming it has infinite fatigue life. We know aluminum doesn’t so the threshold of evidence needs to be very, very high or the mechanic should remain skeptical. If the part continues to fail, but the manufacturer keeps making new, novel excuses the mechanic should be throwing the BS flag about their infinite fatigue life claims.
It seems that in the US there has been a trend to "de-regulate" or let businesses regulate themselves. It works for a while, but eventually it seems to go south. I think "regulatory capture" is the term. I think of Boeing being allowed to inspect there own planes.. I think drug manufactures submit there own studies, as the FDA doesn't have a budget to test all the things themselves.
The opiod manufactures are organized too. They have trade groups and conferences.
De-regulation and regulatory capture are almost opposite things. De-regulation is a solution to the problem of regulatory capture.
Regulatory capture is a central problem in America today. The big powerful entities- major corporations, large unions, special interest groups, etc have the time, resources and incentives to lobby for laws (regulations) to be written in their favor.
The result is the American public is very heavily regulated, but in ways that are beneficial primarily to the powerful incumbents. This spans everything from copyright law favoring big hollywood studios to USDA regulations favoring the handful of major meat producer corporations to medicine, manufacturing, retail, real estate, etc.
Regulatory capture is also why the divide between leftists saying more regulation and rightists saying less regulation are both often missing the real problem. The US already has millions of lines of text for regulation, the problem is that so much of the regulation is bad and written to favor whoever donated or could sway votes to whichever representative crafted the language.
Arguably, you have it backwards. Self-regulation doesn't work for a while, and then it works ultra well. Boeing got away with poor self-regulation for decades but now their business almost certainly will implode within decades and their market position will be taken over by those who were willing and able to self-regulate. They were rightfully punished and the US government was (theoretically) able to spend more resources regulating elsewhere.
That said, the lag time between the beginning of failing to self-regulate and the beginning of consequences showing up are likely too far apart to make it a sound doctrine for the US government.
Additionally, I recommend the book Empire of Pain for an excellent deep dive into the Sackler family and how they essentially created the opioid epidemic. You'll be infuriated as you read it.
Without proper context, it’s not clear to me if this is good or bad. It bad for the victims because there’s no settlement. It’s good for justice as people with a ton of money shouldn’t be above the law.
It’s good if you think judges should follow the law more or less as written by congress. The whole concept of a 3rd party release in bankruptcy is simply not in the law. Congress could add it, but they have not.
Piercing the corporate veil would mean disregarding the corporate form entirely. It usually comes up when the owner-manager of a company fails to distinguish the corporation as a separate entity with its own purpose and finances, using the company as a personal piggie bank or otherwise going about life as usual and not going through the motions required of corporations under the law.
What plaintiffs have alleged against the Sacklers is different, and specific to bankruptcy. Perdue is out of money and is bankrupt, mostly because it caused billions of dollars of damages to hundreds of thousands of people and to the states (which now have to clean up the opioid mess). But not that long before it went bankrupt, it was swimming in money. Perdue didn't use those profits to avoid harming people. Nor did it keep the money on hand to pay potential tort claims from the people it was harming. Instead, Perdue's officers and board of directors (that is, the Sacklers) approved dividends of billions of dollars to be paid to the company's shareholders (that is, again, the Sacklers).
The plaintiffs in various lawsuits have alleged that the Sacklers knew that the profits were temporary and the bill would come due, so they purposefully got the money out of the company while the getting was good. More technically: it is alleged that Perdue's owners received assets that were transferred from Purdue with actual intent to hinder, delay, or defraud creditors.
One thing you absolutely are not allowed to do is use your company to rack up a bunch of debt or liability, take all the assets out of the company, and then declare bankruptcy and expect to get to keep the money. We call that "fraudulent transfer," and if a court finds that you did fraudulent transfers from your company to your personal bank account you will be ordered to pay that money back to the company (so it can use that money to pay back its creditors and other claimants). The company still exists, it's a distinct legal person (so not technically piercing the veil), you just took the company's money as if it were a profit when you knew full well the company couldn't afford to pay out profits.
One big difference between the concepts is this: If Perdue's corporate veil were pierced, the Sacklers would be personally on the hook for all the harm their company caused -- they could lose their bank accounts, vacation homes, nice cars, artwork, everything, as if they themselves (rather than "Perdue") had been the ones going around knowingly fueling a drug addiction crisis. Whereas if they merely engaged in fraulent transfer of assets, the Sacklers are only on the hook to give back what they fraudulently took from the company during the period it can be proven that they knew of the looming liability -- limited to the statute of limitations, which I think is around 6 years. So all the money they made before that, and all the money they have from non-fraudulent sources, is safe from creditors.
What share of the guild do the medical providers that prescribed the opioids to their patients have? There would be no opioid crisis if none were willing to do it.
The US is the only place in the world AFAIK where you will get prescribed opioids for something as trivial as a wisdom tooth extraction (kind of like one of the cases cited). It is also the only place in the world AFAIK going through the opioid epidemic.
Every other country in the world has got the problem of painkillers figured out. So it can't be that complicated.
The point is that people are overall too cavalier about opioids in the US.
I don't think it's necessary to get into the details of how much pain is enough pain, how acute is acute enough, etc... because this is not a problem essentially anywhere else in the world -- and not because they thought really hard about it.
Objectively, opioids are prescribed much less often outside the US.
Subjectively, I got four wisdom teeth extracted in two sessions of two extractions each. Both times I only needed generic acetaminophen to manage the pain.
Perhaps an US surgeon have insisted on doing it all in one session, in which case I would have found the pain and discomfort intolerable and opioids would have made more sense.
In any case, they should probably figure out why their patients are in more pain than the patients of foreign surgeons and fix that. It could be something silly like them being less gentle during surgery because they are used to their patients being on opioids.
Court skipped an opportunity to quote Franklin, since "Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety" actually referred to a legislature entertaining a very similar Faustian bargain (i.e. value now in exchange for perpetual promise to remove responsibility from a family).
... but probably the correct choice, as that was a legislative, not judicial, circumstance and their decision in the time has no bearing on jurisprudence.
For those claiming the Supreme Court is a political institution, I'd like to note that this was indeed a 5-4 decision.
But one with Justices in the majority who were appointed by Biden, Trump, Bush 43, and Bush 41, and in the minority who were appointed by Bush 43, Obama, and Trump.
It was Jackson, Gorsuch, Barrett, Alito, and Thomas in the majority and Sotomayor, Kagan, Roberts, and Kavanaugh in the minority.
I won't argue against the Supreme Court being a political institution. However, I do think the court is more nuanced than popular opinion realizes. The article below shows a nice graphic of how often justices rule together on non-unanimous decisions.
A single vote means little and being partisan doesn't mean 0% voting with the other side. By this logic Congress is not a partisan institution given that people from both sides frequently vote together, but anyone who remotely follows national politics knows that it's a deeply partisan time.
And I don't think it's a singular judgement. If anything, the "ideological split" types of decisions are rarer, so it's more accurate to say that a few decisions on hot political topics doesn't mean that the SCOTUS is increasingly political.
> For those claiming the Supreme Court is a political institution, I'd like to note that this was indeed a 5-4 decision.
Is there a name for this type of fallacy, in which a single data point is used to argue that a global trend does not exist? (Another prominent example is "it snowed somewhere, therefore climate change is not real.")
I guess this is not a topic that is politically divisive, so the judges were free to vote as they saw fit. Which doesn't say anything about how they will vote on other topics, like abortion, environmental protection etc.
The justices don't vote on "abortion, environmental protection, etc." They vote on the legal vehicles that have been used to address those things. And views on those legal vehicles map onto judicial philosophies that have nothing to do with the substantive issues.
To use an analogy: there's people who think operating systems should be microkernels, and people who think they should be monolithic kernels. Windows NT was created to be a microkernel. But around NT 4.0 they shoved the GUI into the kernel space. If you're on the "Supreme Court of Windows NT," how do you view that? One camp might say, "NT is supposed to be a microkernel, get that GUI out of there." Another might say, "yeah but here in the real world, customers demand a fast GUI so it's fine to cut corners."
Constitutional law is basically that, except we're talking about cutting corners with the highest law in the land.
I'm trying to convey how legal conservatives think, as someone who is one. I am, on many policy issues, quite liberal. I think rich people should pay more taxes, people should drive EVs, etc. But ultimately I care more about the rules--especially the rules about who makes decisions and where power is allocated--than I do about what people or outcomes. I'd rather see 3C of global warming than administrative agencies operating contrary to the tripartite system of government the Founders designed. I care more about the Constitutional rules for allocating power to states than I do about what citizens of those states might do with that power. Etc.
Issues like abortion and environmental laws just happen to map onto particular legal issues as an accident of history. If state-by-state legislation leads to widely legalized abortion, for example, I don't think most legal conservatives would support a Roe-like judicial decision ginning up a "right to fetal life" (which actually exists in Germany). If Congress passed environmental laws itself, instead of outsourcing it to an executive agency, I don't think most legal conservatives would be looking for ways to second-guess Congress's judgment.
You actually see this in Europe. The legal system in European countries tends to be pretty boring, because they have more social cohesion and can legislate things according to the rules, rather than hacking up the system. The equivalent of Roe, for example, doesn't exist in continental Europe. In an irony, Emmanuel Macron criticized Dobbs when it came down. But France never had anything like Roe. And after Dobbs, France passed a constitutional amendment addressing abortion, which is exactly how legal conservatives would say you should handle the issue!
I think the most redeeming quality of Americans--an inheritance from the British--is that they'll jump off a bridge if they're told to do so by a court and the required procedures have been followed. Rule following, more than anything else, what separates advanced democracies from the third world country I come from. And in the long run it's what will save the most lives and lead to the most prosperity and social harmony.
Both examples are expressing the same belief about Dobbs! Yes, I believe the social harmony from allowing these questions to be decided democratically outweighs individual "rights."
What about Ireland? Abortion was illegal in Ireland until 2018, and then it was put to the public for vote in a referendum. In 2010, the European Court of Human Rights refused to overturn Ireland's abortion ban (though it did find a due process violation with respect to the lack of procedures for qualifying for a pre-existing exception for life-threatening conditions). That's how the law works in civilized democracies. People make decisions on social issues, not judges.
We had a decision on the SEC vacating some of its enforcement powers, 6-3 with only the 3 liberal justices dissenting.
We had this decision, which was 5-4, although it wasn't a clear ideological split.
We had a 5-4 decision vacating an EPA regulation, with the 3 liberal justices and one of the more moderate conservative justices dissenting.
We had a 6-3 decision on the EMTALA-abortion decision, with the 3 most conservative justices dissenting. (Technically it's per curiam, and the "majority" opinion is unsigned. But every justice signed onto a concurrence or a dissent, so we know exactly how every justice voted in this case).
Yesterday, we had a decision on social media which was 6-3, with the 3 most conservative justices dissenting.
Yesterday, we also had a decision on bribery which was 6-3, with the 3 liberal justices dissenting.
Out of the most recent 6 decisions, we have 4 decisions that clearly evidence a 3-3-3 ideological split between 3 liberal justices, 3 more moderate conservative justices, and 3 very conservative justices that would be able to pretty fully predict how they would vote on the cases, and there's another case that it's partially predictive on (a 5-4 that peels off either Roberts, Kavanaugh, or Barrett doesn't contradict this lineup). Furthermore, the one case that the ideological breakdown doesn't work on is the case that is the least politically charged (it's literally resolving a circuit split, as opposed to please-intervene-in-this-politically-charged-case).
So yeah, this doesn't disprove the thesis that SCOTUS has become increasingly politicized over the past few years.
That is not a representative sample of Supreme Court decisions. This is one of the last few opinion days of the year, the opinions being released are the most contentious ones the court is dealing with.
Of the first 6 decisions of the year, 4 were unanimous, 1 was per curiam, and one was a 6-3 split with the dissenters being Gorsuch, Sotomayor and Jackson.
Those 6 decisions would also not be a representative sample.
They didn't "overturn" this "corruption law." This was a prosecution under 18 USC 666, which is titled "theft or bribery concerning programs receiving federal funds." In this case, the question was framed to the Supreme Court whether 18 USC 666 applies to so-called "gratuity" payments. That framing was because the prosecution in the case below could not prove that the defendant had anticipated a payment in the future when he undertook the official act. (The defendant himself maintained that the payment was for subsequent consulting.) Federal law makes a distinction between those two things.
You can still bring an 18 USC 666 case for bribery, you just need to prove that the payment had some ability to influence the official act.
In this particular case a mayor rigged the competition for a garbage truck contract so that one particular company would win it. That company then overcharged the city and gave a kickback in the form of $13,000 to the mayor. The Supreme Court said this was fine and let the mayor off of the hook.
If you can't prosecute with this level of evidence the law is effectively dead.
That's not what the Supreme Court decided, and its extremely misleading to suggest that.
At trial, the government alleged the mayor had "rigged the competition." But the government argued, and the jury was instructed, and the Seventh Circuit agreed, that the government did not need to prove that. Because, under the Seventh Circuit's view of the law, it did not matter whether the subsequent payment actually influenced his official act. So on appeal, the Seventh Circuit upheld the jury verdict on the assumption the government did not need to prove that the competition was actually rigged.
So the case that came up to the Supreme Court didn't have the issue of whether he rigged the competition. The jury was told it didn't matter, and we don't know what the jury would have decided had they been told something else. The question before the Supreme Court was only whether 18 USC 666 requires proof that the payment did or could influence the official act. It did not consider the factual scenario under which he rigged the competition because we don't know if the jury would have found he did that.
Now the case goes back to the trial court to see if the government wants to retry the case, where they actually have to prove corrupt influence.
> The question before the Supreme Court was only whether 18 USC 666 requires proof that the payment did or could influence the official act.
And the Supreme Court's finding is that it did not because the payment happened after the action. Certainly corrupt officials in the future will never figure out a way to exploit this loophole.
This isn't the first corruption case before the court where the standard of proof seems to be "they need to write 'This is a bribe' on the notes line of the check for it to count".
> And the Supreme Court's finding is that it did not because the payment happened after the action.
It doesn’t have to do with the timing of the payment. It has to do with whether the defendant had a corrupt motive at the time he took the official act.
The government could have prosecuted this case under the same statute by saying: “he knew he was going to get paid later so he steered the contracts to this company.” They had the evidence to pursue that theory of the case. The jury could have inferred under the circumstances that the after the fact payment effected the official act. If they had done that this Supreme Court decision would’ve had no effect on the outcome.
The government instead made the choice to prosecute this case by having the jury instructed that it did not matter what the defendant was thinking at the time of the official act. That was the government’s choice.
This case just means that when the government brings a case under 18 U.S.C. 666–which is titled “theft or bribery”—they actually have to prove bribery, which requires corrupt motive at the time of the official act.
If the government wants to target the appearance of impropriety that can result from payments for official acts that weren’t corrupt at the time, there’s different laws for that (18 U.S.C. 201(c)).
Politicization and ideological polarization are two different things. Take Dobbs for example. That was an ideologically polarized decision, not a political one. Roe is the product of a judicial philosophy that conservatives think is fundamentally wrong, even if they don't oppose abortion. For half a century, conservatives were unified in saying they would overturn Roe, even though--as we have seen subsequently--there was a lot of intra-party conflict about what abortion law should actually be. Dobbs hurt the party that appointed the justices that voted for it. Trump would probably be cruising to the election in 2024 if Biden didn't have that card to play.
Most of the cases you identify split along ideological rather than political lines.
> We had a decision on the SEC vacating some of its enforcement powers, 6-3 with only the 3 liberal justices dissenting.
What the case actually held was that the executive branch imposing fines without a court order violated the Seventh Amendment. It's a separation of powers case, and reflects the same ideological debate about separation of powers that we have had for 100 years. Do you believe that the Constitutional three-branch structure should be respected, or is it obsolete in light of modern society?
> We had a 5-4 decision vacating an EPA regulation, with the 3 liberal justices and one of the more moderate conservative justices dissenting.
This is an executive agency decisionmaking case. Again, same debate we've been having for 100 years.
> We had a 6-3 decision on the EMTALA-abortion decision, with the 3 most conservative justices dissenting.
This was probably the most idiosyncratic and ideological case, but it's not political at all. It's Thomas and Alito willing to die on an ideological hill, not caring that virtually nobody in their party wants to follow them t here.
> Yesterday, we also had a decision on bribery which was 6-3, with the 3 liberal justices dissenting.
It was actually a decision on whether someone could be prosecuted under a bribery statute for a payment he received after taking the official act. Where other parts of federal criminal law make an express distinction between bribery (which corrupt official acts) and gratuities (which create the appearance of corruption but can't directly influence official acts).
This one is probably the most overtly political. Liberals voting to expand the scope of criminal law and conservatives voting to narrow it is weird. But it's worth pointing out that the Court's conservative wing has a strong libertarian streak these days, especially Gorsuch.
Being a judge in the US is a political job. There's not even a universal requirement that one has to be a lawyer.
However, "political" how liberals are using it currently is a euphemism for "current disputes between the Democrat and Republican party management." If you don't accept that framing, or assume that these people are wind-up toys set into motion by the Presidents that appointed them, things can be very political without this split that the punditocracy project onto the court.
Whether bankruptcy courts can dictate a settlement for something this wide-reaching, and simply indemnify someone against future lawsuits is a very political question. What if the courts had settled with the Sacklers for $10, and indemnified them against future suits? Why are the bankruptcy courts allowed to improvise restrictions against what other courts and other victims are allowed to do?
It's redolent of one of the most disturbing elements of Epstein's first conviction, during which they immunized unidentified, unindicted co-conspirators. In order to avail yourself of this immunity, you had to be guilty of child trafficking with Epstein. Otherwise, you wouldn't have been a co-conspirator. Can a court name a sacrifice to suffer for others?
I'm not concerned in this case that some of the victims' lawyers were clamoring for it. Those lawyers could very well be paid for by people with another agenda. Why should the Sacklers be left with anything? The main guilty parties in their family are dead - now we're arguing with the people who are inheriting the proceeds of the crime. Why argue? Just seize it all; the damage far outstrips their worth, and their worth isn't even from their own labor, it's inherited.
Meanwhile, the descendants of slaves are mocked over 400 years of stolen wealth. And we can't even take the proceeds of the most horrific crimes from people who don't even work for a living, and will likely be left wealthy if every dime of that inheritance is taken away.
I blame the doctors too. I was a teen in the early/mid 2000s and even I knew about the addictiveness of oxycodone. It wasn't called hillbilly heroin for nothing.
I find the Supreme court decisions to be fascinating reads and overall much more interesting and complicated than most news services make them out to be.
They're also eminently readable, which (to me) shows the massive skill of whoever writes these. The fact that I, a layman, can easily understand them speaks to the quality of the writing.
Or to how unexceptionally average most of the judges actually are.
If you're willing to entertain these are skilled brilliant jurists with some kind of mystical levels of elucidation, maybe they're actually just people who failed upward into a job with a fancy robe
The difficulty of understanding a text isn't proportional to how skilled the person is at their job (I think it's inversely proportional, if anything), but to how familiar a field is.
It doesn't take a good developer to describe a system in a way that nobody can understand it. It does take a great one to describe a system in a way that a layman can understand it.
If you've been around the valley long enough to hear pitches, you've surely met some remarkable bullshitters who can convincingly describe with clarity and crispness something that is actually nonsense and simply is not real.
There's a group of attorneys that host a podcast on SCOTUS that present a pretty convincing case for this interpretation, at least to me. Here's the most recent episode
Pretty much. He also authored an opinion today against the EPA's good neighbor rule. Directly continuing the work of his mother, who was head of the EPA during the early Reagan years until she was forced to resign as even within that administration she was flagrantly unwilling to do her job of enforcing regs to prevent pollution while also illegally utilizing the power of the office for personal politics.
Always strikes me as weird that the clear through line from her time in power to his own jurisprudence on environmental issues doesn't come up more.
And honestly, while we like to lump them into "conservative" and "liberal" camps for simplicity, it's easy to get the correlation wrong. Like anyone else, their moral and legal philosophies might make them lean one way or another politically, not the other way around. Even for the most extremely political justices, to hear them expound on the legal principles of federalism or human rights is very fascinating.
It's easy to forget that, while they are political appointees, they have to have fairly long careers as acting judges to even qualify for the appointments.
Save for at least one current sitting Justice: Amy Coney Barrett. They only had ~3 years of experience being a judge, Seventh Circuit Court of Appeals (2017–2020), before being nominated to the Supreme Court. Yes, they have experience in other law related roles, however your comment explicitly stated, "...fairly long careers as acting judges...," so that is what I'm speaking to.
Liberal vs. conservative has always been the wrong take. The stronger dividing line is textualism vs pragmatism.
In fact Scalia famously said this coming from a textualist perspective which I think most people can agree with even if they hate him: “ If you’re going to be a good and faithful judge, you have to resign yourself to the fact that you’re not always going to like the conclusions you reach.”
This seems absolutely correct, but when is the last time ypu ever saw a commentator observe this? Critique has been reduced to “i dont like the effect so the interpretation of the law is wrong.” Put the other way, a fair observer must eventually say “i really hate the conclusion but they got it right.”
>The stronger dividing line is textualism vs pragmatism.
They should be doing what is right for the American people. There are clearly laws on the books today which infringe on individual freedoms (abortion), harm society as a whole (citizens united), etc.
The 'justice system' is supposed to be the government branch protecting the little guy from powerful elites. I've not often seen that. I see the opposite. If the legal system won't deliver justice, well, people are going to take things into their own hands whether that's 'justice' or not. If you bury your child, and you see the people ultimately responsible get away with it, I'm not sure I could really blame them.
Strong but respectful disagree from me. Justice is supposed to be blind. And if right and wrong were so clear cut there would no need for democracy at all.
The court is not a democratic institution and exists to uphold the textual rule of law as determined by lawmakers. If a pragmatic ruling by the court can circumvent a politically logjammed congress, so be it. But the courts deciding what is right or wrong for the American people is a very slippery slope that leads to disaster. And a court that just rules against the (existing) elite every time is a junta.
Both sides have their merit, but some people want to have it both ways - do you want pragmatic judges or more democracy? They can often be mutually exclusive.
> The stronger dividing line is textualism vs pragmatism.
Except when it came to "textualism vs pragmatism", I've seen that the "textualist" judges have, in many cases, no problem being "pragmatists" when it suits their desired outcome on an issue.
For example, when Scalia dissented in some famous gay rights cases (I'm thinking of Lawrence v Texas specifically) his basic disgust at the thought of same sex relations was laid bare. Ironically, in Lawrence v Texas his dissent was basically correct - striking down laws against sodomy was a step towards gay marriage - but the gist of his argument was that gay marriage was such a god awful, horrible, unthinkable thing that any decision that allowed it must be prima facie wrong. He was basically warning "This decision will force us to allow gay marriage" as if, instead of that being a good thing, it was akin to allowing the apocalypse.
Scalia also authored the 5-4 decision in District of Columbia v. Heller, a major second amendment case that held, for the first time, that individuals had a private right to own guns (not just "a well-regulated militia"). Read up on that case, as tons of "conservative" judicial scholars argued that it was "pulled from thin air" just as much as Roe v Wade was. From the Wikipedia page:
> Richard Posner, judge for the United States Court of Appeals for the Seventh Circuit, compares Heller to Roe v. Wade, stating that it created a federal constitutional right that did not previously exist, and he asserts that the originalist method – to which Justice Antonin Scalia claimed to adhere – would have yielded the opposite result of the majority opinion.
>> The text of the amendment, whether viewed alone or in light of the concerns that actuated its adoption, creates no right to the private possession of guns for hunting or other sport, or for the defense of person or property. It is doubtful that the amendment could even be thought to require that members of state militias be allowed to keep weapons in their homes, since that would reduce the militias' effectiveness. Suppose part of a state's militia was engaged in combat and needed additional weaponry. Would the militia's commander have to collect the weapons from the homes of militiamen who had not been mobilized, as opposed to obtaining them from a storage facility? Since the purpose of the Second Amendment, judging from its language and background, was to assure the effectiveness of state militias, an interpretation that undermined their effectiveness by preventing states from making efficient arrangements for the storage and distribution of military weapons would not make sense.
> It's easy to forget that, while they are political appointees, they have to have fairly long careers as acting judges to even qualify for the appointments.
This is objectively false. There are no requirements like this and there have been several appointees throughout history without many, if any, qualifications for the role.
I totally agree. I have also been captivated by the oral arguments. To the extent that I find myself pre-researching some of the cases' background beforehand. Makes for compelling entertainment when you have a sense on why the justices approach questioning the way that they do. Beats any podcast I know.
I studied international politics in college and as a result I read not only a ton of news, but often the primary sources they were based on, and I was shocked by the amount of omissions and oversimplifications. I've never understood people who don't "trust" the news given that it is provably accurate and factual nearly all of the time. But I've long despised the arrogance from mainstream media wherein they confidently decide what to print and what not to print with no explanation or accountability on those decisions.
Yes, indubitably. It's easy to lose sight of (if one doesn't read the rulings regularly) the fact that SCOTUS's job is to come to rational and deliberate rulings grounded firmly in textual and common law dating back over a thousand years. Even when one doesn't agree with the conclusion, one rarely sees a ruling that isn't reasonable (though sometimes seeing the reason involves entertaining a fact pattern other than the one you believe to be true!).
Most of the current legitimacy damage stems from a perception that the Court has members that are arbitrating law over bribery while simultaneously engaging in behavior that looks suspiciously coercive. I think that's a major issue, but it's a bit orthogonal to the question of whether they use sound judgment to arrive at rulings like, say, US v. Rahimi 22-915.
(The other source, to my eyes, of questions of legitimacy is that the appointment of three judges in a narrow amount of time under one party's dominance of Congress and the Presidency has fundamentally shifted the "flavor" of the way the Court interprets law. Rather than bringing their legitimacy into question, that's rather the point of the process by which the US appoints Justices and the length of their term; the Court's "personality" is stable over long stretches of time, but it can shift and it does go through eras. People complaining about the new era don't seem to realize that for many Americans, the previous era was strange times that called to question in their minds the legitimacy of the Court).
Lol, they're also quite ideological. Don't fall for the trap that these people are enlightened philosophers. They have a lot of flaws in their own right.
Ask good lawyers about their thoughts on SCOTUS Justices, it's not always peachy.
Even if they are ideological, they are not usually political hacks (cough Thomas cough).
Honestly though, for as much flak as this current court gets, there is at least a certain consistency where they at least mostly stick to arguments about the letter of the law. In previous courts you would see some truly wild written arguments about how, like, a specific word in the Commerce Clause or whatever could mean whatever you wanted it to.
The interpretations break with precedent but they are rarely ridiculous.
As detestable as I find the outcome, Roe v. Wade built a right to privacy out of whole cloth where none existed before, and whether that was good law has been hotly debated ever since it was decided (https://scholarship.law.missouri.edu/cgi/viewcontent.cgi?ref...). It's within the purview of SCOTUS to go "This was bad lawcraft done by our predecessors, and we reverse it based on this reasoning..."
We can disagree with their reasoning, but my main point is you rarely see a ruling from SCOTUS that is nakedly "Because I said so," even though that's de facto the power they have. The initial Roe decision was shaky. "That was a shaky decision, so we have reversed it" was at most equally shaky. It's hard to argue that one is well-reasoned and the other not (though I think there's room to disagree on what facts the two Courts considered).
Haha. Sure. Like when they make up Qualified Immunity which is a completely made up special status/protection given by the Courts, not by law or common law but abusing the concept of Judicial immunity and expanding it to all governmental officials.
My bad. I can no longer edit/delete my comment to fix it.
I haven't responded that way in the past but was responded to that way a couple of days ago and guess it took hold. I can see why you have to clamp down on it, it easily spreads.
Thank you. For my purpose as a reader it is editorial incompetence that the article neither provided that link, nor the name of the case to make it easy to lookup.
This is my gripe with regular news. Science paper? No link. New law bill? No link. Someone made an hour-long speech? 30 second cut, no link to the full speech. Is it almost as if they'd rather we didn't see their sources?
It's really painful when you've got coverage of state court cases where you have neither the case name nor the court it was filed in nor the docket nor any document nor anything that would let you figure any of this out.
A more cynical take is that it isn't editorial incompetence, it's an editorial decision. Once you notice it, it's hard not to notice how often you aren't given the sources or ways to further confirm stories, especially those that might be controversial.
There will be people like Sacklers until we start putting them away and throwing away the key. We do need to put rich people in jail at least every now and again, if for no other reason than to demonstrate we're not a banana republic.
It's best to avoid generic tangents in HN threads, especially generic flamewar tangents. They tend to make discussion more repetitive and therefore more tedious and eventually more nasty. This particular one has been repeated hundreds if not thousands of times in the past.
You're attacking a strawman, try steelmanning the argument to "rich people who commit crimes should go to jail every now and then". I think we can all agree.
Please don't cross into personal attack regardless of how provocative another comment is or you feel it is.
Edit: Could you please stop posting unsubstantive comments and flamebait generally? It looks like your account has been doing this repeatedly. It's not what this site is for, and destroys what it is for. If you wouldn't mind reviewing https://news.ycombinator.com/newsguidelines.html and taking the intended spirit of the site more to heart, we'd be grateful.
Unfortunately, vermin like the Sacklers have access to top lawyers. The two founding brothers are dead, so you won't be able to put them away; they are already put away, permanently.
However, their despicable offspring managed to flee the country with their ill-gotten gains; good luck finding them now.
My biggest beef with this case has been that people should not be allowed to just "buy" themselves out of jail. The US does not have a concept of "blood money" in its legal code (at least, not yet anyways). This agreement amounted to blood money, practically. Blood money != justice.
Is rule of law totalitarian? Wealth is not be a get out of jail free card, and imprisonment is not inherently an abuse of rights. While the US prison industrial complex is vile and abusive, the cushy white collar prisons aren’t where those abuses are happening.
If your boss tells you you'll lose your job if you don't have sex with him, and you quit to avoid that, would you disagree with the statement that you were forced to quit?
the choice to have sex with someone or be fired is not a legitimate choice and framing it as one is also illegitimate. do you have a better suggestion for a term you would prefer?
It is choice. That's the whole point of the discussion you might not like the choice you would have to take but it still is. If you want to convey that you get extorted do so but use the right words.
>to make something happen or make someone do something difficult, unpleasant, or unusual, especially by threatening or not offering the possibility of choice[0] (notice or here)
>If someone forces you to do something, they make you do it even though you do not want to, for example, by threatening you.[1]
>to make someone do something that they do not want to do
>I was forced to take a taxi because the last bus had left.[2]
Yeah, still nobody can "force you to trust" anything. They might force you to comply with something but they can't force you to trust. That's just nonsense.
I didn't commend on that. I commented on you replying "no" to the question "If your boss tells you you'll lose your job if you don't have sex with him, and you quit to avoid that, would you disagree with the statement that you were forced to quit?" after which you edited all your previous comments. The first of which originally just read "force?" (a single word) which leads me to believe, along with your original response to the point I initially commented on, that you didn't have that point in mind. Also, "tust" in "force people to trust the medical industry" clearly means something along the lines of "to commit or place in one's care or keeping."[0] But that point is irrelevant because you made up that point after my initial response.
I edited my first comment to clarify and nothing else and YOU commented on that.
We can throw dictionaries on each other however we want for me it still stands as long as you have agency over yourself nobody can force you to do anything. If they take away your agency we can talk about your arguments. But looking at your last comment you are not arguing in good faith so the discussion is over me.
>I edited my first comment to clarify and nothing else
You edited "No, words have meanings" to "No, words have specific meanings that should accurately reflect the nuances of the situation at hand." You also edited "So?" (single word) to 'So? "Force to trust" like op wrote made absolutely no sense.'
>for me it still stands as long as you have agency over yourself nobody can force you to do anything.
It can and often does mean that though. Here's a list of 170,000 books using the phrase "forced to trust"
Both edits are for clarity and don't change the meaning of the comments... and both edits are not in our comment chain. You seem to have another agenda here and I really won't entertain it anymore. We have different views of what force means. One is rather clear and the other one is nitpicking to get an agenda across. Nobody forced anyone to get vaccinated and nobody forced anyone to blindly trust medical professionals. There are billions of people who didn't get vaccinated. You might want it to be but it's not the reality we live in.
Reality is what doesn't change if you stop believing in it.
The first edit I mentioned is in this comment chain and the second one was in response to my post in a different chain.
>Nobody forced anyone to get vaccinated
Really? This is trivially false. For example vaccination was extensively mandated in several countries by law, for example some provinces in China.[0] In the US certain states require proof of vaccination for certain activities. For example in New York vaccination is required to go to school.[1] Perhaps you meant "not all people were forced to get vaccinated?" That is not being debated here. In any case I never even made an argument about this point until now. And in any case I don't feel too strongly about whether "force" is the right word to describe vaccine mandates. My only points were that if your boss tells you you'll lose your job if you don't have sex with him he has forced you to quit (assuming you cannot get him fired, for example if you have no proof he said that and will continue harassing you) and secondly that "forced to trust" is not complete nonsense.
>You seem to have another agenda here
You're the one that tried to say that a boss extorting sex isn't considered forcing you to quit your job in order to maintain your position. My point was actually fairly clear and not even about vaccination.
>One is rather clear and the other one is nitpicking to get an agenda across.
I would agree except you're not even nitpicking you're just claiming that whatever you decide "force" means is the one that OP must hold by as opposed to "throwing dictionaries" at the problem.
If your boss sexually harasses or extorts you, you take legal action immediately, you don't quit.
China? Really? ¯\_(ツ)_/¯
I won't delve into the possibility that you might have experienced inconvenience had you not been vaccinated. It appears that you're primarily concerned with your own interests and failed to grasp the broader implications during the COVID-19 pandemic, a perspective you seem to maintain even now. The choice was yours*.
*Except if you were residing under totalitarian regimes. Where they might actually forced you to get vaccinated.
There's a commonly understood definition of "force" among the general population, which you and op are attempting to distort by cherry-picking definitions from various dictionaries, often focusing on the less common usages found at the bottom of these entries. (If you go back and think about your china argument you might just understand this.)
As I previously stated, engaging in further discussion with you is unlikely to yield any meaningful results. bye.
>If your boss sexually harasses or extorts you, you take legal action immediately, you don't quit.
It's a hypothetical.
>China? Really? ¯\_(ツ)_/¯
You mentioned billions of people. So your argument was clearly not limited to the US. Or you just didn't make the point well.
>which you and op are attempting to distort by cherry-picking definitions from various dictionaries, often focusing on the less common usages found at the bottom of these entries.
One of the dictionaries is an ESL dictionary. It gives words as they are used and it gives the usage I quoted as the first definition.[0] The reason that the usage in the other dictionaries have the usages I quoted at the bottom is becasue they all give the noun form of "force" first.
Words have specific meanings that should accurately reflect the nuances of the situation at hand. You can write your comment without emotional exasperation or maybe not...
If someone didn't get vaccinated then the government would start basically attacking basic human rights. In particular rights of freedom work, assemble, free travel, freely to participate in the cultural life of the community, to practice a religion, etc (and to maintain their own health I might add) which turn up in some pretty hefty documents like the UN Declaration of Human Rights. Once those things are bargaining chips that you get to have for following a government policy, the policy is forced. This might make you uncomfortable. Indeed, it probably should.
Freedom means you don't have to trust hastily developed medical products. They can't have done any long term studies on the COVID vaccines yet because not enough time has passed for one to happen yet.
If someone doesn't trust the vaccine providers they shouldn't be forced to take it. You could have figured that out by analysing the specific meanings that the words have. That position on the topic of vaccines is neither rare nor subtle.
And the sentence still looks fine to me, I don't know why you think that phrase isn't kosher.
As trust is fundamentally a voluntary act. Trust involves choosing to rely on or have confidence in someone or something. By its very nature, trust cannot be forced.
1. Trust is a personal choice: It's a decision made by an individual based on their own judgment, experiences, and perceptions.
2. Trust requires vulnerability: When we trust, we willingly make ourselves vulnerable, believing the other party will not take advantage of that vulnerability.
3. Trust is built over time: It's typically developed through consistent positive interactions and experiences, not through coercion.
4.Forced compliance is not trust: If someone is compelled to act as if they trust something, it's not genuine trust but rather obedience under duress.
5. Trust can be withdrawn: Because trust is given voluntarily, it can also be taken away by the person who gave it. No one else can remove your ability to trust or distrust.
Ah, well circling back to the "words have meaning" point, that isn't a comprehensive understanding of what trust means - you're overly loading it on one aspect of the word. For example, Cambridge dictionary includes the meaning "to hope and expect that something is true" [0].
Trust doesn't require a personal choice built up over time. Some types of trust do, but that isn't a factor here as you can detected from the context. Trust is actually quite a flexible concept - you can catch some other interesting applications in security with ideas like "trusted systems" which people also may not trust in the personal sense even though they will agree that the system is trusted. That leads to awkward situations where a system can be a trusted system even if it is known to be compromised. You also get interesting things like "Trust" in the legal sense that showcase a similar flexibility.
Just to preempt a possible next comment, if you identify that one reading of a word doesn't make sense in context, the reasonable thing to do is to try the alternate readings to see which ones fit.
I will just annotate that with the observation that at the equivalent point (~4 years) into oxycodone's history I doubt it was well known to be addictive. Wiki suggests it was a "Miracle Drug of the 1930s" and they didn't get nervous about it until the 1970s [0].
And I doubt OxyContin came with the liability waivers that I seem to recall the COVID vaccines having.
That is a fairly safe base case - but would you have seen the opioid epidemic coming that resulted in this Supreme Court lawsuit? These things are being proscribed by reasonable doctors as painkillers and appear to have done more rather serious damage.
I will cheekily note that you wouldn't have been following the science if you did, these things were safe, effective, FDA approved and administered by the experts.
Interestingly the same kinds of tactics used to push opiates on the general public are still being used to push amphetamine analogs - but the death rate from amphetamine addiction/overdose is much much lower (>1000X lower) than that from opiate addiction/overdose so it doesn't really hit the headlines, and arguably is not as much of a concern.
From a libertarian point of view, mood- and mind-altering substance use should be the citizen's choice, but for this to not result in an epidemic of addiction, it would require a well-educated public who understands that whatever short-term apparent benefit a drug (including alcohol and nicotine and caffeine) delivers, there's always a tax that must be paid afterwards, and use must be kept below the addictive threshold, meaning if you start needing more of the drug to get the same effect, the only rational thing to do is to stop using the drug until your tolerance goes back to zero.
This of couse goes against consumer society norms, where the concept of 'less is more' is almost a heresy.
The problem with mind altering substances is they can short circuit your rational thinking. So you can start with the most well-considered decision process ever and still end up addicted. In fact, this doesn't even require a substance. Gambling is plenty addictive to many.
There's a kind of fallacy to thinking that sufficient education can counter biological human desires and impulses in all cases.
That's the authoritarian view - people don't know what's good for them, so their behavior needs to be controlled by the state as informed by a small group of elites who themselves are somehow free from the influence of those biological human desires and impulses... which is why drug testing as a condition of employment was never implemented for political candidates, heads of bureaucratic government agencies, or corporate CEOs.
>a small group of elites who themselves are somehow free from the influence of those biological human desires and impulses...
They don't need to be. A person addicted to drugs is perfectly capable of creating laws prohibiting drug use.
The "impulse" equivalent for a lawmaker would be that once they feel withdrawal, they will spontaneously pass a law allowing drug use again.
Since (luckily) passing a law is far too complex to happen spontaneously, this scenario cannot occur.
ETA:
>which is why drug testing as a condition of employment was never implemented for political candidates, heads of bureaucratic government agencies, or corporate CEOs.
If drug use is "only" prevented for the 99% of people who do not fill these roles, that is still a massive improvement.
I guess I'm not sure what the point of the comparison is. If the death rate from opioid addiction were 1000x lower, I would happily bite the bullet and say Purdue did nothing wrong. Chronic pain is real and terrible - it would be great to have a solution where the downside risk is no worse than an Adderall dependency.
In my experience, people who use amphetamines (and cocaine) regularly start making very bad decisions, and heavy use leads to amphetamine psychosis. A very public example of this was the behavior of the SBF / FTX / Alameda operation, where by several accounts regular amphetamine use was the norm. That doesn't mean it should be illegal, but I'd avoid associating with anyone I knew had an amphetamine or cocaine dependency.
Difference is the death rate from prescription ADHD meds is zero, and they’re not addictive like opiates.
I’m open to discussing the underlying problems that push people to take ADHD meds. Like the insane work life required to just maintain the same standard of lives as our parents generation, or modern devices eating our attention spans.
But limiting access to ADHD drugs is just going to affect the most vulnerable and the positive outcome is just for the benefit of Calvinist pushing their world view on the rest of us. Hey, while we’re at it let’s make caffeine a scheduled drug. It’s actually addicting, it’s long we half-life makes it more likely to effect sleep, and its vastly over consumed by everyone starting in middle school.
>Hey, while we’re at it let’s make caffeine a scheduled drug. It’s actually addicting, it’s long we half-life makes it more likely to effect sleep, and its vastly over consumed by everyone starting in middle school.
Another thing to note is that the scheduling of the substances you speak of (and other non-scheduled like ozempic for example) merely puts them behind a prescription paywall--the wealthy have easy access to beneficial medicine and few to no consequenses from their use, whether that be criminal (possession or behavioral problems under the influence) or the cost of resulting health and addiction issues. Resulting in the non-wealthy suffering exponentially more.
It's very important that these societal and monetary debts are not only paid out, but go to the right people.
I don't understand the hatred directed at the Sacklers. Oxycodone is, just like all other opiates, highly effective at suppressing pain, potentially addictive, and deadly in large enough doses. This has been common medical knowledge for millennia. Why do so many people believe that they are responsible for overdose deaths?
Because they marketed an opioid as an "extended release" form when they knew from their own internal studies that the pain relief only lasted the standard 6 hours instead of the 8 hours that were claimed. As a result, people would find themselves taking more to stay on top of their symptoms and the resulting ramp in use would leave people debilitated.
> A recent study, by a team of economists from the Wharton School, Notre Dame, and rand, reviewed overdose statistics in five states where Purdue opted, because of local regulations, to concentrate fewer resources in promoting its drug. The scholars found that, in those states, overdose rates—even from heroin and fentanyl—are markedly lower than in states where Purdue did the full marketing push. The study concludes that “the introduction and marketing of OxyContin explain a substantial share of overdose deaths over the last two decades.”
This is a correlation study—I understand that increasing marketing efforts leads to an increase in physician prescription, but those overdose deaths were caused by a tiny fraction of patients refusing to follow the script as issued by their physicians. Whose fault is that?
It's especially tough for me because they clearly pushed their sketchy marketing and sales tactics because they honestly believed they were helping people, and in their lifetimes the medical industry lauded them as heroes for "safe" and affordable ways to ease suffering.
Right now people have no problem suppressing research they don't like about the negative effects of marijuana or anti-depressants or whatever their de jour personal treatment is - in 20 years if something bad really comes to light everyone is going to pretend that they knew all along and that everything was a smoking gun. Hindsight is 20/20 and history is written by the victors.
because the way they encouraged doctors to push it to everyone, regardless if they needed it or not. they aggressively marketed and pushed the drug in situations that didnt call for it
How much of this issue have you investigated already?
It’s worth skimming through the Massachusetts AG complaint about their actions, and the strategies employed by Purdue (of which the Sacklers always held the majority of board seats)
> Although a different formulation of oxycodone, manufactured by Merck & Co., was removed from the market in 1990 because of a high risk of addiction, members of the Sackler family downplayed the dangers of OxyContin, deceiving doctors into thinking that it was weaker than morphine and convincing them to prescribe the drug liberally
Because they marketed it as a non-addictive opioid because it was extended release and encouraged doctors always to prescribe the maximum amount despite internal testing showing the extended release was bogus and it was still addictive?
The vendor who sells many different things seems to be at least a bit less culpable than the provider who sells just their thing while lying about certain effects of it. Yes, we can examine how we got into this situation where doctors take drug advice from the people who make the drugs but the people who lied for profit deserve the lion's share of the criticism.
In practice, even many of the general public knew that what the vendor was selling was addictive and dangerous -- there are some reports even in this thread. So it's hard for the vendor to claim ignorance, even more so when often they also stood to profit from the lie (repeat customers).
Link to ruling:
https://www.supremecourt.gov/opinions/23pdf/23-124_8nk0.pdf
It’s pretty wild that everyone acknowledges that the Sacklers engaged in a “milking program” going from 15% to 70% distributions after the first lawsuits in order to strip the company of assets and then hide behind the company to shield liability. This alone should allow claimants to pierce the corporate veil and go after the family directly.
> allow claimants to pierce the corporate veil and go after the family directly.
This decision is a win both for that cause, and also forestalling precedent that would allow future wrongdoing corporations from 'shielding the veil' so to speak through bankruptcy. A win-win indeed.
At least initially, I'm glad to see this verdict if it means such behavior can't hide behind the corporate veil. However, it's important to acknowledge it's not necessarily a win-win-win. By reading Justice Kavanaugh's dissenting opinion, this decision seems to delay opioid victims the settlement they previously won.
>"As a result, opioid victims are now deprived of the substantial monetary recovery that they long fought for and finally secured after years of litigation...virtually all of the opioid victims and creditors in this case fervently support approval of Purdue’s bankruptcy reorganization plan."
Time will tell if this ruling gives enough preventative pressure to future cases to make it worth the additional pain to the present claimants.
But now that the ruling potentially exposes the Sacklers directly, they have much more incentive to negotiate a new settlement. If the plaintiff's attorneys are clever, they will leverage this to come to a quick settlement of approximately the same amount, with the threat that delays will bring demands for higher amounts.
> By reading Justice Kavanaugh's dissenting opinion, this decision seems to delay opioid victims the settlement they previously won.
The problem is that this sets an ugly precedent. The bankruptcy settlement is basically "I can make a deal with A that takes away your ability to sue B, even though I wasn't suing B and you are". It makes no sense. The dissenting opinion is the epitome of "fuck you, I got mine."
Suppose we discover next year that one of the RNA covid vaccines causes cancer with 100% probability. The vaccine maker, on the hook for trillions of dollars of damages with no possible way to pay, declares bankruptcy (victims get approximately nothing). Elon Musk steps in and offers to contribute 20 billion dollars to help compensate the victims who would otherwise get nothing. All he asks is that the bankruptcy court dismiss all claims related to his pay package, stock manipulation and libel on twitter. The victims overwhelmingly approve the settlement and the judge oks it. After all, bankruptcy judges have wide discretion and $20 billion is better than $0.
Is that ok?
In my analogy, Elon Musk (and most of the people suing him) are not related to the vaccine maker (but there could be overlap among some of the plaintiffs and Musk could own some shares of the vaccine maker). But, technically, the same is true with Purdue Pharma, the Sackler family and plaintiffs. Yes, the Sacklers are more closely related to Purdue than Musk and the hypothetical vaccine company, but that's just a matter of degree.
In the Purdue bankruptcy, the victims of Purdue voted (and the court agreed) to take the Sackler's money and in exchange prevent anyone at all in the United States from suing the Sacklers about anything at all related to opioids. Even people who are not eligible to be members of the Purdue bankruptcy settlement cannot sue the Sacklers!
If the Sackler settlement was allowed to stand, it effectively allows billionaires to buy their way out of liability for unrelated things if they donate some money to sympathetic victims. All they would need to do is create some degree of nexus between themselves and the entity declaring bankruptcy, sufficient for a bankruptcy judge to ok the settlement.
I don't disagree with any of this. That's the main reason why I said I think we'll have to wait and see if this ultimately leads to better outcomes. However, I think it's been shown that the very human idea of "fairness" can create spiteful, sub-optimal outcomes. Remember, "nobody gets anything" is also fair amongst victims, but certainly not optimal.
> the court agreed
As I understand it, the court didn't so much agree as practically force them to accept the deal.
The whole thing was largely engineered by the Sacklers managing to get the case heard by probably the most Sackler-friendly judge in the country.
I could see shielding from future civil liability as an option, but only after a true bankruptcy has occurred. Liquidate everything, and by that I mean everything, and then you can move on with your life. Definitely no shielding money in offshore accounts.
If you're not willing to do that ... well, see you in court. Over and over, because every individual you hurt should have a chance to come at you with a liability claim.
One problem of which I was unaware is that the Sackler family has largely fled the United States.
Pursuing their assets introduces vast complexities of international law.
"In a brief filed on behalf of the relatives of Mortimer Sackler, most of whom are based overseas, lawyers warned of “significant litigation costs and risks” in seeking to enforce any foreign court judgments against the family if the settlement were thrown out."
> "In a brief filed on behalf of the relatives of Mortimer Sackler, most of whom are based overseas, lawyers warned of “significant litigation costs and risks” in seeking to enforce any foreign court judgments against the family if the settlement were thrown out."
I understand your point, but basically they are saying: "We hid all our assets to evade the law. Give us immunity from criminal money laundering evasion and we will only pay part of what we likely would have owed."
Can you imagine a member of Congress or the President saying this? Forgoing immunity is a scorched earth tactic, but it is also one that will dissuade future abusers. We have those overseas money reporting laws that make it difficult for Americans to get bank accounts overseas. Let's use them!
> "We hid all our assets to evade the law. Give us immunity from criminal money laundering evasion and we will only pay part of what we likely would have owed."
> Can you imagine a member of Congress or the President saying this?
Yes.
Well, we haven't gotten to that part just yet. Right now, we're still in the stage of deny deny deny even in the face of evidence and convictions. They are still in the deny stage.
Consider a few issues:
- the foremost among the perpetrators are dead
- the rest of the family is culpable, but less so
- the settlement money will now be entirely repurposed for legal defense
- meanwhile the victims get nothing
Does justice demand punishment or compensation?
> Does justice demand punishment or compensation?
Which outcome provides the greatest disincentive against anyone else even contemplating doing something like this ever again?
It generally demands deterrence. Helping the victims out is great, and the proceedings should do that as best they can, but the largest benefit that can be brought to society as a whole is showing that doing these kinds of things will be bad for you.
That's basically the argument made in the dissenting opinion. I find the split among the justices here very interesting as it is not along party lines, as such splits usually are.
> Can you imagine a member of Congress or the President saying this?
definitely. The 2012 STOCK Act is routinely violated by members of congress who insider trade on information from congressional committees before laws are enacted. that money the openly argued about the legitimacy of in congress and Pelosi, for one, and Tommy Tuberville, for another argued that it should be allowed. Pelosi later changed her stance, but continues insider trading. you can find datasets for all this at (no relation...just interesting data) https://quiverquant.com
> "We hid all our assets to evade the law. Give us immunity from criminal money laundering evasion and we will only pay part of what we likely would have owed."
> We have those overseas money reporting laws that make it difficult for Americans to get bank accounts overseas. Let's use them!
This is conflating two things.
It is not criminal to move money offshore, and nothing suggested any money laundering occurred, because it is not necessary to launder money to move it offshore. And it is also not money laundering to obfuscate money's origin or destination. Money laundering requires a criminal origin and then obfuscation.
Despite how much the US has convinced its entire culture to stigmatize the concept of moving money, the US is operating in its own bubble of hubris to suggest money has to stay within its ecosystem. It doesn't make any sense at all when you say it out loud does it?
To your second point, the US has reporting laws on money held offshore legally, for US citizens. For banks, this is merely an additional compliance burden that disincentivizes them from dealing with small accounts because its not worth it. But at Sackler money, it is worth it. It is not hard to find someone to bank you as an American. And at Sackler levels of money you don't have to remain a US citizen, hence absolving the reporting requirements if they went that direction.
Or when you have a second citizenship, you can just not tell the US about it, and you can just not tell the foreign bank about your US citizenship. Prosecute that on its own, if you find out.
and finally, there are gaps in this reporting framework. FATCA treaty was a broad expansion of a country's power, to the limit of our global society in the continuum of history. And its not completely as omnipresent as the American psyche imagined. Just like the global sanctions attempt on Russia showed, its a nice try but now everyone can see how much is hubris in plain sight.
> And at Sackler levels of money you don't have to remain a US citizen, hence absolving the reporting requirements if they went that direction.
Renouncing your citizenship because you owe the US government money is generally not seen as a valid reason by the US government to renounce your citizenship.
Nor should it be. These people are leeches whose very existence is antithetical to a healthy and just society. They've done immeasurable damage and then hide behind the courts to avoid any repercussions. Disgusting, the lot of them.
That’s not the reason you would say in your renunciation ceremony
Even if they let you go through with the ceremony, it doesn't actually stop them coming after you.
> and you can just not tell the foreign bank about your US citizenship
Holding foreign assets that you did not report on an FBAR is a crime. Lying about it to the bank that asks if you are a US citizen wod be obfuscation to support a crime. I'm not sure why you are trying to argue that nothing criminal is being done in these scenarios.
Considering the patience the US has with getting justice against other individuals who have fled our jurisdiction, we could do the same here. We also have an enormous amount of influence in the financial sector in other western nations, so we could at least make their lives less lavish and comfortable.
Throwing up our hands and declaring it an unsolvable issue just encourages others to misbehave and then escape the same way.
Hey, it's not like they shared copyrighted movies on a server or something.
If we can seize Russian oligarch's money, why could the US Gov't not seize assets of a US citizen even if living abroad?
Because US citizens have rights that are not granted to non-US citizens.
Nit: the assets were frozen, not seized. There was recently hand wringing in the EU over using the principle or interest to fund Ukraine, and they settled on interest because seizing assets scares any foreign investors who might someday disagree with a government.
The question is whether to allow a smaller settlement immediately, or pursue a less-likely and possibly larger set of judgements in the future. It's not clear that it is possible to get more money out of them.
The EPA values one human life at $10M. A conservative estimate of the number of people killed by the Sackler family's companies (testified in court) was ~~245,000~~ Edit: probably at least 100,000, see below. So if opiates were environmental pollutants, the Sacklers would be on the hook for $1T in damages. Their immediate settlement was $6B.
Roughly three orders of magnitude too small.
Attributing every single opioid overdose to solely the Sackler family is so laughably ludicrous it's hard to take this comment seriously.
The number of opioid overdoses between 1999 and 2021 was 645,000, according to CDC. Purdue Pharma brought in $35B in OxyContin revenue from 1995 to 2017. OxyContin was prescribed to 6.2 million people in 2002.
I'll edit the number above to ~100,000 as an estimate of the number of victims, since it looks like I misremembered 645,000 as the number of Purdue-related deaths. Still, that's assuming only 1.6% of those 6.2 million people taking OxyContin in 2002 developed an addiction, which seems low.
ok, so now you are just arguing percentages. What is an appropriate amount of the harm to be apportioned to the Sackler family?
We just need to convince people they leaked a couple videos of the war state doing bad stuff
Come to think of it, it's mind blowing when you compare the slap on the wrist of a punishment the Sacklers have received against what Julian Assange had to endure. One is responsible for the deaths of more than half a million people while the other is responsible for zero. The justice system really needs to get its shit together.
With that first sentence, I thought this might be doing down the road of, "boy, there sure is a lot of 'democracy' that needs to be spread."
Didn't stop them with Julian Assange or Kim Dotcom, and these people are actually evil.
The US are proud of getting some terrorist in the middle of Pakistan or putting pressure on whistleblowers internationally but when big money is involved getting a criminal scumbag responsible for ~1m deaths is suddenly a huge problem.
Listen, we can't spend like we did going after Julian Assange on this. It's just business people doing business.
El Chapo is crying.
El Chapo was free to form a corporation and then create an indemnification agreement between that company and himself. That he chose not to is on him.
I think you're mixing up the Purdue bankruptcy and individual, personal bankruptcies for the Sacklers. This case was about the corporate bankruptcy.
Matt Levine has covered this several times in the past, worth reading. From memory, the Purdue family had put away their money in legally sheltered arrangements, so even an unfavorable decision (to the Sacklers) would likely not be able to claw back much money. The previous deal traded the risk of trial for a perceived as decent compensation. My read is that the majority in the supreme court disagreed that you can always financial-engineer your way out of trials
They were (apparently) sheltering money specifically to pay for personal legal damages, and they voluntarily offered it back during the bankruptcy proceedings in exchange for giving up their liability.
The court ruling is not about the legality of their financial shenanigans, but the authority of the bankruptcy court on deciding such matters.
Lawyers are fixated on the money for obvious reasons, but the money will never really fix what the Sacklers did (particularly for the many victims who are now dead.) Restitution is largely a farce and we should be focusing on retribution.
Removing the profitability angle mildly dissuades this sort of behavior in the future.
I'm all for rendering the Sacklers paupers. Whether that money is given to surviving victims or piled up and burned matters less.
But a scorched earth destruction of their assets would be an appropriate end result.
We don't put killers in prison because 10 years will make the dead person alive again.
We do it because we don't like them.
We actually do it because they're a danger and people tend to age out of criminal impulses.
If there was zero risk of recidivism, we still would.
I'm really not sure what other retribution you're suggesting. There's always public lynching if that's what you're after, but we've kind of decided that is not a good idea in modern society
Jail. Jail would be reasonable for purposefully poisoning tens of millions of people.
Point of order.
Jail is for people not convicted of crimes.
Prison is for convicts.
To those in jail, I doubt it matters
They could be imprisoned.
Really unclear how knowingly creating a scenario where people die of overdosing for profit isn't criminal.
Because car manufacturers exist, and this isn't theoretical or a jab at cars themselves. We are 100% certain that people will die while using cars, and by cars. Vehicular manslaughter even has a high bar for real punishment precisely because driving a car has an inherent risk of killing others and that risk is legal to take on.
Knowing that some people using your product will die, and even that selling more of your product increases the deaths is something we're okay with. It's true of guns, red meat, skateboards, alcohol, lawn mowers, and industrial equipment — all sold for profit.
I very much dislike cases like this because while yes, opioids were overprescribed and Purdue sales people did go out and sell often times not in legal ways, doctors still prescribed them and we knew that people dying was necessarily an outcome. So while the crime they actually committed was about kickbacks, not doing the DEAs job enough for them, and lying with statistics they get blamed for the actual deaths which is silly. I take stimulants that double my risk of heart attack and are also known to be addictive, neither outcome is the maker's fault if those happen. It's the tobacco settlement all over again where when bad thing happens the proximate deepest pockets get blamed. I couldn't care less about the government taking money from rich people because reasons, have at it, but I think they're the scapegoat.
Except Purdue clearly stated that addiction was not an issue with their product. Car manufactures never say that death is no longer possible with their product. They blatantly misrepresented the dangers of their product in ways none of the other examples you listed come close.
They didn't though, they cited a medical journal article where an unaffiliated doctor reported the extremely low addiction rate. Which was true and misleading because short term opioid use addiction rates don't predict long term addiction rates — lying with statistics. And they should be charged and convicted for this, in fact they already were. However, since 2001 every bottle of oxy has made no claim that it's less addictive than other opioids. And we still prescribed them like candy.
> And we still prescribed them like candy.
Part of the claim is that the Sacklers were involved in this portion.
Isn't that a form of punishment instead of retribution?
Matt Levine wrote again today, this time about the decision that just came out:
https://www.bloomberg.com/opinion/articles/2024-06-27/purdue...
He quotes and explains parts of both the majority and dissenting opinions.
It was closely submitted, but didn't win the votes (4 points, 7 hours ago) https://news.ycombinator.com/item?id=40813446
I understand people who think the Sacklers are villains who destroyed lives, Purdue should be shut down, and we should transform the legal regime around opioids.
I understand people who think Purdue should continue, the status quo is OK, and the Sacklers are not [simply] villainous.
I don't understand people who think the Sacklers are villains who destroyed lives, but Purdue should continue operating more-or-less as-is. Which is, I think, the conclusion from this settlement. If this is you, can you help me understand? Do you think there is/was a realistic way to prescribe opioids routinely and safely?
I think there's a misunderstanding in what the settlement is about. As part of Purdue's bankruptcy, the Sackler family is voluntarily providing 6 billion dollars to help settle claims opioid victims have brought against Purdue Pharma.
As a condition to provide the 6 billion dollars, the Sackler family has asked the bankruptcy judge to not even allow any new suits against the Sacklers related to the Opioid epidemic. This is something bankruptcy courts do regular for the company Purdue Pharma, but it is irregular when it comes to the Sackler family (this is not the entity going bankrupt!)
This is the issue that went up to the Supreme Court, and the Supreme Court ruled that the protection given to the Sackler family is not something that can be given by a bankruptcy judge during the bankruptcy of Purdue Pharma.
Matt Levine has a much better explanation here: https://www.bloomberg.com/opinion/articles/2024-06-27/purdue...
To try to illustrate the (bad) principle with a starker hypothetical:
1. Scrooge McDuck owns a thousand different corporations that are restaurants and eateries.
2. A one-taco-stand company is in bankruptcy court, after recklessly inflicting severe food-poisoning on a dozen customers.
3. Scrooge McDuck says: "Out of the goodness of my heart, I will charitably donate $X of my personal funds to help these poor unfortunates... If you give me personal immunity to any lawsuits somehow involving recent food-poisoning problems anywhere."
4. The dozen hospitalized taco-eaters are puzzled but OK with this, since they'll at least get something. The judge shrugs and things move forward.
5. Meanwhile a million other customers of other restaurants see the news on their phones, which they have out because they're stuck on their toilets with raging diarrhea. Plus maybe a few whistleblowers that can't get work anywhere because Scrooge blacklisted them.
6. All of them are justifiably outraged that their rights to seek justice/compensation have been (partly) signed-away in the bankruptcy of some unrelated tiny taco stand case that they didn't--couldn't--participate in.
I don't understand why your analogy requires multiple taco trucks. So if I'm missing something please explain.
Otherwise, I find your analogy helpful and illustrative of my confusion. Here is the simplified analogy:
1. Scrooge owns a nasty taco truck that makes everyone sick. He runs to the bahamas and is gone. 2. A dozen customers take it to bankruptcy court and get ownership of the taco truck and Scrooge's "charitable" donation, but Scrooge would get immunity, and so would the taco truck. 3. Meanwhile, the victims that weren't in the settlement are outraged that Scrooge might be immune. Not everyone was a part of the first suit -- plus, the taco truck is still selling tacos, and people are still getting sick!
This illustrates my confusion.
To me it seems like we should shut down the taco truck, and not give it immunity. I'm kind of a utilitarian and I don't much care about Scrooge, though I wish I could take his money away and put him in jail.
But it seems like most of the people who are mad about the diarrhea are not talking about the taco truck's continued operations and immunity??? And they are chiefly concerned about Scrooge, who is no longer involved with the taco truck??? What gives?
> multiple taco trucks
Trucks? The lawsuit involves one discrete corporation, and its small size is underscored by how it's just one stand/kiosk. (I suppose it could be mobile, but that's not what I was thinking of.)
However same owner/investor happens to be involved in many un-enumerated companies, some of which might easily be guilty of the same problems, including ones that would normally "pierce the corporate veil" and affect investors directly.
> but Scrooge would get immunity, and so would the taco truck.
The taco-stand corporation isn't immune, it's going bankrupt paying judgements. CEO/Owner Scrooge is coming in from the sidelines to preempt a personal lawsuit, and also trying to get someone in authority to (wrongly) grant him immunity from other potential lawsuits from other claimants.
> plus, the taco truck is still selling tacos
Oh, I think I see: No, this isn't a duck-ified version of the entire national controversy, I'm just trying to illustrate the how an "immunity" grant can be bogus.
In other words, the taco-stand is not a 1:1 analogy placeholder for Purdue Pharma, you can assume it's been bankrupted into Chapter 7 and broken up and sold off.
+1 for Levine's explanation. As usual he is insightful, great at communicating a complex topic, and just fun to read.
Matt Levine is a treasure. He is tied only with Derek Lowe for being a fantastic writer who makes complex topics understandable, interesting, and enjoyable.
https://archive.ph/Co2A1
My question is not about the settlement; it's a question about moral judgements people have around Sacklers/Purdue, including judgements I see on this comment page. I already understand the mechanical details you've explained and they don't answer my question.
> Do you think there is/was a realistic way to prescribe opioids routinely and safely?
Oxycodone is routinely and safely administered right now, to tens of thousands of people, every day. But this is kind of like, an FDA question, no?
Which is why going after the Sackler's is about politics and not about the law.
Or maybe it's about the horrible crimes against humanity committed by the Sacklers?
You said:
>I don't understand people who think the Sacklers are villains who destroyed lives, but Purdue should continue operating more-or-less as-is. Which is, I think, the conclusion from this settlement. If this is you, can you help me understand? Do you think there is/was a realistic way to prescribe opioids routinely and safely?
As GP noted, that is not the conclusion of the settlement - not even close. If you want to better understand comments on this page, perhaps reply to them asking for clarity?
This is an excellent ELI5 explainer, thanks.
Yes of course there are realistic ways to prescribe opioids routine and safely. Purdue did not invent opioids, what they did is patent a particularly strong formulation, and then work to undermine the cultural taboo in medicine around their use. That last thing was their crime.
There isn't, at this time, any other way to treat serious pain (in all cases). Opioid prescriptions will continue to be an unfortunately necessary feature of our medical system until we invent painkillers strong/good enough to replace them. I say this as someone who was personally addicted to opioids in general and Oxycontin in particular and feel very lucky to have only one dead friend as a result.
Opioids can't be banned until we can replace them with something equally generally effective. But what we should do is reinstate the taboo around prescribing them, and probably stop offering take home fentanyl prescriptions at all (it's still useful for anaesthesia, in hospitals). Perhaps more importantly, I think the cat is kind of out of the bag on prescriptions. I haven't been around that world for a long time, but it seems to me like pharmaceuticals aren't the primary entrypoint to opioid addiction anymore - people just start with fentanyl.
Dealing with fentanyl seems to me to be basically impossible. One kilogram of pure fentanyl is ~2,000,000 doses, for someone without a tolerance. This is impossible to interdict at the border. It is also fully synthetic, with no great choke point on synthesis routes. I have heard that there are other, even more dangerous, compounds like https://en.wikipedia.org/wiki/Etonitazene that are also even easier to synthesize. I don't really know if there is a good way out of this other than doing the slightly less impossible thing, which is curing addiction.
Thank you for the reply! I am honestly not informed about this stuff and not asking to covertly push an agenda.
Follow-up Q for you. What is the realistic way to prescribe opioids routinely and safely? Are there certain formulations that have been or should be removed from the market? How do we reinstate the taboo on prescribing them?
For EG: I got a vasectomy recently and was told to expect a day or two of pain. I was prescribed a month's supply of opioids without a single comment from the doctor on their addictive nature. My understanding is that this is how people get introduced to opioids; the pathway goes "legal scrip -> addiction -> illegal supply -> fentanyl -> death" and that's the engine of the epidemic.
Should it be legal for the doctor to prescribe pain meds like this? (Or, should it be legal but discouraged? Is there a well-understood way to do this?) If it should be legal, should we expect the epidemic to continue? And if so, is post-bankruptcy Purdue a good thing or a bad thing?
(My instinctive answers here are that we should make opioids illegal for much of their current use pattern, and that post-bankruptcy Purdue is approximately as gross as Sackler-era Purdue, for what it's worth.)
> I was prescribed a month's supply of opioids without a single comment from the doctor on their addictive nature.
Is this really what the question was about? Reflections on a personal experience? Those are perfectly valid concerns. Nobody is stopping you from asking any of the professionals you interacted with about addiction, if you are worried, go and ask!
No, my question is about how people judge our opioid status quo: a medical system that prescribes addictive opioids for routine and low-grade pain.
Correcting in the other direction is way worse. I had a huge surgery last year in Germany and 8 days later when released from the hospital, bones still not yet fused, I was given no industrial-grade painkillers whatsoever.
I had to cop on the black market to keep from going insane from insomnia and screaming, until I could check myself into an inpatient clinic that would dispense them legally.
There is more harm in making them difficult to get.
I just wonder why random people would know better about this than your highly educated providers. Go ahead and ask. You can say those exact words. They will give better answers!
If you want a poll, this court case was a poll. A majority of victims who had ample time to participate in litigation agreed to the settlement terms. They told you that addiction is bad, the new Purdue would help, and that money from its owners was sufficient justice. That some agitator basically played the Yogg-Sauron of this meta, the Supreme Court, and cast 5 fireballs against his opponent versus 4 fireballs on himself, isn't super material to the seeming success of the hard political work of this bankruptcy judge.
Oxycontin was, and still is, a prescription drug. I'm not sure if you're aware, but at least in the United States (where this court judgment was), it is doctors that write prescriptions. Listening to them is how the first opioid crisis happened. McKinsey dangled some shiny slides in front of Purdue, Purdue dangled them in front of doctors, and then doctors prescribed them en masse. This has, arguably, not gone well.
> I just wonder why random people would know better about this than your highly educated providers. Go ahead and ask. You can say those exact words. They will give better answers!
Are you sure they'll give "better answers" when they're the ones prescribing like that?
its easier to ask random people from home then go to a provider when I have no such problem or need to physically introduce myself to a highly educated provider. it's like a google search.
What I wonder is why someone like you wouldn't know this?
My question is specifically about the judgements that uninvolved people have formed. I can't learn about this from my doctor, or from the victims' decision in the context of a highly-constrained kabuki dance.
It seems most commenters here are fine with a settlement that clears Purdue to sell opioids (for the benefit of victims), but not with a settlement that lets the Sacklers off with a fine. That is exactly the opposite of my moral intuitions. What gives?
Some questions are message board questions.
> I got a vasectomy recently and was told to expect a day or two of pain
I didn't get anything after mine. I nearly fainted outside the clinic waiting to be picked up when the feelings all suddenly caught up with me.
Neither did I. "If you have pain then take ibuprofen"
np,
> Follow-up Q for you. What is the realistic way to prescribe opioids routinely and safely?
The simple answer is "less and with better monitoring". The first half of that was the equilibrium that Purdue intentionally shifted in the medical establishment. The cascading effects of that are what caused the modern day opioid crisis. Unfortunately, the modern-day opioid crisis as I understand it is mostly no longer related to pharmaceutical availability. So, while we should improve and lock down that supply chain route, unfortunately I don't expect it to make a large dent in the overall problem.
> Are there certain formulations that have been or should be removed from the market?
Take-home fentanyl is probably unnecessary, but again, I wouldn't really expect this to be a silver bullet. The DEA/FDA has gotten much tighter on their prescribing rules for powerful opioids, but their doing so has largely coincided with the expansion of the illegal heroin, and then fentanyl markets. It is now too late to fix by choking off supply, because the market has mostly moved outside of the regulatory regime (though we should still do that, to the extent we can).
> How do we reinstate the taboo on prescribing them?
These answers keep getting worse but we largely already have. We could probably do more, but if you are an MD and you are not "opioids are dangerous actually"-pilled, I think you need to go back to medical school. There was a short period in the mid 2000s where doctors were convinced otherwise by Purdue among others. Doctors who "think otherwise" today are almost without exception just outright criminals.
> For EG: I got a vasectomy recently and was told to expect a day or two of pain. I was prescribed a month's supply of opioids without a single comment from the doctor on their addictive nature. My understanding is that this is how people get introduced to opioids; the pathway goes "legal scrip -> addiction -> illegal supply -> fentanyl -> death" and that's the engine of the epidemic.
Overprescription like that (which that definitely is) is bad and unfortunately common. It's hard to say exactly how much addiction is caused by that variety, though. Most serious opioid addictions that I am aware of didn't get that way from a one time moderate overprescription of things like Vicodin or Percocet. It is possible to get "mildly" addicted from a month's supply of that and when you run out you might have a slightly unpleasant day or two, but not worse than that. If the illicit market wasn't there, that 30 day supply would be the end of any binge, and that would be "mostly fine", as such. That is not an endorsement or to say that it is at all a safe thing to do, but the risk comes primarily from not wanting to quit when you run out, and having other options available.
Two things changed with the introduction of Oxycontin:
1. It started being prescribed for chronic, not acute pain. This meant that people had permanent, ongoing prescriptions for them. Which meant that people built up a very large tolerance, which led to..
2. Oxycontin is pure oxycodone, it is not formulated with an NSAID (like Percocet is). The presence of an NSAID limits the amount you can take before you get sick, and prevents you from (straightforwardly) consuming it via non-oral routes of administration, which is exponentially more addictive.
> Should it be legal for the doctor to prescribe pain meds like this? (Or, should it be legal but discouraged? Is there a well-understood way to do this?) If it should be legal, should we expect the epidemic to continue? And if so, is post-bankruptcy Purdue a good thing or a bad thing?
Legal but discouraged, definitely. They are an important tool in the treatment of acute pain. They can, more rarely, be an important tool in the treatment of chronic pain (cancer / chemotherapy being a good example of a sufficiently serious condition). And finally, they are absolutely worthwhile for palliative care. For these reasons and what is now the magnitude of the illicit market, I don't think there is a lot of value in a total restriction.
> Take-home fentanyl is probably unnecessary
Nah, a friend and colleague needed fentanyl lollipops at one point. You'd be at lunch and he's like "Oh I can't eat food, they had to remove my entire stomach" sucking on the lollipop, and he'd calmly explain that you mustn't touch his weird lollipop because while he can suck on it for a normal person the dose from doing so would be fatal, he'd just used so many strong painkillers for so long that it was now necessary because the painkillers they give regular people did nothing.
Weaned himself off eventually too. Amazing willpower, probably related to why he's not dead.
Fentanyl lollipops/patches are useful in rare circumstances where someone can't swallow pills for some reason, like this one. There are other ways of achieving similar effects but its possible fentanyl is the best way to go in this situation. It is a fairly rare situation though.
I don't know if it is genetic, a side effect of chronic or acute pain, or just plain luck but I've seen family wind up not addicted at all despite heavier doses. If it is genetic it might be linked to not finding painkillers enjoyable at all.
I know from my wisdom teeth removal getting a few days of oxycontin while it helped with the pain it mostly made me feel weak not only while taking it but for about a week or so after discontinuing it. And this is from someone with a low pain tolerance.
> Opioids can't be banned until we can replace them with something equally generally effective.
Opioids should not be banned
Opioid addiction (I have seen a lot of it, not had it) is a social problem and is best managed with, opioids
The problems stem from putting unreasonable obstacles between adicts amd their appropriate treatment. Practical legal and financial obstacles, sadistic legal obstacles, and bizarre moral obstacles
Great Britain for many y4ars managed Opioid addiction with opioids, principally methadone and heroin
Nineteenth century society managed it with laudinum
We westerners in the twenty first century are failing to manage it with cruelty
The Sacklers are, were, parasites profiting from that social malaise and bad things will finally happen to them. But the cause of the malaise is our irrational attitude to drugs
> Opioid addiction (I have seen a lot of it, not had it) is a social problem and is best managed with, opioids
I don't entirely disagree with you, but I have also seen enough people stop, who probably wouldn't have if that were the typical treatment, to be pretty cautious about that. There are a number of promising addiction treatments in the wings at the moment, in particular Ozempic and the general GLP-1 agonist class.
Transitional opioids like Buprenorphine are fine as a detox strategy, and maybe even fine for the medium term, but committing to them for life I think is a mistake (in most cases).
> The problems stem from putting unreasonable obstacles between adicts amd their appropriate treatment. Practical legal and financial obstacles, sadistic legal obstacles, and bizarre moral obstacles
There is a lot of truth to this. It is, in fact, what I used to say when I used them. And it is and remains true. It is also true that prolonged opioid use is mostly physiologically harmless (overdoses notwithstanding). However, there are psychological elements that come with long term use that these measures do not capture, and are not fully internalized by the transaction costs (or literal costs) associated with obtaining them.
> Nineteenth century society managed it with laudinum
Ask China why they fought that opium war, and how they feel about such things lately. They are still mad about it.
> The Sacklers are, were, parasites profiting from that social malaise and bad things will finally happen to them. But the cause of the malaise is our irrational attitude to drugs
Agree on the Sacklers although personally I'd place more blame on the McKinsey consultants that wrote the original deck that proposed the strategy. I don't know how much the Sackler individuals personally made these decisions, but those people certainly did.
Re: irrational attitudes to drugs, I agree, but the situation is substantially more nuanced than it might superficially appear. Laudanum did used to be over the counter, as did cocaine among other things. However, these things were not criminalized for no reason - heroin wasn't criminalized in the 60s/70s anti-hippie craze, or for racist reasons in the 1930s (like marijuana).
Heroin was first criminalized for over the counter sale in 1910 - 15 years after Bayer first marketed it. Easily the fastest criminalization of a novel pharmaceutical compound in the history of the world. This is not an accident or a product of some temporary social hysteria. And unfortunately, it was also not criminalized because all of its harms were due to its being illegal.
If criminality were the problem we would expect things to get better, not worse, with the introduction of fentanyl which is far cheaper and more readily available. I could be misreading the data, but that does not seem to be working out.
> Ask China why they fought that opium war, and how they feel about such things lately. They are still mad about it.
Was this meant to be ironic? Most of the illicit fent precursors comes from China now, I would guess it’s only a matter of time until Chinese producers look inward rather than just at export, which is why I’m surprised the Chinese government isn’t taking a harder line stance on illicit fent production and export.
An agree fest ensues
I am not advocating pure herion (ironically quite a safe drug aside from addiction) or cocaine powder as modern consumer products.
Opium caused upheavals when used as a wedge by Westerners in China, but remember it had been present, and used for millenia in Arabia.
The same, roughly, with cocaine and coca
It is not a choice between continued sadism or free reign herion and cocaine dealing.
We can do better
And I think the "psychological elements that come with long term use" is largely confusing cause and effect.
From my experience people having drug problems recover when the problems recede. Hence advocating treating drug addiction with drugs
One size does not fit all, and some halt and are abstinent. Good on them, I know no-one like that
I mostly agree!
I'll quibble on two points. "used as a wedge issue by foreigners", while perhaps true in some moral sense, it does not really make much sense, on closer scrutiny. To reduce things down to being some foreign imposition is to suggest that it could have been any product. But it couldn't - only opium has the special properties necessary to become this kind of product. Nobody fought a war over tobacco, or even cocaine.
It is also true that Arabia, and even the ancient Greeks ('land of the lotus eaters') were aware of and could obtain Opium. However, I'd inquire as to how it is that the primary opium growing regions of Arabia are doing lately, or say, ever.
It is true that Opium has been available to varying degrees, at various times, in various places without a total social breakdown. However, widespread, sustained, cheap availability of pure Opium without total social breakdown is, as far as I know, unheard of. The over the counter stuff in Europe and the early US were mixed with other things, as in Laudanum. Almost all of high society at the time was addicted anyway, and this was the mild form.
The Chinese discovered that they could smoke it, and changing ROA from oral to smoking is a radical step change in addictiveness. I'm not entirely sure why this didn't catch on elsewhere at the time, but the fact of the matter is it didn't, and the difference between these things is a difference in kind, not degree.
> It is not a choice between continued sadism or free reign herion and cocaine dealing
I hope you're right! But I don't observe anything in the world that would support it, unfortunately. I quit because I was arrested, for instance. I want to be careful about causal meaning here, I didn't stay off because I was arrested, but it was the excipient that proximately caused and also facilitated it. It was a structural break that allowed other things to change around it.
That's not to say that the judicial system is a good way to deal with things - it's not. But the credible threat of the judicial system cannot really be done away with here without courting disaster. When dealing with highly physically addictive substances, shaping short term behavior by force is often a necessary ingredient in having any hope of shaping medium or long term behavior via therapy, life circumstance changes, or anything else.
> opium growing regions of Arabia
The centre of civilisation for centuries
That was a very long time ago. I don't think the middle east was a significant producer of Opium during that time.
> without courting disaster
Too late?
weeping...
> But I don't observe anything in the world that would support it,
Portugal
Legalisation of capabilities across the globe
Coca in Bolivia (I am on thin ice, I know too little, but they elected a coca grower as president)
I think there is plenty of evidence that a considered thoughtful approach to drugs is better
But the psychopaths and sociopaths that make up the bulk of our governments (here in Aotearoa and in the USA) refuse to pay attention
> Portugal
Portugal is not the ringing endorsement that it is sometimes touted as. Some indicators have improved, some have worsened substantially:
https://en.wikipedia.org/wiki/Drug_policy_of_Portugal#Observ...
Causality is hard to tease out here, but more importantly, all they're doing is decriminalizing it and offering methadone/buprenorphine maintenance treatments. And the effect on number of addicts has not been good:
https://www.washingtonpost.com/world/2023/07/07/portugal-dru...
> Coca in Bolivia (I am on thin ice, I know too little, but they elected a coca grower as president)
Coca is really not anything. If you've ever chewed coca leaves, they're mildly stimulating. They're nothing like cocaine.
> I think there is plenty of evidence that a considered thoughtful approach to drugs is better
Considered, thoughtful approaches are always better! The question is, what are you considering and being thoughtful about. And the fact of the matter is that the most drug-liberal cities in the US have the worst drug problems, and so do the most drug liberal countries (like Portugal).
The countries that have the fewest problems with addiction are the harshest: Singapore, China, Japan. These things are not an accident. I'm not necessarily advocating adopting policies that harsh, just pointing out that they do actually work, whereas the liberal policies fail disastrously everywhere they're implemented. I'm in favor of criminalization, but only as a tool to force people into deferral/treatment programs. I don't want to see anyone actually put in jail for using drugs, unless they fail to complete their deferral program.
“Opioids can't be banned until we can replace them with something equally generally effective.”
If only doctors took this advice! When the CDC made its first recommendation against using opioids there was a chilling effect and thousands of chronic pain patients who desperately in need of opioids to function were cut off. There were suicides.
It wasn’t until 2022 that the CDC loosened its recommendations and, in my experience, only a few doctors have caught up.
I could not agree more. Fentanyl enforcement is obviously not feasible to anyone that has been, or known, an addict. Its incredibly cheap to buy, and you can store enough to kill 1000 people in a bag in your pocket.
You might as well have cops trying to arrest the pollen in the air.
> That last thing was their crime
Taboos are bullshit. Either something is a clearly articulated, written, rule with an enforcement mechanism, or it's fair game.
Prescribing doctors are responsible for the opioid epidemic. Doctors failed in their duty of care to patients. Doctors massively overprescribed, failed to track their patient's medication usage, and failed to spot addictive behaviour. Why aren't we holding them responsible? Simply because that's hard to do?
Purdue aggressively marketed OxyContin as having a very small rate of addiction to doctors who weren't pain specialists and thus had little experience with controlled medications, while providing a dosing regime that was almost designed to cause addiction. (It's sole advantage was as a timed-release medication; if pain returned before time for the next dose, doctors were instructed (strongly) to raise the dosage rather than increase the number of doses per day.)
"The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/)
"The Family That Built an Empire of Pain" (https://www.newyorker.com/magazine/2017/10/30/the-family-tha...)
> . (It's sole advantage was as a timed-release medication; if pain returned before time for the next dose, doctors were instructed (strongly) to raise the dosage rather than increase the number of doses per day.)
The same thing happens with ADHD medications, the timed release dosages are supposed to last 12+ hours, but in reality they vary from 8 to 16.
Thankfully most doctors will willingly prescribe a small after lunch short acting dose.
There is a large delta between the average response curve and an individual's response curve!
> The same thing happens with ADHD medications, the timed release dosages are supposed to last 12+ hours, but in reality they vary from 8 to 16.
Modern ADHD meds are really not comparable to powerful opioids. They are both dopaminergic, but they are night and day in terms of addictiveness. Even weak opioids vs strong opioids is night and day.
> There is a large delta between the average response curve and an individual's response curve!
True! But the word "average" is actually not, itself, precise. It has at least three typical meanings: mean, median, mode. These all have quite large deltas to each other when talking about dose-response curves, and since they are curves, you would also have to pick a norm first.
There are a lot of sources of variability, but variation does not actually make it very difficult to detect improper opioid prescribing behavior. Just like the variation in people's weights would not tell you much about the strength of asphalt roads. These things are not measured in the same scale.
The majority of the pharmaceutical problem came from a very small number of people who churned out prescriptions like a literal mill. Like 5 minute appointments all day every day - not random doctors overprescribing their patients by accident. What is true is that the random doctors overprescribing provided a certain amount of cover for the corrupt doctors, for a while.
> Modern ADHD meds are really not comparable to powerful opioids. They are both dopaminergic, but they are night and day in terms of addictiveness. Even weak opioids vs strong opioids is night and day.
True, my point more was that false advertising about "duration of extended release action" is a problem across multiple types of prescription drugs.
> True! But the word "average" is actually not, itself, precise. It has at least three typical meanings: mean, median, mode. These all have quite large deltas to each other when talking about dose-response curves, and since they are curves, you would also have to pick a norm first.
The marketing material doesn't care. "All day", "24 hour", "12 hour" are the phrases that get used.
Meanwhile reality is that every person who takes a drug is different and doctors need to be aware of this and just ask the patient how well things are working out.
> The majority of the pharmaceutical problem came from a very small number of people who churned out prescriptions like a literal mill. Like 5 minute appointments all day every day - not random doctors overprescribing their patients by accident. What is true is that the random doctors overprescribing provided a certain amount of cover for the corrupt doctors, for a while.
Yeah it got out of hand, but I'd imagine that this wasn't happening from day 1.
Also when we talk about preventative measures, people going to a pill mill doctors to get a refill are already addicted, but what can have a long term impact is putting in the effort to prevent people from becoming addicted in the first place, which means understanding how so many people who did not want to get addicted to opioids ended up that way.
> Also when we talk about preventative measures, people going to a pill mill doctors to get a refill are already addicted, but what can have a long term impact is putting in the effort to prevent people from becoming addicted in the first place, which means understanding how so many people who did not want to get addicted to opioids ended up that way.
This has changed over time. At first it was the pharmaceutical route, largely due to the shift in medical norms to prescribe opioids for chronic, not just acute, pain. Prescribing them for chronic pain is a near guaranteed recipe for addiction. However, I think things have changed in the past decade or so, with people largely moving straight to fentanyl and/or other illicit opioids. I don't think the pipeline is largely pharmaceutical in nature anymore.
Blindly listening to a company trying to sell you something has never been a good idea. Doctors doing just that despite the clear, obvious, conflict of interest is their failure, not Purdue's.
Thinking that an individual or organization with a vested interest will not bullshit you at every turn is absurdly naive. This is why third-party testing, accreditation, certification, and audits are a thing.
> doctors who weren't pain specialists
Then they should have insisted on third party, board approved, usage guidelines; especially when it became obvious that OxyContin is highly addictive. It doesn't take that long. Doctors have not however been held responsible for their abject failure towards their patients, and continue to prescribe a month's worth of Oxy for minor issues. This will continue until doctors start losing their licenses.
Everyone in every industry that I know about relies on true information from their suppliers, from software to produce. They're the ones who know about the products, after all. In fact, pharmaceuticals are the one industry most likely to treat suppliers at adversaries, with FDA regulations continually attacked as too stringent.
Purdue was actively lying about their drugs.
"Purdue trained its sales representatives to carry the message that the risk of addiction was “less than one percent.”50(p99) The company cited studies by Porter and Jick,51 who found iatrogenic addiction in only 4 of 11 882 patients using opioids and by Perry and Heidrich,52 who found no addiction among 10 000 burn patients treated with opioids. Both of these studies, although shedding some light on the risk of addiction for acute pain, do not help establish the risk of iatrogenic addiction when opioids are used daily for a prolonged time in treating chronic pain. There are a number of studies, however, that demonstrate that in the treatment of chronic non–cancer-related pain with opioids, there is a high incidence of prescription drug abuse. Prescription drug abuse in a substantial minority of chronic-pain patients has been demonstrated in studies by Fishbain et al. (3%–18% of patients),53 Hoffman et al. (23%),54 Kouyanou et al. (12%),55 Chabal et al. (34%),56 Katz et al. (43%),57 Reid et al. (24%–31%),58 and Michna et al. (45%).59 A recent literature review showed that the prevalence of addiction in patients with long-term opioid treatment for chronic non–cancer-related pain varied from 0% to 50%, depending on the criteria used and the subpopulation studied.60"
"The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/)
"Purdue has known about the problem for decades. Even before OxyContin went on the market, clinical trials showed many patients weren’t getting 12 hours of relief. Since the drug’s debut in 1996, the company has been confronted with additional evidence, including complaints from doctors, reports from its own sales reps and independent research.
"When many doctors began prescribing OxyContin at shorter intervals in the late 1990s, Purdue executives mobilized hundreds of sales reps to “refocus” physicians on 12-hour dosing. Anything shorter “needs to be nipped in the bud. NOW!!” one manager wrote to her staff."
"‘You want a description of hell?’ OxyContin’s 12-hour problem" (https://www.latimes.com/projects/oxycontin-part1/)
From what I've seen (women sent home days after a c-section with Ibuprofen as the only pain medication; all of the doctors near me displaying signs saying they will not treat chronic pain), pain medication may well be under-prescribed at this point.
> Prescribing doctors are responsible for the opioid epidemic. Doctors failed in their duty of care to patients. Doctors failed to track their patient's medication usage, and failed to spot addictive behaviour. Why aren't we holding them responsible? Simply because that's hard to do?
This is a nice idea, but most Oxycontin is not prescribed by someone's doctor (it is prescribed by a doctor, but it is power-law distributed, most of it is sold by dealers). There are a small number of doctors in the country at any given time that prescribe almost all of the supply. This is not something you can readily fix with responsibility at the doctor level. It may seem like you can, because you could just prosecute "those doctors", but the problem is that the incentives are too concentrated.
That isn't to absolve these individuals of responsibility. They are responsible, and we should prosecute them legally. The problem is that we already do and always have. We should keep doing it, but I don't expect it to fix anything.
EDIT: To be clear I'm not necessarily for or against this settlement. There was a time that we might have stopped the opioid crisis at the corporate or pharmaceutical level, but that time has long since past. We could criminalize all opioids tomorrow and it would make almost no difference. Most opioid addicts use fentanyl now, and most fentanyl is produced/sold illegally. Heroin, for instance, has been Schedule I forever - the only thing that reduced its popularity was a cheaper substitute in fentanyl.
If we are going to bother prosecuting or civilly charging Purdue or its principals, it would have to be for purely punitive reasons. Corporate behavior unfortunately does not matter anymore.
The on-ramp from minor pain or surgery; to a massive, blindly-renewed, over-prescription of Oxy; to an opioid addiction that spirals into street drugs is still mediated by doctors. Until these doctors start losing their licenses for their clear and obvious breaches in their duty of care, this on-ramp will remain open.
> a small number of doctors in the country at any given time that prescribe almost all of the supply
The fact that medical boards allow these doctors to retain their licenses is the core of the issue.
> we already do and always have
I am only aware of a handful of the most obvious, blatant, and egregious pill mill operators being prosecuted. Regular doctors who simply cannot be fucked to care for their patients, and prescribe them pills so they leave their office, have yet to be held accountable.
> The on-ramp from minor pain or surgery to a massive, blindly-renewed, over-prescription of Oxy to an opioid addiction that spirals into street drugs
This is mostly not a thing. I have known hundreds of current and former opioid addicts. I don't think I know a single one that was "on-ramped" from Vicodin or Percocet in any truly meaningful sense. It is the case that people almost always use these first. But it is relatively rare to become an opioid addict as the result of a one-off, acute vicodin prescription, per se.
> is still mediated by doctors. Until these doctors start losing their licenses for their clear and obvious breaches in their duty of care, this on-ramp will remain open.
I hope that is true! It doesn't seem like that to me, but I admit to not having carefully studied the data. Casually, there are 1.6 million opioid addictions currently in the US [1]. There were ~50,000 overdose deaths in 2019. That is, 1/1600 opioid addicts died in 2019 alone. To a first approximation, 0 people overdose annually from vicodin/percocet and other short term acute pain treatments.
It would be fairly surprising to me if (much) more than 1/1000 strong opioid users (per year) dies from an overdose. If the numbers were substantially higher than this, the epidemic would burn itself out in the population rather quickly. We can infer from this that most active opioid addicts are users of strong opioids, which are basically never prescribed for acute use. Hence, the overwhelming majority of current addicts are users of strong, non-acute opioids.
This doesn't mean there can't be some gateway effect (I do in fact think there is), but it does mean that "the problem" is mostly the presence of the strong opioids, not the Vicodin prescription for your wisdom teeth.
I'd be open to contrary data on the matter, though.
> The fact that medical boards allow these doctors to retain their licenses is the core of the issue
It is an issue, and we should absolutely try to improve it. It's just unlikely to materially dent the larger issue.
> I am only aware of a handful of the most obvious, blatant, and egregious pill mill operators being prosecuted. Regular doctors who simply cannot be fucked to care for their patients, and prescribe them pills so they leave their office, have yet to be held accountable.
I can personally attest to this being false. It was really quite annoying - I had to find new doctors on a number of occasions as a result, and that was ~15 years ago. Things have gotten much, much tighter on the pharmaceutical side since then. Every doctor who wrote me something was in prison or dead (from suicide, in prison) within 2-3 years of the last time I saw them, and I didn't even turn them in.
It is true that at any given time the Oxycontin prescriptions are power-law distributed, with most of the scripts being written by a small number of doctors. But this is a little bit like looking at the profits in the high frequency trading industry, or the cartels in Mexico (not to morally equate these things). Yes, there are a small number of them and they seem to make a lot of excess profits, but that does not mean you can knock them off and change anything. Nature abhors a vacuum, as they say.
1. https://www.hhs.gov/opioids/statistics/index.html
Taboos are part of how a society functions. Taboos can prevent the 'tragedy of the commons' in a way that rules and laws cannot. Think about it - people break the law all the time. They rarely break taboos.
> Either something is a clearly articulated, written, rule with an enforcement mechanism, or it's fair game.
No. There are many legal and bad things.
Laws are a boundary, that few of us need.
Laws are not a target
Taboos are not simply undesirable things, they are rules which carry severe penalties if you break them. The difference is that rather than going through the effort of getting society on the same page and agreeing what is okay and what isn't, you instead leave ambiguity that harms the well meaning and benefits the malicious. If something is bad enough that it should be banned by an unwritten rule, it's bad enough to be banned by a written rule. If you aren't willing to ban something by law, then it ought to be permissible.
I am not a lawyer. I am from a legal family (three generations) and I understand jurisprudence
> you instead leave ambiguity that harms the well meaning and benefits the malicious.
Two points
1. Law advantages those with access, and often benefits the malicious and harms the good. Case in point: Drug law. Another is IP law
2. Law is not objective. The words that form it are in black and white, but there are courts and judges because the application of the law is subjective. The boundary cases are numerous and important
More generally....
> If something is bad enough that it should be banned by an unwritten rule, it's bad enough to be banned by a written rule.
Sotp, just stop! This is the idea that we must punish and scantion people into being good.
I think of things that are good (like treating drug addicts as ill, not criminal or imoral). I think not of "bans". They accomplish little.
Permissible, impermissible, these are blunt concepts that are not very useful. We can be, and should be, aspirational and collegial not judgemental and competitive
> Sotp, just stop! This is the idea that we must punish and scantion people into being good.
You're not understanding what this conversation is about. Taboos punish and sanction people into being good. We are in full agreement that this is undesirable. There are some things that should be banned, and if they should be banned, they should be banned explicitly. There are many other things that should not be banned, and if it should not be banned it should not be a taboo, which is a form of ban.
You give a perfect example for my argument - treating drug addiction as an illness that should be treated instead of a moral failure to be punished. Where drug use is a taboo, you can't treat it; eliminating the taboo and accepting that these are people in need of help is, in my and many other people's opinion, the correct course of action. Most would agree that making drug use legal but ostracizing drug users would be an absurd strategy.
Taboos are fundamentally about what is permissible and impermissible, there is no other framework in which to talk about them.
> There are some things that should be banned, and if they should be banned, they should be banned explicitly.
What about the things that are missed? Are you going to make an explicit rule for every bad thing?
Is the only way to be good, to be punished?
The creative bad folks, they are free to do their bad stuff, so long as they are more creative than the rule makers?
I do not want to live in the world where the only reason good things happen, is because all the options for being bad are outlawed
I want to live in a world, li,e the one I mostly live in, where we cooperate and love one another.
I am not advocating taboos. I am advocating the literal opposite
I would argue that fiduciary responsibility mandates that corporate leaders do everything right up to the legal boundary in pursuit of their shareholders interests. In fact profitably violating regulations would also be the right thing to do in this case. Certainly most shareholders seem to appoint executives that do exactly that.
> corporate leaders do everything right up to the legal boundary in pursuit of their shareholders interests.
Yes, that happens
Those are evil, short sighted people, sociopaths, who should not be emulated
Sociopaths and other dark triad types have been the driving force in unifying and leading people since prehistory. It takes exactly that kind of person to unite tribes of strangers in order to go conquer, subjugate, and murder your neighbours.
"Evil" is immaterial. Markets and society are ecosystems, and the optimal patterns of behaviour in ecosystems are as ruthless as they are predictable.
> "Evil" is immaterial.
No. Never
Nobody is forcing you to see any doctors for any of your problems.
That's pretty reductive, right? Well so is what you are saying.
The ruling was only about whether or not a bankruptcy court has the legal authority to declare that the individual members of the Sackler family are immune to being sued directly, which is an agreed-upon condition of the bankruptcy settlement. SCOTUS ruled that it did not, so the settlement as it stands is dead.
Purdue is not going to be operating in any capacity regardless of this ruling (except as a bank account holding the settlement funds).
1) I don’t think this is an accurate read of the situation but others discuss that
2) a company is a set of processes and infrastructure, with some legal rights to employ people etc. The decisions of a driver of a car are the drivers fault not the cars. The car itself may be unsafe and should be adjusted if it’s possible. But there is no point in destroying the car if it has utility with different drivers and safety. Revenge isn’t a good reason to dismantle infrastructure. Revenge can only be taken on humans.
3) yes if you know people with chronic pain opioids are the difference between a full life and an early suicide. The consequence of all this is all opioid use is treated as potentially criminal by everyone involved from pharmacies to doctors to patients. This isn’t a feature this is a flaw. And the lack of legal opioid access is leading chronic sufferers into fentanyl from the street.
Loaning money at 8% interest to informed parties is OK. Loaning money at 200% interest to vulnerable people is usury and should be illegal. Where in the middle is the right line to draw, legally? Does the intent of the lender matter? Does it matter if the lender is intentionally trying to keep people uninformed and vulnerable? These are hard questions, but that doesn't change the basic facts at the extreme ends of the spectrum.
Clearly the Sacklers' behavior was in the realm of exploiting vulnerable people as much as possible in order to create a cycle of dependence. I think they're villains who destroyed lives. I don't think that means no pharmaceutical companies should be allowed to sell opioids, or that Purdue should be shut down for that reason. Clearly giving birthing women access to epidurals (fentanyl!) is OK. Clearly bribing doctors to over-prescribe addictive opioids to vulnerable people is villainous and should be illegal. It's a hard problem to find the exact right line in the middle, but it's a problem worth attempting. Obviously it involves a lot of regulatory oversight.
> Loaning money at 200% interest to vulnerable people is usury and should be illegal
Stop with the patronizing. Any transaction between consenting parties (backed by bankruptcy protection) should be allowed. We're all grown ups, let people make their own decisions.
Setting upper limits on interest rates simply makes it so that high-risk borrowers are unable to access credit. This harms those borrowers more than anyone else, by limiting their opportunities.
Regarding the Sacklers, they never prescribed any drugs to anyone. Doctors did. Why aren't we holding them responsible? It is doctors who have a duty of care to their patients, not pharmaceutical companies.
> Stop with the patronizing. Any transaction between consenting parties (backed by bankruptcy protection) should be allowed.
Any? Can I sell my kidney?
You are arguing an extreme minority opinion, consumer protection laws exist because it is not possible for an average consumer to understand all safety implications of vehicle design, house construction or a medical procedure.
Unfortunately the people who make the laws don't understand the safety implications either.
Letting people make their own choices, on net, probably is better than the alternative (and that included selling their own kidneys)
> it is not possible for an average consumer to understand all safety implications of vehicle design
and that is why there is and must be independent regulation. The consumer doesn't need to understand vehicle design, they just need to understand safety _ratings_ that must be assessed via third parties (typically, a gov't institution).
So why did the FDA fail to assess the drug properly?
> Can I sell my kidney?
I don't see why not. Me saying you can't would imply that I have a stronger claim to your own kidney than you do. This is a pretty hard claim to substantiate. The majority can be, and often is, wrong.
Interesting
if I can sell my organs, Essential for survival, That I’m selling my life
logically I should be able to sell my life in other ways. So I should be able to sell myself into slavery.
If so, Then your idea of freedom creates more un-freedom.
If not, Then you must have a logical reason why selling my liver and dying after that is okay but selling myself and living after that is not okay.
And it cannot rely on the fact that it’s been hammered into us from a young age that slavery is bad. It has to be consistent and logical
> So I should be able to sell myself into slavery.
No, because that would imply that a person can own another person. Free, morally equal, people cannot own each other. It would also imply that present-you can obligate future-you in a way that fundamentally compromises future-you's freedom.
Present-you can however terminate his own existence, since present-you has the strongest claim on it.
Interactions must be consensual with the possibility to opt-out backed by bankruptcy protection. If you agree to donate your organs in return for compensation (presumably to your estate), but change your mind on the operating table, you should be perfectly entitled to do so. You may incur a bankruptcy protected obligation if you signed an agreement to that effect
Consent should be the fundamental principle guiding all interactions. It also conveniently precludes slavery.
> Interactions must be consensual with the possibility to opt-out backed by bankruptcy protection
So student loans, as they are not discharge able in bankruptcy, are a form of debt bondage / slavery?
Also in UK you have to pay to declare yourself bankrupt, which is also questionable.
Also you can’t back-out of an organ sale, you are under Anastasia and then you are dead. The idea that it’s better than still being alive seems morally myopic to me.
Student loans are not dischargeable by bankruptcy because an education is not an asset that can be seized and sold during the process. There should be (and are) pretty strict limits on how your wages can be garnished to repay this debt. However I do agree that student loans are a form of debt bondage, and are questionably ethical for that reason. I would much prefer student loans not be given special protection. That would at least help us stop subsidizing educations that do not lead to productive careers.
I would not be opposed to licensed professions (eg. doctors, lawyers) adopting policies that would revoke licenses for members defaulting on their student loans via bankruptcy. I don't imagine any intervention would be required for such policies to arise if the special status of student loans were to be reconsidered.
> Also you can’t back-out of an organ sale
Yes of course you can only back out up until the point you are rendered unconscious. You have to reconsider before then. The idea that "life" and "death" are somehow morally important states is what has been "hammered into us from a young age". Morality is a relationship between (free and equal) moral agents. The important concept is therefore agency and its expression via consent.
You have just spent four paragraphs outlining how it must be important to be able to backout of any agreement, how freedom is important, and now you propose semi-facist system!
> licensed professions (eg. doctors, lawyers) adopting policies that would revoke licenses for members defaulting on their student loans via bankruptcy.
Let's consider the meaning of this, and why it smells of fascism:
* An unrelated third party is recruited to use it's power to enforce government policy (if it's taxpayer money) or protect someone else's private investment. This is no longer an agreement between two parties, the loan is now backed by threat of force. The lender no longer has to ask themselves "well if we raise interest rate too much, people will default and we will suffer"
* The revoked license cannot be sold, like a house would be, it is of no use to the bank, the only effect is punitive and moral police
* If i am the doctor's employer, you have just inflicted loses upon me, to protect your investment that I have nothing to do with.
* If I am a customer or patient, and paid for a service, you have also inflicted loses upon me, it's now a crime for me to receive treatment from this doctor, despite the fact that they are qualified.
* It is affected by government policy and macroeconomics that even professional fund managers cannot predict, let alone an 18-year old student. You get high inflation due to war in Ukraine, and suddenly half of your doctors have their license revoked! Great result!
> an education is not an asset that can be seized and sold during the process
As any unsecured loan, you can take out a loan and spend it all on hookers and drugs.
I think this entire attitude is driven by the fact that in the English speaking west there is great contempt for the younger generation and they are okay to exploit. They are subject of derision and almost seen as sub-human. Why don't we treat pensioners this way, make them do some mandatory community service in the nursery to get their state pension! There would be riots in the streets!
There's no force here, and hence no fascism. Having your license revoked, while harmful to your career, is not violence. Professional licensing boards and private lenders are also free agents, and can come to any sort of agreements they please. I would oppose any government intervention, as I already mentioned.
I don't however agree with any laws that bar anyone from practicing their profession without a license. If all you can afford is to get your tooth extracted with a rusty tool by a street dentist (as is common for lower classes in places like India), there should be no law preventing that from happening. It represents a consensual exchange. Making it illegal harms exactly the people who cannot afford anything else.
> You can take out a loan and spend it all on hookers and drugs
Lenders don't typically offer unsecured loans, for exactly this reason.
> the younger generation
This has nothing to do with the younger generation. It stems from from a definition of liberty that rejects implicit obligation, and emphasizes consent. We are all born into this world with nothing, and all must negotiate with the people already here for everything.
> Why don't we treat pensioners this way
I would be all for entirely abolishing taxpayer-funded old age security, which represents a quarter of the federal budget in the US. There is no consent, nor any ability to opt-out of this mandatory insurance scheme. Preparing for your old age is an individual responsibility, not a collective one.
I like this analogy. How does it apply to the status quo of opioids? What rate of interest is the present-day Purdue business charging? This year I was prescribed 30 days of opioids for post-vasectomy use and guided to expect low-grade pain for 1-2 days. Is this like 8% interest or 200%? Does anyone here feel like they know the answers to these questions?
It seems to me like the emergent answer I get is that the old Purdue was charging 200% interest and the new Purdue is charging 8%. But why does anyone think that? It seems like the core doom loop (dumb opioid scrips -> addiction -> fentanyl) is still in place, from what I can tell.
> I don't understand people who think the Sacklers are villains who destroyed lives, but Purdue should continue operating more-or-less as-is. Which is, I think, the conclusion from this settlement. If this is you, can you help me understand? Do you think there is/was a realistic way to prescribe opioids routinely and safely?
This is an extremely easy answer that doesn’t require any details of the case.
The supreme court clarifies what the law is, not if the Sacklers are villains and if Purdue should continue.
So the people who think the the Sacklers are Villains and that Pursue should continue are people who believe the settlement is not legal and dont believe in legislating from the bench.
That's not the settlement. The settlement is that purdue pays 8+ bn and shuts down, but the sacklers are immune personally. The supreme court threw out that deal saying that the sacklers can't be given immunity as a part of the deal.
The settlement was not at all about Purdue operating as is. Purdue was going to be turned into a legal fund and treatment provider as part of the settlement agreement.
Under the bankruptcy settlement, Purdue will continue to sell opioids. The ownership will change (profits will be used to fund the causes you listed) but the operations will not. Right?
You know I can't actually find a lot of details about what the "new" Purdue was supposed to operate like - my understanding was that it was going to turn into a receivership under the court.
But that's kind of the weirdness of all of this - at no point was OxyContin itself banned or been made illegal.
The only way is if it is done without a profit driven system incentivizing their overprescription. But this requires a gigantic systemic overhaul of healthcare to a nationalized system. And there seems to be a lot of peer reviewed evidence in favor of such a system, and there seems to be broad popular support for such a system. Yet we never manage to get there. It's almost like there's a group of people who simultaneously benefit from its existence and have the capital to influence legislation in their favor. Feels almost undemocratic.
Here is a good resource on it [1]. My understanding is that Purdue pushed hard for marketing, including paying doctors to market for them. This paragraph sums up most of it.
> “Purdue admitted that it marketed and sold its dangerous opioid products to healthcare providers, even though it had reason to believe those providers were diverting them to abusers,” said Rachael A. Honig, First Assistant U.S. Attorney for the District of New Jersey. “The company lied to the Drug Enforcement Administration about steps it had taken to prevent such diversion, fraudulently increasing the amount of its products it was permitted to sell. Purdue also paid kickbacks to providers to encourage them to prescribe even more of its products.”
Is purdue solely at fault here? Absolutely not. Does it seem that Purdue likely knew what was happening, but put profits above public health? In my opinion, yes.
[1] - https://www.justice.gov/opa/pr/opioid-manufacturer-purdue-ph...
I understand the contents of the link; that judgement prompts my question rather than answering it.
The DOJ found that old Purdue's problem was illgal marketing, kickbacks, etc. I understand that as a legalistic thing.
But as far as human judgement goes: I thought the problem here was opioid addiction, which is continuing to rise in the "new Purdue" regime. We all think old Purdue should not have been doing the illegal stuff. But was the illegal stuff the real problem here? It seems like the "new Purdue" reforms are not affecting the growth of the opioid epidemic.
> I don't understand people who think the Sacklers are villains who destroyed lives, but Purdue should continue operating more-or-less as-is
I’ve got a friend that’s the same in Afghanistan - he thinks it was right to go in, and it was right to abandon it - which to me sounds like moral myopia. Surely it was either wrong to begin with, or you have to stick around.
Here's a way to help you understand. Let's say I gave you 1 million dollars to help you understand. Then would you understand? That's likely how other people started understanding the situation. Something along those lines. Something this obviously wrong, some sort of coercion or bribery or some other shady thing has got to be a part of it.
I understand there's fraud and bribes and such, but it seems to me that in the end it is doctors and the medical system, with a bit of help from government regulators, that decide prescriptions, dosages, limitations and such. Purdue could have been making pure poison, but they don't prescribe anything.
Is it fraud if the pharmaceutical company falsely claims that the addiction rate is very low? If the company aggressively pushes a dose regimen that is almost designed to produce addiction?
I mean I have been prescribed opioids many times and I just take them as prescribed and they help the pain of the surgery or whatever. I don’t even take the whole bottle. What will replace the opioids if we don’t allow them to be prescribed?
I don't think it s a black or white on opioids. But more of a being honest in the marketing and recommended dosages. For instance, Morphine is an opioid that often gets used in end-of-life care, this is a 90 year old on hospice actively dying from terminal cancer, so morphine to ease the suffering. No reason to not give them opioids. However, before the opioid crisis became a known crisis, my dad who is a disabled vet would get like 300 pills mailed to him a month, at the time to be indefinite, from the VA. This was when marketing was telling everyone percocet and vicoden were safe and non-addictive.
These heavy hitters do have a purpose. But it should as narrow as necessary.
I understand two answers to your question:
1. Nothing will replace the opioids, but we should make most routine use illegal anyway, because the usage you described causes addiction, abuse, and death in some cases, which overrules your QOL improvements.
2. Nothing could replace the opioids, so we should keep the status quo. The addiction, abuse, and death are a relatively minor downside to an important bundle of benefits. The Sacklers marketed them illegally, but we've course-corrected as best as possible, and the new status quo is uncomfortable but OK.
These are, I think, the first two buckets of people I listed. I understand them both. I think you're in the second camp. I'm in the first. But I think most commenters here are in neither camp???
Could you have recovered without pain killers? Or maybe used a pain killer that is much weaker that doesn't kill all the pain but is much safer like marijuana?
Are there scientific studies that shows that opioids help patients recover quicker?
Why is this question important? The primary purpose of pain medication is not to facilitate recovery, but to reduce suffering and increase quality of life.
Exactly! Opioids increase suffering and ruin the quality of life for hundreds of thousands of Americans. 80k+ yearly overdose deaths, plus a percentage of those using opioids for recovery become addicted to it.
Is that a worthy tradeoff? I presume (could be wrong) but we did fine recovering with surgical operations 80 years ago without opioids.
Morphine was commonly administered for post-surgical pain 100 years ago:
"The after-treatment of surgical patients, by Willard Bartlett and collaborators." (1925)
https://babel.hathitrust.org/cgi/pt?id=mdp.39015071056918&se...
One of the first complaints made by the postoperative patient on returning to consciousness is pain. This if due to the actual operative procedure should be at once relieved. William J. Mayo taught us long ago to give morphine during the first twenty-four hours for the pain which we make; viz., by cutting, retracting, suturing, etc. The discomfort caused by such procedures is relieved best by this drug and it is given by us if there be no contraindications for its use, regardless of the amount until full relief is experienced or its physiologic effects obtained.
24 hours post operation is fine. But giving them for weeks after an operation seems unnecessary. I've also heard that oxycontin in the USA is given to pregnant women to deal with pain.
Most countries do without them now and have always done without them except in special cases such as palliative cures. You get opioids during recovery in the hospital, but not once you're discharged. You might get codeine rarely, but that's it.
Ibuprofen, paracetamol, rest?
From https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-ge...: if you "no longer feel the pain you will no longer know what your body is telling you. You might overexert yourself because you are no longer feeling the pain signals".
One thinks you have never had a really damaging surgery. For obstructive sleep apnea I had the back of my tongue microwaved, my deviated septum repaired, and my uvula and back of throat removed. Ibuprofen and Tylenol would not have been sufficient for recovery from that. And that is even nothing compared to other more damaging surgeries.
The article I linked explains that you can still get opioids during recovery in the hospital in other countries, it's only once you're discharged that they're a lot more careful.
There must be something intermediate between "Tylenol and ibuprofen for everything" and "Vicodin before and after canal therapy".
I changed the URL from https://arstechnica.com/science/2024/06/opioid-settlement-to... to an article that has more information and a less baity title. If there's a better (more accurate and neutral) article, we can change it again.
Seems impossible to read Washington Post articles without opening them in incognito mode.
I know that's annoying but it's allowed ("paywalls with workarounds" has been the rule for a long time on HN - see https://news.ycombinator.com/item?id=10178989, https://news.ycombinator.com/newsfaq.html). Not that we like the annoyances any more than anyone else does, but it's the lesser of two evils.
But we can change the URL if there's a better one.
i vote link to the ruling itself
I almost agree but I think probably the best place for that is as a link in the comments, with the best accessible third-party report at the top.
I don't know what the best accessible third-party report is though...
Thanks Dang!
This is a more complex case than I thought, and the dissent argument is actually very powerful and convincing:
https://www.supremecourt.gov/opinions/23pdf/23-124_8nk0.pdf
Basically, the original judge did a good job - the settlement plan was reasonable and widely popular. And the Sackler family being released from liability by putting billions of personal dollars into the payment fund meant more victims would get more money immediately.
With this ruling, the Sacklers are personally legally liable again - which may make you or I more happy, but this means that victims have to pursue a much harder and more expensive set of lawsuits to get money from the Sackler family. It also means the victims of the deal don't get a voice in the proceedings, and it may also make future payouts and bankruptcies harder if there is no reason to cooperate with the state.
I disagree. The dissent focused way too much on emotional appeals. It shouldn’t matter if the remedy was popular amongst the primary parties if the law doesn’t allow for such a remedy, “it was popular” is not a solid legal footing.
If we want to make sure that the victims of people like the Sacklers can get some justice then let’s actually write some laws for that purpose. Let’s remove the loopholes that let them make a ton of money at the expense of a nation, and them take it all offshore. Let’s add transparency to corporate structuring. Let’s fully pierce the corporate veil for egregious situations such as this.
What we shouldn’t do is allow the powerful yet another tool to escape consequences. Whether or not this particular deal was a net-positive for victims is besides the point. It gives too much power to bankruptcy judges and is a ripe avenue for corruption. Go to a “friendly” judge and have them absolve you of any personal liability, then send them a nice gift basket full of Benjamins, now fully legally (Thanks Supreme Court!).
> If we want to make sure that the victims of people like the Sacklers can get some justice
This isn't just about the Sacklers either, this could potentially impact a lot of other important cases in the future once the law is more well defined.
> victims have to pursue a much harder and more expensive set of lawsuits to get money from the Sackler family
They also have to litigate away a 2004 indemnification agreement extended by Purdue to the Sacklers in 2004, which could result in litigation and liability draining the pot before pay-outs can begin.
Definitely more complicated than I first appreciated.
If I had lost a family member to drug abuse I would want justice (ie. jail time) not money.
> I would want justice (ie. jail time) not money
Retribution not restitution [1]. “Justice” in this context is ambiguous.
[1] https://open.lib.umn.edu/criminallaw/chapter/1-5-the-purpose...
What's the point of "restitution" if it came from the victims anyways? The Sacklers would have kept all of their ill-gotten gains under this settlement. The amount they'd be paying is practically just the interest from their earnings.
> What's the point of "restitution" if it came from the victims anyways?
The difference between having money and not.
> amount they'd be paying is practically just the interest from their earnings
Not disputing, the majority almost admits as much, but source?
Restoring what was taken from the victims is literally the definition of restitution.
Except if all you have is restitution, there's no punishment.
"Hey, I stole this money from you but since I gave it back - after a court ordered me to - we're all square, right?"
Exactly. If they're just returning the money (sans interest), where's the punishment?
If you steal $100 from a bank, you spend more time in jail than these scumbags ever will.
I have a hard time with the concept of retribution alone, but I think if it is phrased in terms of modeling societal standards and demonstrating to others that this behavior is unacceptable, it is still valuable to society. I guess you can mark that under "deterrence", but it's less about sending a signal to future would-be criminals, and more about communicating and demonstrating societal standards to the entire society at large.
justice from whom? Just because they got a prescription doesn't mean they lost complete body autonomy. The lack of personal responsibility regarding drugs around here is insane.
The whole basis of this suit is that a Purdue subsidiary went out of their way to market these pills as non-addicting. "Personal responsibility" in this case clearly lies on those actors, not the addicts.
I'm not sure about the justice aspect, but I wouldn't underestimate how powerfully addicting some of these drugs can be to the point where it can override your "personal responsibility". Same thing with any substance like alcohol or cigarettes, gambling, over-eating, etc. It's very easy to slip into abuse and an addictive response and susceptibility isn't universal.
Opioids are highly addictive. If you're vulnerable and your doctor eagerly prescribes them because it feeds their wallet, you can easily loose control.
Don't blame the victims.
> Don't blame the victims.
Expecting some personal agency is now victim blaming? Detoxing from opioids is not fatal. It sucks. But it's doable. You don't need to take your entire prescription. Take it while you're in pain.
If you were prescribed heroin and proceeded to take it, you would end up addicted and unable to quit. Full stop. It is exceedingly rare to overcome opiates, you underestimate them greatly.
why would it be harder? wouldn't it just be the next family that tries to get away with crap like this will be scolded sooner?
it seeem like if you want people stop doing bad things you can't let them get away with bad things. here, the family was trying to get away with billions. The bankruptcy court said, "yay, ok". The Supreme Court said "no, not ok"
I don't understand the dissent. unless the dissent is friends of the family trying to spin.
If you want money from the Purdue bankruptcy entity: you just file a claim while they still have money.
If you want money from the Sackler family: you need to lawyer up, prove a bunch of personal liability claims (which are very, very hard cases to win), and wait a long time. And hope they still have money.
While it may feel nice to eventually, maybe, be able to throw the Sackler family in jail, it basically just blows up the ability to do mass tort arbitration.
From the dissent, which even includes Sotomayor and Kagan:
"As a result of the Court’s decision, each victim and creditor receives the essential equivalent of a lottery ticket for a possible future recovery for (at most) a few of them. And as the Bankruptcy Court explained, without the non-debtor releases, there is no good reason to believe that any of the victims or state or local governments will ever recover anything."
> If you want money from the Purdue bankruptcy entity: you just file a claim while they still have money
And as the dissent notes, this class includes the Sacklers per their 2004 indemnification agreement. So we first need to nullify that to avoid draining.
How would you propose the agreement be nullified? Was it fraudulent, or performed without shareholder approval?
It’s harder because it requires piercing the veil of protection of an LLC, a legal construct that is explicitly designed to limit liabilities. There are simply more legal hurdles to this.
Though I do agree with the conclusion that the bankruptcy court should not be able to grant immunity to the Sackler family. It feels deeply, deeply immoral
> harder because it requires piercing the veil of protection of an LLC
Source?
It’s harder because they’re indemnified by Purdue, and their individual liability is far from established. (The opinion and dissent both refer to a monolithic “Sacklers,” but they’re individuals and trusts and whatever.)
I think the argument is against the Sacklers personally and their actions, not based on their ownership stake of the LLC. So this wouldn’t involve piercing the veil.
Only if suitors were going against Sackler assets to pay off Purdue corporate stuff.
An important but frequently overlooked aspect of the law is that by the time the courts are involve it is often too late for there to truly be justice. Things have often happened that cannot be undone. Often parties that are at fault do not have the resources to pay their share of damages.
No matter what the court does in those situations someone is getting screwed.
> no reason to cooperate with the state
The idea of the rule of law + the state's monopoly on violence is that you WILL cooperate with the state if the law says you should. It may even be worth some losses to keep that up.
> you WILL cooperate with the state if the law says you should
As the dissent notes, we don’t yet know what the law says about the Sacklers’ liability.
It's really not that complex. The question is NOT whether the plan was a good idea or reasonable. The question was whether the Bankruptcy Code authorized the bankruptcy judge to approve the plan. It doesn't. It's really not more complex than that.
Courts cannot legislate from the bench. Why not? Because the Constitution says so; i.e., Congress gets to say what the statutes say, while the Judiciary gets to say what the Constitutions says. That's the balance of power under the Constitution.
To me...the waaaaaaay bigger and more intriguing thing is: the story underlying this split 5-4 decision.
I mean this spit the "right" justices and the "left" justices. J Jackson came out of nowhere and sided with four "right" justices. Like, what?
Also, I can't for the life of me understand how J Sotomayor and J Kagan could ever come to the conclusion that this sweetheart deal for rich billionaires, who made their money killing $247k humans, was a good idea and totally fine. Again, what? But no the efficacy of the deal doesn't legally matter and is irrelevant.
Nevertheless, we don't know that the victims will be harmed by this decision. However, we DO KNOW that the rich billionaires would have benefited if this decision went the other way.
Remember that.
There's gotta be a Pulitzer worthy story behind this split.
The Sacklers want to have their cake and eat it. They want both:
- To avoid filing for bankruptcy, and
- For a bankruptcy settlement to release them from additional liability.
Are you talking about the Sacklers as individuals, a family unit, or in their capacity as decision-makers for Purdue? There seem to be a relatively complex set of incentives and options in each of these capacities.
And they'll get it - they stashed a lot of their gains overseas, and they'll keep those gains while continuing to live a lavish life amongst the elites of the world.
I lost a very close friend to opoid addiction, and Purdue was based one town over from where I grew up. I hope the entire Sackler family gets fined and taxed to the point of genuine destitute poverty, and then some. Genuine scum.
I think this is where the settlement went wrong. The Sacklers were going to remain billionaires after the $6B payout. In all real respects they were going to feel no pain. They already have way more money than any of them could hope to spend in their remaining years, and that really rubbed people the wrong way. With the immunity removed they will at least spend some of their retirement in court room after court room instead of sipping drinks on the deck of one of their many megayachts.
It sucks for the victims who are realistically not going to get any help before they die, but it does send a message that you can't kill thousands (probably millions) and get off scot free.
Matt Levine at Bloomberg gives an excellent explanation of what happened, the ruling, why etc without telling you what you should think is the right thing or right outcome.
His explanations from first principles covering ground you already know are just excellent. Worthwhile reading for anyone who has to explain detailed, complex & technical subject matter.
https://www.bloomberg.com/opinion/articles/2024-06-27/purdue...
The truly awesome thing about Matt Levine is how in complicated situations like this he doesn't try to pick the "right" side but instead leans in to how both sides have good points of view. In today's newsletter he quotes the majority opinion and says it's reasonable, and then quotes the contradicting dissent and says that's reasonable too. And they both are! A really difficult case with really difficult trade offs.
As a layman, I find the dissenting opinion strange -- for a judge. Sure it might be more pragmatic and beneficial for the victims of this particular case to take the deal. But a supreme court can't possibly cover all cases, so IMHO it must deal with the law on a higher more principled level. The argument that the bankruptcy court did ok in this case and should be allowed to do this in general is iffy because it fails to take into account various realities of life, e.g. corruption. Limitless authority is for me not a good idea, and I think the decision of the majority makes more sense.
> A bankruptcy court’s powers are not limitless and do not endow it with the power to extinguish without their consent claims held by nondebtors (here, the opioid victims) against other nondebtors (here, the Sacklers).
But again, this is my regular Joe view on the matter. And it's true that the majority of victims in this case might be in the end worse off, but the decisions of a supreme court are relevant for a long long time.
> WASHINGTON — The Supreme Court on Thursday blew up the massive bankruptcy reorganization of opioid maker Purdue Pharma, finding that the settlement inappropriately included legal protections for the Sackler family, meaning that billions of dollars secured for victims is now threatened.
Does anyone find it strange that this is described as a loss for the victims?
Well, it is. The victims had a settlement agreement worth billions of dollars, which the Sackler family was going to willingly provide in exchange for legal protections.
Now that legal protections are off the table, it is very unlikely that any new settlement will be as generous, and in fact quite unlikely that any settlement will be achieved at all.
But also very likely that the case will go to court and the damages will be substantially higher.
Even if that's the result (which is questionable), the Sacklers are almost all overseas and their assets are "hidden" in complex schemes. So, collection is as big a hurdle as coming to a reasonable judgement.
Victory is not guaranteed, and even if the victims do win, going to court takes a lot of time and costs a lot of money. The victims agreed to the settlement because they preferred that option to going to court.
OK - but the individual payouts are going to be small and do little to compensate for the harm caused.
The primary goal for the suit is to punish the wrongdoing and disincentivize similar future behavior by others. Higher costs and uncertainty does that.
In your opinion. I think those owed restitution would feel differently about the primary purpose.
Yeah. I looked up the settlement - it amounts to tens of thousands of dollars per individual. I can see how that would be important to many people.
And to people whose lives were wrecked by addiction. Tens of thousands of dollars would be a welcome windfall to people on HN, but to these families it could even be life changing amounts of money. Sucks that their payout is now delayed indefinitely.
Not really, it will be played out in a number of separate cases and each case is in a weaker position separately simply due to scale and resources. The Sacklers have an estimated $1bn liquid available to fight these things.
The $6bn ruling was significant and not an amazing outcome for either side (so, a compromise).
Additionally most of the Sacklers are well into old age, so they'll probably die before losing $6bn.
> The $6bn ruling was significant and not an amazing outcome for either side (so, a compromise).
I find this framing extremely bizarre. A $6bn ruling means the family profits $5 BILLION. In no universe is that not an amazing outcome for them.
It's a loss of ~1/2 of their net worth. That's significant.
They are now likely to pay much less by settling smaller individual cases, which will take significantly longer and cost claimants significantly more to pursue.
When they die (which will be soon, most of them are 75+) it'll become even more difficult to get anything.
The deal that was overruled was certainly not justice, but reality will likely be worse. There's no outcome that will render them not billionaires within their lifetimes.
> It's a loss of ~1/2 of their net worth. That's significant.
It's a gain of billions of dollars that everyone agrees they should not have had in the first place. That's really much more significant.
It's pretty telling that literally nobody says that the Sackler family should actually have this money, just varying degrees of it being hard to claw back from them.
If someone walks into my house, stabs me with a knife, and steals the money on my dresser, keeping half of the money they took from me is the exact opposite of a loss for them.
There's no strong legal structure to allow it, the US justice system strongly favors the rich and corporations. Loose consensus isn't enough if there's no legal mechanism to do so.
The deal was pragmatic in the absence of a clear path for actual consequences.
It would be easier to rally an angry mob at this point.
It sounds like you agree with me, since this is exactly a variation of it being hard to claw back, which is annoyingly analogous to letting rich people get away with whatever they want including theft and murder because trying is hard.
"Trying is hard" is kind of an edge-lord take on an incredibly complicated problem. People have been trying to fix this longer than we've been alive.
> They are now likely to pay much less...
So then why did they choose to settle? That makes no sense. The only reason a defendant settles is to minimize potential losses.
>The only reason a defendant settles is to minimize potential losses.
???
Companies don't give away their money for free.
If a company voluntarily enters into a settlement, it's because they think they're saving money somewhere else.
In this case the Sacklers are granted immunity to all future lawsuits.
predictably of asset distribution, the end of a long campaign of bad pr, and government pressure (which is now fairly deflated)
the settlement was also in the interest of the government, which may now end up with tens of thousands of separate suits to manage and $6bn less to help manage the crisis unfolding in the meantime
don't get me wrong, the sacklers could end up worse off... but it's a big if and will take much much longer
> Does anyone find it strange that this is described as a loss for the victims?
As the dissent notes, this decision means the victims won’t get money now. When is an open question, as well as whether it will be similar, more or less after litigation costs, and to whom it will be paid.
What is certain is the Sacklers will be hurt more. (Unless a couple bizarre legal maneuvres pay off, e.g. the Sacklers extinguishing liability by way of a 2004 indemnification agreement.) So in a sense, this is deterrence and retribution winning over restitution [1].
[1] https://open.lib.umn.edu/criminallaw/chapter/1-5-the-purpose...
> What is certain is the Sacklers will be hurt more.
Maybe? They get all of the billions back and now have time and a reason to start building a defense.
> get all of the billions back
They never gave up any cash to my knowledge. The plan was a promise.
We can conclude the Sacklers are worse off right now given they (and the creditors) accepted the deal. They may be materially better off in the future. But the rest of their lives will be about this.
???
The Supreme court case was specifically about the $6 billion dollars the Sacklers committed to the bankruptcy fund. And this ruling says they are not allowed to contribute to it.
> Supreme court case was specifically about the $6 billion dollars the Sacklers committed to the bankruptcy fund
Committed, not contributed.
No, if it wasn't a better realization of the victims’s goals than going to trial, why would the victims have accepted it?
Its absolutely a loss for the victims.
Not just them, but they are among those losing.
> Does anyone find it strange that this is described as a loss for the victims?
I can see it going both ways, yes: this means that 6 billion dollars are not immediately available for compensation.
On the other hand, certain states (Washington was one, if I recall) argued that 6 billion dollars was such a pitifully small amount (relative to the damage done) that they declined to accept compensation in hopes that future lawsuits would yield more.
I view this decision as rejecting the immediate compensation, but opening up possibility for greater compensation in the future (with obvious risks and delays).
> certain states (Washington was one, if I recall) argued that 6 billion dollars was such a pitifully small amount (relative to the damage done) that they declined to accept compensation
As the dissent notes, “all 50 state Attorneys General have signed on to this plan.” The holdouts were “a small group of Canadian creditors and one lone individual.”
I always thought of the Sackler carve-out as a scam. But the dissent gives me pause. This ruling trades restitution for retribution. In all likelihood, many classes of victims—such as small victims, small states and local governments—won’t see a penny, at least for years.
> This ruling trades restitution for retribution
IMO the money is a pittance, sounds like a lot but it's just a fraction of what the federal government spends on any given day. We can afford to carve out the financial resources to help victims. The retribution is totally worth it, because it needs to be understood that behavior like this will get punished. It should be painful, not just the cost of doing business.
You may find the money a pittance, but the victims decided otherwise.
It seems the case that the interests of the victims/plaintiffs (e.g. compensation) may be different than the public at large (e.g. punishment).
If so, perhaps the interests of the public should be pursued by a different avenue than the civil case of the victims, which requires superseding the agency of the victims.
> You may find the money a pittance, but the victims decided otherwise.
When you say 'the victims' are you implying they all agreed to this? So they are all okay with giving up their individual right to sue for damages? You make several points which imply that this is some kind of consensus position that everyone is okay with. That's the root of the problem, though -- this settlement in no way addresses the damage to all the victims.
Perhaps renegotiate the agreement so that it only immunizes Purdue/Sacklers from further civil action from
In any case, when I say pittance, I was clearly talking about relative to the financial resources of the US. This is a national problem, we can afford to solve it at a societal level without being forced into accepting an unjust settlement.
The case and settlement has almost nothing to do with solving the problem at a societal level, with either outcome being negligible.
Real progress would involve systemic changes to the treatment and causes of drug addiction, as well as medical treatment philosophy.
To hang the opioid epidemic on perdue is a gross oversimplification, essentially a scapegoating of a multifactorial problem. Perdue sold the same pills in Europe, but the US has an overdose rate 2,000% higher.
> To hang the opioid epidemic on perdue is a gross oversimplification
The only sane comment here. It's laughably ridiculous to call for retribution against a single family as if they were personally responsible for every overdose the country has seen.
I don't excuse their unethical and potentially criminal behavior, but I do think they way people talk about it is detached from reality. The corporate choices likely had some effect on the margin, but I dont think the appropriate disclosure around addiction potential and would have moved the needle much.
I think that was because they could more effectively market their "pain is bad mkay" strategy in the culturally and politically more homogeneous market that is the US. The European healthcare market is completely different for each country in multiple dimensions. Be it political, the way insurance is structured, laws are setup and governmental agencies handle them. That means while it is entirely possible to sell the pills in Europe they won't be prescribed in the amounts necessary to jump start the "vibrant free market" for them the US has. So they are just an opioid that is prescribed in extreme cases.
I dont think the idea that patient pain is bad was unique to perdue and their drugs. Many European countries have private health insurance, with reimbursement quite similar to the US.
Like I said above, I think it would be extremely shallow thinking to claim that there is a single reason.
If I were to pick a leading difference, I would say that the US has embraced trained consumerism to a greater degree than most European countries. As such, the idea that a simple pill/product will make a problem go away has more traction, both with prescribers, patients, and abusers.
You see this difference manifest in many cultural and social forms, where people in the US are especially prone to "quick fix" marketing and products that offer escape and excitement through consumption.
This is one thing that leads into higher rates of substance abuse in the US than Europe. For example, the US has a higher rate of alcohol use disorder than most European countries, despite most of the countries having more permissive laws around alcohol and more consumption of it on average.
I agree, but absent John Stewart taking it up [1] were not paying out the victims, and I’m not a victim, so it’s easy to discount their desire for the $3,500 to $48k.
[1] https://www.nytimes.com/2019/06/12/nyregion/jon-stewart-9-11...
> As the dissent notes, “all 50 state Attorneys General have signed on to this plan.”
Thanks for the correction! I must have read about Washington States objection a while ago, and been unaware of a change in their position (since I first read about it)
"is now threatened" is not characterizing this as a loss for the victims. It's characterizing this as opening up the possibility of a loss for the victims, relative to what had been settled. That characterization seems accurate and relevant.
(This ruling also brings a certainty of delay for compensation, since negotiations for a settlement have to start anew, and with lower chances of success.)
Well, not a loss for the legal profession for sure :D Will the victims come out with more in their pockets than they would have from this settlement? I guess we'll find out...
> Does anyone find it strange that this is described as a loss for the victims?
Pay attention to the ads appearing on NBC, I guess... (cf. Manufacturing Consent)
>The court on a 5-4 vote ruled that the bankruptcy court did not have the authority to release the Sackler family members from legal claims made by opioid victims. As part of the deal, the family, which controlled the company, had agreed to pay $6 billion that could be used to settle opioid-related claims, but only in return for a complete release from any liability in future cases.
Is this actually a positive outcome or a kick-the-can?
It depends on what your personal views are here.
If you wanted the outcome of the case to be at least some money going towards opioid treatment, then this decision could jeopardize that outcome.
However, if you thought that the Sackler family being able to escape any personal liability despite the myriad of evidence of many of their involvement in stoking the opioid epidemic— and they still got to keep a very sizeable amount of the family fortune— is morally repugnant and legally dubious, then this court decision is a positive.
I would personally prefer many of the executives and members of the Sackler family to be held liable, their assets seized, and formal charges brought against them. But that’s unlikely
I wouldn't be opposed to similar outcomes as the Chinese baby milk scandal in the end.
From Wikipedia:
> A number of trials were conducted by the Chinese government resulting in two executions, three sentences of life imprisonment, two 15-year prison sentences, and the firing or forced resignation of seven local government officials and the Director of the Administration of Quality Supervision, Inspection and Quarantine (AQSIQ). The former chairwoman of China's Sanlu dairy was sentenced to life in prison.
Yeah, that sounds nice :-)
To save everyone the google, several people went to jail with terms ranging from 5 to 15 years (after reduced sentences). Two people were executed.
They should have their wages garnished until the end of time.
Many of the most high profile names involved in Purdue Pharma or the Sackler family have retired or have passed away, so garnishment wouldn’t be as impactful as asset seizure (directly or from the estate of those that died)
Positive outcome. They earned hundreds of billions from their actions which resulted in the deaths of thousands.
Giving them permanent immunity was insane.
> resulted in the deaths of thousands.
The number the Supreme Court used in its decision was 247,000 deaths over a twenty year period. That's the verified number and therefore almost certainly lower than reality.
It also makes sense to me. If someone didn't join the class action, they should not be bound by its settlement, and should be free to pursue damage claims on their own.
deaths of thousands is a massive understatement. Just overdose deaths is probably getting close to a million. But they are also responsible for:
The people who don't OD but have their lives destroyed by opiods.
The family and friends who suffer because someone they know is an addict.
The time, money and energy society has spent trying to help addicts.
All the crimes, victims of crime and criminal justice costs that are a result of addiction.
They didn't kill thousands of people, they killed millions, affected every single person in the country negatively and contributed to the destabilization of our society.
The settlement was really a bit insane to me - we’re giving immunity to a family that killed hundreds of thousands and destroyed who knows how many more, and the money is being paid to local governments. In my area they planned on spending their share on things like “outreach” and free-to-the-addict narcan so they could continue to run around causing local mayhem.
Speaking as a man with a deceased father and aunt as a result of the Sacklers, really it’s a spit in the face kind of outcome that was shot down. They ought to be locked up next to El Chapo in ADX Florence.
Definitely a positive income. These people bear some of the responsibility for the deaths of hundreds of thousands of people.
There is no way they should ever be immune from further punishments and get to live out the rest of their lives as billionaires.
Justices Brett Kavanaugh, Ketanji Brown Jackson, Elena Kagan and Sonia Sotomayor dissented.
Not quite. From the NY Times:
> In a 5-to-4 decision, written by Justice Neil M. Gorsuch, a majority of the justices held that the federal bankruptcy code does not authorize a liability shield for third parties in bankruptcy agreements. Justice Gorsuch was joined by Justices Clarence Thomas, Samuel A. Alito Jr., Amy Coney Barrett and Ketanji Brown Jackson.
My lineup was extracted from an AP story. Which is correct?
https://apnews.com/article/supreme-court-purdue-pharma-opioi...
The decision itself:
> GORSUCH, J., delivered the opinion of the Court, in which THOMAS, ALITO, BARRETT, and JACKSON, JJ., joined. KAVANAUGH, J., filed a dissenting opinion, in which ROBERTS, C. J., and SOTOMAYOR and KAGAN, JJ., joined.
NYT was right and AP has now corrected theirs. Reload and check errata at the bottom.
The NY times. The AP story seems to have just been corrected.
You mean John Roberts instead of Ketanji Brown Jackson.
US$ 6bi to be disbursed across hundreds of local governments to use for settlements over millions of individuals is nothing compared to the damage the Sacklers inflicted. On top of that having a sweet deal to never see any future liability case is an egregious misjustice.
The minimum would be for them to be arrested, if we pushed drugs to someone who eventually dies from it we wouldn't be getting just a fine. At the scale they did it's simply inconceivable to me that paying a fine which is less than their profit is anywhere close to justice.
It really depends on what you mean by "pushed drugs". If you or I recommended that someone should get an oxycodone prescription from their doctor, and they eventually died after getting that prescription, I don't think we'd get arrested or fined. (And the Sacklers were never getting criminal immunity in the first place.)
That doesn’t describe what happened.
The recipients of the settlement are mixed about this. Some raised this suit because they felt the Sacklers were not sufficiently punished. Others felt that this was likely to be the best deal that could realistically achieved and dragging out proceedings in court for years and adding uncertainty of any settlement or victorious law suit was not worth the risks and emotional turmoil.
If you rob a bank and can pay the bank off with interest from the money you stole, was justice served?
If you sell drugs and use the interest from your profits to pay a fine, it doesn’t sound like punishment.
Part of the problem with this is that much of an old money wealth is from less than reputable sources (slavery, piracy, war, crime, smuggling, opium and alcohol).
From the article:
> Harrington objected to the release of additional claims against the Sacklers, saying it would be unfair to potential future plaintiffs.
> Purdue criticized Harrington’s role, saying that groups representing thousands of plaintiffs have signed on to the settlement, which could not have happened without the Sackler family contribution.
The concern is the set of current plaintiffs is incomplete and those plaintiffs who are missing are going to be hurt by this and the bankruptcy judge over this decision does not have the authority to approve this deal despite the current set of plaintiffs wanting it.
Negative outcome. Some important points that the article here did not emphasize: 1) The Sackler family was not actually a party to this litigation. They came to the table (with most of the settlement money) specifically to get these so called '3rd party releases'. 2) Purdue is basically broke. It's also an LLC. Thus, in order to go after the Sackler family's money, you basically have to claw back money that Purdue paid out to the family over the years. It's not impossible to do, but it requires a whole more litigation, the outcome of which is not at all certain.
Now, 3rd party releases are a genuinely weird thing: a court ruling that a party that's not directly involved in the case is immune from future lawsuits. Partially the reason it went all the way to the supreme court is that there was a circuit split - they were allowed in some circuits, but not others. However, (and this is according to a friend who represented the victims in the settlement), it's really unfortunate that THIS is the case where they get struck down. If the Sacklers walk away from the settlement, it makes the victims getting their payout much less certain, and certainly delays that payout by many years.
My understanding is that Piercing the Corporate Veil has gotten easier over the years. The more egregious the robber baron class has gotten the less sympathetic the courts have been.
> Thus, in order to go after the Sackler family's money, you basically have to claw back money that Purdue paid out to the family over the years.
Or you can find them personally, directly, criminally liable and their profits the result from a criminal conspiracy.
Personal crimes aren’t protected by the “veil” of LLC, so any assets of the family could be liable, after criminal conviction, for any civil claims from victims.
At least, I think.
IANAL, but I don't think this would help the victims (and incidentally, that could have still happened even with the settlement). If there were a criminal lawsuit of the Sacklers, and if that lawsuit was successful, the seized money would just go to the justice department.
The only way the victims actually see any money is through civil litigation.
> the seized money would just go to the justice department
The DoJ operates victims’ funds [1][2].
[1] https://ovc.ojp.gov/about/crime-victims-fund
[2] https://www.justice.gov/enrd/environmental-crime-victim-assi...
I would think civil forfeiture could be used to take all their assets if not then the drug dealers in my town need to each form an LLC.
Well, I don't think civil forfeiture specifically would work, but like I mentioned above, yes, if the justice department wanted to criminally charge the Sacklers, they could possibly win and get a judgement against some of the money. But then that money doesn't really go to the victims - it's just a way to punish the Sacklers.
The bankruptcy settlement had a bunch of money going to families of the victims, and also to the states for anti-addiction programs, and also some money towards documenting the Purdue wrongdoings, so that the public would have better visibility just HOW this was allowed to happen in the first place
Are the victims themselves getting anything? I thought it was States that were suing.
Well, it's a bankruptcy, so anyone can file a claim. The states have, but so have the victims and their families directly (as a class).
The next likely step to this will be how it affects the future hypothetical (but almost certain) trial of Boeing execs. Depending on what you want that to look like, then this was either positive or negative.
[flagged]
How is there such a big divide in the court on this? Is the law really this unclear on the matter?
The opinion and dissent are actually relatively approachable and lay out exactly what the disagreement is about: https://www.supremecourt.gov/opinions/23pdf/23-124_8nk0.pdf
It seems to come down to whether the sentence "[A chapter 11 bankruptcy plan may] include any other appropriate provision not inconsistent with the applicable provisions of this title" means "A plan can contain anything anyone can imagine as reasonable as long as it isn't expressly forbidden" or "A plan can contain other types of provisions that follow the same general theme as the concrete list given just before this sentence".
The Sacklers argued that the law says they can take away other peoples rights to sue them, since the law says these bankruptcy plans can include "anything", and the majority opinion of SCOTUS was that that's not the right way to read the law.
It also seems to turn whether the Sacklers seek a third-party “release,” which is precedented, or “discharge,” which is not. (The Court also assumes Purdue’s indemnification of the Sacklers will not hold, which would allow the Sacklers to drain Purdue as they fight the various claims against them.)
Interestingly, the argument for is textual. The argument against is pragmatic. (Both argue history, in my opinion, unconvincingly. They’re talking past each other on release vs discharge, a delineation neither side bothers to delve into.) The dividing line defies easy summary. (Gorsuch, Thomas, Alito, Barrett and Jackson concurring, Kavanaugh, Roberts, Sotomayor and Kagan dissenting.)
The argument for is a mixture of textualism and moral repugnance at the idea of letting the Sacklers keeping billions in profits they made from killing a quarter of a million people. I suspect the second part was strengthened to swing Jackson's vote and aside from her, it's a fairly standard split.
> the argument for is textual
And here's the language: "any other appropriate provision"
The Sacklers: the law says we can take away other people's rights to sue us as part of a bankruptcy settlement.
SC: Yeah, no, the text doesn't say that.
> the law says we can take away other people's rights to sue us as part of a bankruptcy settlement
As the dissent notes, third-party releases are part of the law. The turn is on whether the Sacklers are having third-party liabilities discharged versus released.
The solution may be in re-drafting the Plan so it’s more clearly a release. That might mean the Sacklers can be sued for fraud, but not other things.
If this decision was just about third-party releases, it wouldn't be before the court. And you know that.
> If this decision was just about third-party releases, it wouldn't be before the court. And you know that.
What is the difference between a discharge and release as it relates to the §1123(b)(6) “any other appropriate provision” power this case is about? You seem to have clarity the Court’s members couldn’t find.
You, then: As the dissent notes, third-party releases are part of the law.
Gets called out for over-simplifying the case.
You, now: What is the difference between a discharge and release as it relates to the §1123(b)(6) “any other appropriate provision” power this case is about?
Indeed. Maybe next time, stop pretending there isn't more to it.
IANAL but most contested Supreme Court decisions I've read (going all the way back to AP gov class) sounded like they could have reasonably been decided either way depending on who had control over the court. The law is ambiguous and complex enough that there's just so many logical ways to approach a decision and little in the way of prioritizing or disambiguating them. Whatever their bias, judges have lots of ways of reasoning themselves to their predetermined outcome. This is true up and down the courts but most judges are at least somewhat worried about their reputation and their record with appeals courts, which at least mitigates their biases but the SCOTUS is free to do whatever it wants.
As much as each side likes to bloviate about originalism and activist judges, SCOTUS often decides at the whims of ideology and personal bias because the law gives them lots of room.
The law surrounding Chapter 11 reorganisation plans only covers the relationships and responsibilities between debtors and creditors. It doesn't say anything about third parties.
But it does include a term saying a plan "may" also "include any other appropriate provision not inconsistent with the applicable provisions of this title" - subject to the approval of a judge.
Applying the broadest possible interpretation of this catch-all wording would produce absurd results - a bankruptcy plan would be more powerful than the constitution itself. So courts have to figure out just how broad an interpretation to apply.
> law surrounding Chapter 11 reorganisation plans only covers the relationships and responsibilities between debtors and creditors. It doesn't say anything about third parties
Yes it does. It covers third-party releases—there is ample precedent for that. The Court held this isn’t a release, but a discharge. (Idk.)
What really stuck out to me was how soft the opinions were. Especially the dissent. Rather than dry legal reasoning, it was argued much like a politician would. Maybe this happens fairly often, but usually when I read the actual decision from SCOTUS is is very specific and sober, even if I disagree with the conclusion.
Bankruptcy is a unique creature. It's created directly in the Constitution as a federal system. Bankruptcy is inherently "equitable," which means that judicial decisions are guided by case-by-case considerations of fairness rather than strict legal rules. Bankruptcy courts have wide latitude and discretion to basically do what makes sense in each context.
Here, the majority overturned something the bankrutpcy code approved, because, in its view, the remedy of a non-consensual third-party release conflicted with the structure of the Bankruptcy Code. The dissent disagreed, pointing out there were no express prohibitions on the relief the bankruptcy court had granted, and explaining that, in their view, the bankruptcy court should have been given discretion to authorize such a release if ultimately it would make the creditors better off. Basically the majority was focused on the structure of the Code, while the dissent was focused on the practical fact that the creditors would probably get more money from the Sacklers this way than if they had pursued direct lawsuits against them.
> the creditors
Thanks, that word helps clarify my major problem with handling this as a bankruptcy case. I don't see the destroyed lives as an issue of creditors, I see them as victims. Calling off the corporations coming after an individual for unpaid debt is a whole different issue than barring individuals from going after a corporation for actual injuries.
Chapter 11 bankruptcy law includes a "catchall" provision that “may” also “include any other appropriate provision not inconsistent with the applicable provisions of this title.”
Historically bankruptcy courts have wide discretion to make any "appropriate" provisions, and this document is an argument about what the limits of appropriate include.
Pound for pound, the Sacklers probably did more damage to America than any other drug dealers in history. More damage than any serial killer or mass shooter. In my mind they should be considered public enemies 1 through N. I sincerely hope they face civil and criminal liabilities for what they’ve done.
You're really underselling it if anything. Over a million Americans have died so far in the opioid epidemic. That more than any of their wars, including their civil war.
A good book to read regarding this topic is "Death in Mud Lick" by Eric Eyre who was a reporter for a local newspaper in WV during the early discovery phase of the epidemic.
The book details the methods used by the drug companies to pedal these drugs into small communities, the tragic victims, and lastly the refusal of drug suppliers to admit any wrong doing. There's also a slight dose (no pun intended) of WV AG's sheer incompetence on the matter due to donations and gifts by said drug suppliers.
Super depressing book, but great read nonetheless.
Painkiller is a great little short series on them too. does a great job at portraying all of what you mention in a six hour tv format. it can get a little on the nose sometimes but the meat is 100% true
*peddle
Fun fact: early opioid deliveries were actually, in fact, almost exclusively done by bicycle!
If they used those penny farthing bicycles I’m sure they needed quite a few painkillers.
Not to mention creating more homelessness, increasing crime and deteriorating our cities, strengthening Mexican drug cartels, providing business to suppliers in China.
They have objectively made the world a worst place.
I thought the lead guy was bad.
> Over a million Americans have died so far in the opioid epidemic.
Which of those million died from Oxycontin overdoses, which of them died from hepatitis they caught when shooting up pills with a reused drug needle?
That’s a good question. You should do some research. Maybe you can ask the families of the victims?
Don't have to. Virtually none. People die from the street heroin they bought as a substitute for the oxy they couldn't get once the DEA cracked down.
You can see it on every fucking graph, the very week that the DEA did this, if the dates have enough resolution. This is why we don't ask "the families of the victims", because you're irrational with grief and can't process what the problem is.
In America, if I shot you in the leg and you died years later from an infection incurred because of that bullet wound I can and likely would be charged with murder because of the long string of consequence caused by my action.
So I can draw a pretty solid causal line from “my father died in a tent in the woods behind a gas station off of I-95 to the Oxy he was once on.” Maybe the pill itself didn’t directly kill him but it sure lead there.
Perhaps I’m just too emotional here, having literally dealt with the above last month. Can’t think straight?
> if I shot you in the leg and you died years later from an infection incurred because of that bullet wound I can and likely would be charged with murder because of the long string of consequence caused by my action.
Which is a useful convention, because it deters the sort of violence as "shooting people in legs".
The analogy doesn't hold. Drug warriors like yourself murdered the OD junkies. Your policy murders, and somehow you perceive yourself as the overburdened heroes. Prohibition is a bizarre policy, and we don't prosecute beer brewers for drunk driving deaths, no matter how addicted the alcoholic was. You're a bad person. You make the world more miserable than it has to be with nothing more than your evil opinions. And nothing I can say will ever convince you of the truth.
> Perhaps I’m just too emotional here, having literally dealt with the above last month.
You're not just emotional, but irrational. I and others like me could fix the things that make you hurt, but you want more of the same. It is not the sadist who screams "the beatings will continue", it is masochists like yourself who beg for it, telling all involved their morale really will improve.
I can’t respond to any of your comments about policy, because you’ve never elaborated your ideas, and you seem to be assuming a great deal about mine and the other commenters.
1) Real heroin does not exist anymore in real life. All of it is varying cuts of fentanyl and research chemicals.
2) Your original comment asked the question “how many have died from oxy vs hepatitis”, which, along with your comments about heroin, made it clear that your knowledge isn’t up to date. It strains credulity to say that more people died of hepatitis than they did of the opioid they’re injecting into themselves regularly. Do you really think hepatitis is the root cause here? Or is it the proliferation of opioids much stronger than heroin. I’m sure you’ve heard of fentanyl and carfentanil, but there are entire other classes (such as Benzimidazoles) that have been rising to prominence in the last few years that are more dangerous.
3) I’m very anti DEA as well, and agree that prohibition kills. However, this is not simply a case of holding a manufacturer for a substance responsible. It’s what the Sacklers did after learning of the addictive power of these medicines that gives them culpability. It’s like a local bar serving someone even when they’re visibly drunk, which confers criminal responsibility if that drunk person later does something while under the influence. Making opiates == legal, being negligent == not legal. I wish we didn’t have a prohibition, and drugs could be acquired safely, but that doesn’t mean that the ends justify the means, and any drug manufacturer is automatically the good guy.
I just don’t think you’re approaching this subject with the care it deserves. It’s easy to make flippant comments blaming “Drug warriors” (genuinely confused what that even means—does that mean someone who is pro-prohibition?), it’s much harder to interact with the literal decades of research about this topic, and magnitudes harder to actually experience these things yourself. If you’d like a starting point, I found this report to be pretty approachable: https://www.rand.org/pubs/research_reports/RR3117.html. However, I wouldn’t be surprised if posing questions the way you have elicits emotional reactions from those who know people who have died. I lived through the first wave of fentanyl in the US, but I know quite a few who didn’t. Based off what i’ve been able to pick up out of all the vitriol, I think we would likely agree about the policy decisions, but your approach of making simplistic comments and then calling people evil based off of their response seems like an ineffectual strategy. And maybe it isn’t, but then you’d have solved the drug crisis already, right?
7x as many people in the US die from cigarettes every hour, day, week, month, and year as from all opioids combined.
Cigarettes don’t even require a prescription.
If there is an opioid crisis, there is a 7x larger tobacco crisis, too.
Tobacco companies have paid out countless nine figure sums, smoking in public has gone from universal to mostly illegal, cig taxes have skyrocketed, etc…
Tobacco has been treated as a crisis, and I have no doubt that if cigarettes had been invented by one specific family, that family would be hated.
Weird that you don’t know any of this.
True, but it still shows that lobbyists have a lot of influence. Even if it means hundreds of thousands of death people every year. Same goes for Alcohol. And maybe also specific types of food.
What’s weird is that people still think tobacco smoking is about nicotine being addictive and dangerous, when it is literally everything else in the smoke that makes it extremely addictive and mortally dangerous.
The nicotine is what makes it addictive, but everything else makes it deadly.
This distinction is well known here in Sweden where we have snus, and also lower rates of lung cancer and cigarette use than the rest of Europe by a LOT.
That is not true. It is the interaction of nicotine with various monoamine oxidase inhibitors that makes tobacco smoking addictive, to an extent that it could be stated that it is the MAOIs entirely causing the addictive behaviour: the exact same MAOIs are also found in coffee, after all.
Why are nicotine pouches and vapes addictive, then? The answer lies in the flavourings, which themselves have psychoactive properties, likely also through MAO inhibition.
God this Gwern junk will never die. There's tons [0] of evidence that nicotine is addictive on its own.
> Why are nicotine pouches and vapes addictive
It's the nicotine.
[0]: https://duckduckgo.com/?q=nicotine+addictive+site%3Anih.gov&...
I'm not here to argue, but all top 5 links for me are about smoking. I've not heard of people being addicted to nicotine patches for example, especially non-smokers.
Nicotine Addiction: Neurobiology and Mechanism: https://pubmed.ncbi.nlm.nih.gov/32322429/
Neurophysiology of Nicotine Addiction: https://pubmed.ncbi.nlm.nih.gov/22454789/
I looked into this previously, though it was a while ago so I no longer have the sources to hand. Nicotine is still addictive on it's own but when given to non-smokers in a non-tobacco form it's notably less addictive than smoking. Still addictive but far closer to coffee than cigarettes.
Some of this can be explained by different consumptions methods. For example in lozenges, gum and patches nicotine enters the bloodstream much slower than smoking or vaping so even if you consume the same overall amount the peak is lower slowing adaption. But that couldn't explain it entirely.
https://www.fda.gov/tobacco-products/health-effects-tobacco-...
You will have to supply something to back up such a wild statement. Nicotine has been shown to be extremely addictive all the way from humans down to single neurons in a petri dish, for decades.
No, it's because nicotine is an addictive chemical.
https://www.fda.gov/tobacco-products/health-effects-tobacco-...
It's not known in Australia where you have to have a prescription to buy a vape but can buy cigarettes freely. Apparently they're relaxing the prescription requirement later in the year but still only pharmacies will be allowed to sell them.
Though at the same time I would wager a larger rate of gum disease and mouth cancer than the rest of Europe by a lot.
Going by a quick skim of the 2022 WHO oral health numbers, Sweden[0] doesn't seem significantly worse off oral-health wise than Germany, Holland, or the UK. In fact it's oral cancer incident rates appear a bit better. Though the UK doesn't have great cancer incident rates, it's periodontal disease rate seem to be significantly lesser than the other three (perhaps due to close monitoring as a result of the "bad British teeth" stereotype).
Sweden male tobacco use percentages are slightly higher than the other three countries, which might be a function of the population additionally using non-cigarette tobacco substitutes perhaps as was mentioned by others.
[0] https://cdn.who.int/media/docs/default-source/country-profil...
Not cancer. Because it's, again, not the nicotine that causes the cancer. Snus does NOT increase cancer risk.
It decreases cavities by a lot (presumably because the bacteria doesn't like the environment anymore), but also destroys your gums. All in all, depending on your dosage it could be a wash or even positive for your oral health.
It's absolutely disgusting, but it's not dangerous :P
Can you please tell me which of these mandatory warning messages you feel fails to convey that cigarette smoke, on the whole, is dangerous?
https://www.fda.gov/tobacco-products/labeling-and-warning-st...
Don't forget McKinsey:
https://www.nytimes.com/2021/02/03/business/mckinsey-opioids...
I always cringe whenever I see people giving McKinsey credit for stuff (good or bad). It's a powerpoint factory of 20-somethings with zero experience executing anything.
To suggest the virtuous, humble Purdue management could never have figured out how to sell oxycontin and bend regulators--without the insight of a few powerpoint slides--gives me a chuckle.
It's not like Purdue, a drug company, had any experience marketing drugs and dealing with regulators before, right? I mean, it must have been a super hard problem for them to solve. How do you sell an instant painkiller thats wildly addictive, while getting corrupt regulators to be corrupted? Impossible!
Too bad they got duped by those evil 22-year old powerpoint geniuses at McKinsey, who are clearly the real villains of the story.
You might be partially right, but McKinsey Senior Partners have a very long list of friends to call, many of them former McKinseys in positions of power. So while the shitty PowerPoint might seem as the product, the actual product might be trafficking influences and coordinating favors, getting insider information from a competitor, etc.
In this case in particular, if memory serves, they were advising the FDA in parallel, and leaking information to the Purdues. No brain-dead 24yo Harvard grad did that.
I would not give them any slack.
They also provide plausible deniability. "Look, we have independent research by a reputable firm."
In fact that's the main thing they sell.
https://archive.is/Gc1Lh
I mean they were just leveraging synergies between drug company and drug regulator.
They all should be charged with mass murder. The corrupt judge who okayed the settlement deserves prison.
Just after the decision was announced, the victim's lawyers seemed to put out a statement decrying the decision since the victims are not going to be paid (soon?). Is this overzealousness on the part of the lawyers themselves wanting to get paid? Does any law person have a comment on the situation?
Manslaughter maybe, but not murder. They didn't want to kill people using their drugs. That wouldn't make any sense.
Also, I'd be careful about saying the judge (Robert Drain) is corrupt unless you can back that up with facts. You might be opening yourself up to a libel suit.
Where was the FDA? Were the doctors all innocent? Is stupidity a good criminal defense? They should be all in the same cell.
FDA has some culpability, but the fraud was so effective Medical Schools where teaching students to prescribe more opioids.
Perdue Pharma effectively hacked the medical system. I think the real takeaway is there’s likely more of this going on than we realize. The common decongestant phenylephrine being no more effective than placebo comes to mind. Without the mass deaths there’s apparently little to stop modern snake oil salesman.
Perhaps the FDA needs to conduct direct hands on oversight of medical trials? I mean if there’s billions to be made and little chance of prison the incentives get crazy.
There is a phenomenal article in Scientific American talking about the phenylephrine/pseudoephedrine debacle: https://www.scientificamerican.com/article/how-two-pharmacis...
It's sort of a different class of failure than with opioids, but it is a notable area of weakness. Basically, for OTC drugs that were initially approved before 1962, many are still on the market despite sometimes having weak efficacy data. While the FDA has been making some progress in reevaluating these older drugs, we're still far from where we should be.
A few quotes from the conclusion of the article (but the entire piece I linked in SA is worth a read!):
> In 2023, 16 external experts on the second Nonprescription Drug Advisory Committee looked at all the evidence compiled by FDA staff, heard manufacturers' arguments in favor of oral phenylephrine's efficacy, and heard from experts like me who argued that oral phenylephrine is ineffective. In the end, they concluded that oral phenylephrine is not GRASE. A final ruling on whether decongestants containing the drug can still be sold will take time. We hope science will prevail.
> From this experience we've learned that the monograph process for OTC drugs approved before 1962 needs to be reexamined. Systematic reviews of the available evidence indicate that other nonprescription drugs such as guaifenesin (sold in Mucinex and Robitussin), dextromethorphan (sold in Robitussin DM) and antihistamines marketed for colds (for instance, chlorpheniramine) probably don't help with coughs and colds. They are usually not dangerous, but their effects are likely to be the result of a placebo response; more modern research is needed.
> The outcome for oral phenylephrine shows that the FDA needs more funding to look at old drugs. We need public funds to support independent researchers who want to examine these products objectively. The government should be able to spend millions to save consumers billions on ineffective products. Companies that market these products have no incentive to prove they don't work. Nonprescription drugs must be effective, not just safe.
I'm surprised there aren't lots of PhD students doing modern trials on these. "I was the person disproved a widely available drug" seems like it would be a great thing to have on an academic resume. From the outside, it also seems like this would be relatively easy research since the drugs are widely available, safe, and treat common symptoms.
> FDA has some culpability
They appear to have left the oversight up to two individuals - ones with whom there was an obvious quid-pro-quo [1]. It's a stain on the agency and they should take responsibility and make changes.
[1] https://journalofethics.ama-assn.org/article/how-fda-failure...
>Were the doctors all innocent?
Some medical professional went from healers to corporate shills for big pharma in 50 years.
My favorite video about this subject:
Dr. Aseem Malhotra - 'Evidence Based Medicine Has Been Hijacked'
https://www.youtube.com/watch?v=qwovXFzUvfg
Maybe, but its more common than this one example and more than what most people can stomach. The real problem is these people are sociopaths, and the next set of sociopaths will do it again. They don't care who they hurt because they lack empathy and if killing people drives up profits then so be it.
If you really want to show concern or right a wrong then find a way to better criminalize violations of accepted ethical norms. The best way to punish sociopaths is to take all their assets, embarrass them in public, and permanently bar them from practicing in the same industry. For example if a lawyer is disbarred they do not get a second chance.
>" better criminalize violations of accepted ethical norms"
What a load of BS. Wat's next ? Burning witches? I think we are way over our heads with criminalization already and have created big underclass of people who have no second chance because of that. So no fuck you.
P.S. Sure I'd like to see many of our masters in jail for fucking up with people's lives but that will not happen
There is no criminal underclass of convicted billionaire sociopaths. What are you talking about? Of course it won't happen if we continue to permit, excuse, and enable their behavior while crying about how hard life is.
>"There is no criminal underclass of convicted billionaire sociopaths"
To that I agree. However you can not make laws specifically criminalizing rich for "violations of accepted ethical norms". It will just open floodgates diverting regular and poor to underclass. This whole criminal background check should be made illegal with some very specific exceptions. It hunts people for the rest of their lives. Europe handles this situation much better in general from what I've heard.
My understanding is that for regular theft, there are different classes of charges depending on the amount stolen. Perhaps we could apply a similar approach at the top end? E.g. laws that only kick in when there has been more than a billion in damages or thousands of deaths?
>"more than a billion in damages or thousands of deaths?"
They were proposing criminal charges for "violating ethical norms" which is a bit different.
> Pound for pound, the Sacklers probably did more damage to America than any other drug dealers in history.
That's complete horseshit. They produced a drug of known, unvarying dosage in regulated pharmaceutical manufacturing plants, overseen by pharmaceutical engineers making sure that no illegal or unsafe substances adulterated the final product.
For once, there was a drug on the street that wouldn't cause junkies to overdose. It wasn't hot with fentanyl half the time. Jackasses didn't cut it with baby formula or laxatives. Hell, it didn't even encourage druggies to reuse needles.
But if you need empirical evidence, drug overdose deaths only spike after the DEA cracks down on pill mills. They demonstrably saved lives. Any sane person who examines this at even a shallow level would concur. You've drank the kool-aid.
I like to think about it this way:
I cannot name another family that helped introduce a nationwide need for a completely new type of first aid, that being naloxone. It's not just ambulances; it's in police cars, pharmacies, libraries, schools, and workplaces. A complete deployment throughout the third-largest society in the world, in less than ten years, because of the frequency of overdose.
Just consider that for a moment.
Gabapentoids (e.g. pregabalin, gabapentin) need similar scrutiny, as they are routinely prescribed to millions of elderly people, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265598/
> gabapentinoids are increasingly being used for off-label conditions despite the lack of evidence. Prescription rates for off-label conditions have overtaken that for on-label use. Similarly, the use of gabapentinoids in the perioperative period is now embedded in clinical practice despite conflicting evidence. This article summarises the risks associated with this increasing use. There is increasing evidence of the potential to cause harm in vulnerable populations such as the elderly and increasing prevalence of abuse. The risk of respiratory depression in combination with opioids is of particular concern in the context of the current opioid crisis.
I’d argue it’s the opposite.
Look at what’s happened since Oxycontin was heavily regulated.
Opioid deaths in America have exploded by an order of magnitude.
There’s a direct correlation between higher regulation of OxyContin and opioid deaths in the U.S.
The Sacklers have done illegal stuff. Misrepresenting the addictiveness of their drugs (well, it was immoral and wrong…it’s not clear how illegal it was).
But it’s quite clear that America had a parallel opioid crisis going on. By making OxyContin easily available, ie, a slow acting opioid (it had to be crushed to be fast acting) that was produced legitimately and had a legitimate supply chain so people were able to get exactly what they wanted, Purdue Pharma helped keep the number of opioid deaths under control.
IOW, the U.S. has had an addiction crisis that is independent of prescription drugs whose cause is not clear yet because everyone has thrown the blame on Oxy instead of researching it. This is the same kind of drug crisis that hit inner cities in the 20th century but has hit rural areas in the 21st century. By providing easy access to regulated and legitimate opioids the Sacklers may have marginally worsened the addiction crisis, but they minimized the number of deaths and severe negative impacts.
The moment Oxy and the other opioids were made less easy to get, the underlying drug crisis hadn’t gone anywhere, so instead the people suffering from the crisis had to get their opioids from illicit sources as opposed to the pharmacy, exposing them to all sorts of unregulated drugs that had all sorts of nonsense like Fenranyl mixed in, which causes the actual negative impacts of the drug crisis to explode.
The funny thing is that when the entire country was just absolutely united at making the Sacklers the big bad evil, the actual people working on the ground trying to help those who were facing this drug crisis were predicting this exact situation and were asking authorities to not clamp down on Oxy. But they were all ignored and so we have a situation where opioid OD deaths have gone from a consistent 10-15,000/year (a rate which preceded Oxy) to about 50,000/yr now.
Are you one of the lawyers?
None of that would’ve happened if they didn’t start the flood of opiates to begin with. It wasn’t a marginally increased issue, they flooded the market with it. People with minor pain were getting massive bottles of OxyContin and selling or using it. This led to pill mills and crooked doctors. You had normal people getting hooked on high dosages. These are not the people who were using opioids before that. Pills made it seem safer. Most users don’t start with heroin, they start with pills because of exactly that. “A doctor prescribed it, must be okay.”
This is some insane logic to absolve them of responsibility. I say this as someone who also saw the problem firsthand. Was regulation handled badly? Sure but there’s no way you can say they didn’t start the problem.
Not only that, some of the problem with addiction were directly caused by the dosage guidelines for oxycontin. They really wanted it to be a 12h drug, but it really isn't and it wears off after about 8 hours. Rather than admitting this and giving a smaller dosage more frequently they doubled down by using a larger dose and trying to keep with the 12h schedule.
This combination or larger dose followed by mild withdrawal then results in a higher likelihood to become addicted to opioids. So not only they marketed it heavily and got more people on opioids than necessary, they did it in a way that maximizes the likelihood of addiction.
https://www.latimes.com/projects/oxycontin-part1/
A bartender mocked my brother for getting Aspirin for his broken arm.
"man you got nothin', you should get some oxy for that!"
I'd been living outside the US and this in my first few hours back on US soil. A few hours later my friend (working in criminal defense) explained how opiates accounted for roughly 1/3rd of his income (other sources: drunk driving and domestic abuse). They all followed the same trajectory: minor condition -> prescribed oxy -> illegally obtained oxy -> heroin when the money ran out.
This wasn't normal. It didn't happen anywhere else in the world at the time, or at least not where I was living.
> But it’s quite clear that America had a parallel opioid crisis going on
I don’t think that’s really the case. What happened here was that peddling oxy, created the excess demand that is now met by illicit sources that cause more deaths now that oxy is regulated. But what you’re missing in your understanding is that without oxy, demand wouldn’t exist in the first place. And that’s the harm everyone is talking about.
You’re talking about the aftermath of the problem. Parent is talking about the root cause.
You’re saying “created excess demand” like the people that you’re referring to weren’t chronic pain patients.
I know some of them were drug-seekers but we decided it was OK to throw chronic pain patients under the bus so we could eliminate those drug-seekers.
Now, in addition to dealing with pain every day, I also have to “prove” that I’m not an opioid seeker if I end up in the ER for overwhelming pain. Because saying that you’re hurting is clearly a sign that you’re actually an addict trying to get a fix.
This might sound cold-hearted, but as someone who deals with chronic pain I’m fine with some street ODs in exchange for people who are in pain being cared for. Now we just torture patients by doing nothing.
Recreational drugs are a choice. My pain was not. Why we punished for others’ bad choices?
> You’re saying “created excess demand” like the people that you’re referring to weren’t chronic pain patients.
I don’t think you know the full history of how Purdue operated. They did two things: downplay how addictive oxy was & aggressively push oxy through doctors by providing kickbacks.
Chronic pain patients were actually a much smaller portion of the eventual victims. In a lot of cases, normal people would be prescribed oxy after minor procedures and they would get hooked on it and become permanent addicts. Once hooked, doctors would continue prescribing it for far longer and create a perpetual dependency. If the true effects of oxy were made public (which were known by Purdue pharma and Sackler family), oxy would’ve been prescribed with a lot more caution. And prescription of oxy for minor pain would’ve been non existent since a lot of safer alternatives existed.
I’m sorry you have a chronic condition, but not everyone who got hooked onto oxy had chronic conditions, and nor were they junkies.
You can directly count the total amount prescribed opioids through time and adjust for potency.
Purdue Pharma didn’t just manufacture a drug. They did a great deal of behind the scenes manipulating so even people who did not seek out severe pain medication were prescribed extremely high doses.
In terms of long term pain management opioids suck. People need increasing doses over time until the drugs side effects become toxic. Not such a problem in hospice or someone in an ambulance after a major accident, but handing them to people with chronic conditions guarantees a downward spiral. Perdue Pharma knew this, strait up lied about it, and even pleaded guilty to mislabeling OxyContin.
> total amount prescribed opioids through time
This... Dr were involved too!
> long term pain management opioids suck
Opioids suck. And the medical profession was complicit. For a class that is supposed to be professional and well informed most Dr's are, shockingly, not that bright.
> Dr where involved too!
The actions of individual Doctors acting on their own simply don’t explain trends.
Doctors and the FDA etc were straight up lied to. I don’t think it’s reasonable to hold Doctors accountable for when some pharmaceutical company commits fraud. That doesn’t mean every doctor was blameless, but individual Doctors have always behaved poorly it was true before the opioid epidemic and it’s still true today.
> Doctors and the FDA etc were straight up lied to
Oh please.
Doctors, did not believe the preponderance of evidence that ulcers were caused by bacteria. The reason, the person who discovered it was a vet.
They had to give the man a Nobel Prize to get Dr's to pry their heads out of their self aggrandizing asses and pay attention to reality.
Opioids were addictive. They never stoped being that. Dr's were fiscally motivated to prescribe. Nothing more nothing less.
Doctors also refused to believe the germ theory of disease because it would imply they were all incompetent before then. Lots and lots of people died from infections transmitted by unwashed hands.
> Doctors, did not .. The reason, the person who discovered it was a vet.
You’re wildly incorrect, nobody involved was a vet.
Barry Marshall shared that Nobel and is a Doctor. https://en.wikipedia.org/wiki/Barry_Marshall
Robin Warren received his M.B.B.S. an undergraduate degree focused on medical research. https://en.wikipedia.org/wiki/Robin_Warren He worked at: “SA Pathology, (formerly the Institute of Medical and Veterinary Science (IMVS)), is an organisation providing diagnostic and clinical pathology services throughout South Australia for the public health sector.” https://en.wikipedia.org/wiki/SA_Pathology
So whatever source you read that misinformation from is not trustworthy.
> Opioids where addictive
Hindsight bias here. We don’t want medical professionals to discard new information in favor of older treatments. There’s no way doctors can on their own replicate the medical research linking Ulcers with a bacterial infection and independently judge oxycodone’s effectiveness, and a dozen other drugs etc. Extended-release (ER) oxycodone was literally a new drug and described as not having the same issues associated with other Opioids on labeling approved by the FDA.
The crazy thing is how effective this all was. Medical schools were teaching students to hand out more opioids.
Chinese emporers were controlling opiates all the way back in the 1700s and the British were tied up in war for 20 years over the wreckage to the Chinese addicts.
The doctors, all college educated, some of our most studied and intelligent citizens, they knew about the history of opiates and im not talking about the dare campaign. I knew before the epidemic even got into force when I tossed the opiates I was prescribed in the trashcan.
The oxy marketing was just the wink and the nod everybody needed to convince themselves to parrot with a straight face, but they didn't actually really believe it.
“Tied up in a war” is a funny way to say “aggressively breaking Chinese law in order to hook local populations, make tons of drug money, and collapse public order.”
The Opium Wars were a cynical prototype for the modern war on drugs, which was initiated with similar designs and outcomes.
This wasn’t just marketing, this was drug labeling approved by the FDA and new guidelines for pain management they where teaching in med schools.
It's a valid point. Another valid point is at that time it was known the FDA had a history of approving addictive drugs. It is not evidence based to trust FDA over hundreds of years of history countering otherwise. I knew LOTS of people who turned down or tossed opiate scripts during that time because the long history was obvious to anyone with half a brain.
Yep, many people knew all along. Many didn't know, but doctors of all people had no excuse to be among the not knowers.
> You’re saying “created excess demand” like the people that you’re referring to weren’t chronic pain patients.
When a pain patient becomes an addict, their demand tends to be in excess of their prescription. I don't think anything you're saying is a reasonable response to the comment you're responding to.
Even the chronic pain patients should not have had the amounts prescribed to them that they were. Doctors were incentivized to give as much as possible. Creating addicts in people who may otherwise would not have been.
I personally knew people getting more than a cancer patient should’ve been given for day to day chronic pain.
I’m sorry if you were personally affected by regulation but that doesn’t mean they didn’t cause the crisis.
> You’re saying “created excess demand” like the people that you’re referring to weren’t chronic pain patients.
> I know some of them were drug-seekers but we decided it was OK to throw chronic pain patients under the bus so we could eliminate those drug-seekers.
To the GPs point, the cause of the regulation was the abuse of the sale. Many deaths were caused by aggressively selling oxy to folks who weren’t managing pain.
The fallout has resulted into harm with people that have a legitimate need for pain management.
Both can be true. The Sacklers are the culprits any way you slice it.
When I was a teenager I had my wisdom teeth removed and was prescribed Oxy. My mother was smart enough to not fill that prescription and gave me some ibuprofen instead. I was fine, the OTC painkillers were completely adaquate. Taking that Oxy would have been totally unnecessary and potentially life ruining.
Do remember that some of them were acute pain patients, who were supposed to be on oxy for a limited amount of time but got hooked.
Sure, OxyContin is better than Fentanyl, and banning Oxy can push people to way more dangerous opioids. But before painting Purdue as a hero of the people, let’s remember that million of people were pushed to opioids through Oxy when they shouldn’t have in the first place. Purdue played a big part in creating the epidemic in the first place. People that are now pushed to harder drugs because of an addiction they got into for the sake of Purdue making more dough.
Exactly. If it wasn't for the existing demand for cheap powerful opioids, Fentanyl would never have been a problem to begin with.
It's the same shit practically all the way back to opium wars.
Always the drug dealers fault.
I blame the patient. We've known opiates were bad since at least the 1800s, and really longer than that. What the doc said was just what they needed to hear to lie to themselves, but this is taught in every highschool.
> We've known opiates were bad since at least the 1800s, and really longer than that. What the doc said was just what they needed to hear to lie to themselves, but this is taught in every highschool.
I am not sure high schools are teaching people to be distrustful of their doctor’s advice. I think what’s being taught is about the dangers of illicit drugs, not those with a medical expert’s stamp of approval.
On the plus side between oxy and COVID distrust is now at all time highs.
People have learned you can't trust the doc anymore than a quik-lube mecanico.
> I blame the patient. We've known opiates were bad since at least the 1800s, and really longer than that.
As a reminder, Oxy was heavily marketed, (to doctors!) as a "not bad" opioid. As in, not as addictive, not as problematic, and something that can be prescribed more easily and with less worries.
If a doctor comes up and tell you "don't worry about this one, it isn't addictive like the others", and you are in a ton of pain at the time, you are going to thank modern medicine for its new miracle pain drug and accept the prescription.
> but this is taught in every highschool.
And as another reminder, most schools, until recently, just taught that "drugs are bad" and kind of left it at that. They exaggerated some of the down sides, and didn't mention any of the positive experiences.
IMHO South Park actually did the world's best anti pot ad -
"Well, Stan, the truth is marijuana probably isn't gonna make you kill people, and it most likely isn't gonna fund terrorism, but… well, son, pot makes you feel fine with being bored. And it's when you're bored that you should be learning some new skill or discovering some new science or being creative. If you smoke pot you may grow up to find out that you aren't good at anything."
-
And IMHO messages like that are more useful than what kids are being told.
There is also the social contract side of things - Since around 1950s, if people worked hard they things in return from society: A stable job, a house, the opportunity to raise a family. That social contract is shot to shit, and so it should be no surprise that more and more people are choosing to drop out of society via drugs/games/apathy.
Heroin was introduced as a cure to morphine addiction.
You didn't learn about the opium wars? I'm not talking about dare which was obvious bullshit, I'm talking of learning from history. There was no weed war, that a drug caused a couple wars lasting decades should at least raise an eyebrow of any thinking person.
I think this has more to do with the general lack of curiosity about the world beyond the US borders that prevails in most of American society. It's not as if US high schoolers get a comprehensive education in world history except for a few select omissions. I agree with you that this is something they ought to be aware of but I think you've kinda stretched the causality here.
>I think this has more to do with the general lack of curiosity about the world beyond the US borders that prevails in most of American society.
Just learning about all the countries the British messed up would take at least another 5 or 6 years on top of whatever schooling is already done.
If you wanted to add everything America has done, well, people wouldn't be graduating high school until they are in their 30s.
We did learn about the Anglo-Zulu War and the East India Company, but a decision has to be made on what list of British atrocities to include in a history curriculum.
We didn't study the Opium Wars in history at all throughout my education, I learned about those on my own thanks to the Internet. The entire Middle East, our influence in South America, etc, none of that was covered in school, and I went to some pretty good public schools. (E.g. in High School we edited DNA of Bacteria)
For that matter, I think China was only mentioned in passing throughout my entire education. WW1 was also only mentioned very briefly (maybe a couple weeks? Archduke is shot, shit goes down) and then we spent a fair bit of time on WW2, but less than we spent on Ancient Egypt honestly. (I think we spent an entire 2 or 3 months on Ancient Egypt).
We spent a fair amount of time on the Reformation and Renaissance, ancient Greece and Rome, and US history was mostly a ~bullshit~ censored history of the founding of the US. The Washington State history classes went into some history of the local tribes, but failed to mention any of the fun details about how Seattle was founded (prostitution, drinking, Seattle literally poisoning the wells of nearby towns to force them to join Seattle to get access to clean water)
College was better, mostly US history and World History, still nothing about the far east though.
We did an excellent segment on the US Revolution in College, including the funding source behind the revolutionary war, that was very interesting.
Edit: Sex ed was pretty comprehensive, and we ended the quarter by watching Rocky Horror Picture Show, so that was fun. (The Nerd and Goth kids formed a voting block for what movie to watch. :D) I am still surprised they talked about so much about forms of contraceptives that almost no one uses (spermicidal gels and foams), but at least they properly demonstrated how to use a condom, so that was good.
For "don't smoke" the health teacher had lots of pictures of tumors.
Alcohol wasn't really talked about, but honestly in the 90s we didn't know a much about how unhealthy it is as we do now. (Doctors knew it was bad, but just in the last few years research has come out showing that the safe amount of drinking is none)
What lesson should the opium wars have taught that's applicable to oxy prescription?
That’s gotta be the most ignorant opinion I’ve heard on the subject. This clearly is coming from someone who has had the benefit of good health, or hasn’t had the misfortune of a critical ER visit. When I got addicted to opioids, the doctors didn’t ask me what I wanted in the ER. I got Dilauded as they prepped the OR. I wasn’t lucid enough or cognizant enough to give informed consent. During my recovery, there wasn’t an option of alternate anything - I got a lot of morphine and then oxy. I was discharged 4 weeks later from the hospital with a 3 month prescription for 120mg of opioids per day. That would kill most people.
My story is not unique. It is so common it could be a troupe. The doctors saved my life in one way, then discharged me into a hell of addiction that it took 9 months of serious determined effort to overcome.
Then, some uninformed keyboard warrior like yourself comes along and blames people in my situation? Maybe you should have read a little less Opioid Wars and a little more Current Events. You clearly know nothing about this problem.
I've worked in the ER, held a license to work there, and spend everyday with licensed providers in addiction medicine. I assure you I have more familiarity here than even most addicts.
But you win the victim totempole height contest I guess.
That doesn’t clarify anything about your knowledge. The specialized hospital cleaning crews are in the ER every day and dozens of hours per week in the OR, but that doesn’t allow them to practice medicine or perform surgery. Proximity is not the same as practice.
The medical practice (until a few years ago) was profoundly and intentionally misinformed about the addictiveness of Oxycodone and Oxycontin. You brought up a question about why people didn't learn from the Opioid Wars, but your flippant question could just as easily be applied to the MDs who wrote the prescriptions.
Medical doctors are smart; they MUST know about the Opioid Wars and the horror the opium wrecked on Chinese society for centuries. Why would they prescribe such a dangerously addictive compound to injured and vulnerable people having the worst day of their lives?
Instead, you blame patients with little choice (or capacity to evaluate choices) in a terrible situation. And, if you talked to any addicts, you'd sure find that the top of the "victim totempole" is actually really crowded with people who got there the exact same way. That is no coincidence.
The fact of the matter is that Purdue intentionally misinformed everyone - doctors, patients, caregivers, and family. They used marketing, propaganda, bribes, recognition, and myriad other tools to convince everyone that their product was different. Doctors, knowing full well about the Opium Wars, wholeheartedly believed the propaganda. I wasn't the first patient to be discharged from the hospital with a multi-month supply of opioids. This was a common practice.
The worst part is for someone who claims to be around addicts, you think I am somehow unique in my story. My story is so mundanely typical that it should be nauseating. Medical treatment is, by far, the most common way addicts start with opioids. 75% of all heroin users whose addictions started in the 2000s reported that it began with prescriptions from their doctors.
https://nida.nih.gov/publications/research-reports/prescript...
I genuinely suggest you spend some time talking to the addicts around you rather than judging them. You'd quickly come to regret the flippancy of your statement and probably have some empathy for their situation. These were regular people with jobs, families, lives, hopes, and dreams. In a crisis, they entrusted medical doctors to make the best medical decision for them, and the price they paid was their future.
This is spoken like someone who has enjoyed the privilege of living without chronic pain.
Of course, I speak from the pillar of privilege and but am a lowly untouchable on the great victimhood totempole. We should instead only listen to the high priest victims, uncontrollably fented our their minds to kill the pain.
If you want to get rocked on opiates have at it, it's your body, just don't pretend you don't know they're addictive. It's ok to be an addict if you're honest to yourself about what's happening. Might even make sense if the pain is chronically awful.
> but this is taught in every high school
Here's the thing about what they teach you about drugs in high school: lots of it is bullshit. I don't know if it's still a thing but when I was in school there was a lot of pearl clutching about weed being a Gateway Drug. For a lot of people who smoked weed and didn't progress towards any harder drugs, weed was a prime example of how drug education was a sham. No one went crazy, none of the weed horror stories came true, everyone enjoyed the concert and woke up the next morning feeling better than if they'd been drinking alcohol the night before.
As someone who deals with chronic pain, I watched this situation develop: people lost access to their “safer” opioid and switch to whichever one they can get. Or suicide; there were many suicides around this time.
Thankfully opioids have never been an appropriate treatment for my pain so I didn’t have to deal with this, but I feel real empathy for the people who switched to street drugs at that time. OD is a risk but considering how consuming pain is many would probably rather be dead than experience that anyway. This is not hyperbole, on pain forums people talk about assisted suicide all the time.
We failed pain patients across the board.
It took 6 or 7 years for us even start to find therapies that work. To this day doctors have just shoveled handfuls of Gabapentin and muscle relaxers down our throats or sent us for very invasive and painful nerve blocks which both have a high complication rate and need to be repeated as frequently as every three months.
Or told us to get more exercise. I’ve always loved that one! I’ve been improving my fitness for three years, but advancement is very slow because if I go too fast it can trigger pain and be a huge setback.
Fuck the Sacklers, but fuck whoever decided that pain patients don’t deserve opioids at a rate of 100x. As is always our policy with the disabled in America, our suffering doesn’t matter anywhere near as much as the political moralization that gets people in office
Ok, I’ll get off my soapbox. This topic makes me so angry.
The black pill with chronic pain is it’s often better to off yourself depending on the condition. There’s no hope for some things like erythromelalgia.
Lol fentanyl is more toxic by an order or two of magnitude. People would be on prescription opioids, lose a script, get on heroin because that was 4 to 8 times cheaper and more available than black market pills. The fentanyl crisis is a phenomenon between cheap imported precursor and Cartel economics.
The synthetic opioid demand in the US was a result of a chain of events including the purposeful stimulation of demand by marketing directly to Drs, lying about abuse potential, lying about withdrawal and addiction potential, and not introducing mediating controls when evidence of abuse and sales not meeting market demographics was clearly evident. Like they imported millions of pills to small towns with over selling pharmacies. Drs would up dosage to adjust to tolerance. But anyway it’s fentanyl that is killing people. I’d argue just let people use opium and regulate that sale.
Edit: changed and to an. Chinese precursor to imported precursor bc I honestly don’t know how many different countries are sources of a precursor. Added part about importing to small towns and upping dosage.
Opinions like this are why I’m glad I don’t live in the USA anymore. Live practically anywhere else, where there is no opioid crisis, and this line of thinking sounds insane. Copy paste for other uniquely American issues like gun violence - the answer is… more guns?
To be fair, it sounds insane to many of us living in the US, too.
morally: providing more of something that has no societal good is not commendable.
logically: this argument isn't sound at all. looking at what happened since Oxycontin was regulated is not a proper counterfactual. you would have to look at a universe in which it was never introduced to begin with
Wasn't Oxycontin kind of the boot loader for the present opioid crisis in that it mainstreamed opioid use and got a huge number of people introduced to it?
Then it was taken away and things like illicit fentanyl filled the gap, but that came later.
Indeed. At the undergrad college I went to in New England in 2008 it wasn’t uncommon to see people at house parties doing lines of oxycontin out in the open. Was fairly socially acceptable.
Regulation helped cause the deaths by driving people to more dangerous sources. You're 'forgetting,' however, that the oxycontin and prescribed pills were the source of those addictions in the first place. The regulations didn't kill them. If the regulations had always been there, they would have been fine. They weren't tamping down on some mystical parallel crisis, however convenient that would be to shift the blame. They were creating a new one, using the legitimacy of the medical system and doctors prescriptions to get people hooked, to fatal effect when the regulations finally came down and people facing addiction turned to illicit sources.
> a slow acting opioid (it had to be crushed to be fast acting)
You seem to just skip over that point in a bit of a blasé fashion, as if OxyContin's slow release formulation is somehow a defense of the Sacklers' behavior, when the exact opposite is true.
That is, a primary argument is that Purdue pushed OxyContin because they argued it was safer due to its slow release formula. Except they knew full well that "slow release" was pretty much bullshit because people were getting addicted by simply crushing the pills.
Purdue sales people deliberately pushed Oxy with the false promise of additional safety even though they knew this wasn't true.
It's much worse than that. In order to protect the big selling point (10hrs between doses, once per nursing shift) they encouraged larger doses which were more likely to cause addiction instead of more frequent doses which were actually appropriate.
There is a lot in this post that is ...questionable in my opinion but I just have to call out as especially creative the praise for a drug that is so safe and slow-acting that it won't have harmful fast acting effects unless you... Apply a small amount of pressure with a hard object.
Truly a stupendous point.
I would argue that it is the expected outcome of processes exhibiting: Latency... it takes a few years to actually kill their victims, and Exponential behaviour.. the most damage is done in the last few rounds of the expansion.
username "addicted" eh?
What are you talking about? Where was America getting their opioids before The Sacklers? Go ahead and pull a chart of heroin deaths vs. years and draw a vertical bar on where Purdue launched their widespread marketing misinformation and disinformation.
This is the largest and most deadly episode of addictiveness since the tobacco companies were marketing cigarettes as healthy. If this were a fire, you’d be arguing:
“Look, America has always had fires. Sure Purdue started fires in all 50 states that spread into the forest, but they were small when Purdue started them. Now, there is a blaze that has spread uncontrolled across the Continental US. So, obviously there were other parallel organizations starting fires.”
No. That doesn’t follow. Purdue stared the fires. They added tinder with marketing misinformation, then they inhibited any attempt at controlling it with active disinformation campaigns to confuse doctors and regulators about the root cause. Now, it’s a wild uncontrolled inferno, but they started the first fires.
Didn't we also invade the religious nutsos stopping Afghanistan from producing poppies and then prop up a fake regime that let it flourish, massively increasing the supply of natural opiates? If I recall, the timing works out pretty good with illegal opiate use ramping up.
We sure did. About 60-70% of all of the world's opium was sourced from Afghanistan until 2022. That supply was used to make actual prescriptions in non-OECD countries - like India & China - as well as sold to make heroin in the US, EU, Asia, and Africa.
But be careful about confusing cause & effect. The cause of the Afghani farmers growing opium was the insatiable demand for opium that was developed through legal means. Then, when countries like the US started to restrict access to opiates, addicts and patients alike started to seek alternatives to the scarce prescriptions.
More to the point, why didn't patients use something else? Because there is nothing. Purdue's misinformation actively discouraged the discovery of new non-addictive compounds for decades. No one was looking, and the R&D pipeline ran dry.
By the time enough doctors sounded enough alarms to cause a change in the late 2010s, research in non-addictive pain management solutions was decades behind. No one engaged in it because there was no need for it. Now that we realize it was all a lie and these drugs have killed millions, there are no alternatives. Very few potential compounds are even in Phase 2 clinical trials right now, let alone the half dozen that would be needed in Phase 3 to ensure we have a single alternate choice for pain management in the next five years.
So, the outlook looks bleak. Today, in 2024, we don't have good ways to manage pain that is non-addictive, and certainly no good way to reach the millions who are hopelessly addicted to opioids for pain management. But, very little of this is the patient's fault - and a lot of this is directly related to the monumental efforts of Purdue to misinform for profit.
This is the only reasonable outcome... you can't deny some people justice just because other people think it's fine.
The sacklers have done immeasurable damage to the country. All of their wealth should be removed. Their foundation should be dismantled and used to fund damage and mental health services for addicts of the opioid crisis that they went on to create.
And perhaps some of the individual pushers/purveyors of the drugs, too.
The Sacklers were absolved of financial liability, not criminal. A DA that thought there was a strong enough case could have brought charges this whole time irrespective of the settlement agreement.
> Their foundation should be dismantled and used to fund damage and mental health services for addicts of the opioid crisis that they went on to create.
Part of the settlement agreement was that they were going to turn Purdue into a treatment organization. But right now it's back to the drawing board and plaintiffs will have to pursue separate and much harder cases to get reparations directly from all the individual members of the Sackler family.
Last time I looked into things, the fines they were going to pay is a tiny slap on the wrist compared to the obscene money they made. They can put the billions in an account and use just some of the interest for the fines. The biggest hit to them so far was having their name removed from some museums. Let that sink in. They've lost some slight prestige with other wealthy folks.
They took in something like $11 billion and were going to fund something like $6 billion.
As far as purely pragmatic solutions go this was not a bad deal for victims. There are a lot of members of the Sackler family and a lot of them have a lot of money despite personally not being connected to the Purdue business in any way.
Even if they could all be connected to wrongdoing actually getting money from, like, the second step-grand-nephew who lives in Copenhagen is going to be really, really hard.
$6 billion dollars is a lot of money, but it's also just half of what they profited from what was effectively mass murder. Is that really something you want to let people buy their way out of for less than they profited?
Think of it this way - if you found out your great-grand-uncle was a Nazi official, and that the house you grew up in or the favorable college you got into or whatever lifestyle you had growing up was initially partly funded by his misdeeds? Could your assets be targeted by descendants of the victims and you personally be made bankrupt?
That's a bit of an exaggeration, but a lot of the wealth of the Sackler family is distributed this way. The original brothers have died, there is a huge lump of easily gotten money from the direct family, and then there is a lot of money that has been spread around 2 or 3 generations removed. At a certain point if you want the full $11 billion you are going to have to go into the weeds.
I don't think "partly funded by his misdeeds" is an accurate description.
Members of the Sackler family ran Perdue Pharma and they aren't dead. Sure, a relative of the Perdue Pharma executives should be off limit for liability. But there's still plenty of actual executives that should be held accountable.
> and that the house you grew up in or the favorable college you got into or whatever lifestyle you had growing up
Are we talking about wealth I inherited? About wealth I wrongfully inherited from the wrung necks of the dead? When in this framing do we start to consider where that money should have been vs where it is now? I presumably in this scenario did nothing wrong personally, and yet what wealth do I _deserve_? Do I _deserve_ this wealth extracted by mass destruction enacted by my relatives, granted not by myself, but that someone else would otherwise have?
645,000 people died due to opiate abuse while their company was promoting opiates, and their prescriptions peaked at 6.2 million prescription users pee year. Under EPA standards for damages they would be liable for trillions.
> The Sacklers were absolved of financial liability, not criminal
I don't understand how this changes anything; why would it make any more sense for the subset of the victims who settled to absolve the Sacklers of financial liability towards to the victims who didn't settle? The type of liability doesn't change the fact that victims not part of the settlement shouldn't be restricted by the terms of it; being able to push their own case separately is the entire reason why people are allowed to opt out of class action settlements.
As the dissent pointed out, getting voluntary concessions from parties is generally considered a good outcome in bankruptcy court and part of the reason it exists in the first place. Any time you can take a million lawsuits and turn it into one saves a lot of legal fees for everyone and frees up our court system.
Another thing the dissent pointed out is that anyone who doesn't participate in the group settlement is only going to get the money first-come/first-serve. In bankruptcy court you can split the money more or less evenly. If everyone litigates separately, only the people with more senior claims get their money before the funds run out.
Agreed, they should be made an example of. Everyone involved in the fraud of getting this medication approved and then marketed to millions of people should face a fair trial and should be made an example of if found guilty. There is no reason that this medication should have been approved or marketed the way it was, especially considering what the medical community already knew about opioids and the harm they can cause.
The immunity deal on the table here was for civil litigation, not criminal trials. The Sackler family can still declare bankruptcy on their own, they just can't use the bankruptcy of their company to extend protection to themselves- which does make sense. But nothing that was proposed would have shielded them from criminal prosecution.
Considering the three strikes rule and other extremely punitive judgement against drug offenders, how are the sacklers still not in solitary?
Yes, although in theory the justices are ruling on what the law means, rather than ruling on what they think it should mean for justice to be served.
More narrowly, a judge can’t impose an outcome or settlement on someone where the law does not allow for it.
The wild part is how the justices were split: Gorsuch wrote for the majority, joined by Thomas, Alito, Barrett and Jackson. You won't often see these 5 seeing eye to eye in a split decision.
This ruling breaks my usual test that the conservative majority will nearly always side with corporate intersts because this decision definitely isn't pro-corporate.
The settlement would essentially shield the Sacklers from all liability and allow them to keep the proceeds of their crimes while paying a fine over a long period of time essentially from future earnings on thse ill-gotten gains.
The dissent seemed to say this was bad for 100,000 opioid victims. That's not a reason to legally shield the crooks who profited from their death and suffering. I'm shocked that Kagan and Sotomayor, in particular, went for that line of reasoning.
In a just world, the Sacklers would die pennieless in a 6x8 cell. Fines are just the cost of doing business. Intentionally addicting hundreds of thousands (if not millions) to opioids for profit, knowingly, should lead the loss to both your freedom and every dollar you earned from that endeavour.
European here: the fact that "you guys" even know who your judges are, is amazing.
> Purdue made billions from OxyContin, a widely available painkiller that fueled the opioid epidemic
It's more complicated than that. They knew it was killing people and turning thousands (millions) into addicts and they kept pushing doctors to use it at all costs. I'd recommend the John Oliver special on it.
They also designed it to be more addictive. The recommended dosage and timing causes the patients to repeatedly experience minor withdrawal during normal use, which is a standard technique for conditioning someone into being an addict.
All of this is documented in emails that were presented as evidence in court.
Designed it knowingly to be more addictive WHILE producing physician literature that denied or downplayed addiction risk.
They learned it from the tobacco industry probably.
Is there a recommended dosage and timing from the tobacco industry?
Yes - sort of. Many of the additives found in cigarettes are designed to increase the rate of absorption of nicotine. This gives you a distinct rush within seconds of consumption, as well as a more pronounced crash that triggers intense cravings.
That's very different from the effects of (freebase?) nicotine typically found in e-cigarettes which is slower to absorb and doesn't have a noticeable crash.
It was in jest. But part of the problem with nicotine that helps to lead to addiction is its short half-life. If you are a smoker you experience several episodes of abstinence throughout the day, so you lit just another one.
Why are doctors so easy to manipulate? They learn about addiction in medical school. Why would they believe a pharmaceutical company saying "...oh but this opioid is not addictive..."
It’s easy to overlook that OxyContin was very effective. Even a doctor acting in good faith was likely to prescribe the drug— because it worked well. It really did help people struggling with pain management. The downside, of course, was that Purdue pharma was knowingly misleading doctors on the addictiveness of the drug. Also the amount of doctors that were willing to turn a blind eye to the clear signs of addiction is very worrying.
> Also the amount of doctors that were willing to turn a blind eye to the clear signs of addiction is very worrying.
No disagreement, but I think it's worth considering how stigmatized addiction is in our society. I expect many patients would hide any signs of addiction from their doctors - especially since it might result in losing their supply of OxyContin, or worse, their career.
Yes, whole heartedly agree. The social impact of addiction and the ostracism of those suffering with addiction has undoubtedly only made this situation worse. I was more leaning towards doctors/pharmacies that were operating as pill mills - I.e. the handful of regions in the Appalachias where there were more scripts for Oxy than there were people in the county
Also Purdue themselves were pushing pain management as an outcome to manage, to sell more Oxy.
Totally pain-free medical care is a bit misguided.
Because doctors believe studies and health system policies pushed aggressive treatment of pain.
And our unequal society forces a lot of people to damage their bodies in the pursuit of happiness (i.e. earning money). That damage becomes chronic pain.
And unfortunately, painkillers often have a euphoric effect. So people might use that effect to escape the grinding reality that they are trapped within. Consider how popular cannabis is, especially among older adults in states where recreational use is legal.
What a positively wonderful way to look at life.
I can't make sense of this either as sarcastic or earnest. I though GP was a fairly neutral (and imho accurate) appraisal.
I think it’s accurate but it’s bleak imho
Because physicians don't get much if any training in evaluating evidence and research, they generally believe what they're told by scientists. Which is a shame, they should be taught critical evaluation of literature
They also don't have time because of the artificial limits of physicians graduating every year, combined with more bureaucracy being pushed on them day by day
> physicians don't get much if any training in evaluating evidence and research
I find this surprising, if true.
Well I work at med school, grad students get far more training on research, med students can take an optional research elective. This elective isn't a formal course either, what happens is a med student comes to our lab and we put them on a small project as an assistant doing data analysis or a simple experiment. They don't get formally taught how to evaluate research
You have to remember med students are training to be clinicians not researchers. They have to diagnose and treat patients based on information taught to them by clinicians and basic scientists
This is also why it annoys me when lay people refer to the opinions of physicians on some new research that just came out, like with covid stuff. They are not research experts, they're clinicians. They treat people and make diagnoses
It is largely true. Evidence in medicine widely exists but most doctors arent keeping up with it. There has been a bit of a movement toward evidence based medicine in the last decade but most docotrs are still relying on what they learned in med school instead of keeping up with literature.
Many physicians also tend to be very conservative in terms of adopting new treatments. They tend to stick with what they know "works" and don't want to take risks to try something new
"trust the science"
edit: it's meant in sarcasm, mostly.
We can trust the process of science but we need to be mindful of how to critically examine a body of literature. When I see most lay people examine literature all they do is cherry pick what they like and discard the rest and ignore any analysis or methodological concerns
It's incredibly hard to do anything else, since it's pretty easy to cherry pick methodological concerns for any given conclusion you don't care for, since it's incredibly rare for a given body of work to be free of methodological flaws.
Something I have noticed is that non scientists don't understand the methods so when they do try and critique the methods those critiques don't make sense because they lack the understanding of the underlying principles
There is a lot of basic science that is quite solid and is replicable yet people tend to throw it out with nonsense complaints
This generally seems to be true. It doesn't help that poor reporting methods exacerbate the issue.
Oh absolutely, science journalism is absolutely terrible for the most part. That's why I always try to find the original paper they're reporting on to see what's actually going on
Most journalists don't understand research either and I've even seen some PhD science writers get things wrong too but usually less often.
Science journalism is filled with incredible sweeping claims and jumps in logic that boggle the mind and are nothing like what's in the research being reported on, it truly makes me disappointed
I've seen a lot of research around nutrition, where the abstract/summary for the paper itself makes claims not reasonably backed in the paper itself. Then again, I think pharma, food and agriculture in particular have bent to financial forces over everything else.
A friend of mine recently died from cancer. I had looked up some particular things about it while he was still alive, and apparently some cookies got crossed and I was marked as an oncologist. I've had some ads on Facebook or Instagram telling me, the "oncologist," about particular cancer drugs. Of course, everyone in the US has probably seen regular ads for various cancer drugs.
Doctors pretty much need to be intelligent and hard working to get through med school and residency. After that, they might not necessarily keep up with things. You'd think oncologists would know the best treatments for each patient, but if that were true those ads would be worthless - and I doubt those companies like to throw money away.
>Why would they believe a pharmaceutical company saying "...oh but this opioid is not addictive..."
Because the pharma company offered them direct or indirect benefits for doing so. Doctors are just as human and just as susceptible to financial incentive as anybody else, that's why for decades there were doctors advertising the health benefits of smoking.
What makes you sure doctors are "so easy to manipulate"? Is the general public more immune? Are there many professions that are more immune?
I read the OP as "professionals should be less easily manipulated than the general public because of their background knowledge on the subject".
Consider whether most would think a mechanic is more or less easily manipulated into unnecessary vehicle repairs.
> whether most would think a mechanic is more or less easily manipulated into unnecessary vehicle repairs.
That's different. This is closer to a mechanic using a part from Company X in the repairs of their customer's car, because a rep told them it was more durable.
You're right, that's a better example. But wouldn't you expect the mechanic to have a more discerning eye in that case as well? The more contextual knowledge you have, the better you should be able to tell legitimate claims from BS.
To catch some BS, sure. I wouldn't expect them to fall for obvious lies. I doubt a mechanic would be significantly educated metallurgy or production techniques to spot BS in part lifespans. Or to spot pseudoscience in air filters.
I would expect them to notice their repeat customers not getting the benefits. But keep in mind that doctors saw their patients appearing pain free and high functioning.
You may be right and I may be guilty of hindsight bias, but I would probably put this in the realm of BS. It’s not like opioids were unknown to cause addiction, and when physicians witness the company continuing to up the dosage and wordsmith terms like “breakthrough pain” I would expect a cognizant doctor to be throwing red flags.
To overextend the mechanic metaphor, it would be like making a part out of aluminum and claiming it has infinite fatigue life. We know aluminum doesn’t so the threshold of evidence needs to be very, very high or the mechanic should remain skeptical. If the part continues to fail, but the manufacturer keeps making new, novel excuses the mechanic should be throwing the BS flag about their infinite fatigue life claims.
It seems that in the US there has been a trend to "de-regulate" or let businesses regulate themselves. It works for a while, but eventually it seems to go south. I think "regulatory capture" is the term. I think of Boeing being allowed to inspect there own planes.. I think drug manufactures submit there own studies, as the FDA doesn't have a budget to test all the things themselves.
The opiod manufactures are organized too. They have trade groups and conferences.
De-regulation and regulatory capture are almost opposite things. De-regulation is a solution to the problem of regulatory capture.
Regulatory capture is a central problem in America today. The big powerful entities- major corporations, large unions, special interest groups, etc have the time, resources and incentives to lobby for laws (regulations) to be written in their favor.
The result is the American public is very heavily regulated, but in ways that are beneficial primarily to the powerful incumbents. This spans everything from copyright law favoring big hollywood studios to USDA regulations favoring the handful of major meat producer corporations to medicine, manufacturing, retail, real estate, etc.
Regulatory capture is also why the divide between leftists saying more regulation and rightists saying less regulation are both often missing the real problem. The US already has millions of lines of text for regulation, the problem is that so much of the regulation is bad and written to favor whoever donated or could sway votes to whichever representative crafted the language.
Arguably, you have it backwards. Self-regulation doesn't work for a while, and then it works ultra well. Boeing got away with poor self-regulation for decades but now their business almost certainly will implode within decades and their market position will be taken over by those who were willing and able to self-regulate. They were rightfully punished and the US government was (theoretically) able to spend more resources regulating elsewhere.
That said, the lag time between the beginning of failing to self-regulate and the beginning of consequences showing up are likely too far apart to make it a sound doctrine for the US government.
Additionally, I recommend the book Empire of Pain for an excellent deep dive into the Sackler family and how they essentially created the opioid epidemic. You'll be infuriated as you read it.
+1
An amazing read and I also highly recommend it
https://en.wikipedia.org/wiki/Empire_of_Pain
Having read that, I still find it shocking when I see their names on various donor plaques in big British museums.
What responsibility does the FDA have in this?
(genuinely curious, not trolling)
> Justices Kavanaugh, Sotomayor, Kagan, and Roberts disagreed
Fascinating split
Strong language, too, against the majority that includes Jackson ("Brown Jackson"?).
I recently watched these 3 episodes of Last Week Tonight with John Oliver. Highly recommended.
Opioids III: The Sacklers: Last Week Tonight with John Oliver (https://www.youtube.com/watch?v=uaCaIhfETsM)
Opioids II: Last Week Tonight with John Oliver (https://www.youtube.com/watch?v=-qCKR6wy94U)
Opioids: Last Week Tonight with John Oliver (https://www.youtube.com/watch?v=5pdPrQFjo2o)
Without proper context, it’s not clear to me if this is good or bad. It bad for the victims because there’s no settlement. It’s good for justice as people with a ton of money shouldn’t be above the law.
It’s good if you think judges should follow the law more or less as written by congress. The whole concept of a 3rd party release in bankruptcy is simply not in the law. Congress could add it, but they have not.
Fraudulent Transfer...
From Reddit...
Piercing the corporate veil would mean disregarding the corporate form entirely. It usually comes up when the owner-manager of a company fails to distinguish the corporation as a separate entity with its own purpose and finances, using the company as a personal piggie bank or otherwise going about life as usual and not going through the motions required of corporations under the law.
What plaintiffs have alleged against the Sacklers is different, and specific to bankruptcy. Perdue is out of money and is bankrupt, mostly because it caused billions of dollars of damages to hundreds of thousands of people and to the states (which now have to clean up the opioid mess). But not that long before it went bankrupt, it was swimming in money. Perdue didn't use those profits to avoid harming people. Nor did it keep the money on hand to pay potential tort claims from the people it was harming. Instead, Perdue's officers and board of directors (that is, the Sacklers) approved dividends of billions of dollars to be paid to the company's shareholders (that is, again, the Sacklers).
The plaintiffs in various lawsuits have alleged that the Sacklers knew that the profits were temporary and the bill would come due, so they purposefully got the money out of the company while the getting was good. More technically: it is alleged that Perdue's owners received assets that were transferred from Purdue with actual intent to hinder, delay, or defraud creditors.
One thing you absolutely are not allowed to do is use your company to rack up a bunch of debt or liability, take all the assets out of the company, and then declare bankruptcy and expect to get to keep the money. We call that "fraudulent transfer," and if a court finds that you did fraudulent transfers from your company to your personal bank account you will be ordered to pay that money back to the company (so it can use that money to pay back its creditors and other claimants). The company still exists, it's a distinct legal person (so not technically piercing the veil), you just took the company's money as if it were a profit when you knew full well the company couldn't afford to pay out profits.
One big difference between the concepts is this: If Perdue's corporate veil were pierced, the Sacklers would be personally on the hook for all the harm their company caused -- they could lose their bank accounts, vacation homes, nice cars, artwork, everything, as if they themselves (rather than "Perdue") had been the ones going around knowingly fueling a drug addiction crisis. Whereas if they merely engaged in fraulent transfer of assets, the Sacklers are only on the hook to give back what they fraudulently took from the company during the period it can be proven that they knew of the looming liability -- limited to the statute of limitations, which I think is around 6 years. So all the money they made before that, and all the money they have from non-fraudulent sources, is safe from creditors.
What share of the guild do the medical providers that prescribed the opioids to their patients have? There would be no opioid crisis if none were willing to do it.
Scott Alexander had a very interesting writeup about his experiences: https://slatestarcodex.com/2019/09/16/against-against-pseudo...
The US is the only place in the world AFAIK where you will get prescribed opioids for something as trivial as a wisdom tooth extraction (kind of like one of the cases cited). It is also the only place in the world AFAIK going through the opioid epidemic.
Every other country in the world has got the problem of painkillers figured out. So it can't be that complicated.
Wisdom teeth was actually one of the safer use cases. You would only get a short run so it was hard to build dependance.
The opioid crisis was really defined by people with chronic long-term pain being given it for years at a time.
The point is that people are overall too cavalier about opioids in the US.
I don't think it's necessary to get into the details of how much pain is enough pain, how acute is acute enough, etc... because this is not a problem essentially anywhere else in the world -- and not because they thought really hard about it.
Wisdom teeth extraction is far from trivial and opioids are a very reasonable prescription for pain from that surgery.
Objectively, opioids are prescribed much less often outside the US.
Subjectively, I got four wisdom teeth extracted in two sessions of two extractions each. Both times I only needed generic acetaminophen to manage the pain.
Perhaps an US surgeon have insisted on doing it all in one session, in which case I would have found the pain and discomfort intolerable and opioids would have made more sense.
In any case, they should probably figure out why their patients are in more pain than the patients of foreign surgeons and fix that. It could be something silly like them being less gentle during surgery because they are used to their patients being on opioids.
Literally does not happen in two countries that I know of, and I bet in many countries of the world (developed ones even).
I just read it (because of your link), and commend it to other people in this thread; quite a well-described and interesting position.
Did the Sacklers forget to renew their subscription to Clarence Thomas or something?
Court skipped an opportunity to quote Franklin, since "Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety" actually referred to a legislature entertaining a very similar Faustian bargain (i.e. value now in exchange for perpetual promise to remove responsibility from a family).
... but probably the correct choice, as that was a legislative, not judicial, circumstance and their decision in the time has no bearing on jurisprudence.
For those claiming the Supreme Court is a political institution, I'd like to note that this was indeed a 5-4 decision.
But one with Justices in the majority who were appointed by Biden, Trump, Bush 43, and Bush 41, and in the minority who were appointed by Bush 43, Obama, and Trump.
It was Jackson, Gorsuch, Barrett, Alito, and Thomas in the majority and Sotomayor, Kagan, Roberts, and Kavanaugh in the minority.
I won't argue against the Supreme Court being a political institution. However, I do think the court is more nuanced than popular opinion realizes. The article below shows a nice graphic of how often justices rule together on non-unanimous decisions.
https://www.politico.com/news/magazine/2024/06/02/supreme-co...
That's really interesting, because it shows even the most liberal and most conservative justices still are in agreement the majority of the time.
Just reading news articles I would never have thought Sotomayor and Alito ruled the same 63% of the time.
I weirdly track SCOTUS opinions. Most of them are incredibly technical.
A single vote means little and being partisan doesn't mean 0% voting with the other side. By this logic Congress is not a partisan institution given that people from both sides frequently vote together, but anyone who remotely follows national politics knows that it's a deeply partisan time.
Most decisions are mixed or more one sided than following the standard "political lines", but those cases never get spoken about.
Hmmm, I’m not sure pointing to singular rulings like this really demonstrates that the Supreme Court isn’t getting increasingly political.
Increasingly political compared to when?
And I don't think it's a singular judgement. If anything, the "ideological split" types of decisions are rarer, so it's more accurate to say that a few decisions on hot political topics doesn't mean that the SCOTUS is increasingly political.
> For those claiming the Supreme Court is a political institution, I'd like to note that this was indeed a 5-4 decision.
Is there a name for this type of fallacy, in which a single data point is used to argue that a global trend does not exist? (Another prominent example is "it snowed somewhere, therefore climate change is not real.")
> Is there a name for this type of fallacy
It's a type of non-sequitur, i.e. a formal fallacy. General conclusions can't be drawn from a single datapoint.
I guess this is not a topic that is politically divisive, so the judges were free to vote as they saw fit. Which doesn't say anything about how they will vote on other topics, like abortion, environmental protection etc.
The justices don't vote on "abortion, environmental protection, etc." They vote on the legal vehicles that have been used to address those things. And views on those legal vehicles map onto judicial philosophies that have nothing to do with the substantive issues.
To use an analogy: there's people who think operating systems should be microkernels, and people who think they should be monolithic kernels. Windows NT was created to be a microkernel. But around NT 4.0 they shoved the GUI into the kernel space. If you're on the "Supreme Court of Windows NT," how do you view that? One camp might say, "NT is supposed to be a microkernel, get that GUI out of there." Another might say, "yeah but here in the real world, customers demand a fast GUI so it's fine to cut corners."
Constitutional law is basically that, except we're talking about cutting corners with the highest law in the land.
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I'm trying to convey how legal conservatives think, as someone who is one. I am, on many policy issues, quite liberal. I think rich people should pay more taxes, people should drive EVs, etc. But ultimately I care more about the rules--especially the rules about who makes decisions and where power is allocated--than I do about what people or outcomes. I'd rather see 3C of global warming than administrative agencies operating contrary to the tripartite system of government the Founders designed. I care more about the Constitutional rules for allocating power to states than I do about what citizens of those states might do with that power. Etc.
Issues like abortion and environmental laws just happen to map onto particular legal issues as an accident of history. If state-by-state legislation leads to widely legalized abortion, for example, I don't think most legal conservatives would support a Roe-like judicial decision ginning up a "right to fetal life" (which actually exists in Germany). If Congress passed environmental laws itself, instead of outsourcing it to an executive agency, I don't think most legal conservatives would be looking for ways to second-guess Congress's judgment.
You actually see this in Europe. The legal system in European countries tends to be pretty boring, because they have more social cohesion and can legislate things according to the rules, rather than hacking up the system. The equivalent of Roe, for example, doesn't exist in continental Europe. In an irony, Emmanuel Macron criticized Dobbs when it came down. But France never had anything like Roe. And after Dobbs, France passed a constitutional amendment addressing abortion, which is exactly how legal conservatives would say you should handle the issue!
> I'd rather see 3C of global warming than administrative agencies operating contrary to the tripartite system of government the Founders designed.
You want to see millions dead to support your political philosophy?
I think the most redeeming quality of Americans--an inheritance from the British--is that they'll jump off a bridge if they're told to do so by a court and the required procedures have been followed. Rule following, more than anything else, what separates advanced democracies from the third world country I come from. And in the long run it's what will save the most lives and lead to the most prosperity and social harmony.
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Both examples are expressing the same belief about Dobbs! Yes, I believe the social harmony from allowing these questions to be decided democratically outweighs individual "rights."
What about Ireland? Abortion was illegal in Ireland until 2018, and then it was put to the public for vote in a referendum. In 2010, the European Court of Human Rights refused to overturn Ireland's abortion ban (though it did find a due process violation with respect to the lack of procedures for qualifying for a pre-existing exception for life-threatening conditions). That's how the law works in civilized democracies. People make decisions on social issues, not judges.
How do feel about Brown v Board?
He's a lawyer with a lot of professional experience. Are you a lawyer?
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Four decisions were released today.
We had a decision on the SEC vacating some of its enforcement powers, 6-3 with only the 3 liberal justices dissenting.
We had this decision, which was 5-4, although it wasn't a clear ideological split.
We had a 5-4 decision vacating an EPA regulation, with the 3 liberal justices and one of the more moderate conservative justices dissenting.
We had a 6-3 decision on the EMTALA-abortion decision, with the 3 most conservative justices dissenting. (Technically it's per curiam, and the "majority" opinion is unsigned. But every justice signed onto a concurrence or a dissent, so we know exactly how every justice voted in this case).
Yesterday, we had a decision on social media which was 6-3, with the 3 most conservative justices dissenting.
Yesterday, we also had a decision on bribery which was 6-3, with the 3 liberal justices dissenting.
Out of the most recent 6 decisions, we have 4 decisions that clearly evidence a 3-3-3 ideological split between 3 liberal justices, 3 more moderate conservative justices, and 3 very conservative justices that would be able to pretty fully predict how they would vote on the cases, and there's another case that it's partially predictive on (a 5-4 that peels off either Roberts, Kavanaugh, or Barrett doesn't contradict this lineup). Furthermore, the one case that the ideological breakdown doesn't work on is the case that is the least politically charged (it's literally resolving a circuit split, as opposed to please-intervene-in-this-politically-charged-case).
So yeah, this doesn't disprove the thesis that SCOTUS has become increasingly politicized over the past few years.
>> Out of the most recent 6 decisions
That is not a representative sample of Supreme Court decisions. This is one of the last few opinion days of the year, the opinions being released are the most contentious ones the court is dealing with.
Of the first 6 decisions of the year, 4 were unanimous, 1 was per curiam, and one was a 6-3 split with the dissenters being Gorsuch, Sotomayor and Jackson.
Those 6 decisions would also not be a representative sample.
Is there any corruption law that this court won't overturn? They seem extremely "pro" on quid pro quo.
They didn't "overturn" this "corruption law." This was a prosecution under 18 USC 666, which is titled "theft or bribery concerning programs receiving federal funds." In this case, the question was framed to the Supreme Court whether 18 USC 666 applies to so-called "gratuity" payments. That framing was because the prosecution in the case below could not prove that the defendant had anticipated a payment in the future when he undertook the official act. (The defendant himself maintained that the payment was for subsequent consulting.) Federal law makes a distinction between those two things.
You can still bring an 18 USC 666 case for bribery, you just need to prove that the payment had some ability to influence the official act.
In this particular case a mayor rigged the competition for a garbage truck contract so that one particular company would win it. That company then overcharged the city and gave a kickback in the form of $13,000 to the mayor. The Supreme Court said this was fine and let the mayor off of the hook.
If you can't prosecute with this level of evidence the law is effectively dead.
That's not what the Supreme Court decided, and its extremely misleading to suggest that.
At trial, the government alleged the mayor had "rigged the competition." But the government argued, and the jury was instructed, and the Seventh Circuit agreed, that the government did not need to prove that. Because, under the Seventh Circuit's view of the law, it did not matter whether the subsequent payment actually influenced his official act. So on appeal, the Seventh Circuit upheld the jury verdict on the assumption the government did not need to prove that the competition was actually rigged.
So the case that came up to the Supreme Court didn't have the issue of whether he rigged the competition. The jury was told it didn't matter, and we don't know what the jury would have decided had they been told something else. The question before the Supreme Court was only whether 18 USC 666 requires proof that the payment did or could influence the official act. It did not consider the factual scenario under which he rigged the competition because we don't know if the jury would have found he did that.
Now the case goes back to the trial court to see if the government wants to retry the case, where they actually have to prove corrupt influence.
> The question before the Supreme Court was only whether 18 USC 666 requires proof that the payment did or could influence the official act.
And the Supreme Court's finding is that it did not because the payment happened after the action. Certainly corrupt officials in the future will never figure out a way to exploit this loophole.
This isn't the first corruption case before the court where the standard of proof seems to be "they need to write 'This is a bribe' on the notes line of the check for it to count".
> And the Supreme Court's finding is that it did not because the payment happened after the action.
It doesn’t have to do with the timing of the payment. It has to do with whether the defendant had a corrupt motive at the time he took the official act.
The government could have prosecuted this case under the same statute by saying: “he knew he was going to get paid later so he steered the contracts to this company.” They had the evidence to pursue that theory of the case. The jury could have inferred under the circumstances that the after the fact payment effected the official act. If they had done that this Supreme Court decision would’ve had no effect on the outcome.
The government instead made the choice to prosecute this case by having the jury instructed that it did not matter what the defendant was thinking at the time of the official act. That was the government’s choice.
This case just means that when the government brings a case under 18 U.S.C. 666–which is titled “theft or bribery”—they actually have to prove bribery, which requires corrupt motive at the time of the official act.
If the government wants to target the appearance of impropriety that can result from payments for official acts that weren’t corrupt at the time, there’s different laws for that (18 U.S.C. 201(c)).
Politicization and ideological polarization are two different things. Take Dobbs for example. That was an ideologically polarized decision, not a political one. Roe is the product of a judicial philosophy that conservatives think is fundamentally wrong, even if they don't oppose abortion. For half a century, conservatives were unified in saying they would overturn Roe, even though--as we have seen subsequently--there was a lot of intra-party conflict about what abortion law should actually be. Dobbs hurt the party that appointed the justices that voted for it. Trump would probably be cruising to the election in 2024 if Biden didn't have that card to play.
Most of the cases you identify split along ideological rather than political lines.
> We had a decision on the SEC vacating some of its enforcement powers, 6-3 with only the 3 liberal justices dissenting.
What the case actually held was that the executive branch imposing fines without a court order violated the Seventh Amendment. It's a separation of powers case, and reflects the same ideological debate about separation of powers that we have had for 100 years. Do you believe that the Constitutional three-branch structure should be respected, or is it obsolete in light of modern society?
> We had a 5-4 decision vacating an EPA regulation, with the 3 liberal justices and one of the more moderate conservative justices dissenting.
This is an executive agency decisionmaking case. Again, same debate we've been having for 100 years.
> We had a 6-3 decision on the EMTALA-abortion decision, with the 3 most conservative justices dissenting.
This was probably the most idiosyncratic and ideological case, but it's not political at all. It's Thomas and Alito willing to die on an ideological hill, not caring that virtually nobody in their party wants to follow them t here.
> Yesterday, we also had a decision on bribery which was 6-3, with the 3 liberal justices dissenting.
It was actually a decision on whether someone could be prosecuted under a bribery statute for a payment he received after taking the official act. Where other parts of federal criminal law make an express distinction between bribery (which corrupt official acts) and gratuities (which create the appearance of corruption but can't directly influence official acts).
This one is probably the most overtly political. Liberals voting to expand the scope of criminal law and conservatives voting to narrow it is weird. But it's worth pointing out that the Court's conservative wing has a strong libertarian streak these days, especially Gorsuch.
Being a judge in the US is a political job. There's not even a universal requirement that one has to be a lawyer.
However, "political" how liberals are using it currently is a euphemism for "current disputes between the Democrat and Republican party management." If you don't accept that framing, or assume that these people are wind-up toys set into motion by the Presidents that appointed them, things can be very political without this split that the punditocracy project onto the court.
Whether bankruptcy courts can dictate a settlement for something this wide-reaching, and simply indemnify someone against future lawsuits is a very political question. What if the courts had settled with the Sacklers for $10, and indemnified them against future suits? Why are the bankruptcy courts allowed to improvise restrictions against what other courts and other victims are allowed to do?
It's redolent of one of the most disturbing elements of Epstein's first conviction, during which they immunized unidentified, unindicted co-conspirators. In order to avail yourself of this immunity, you had to be guilty of child trafficking with Epstein. Otherwise, you wouldn't have been a co-conspirator. Can a court name a sacrifice to suffer for others?
I'm not concerned in this case that some of the victims' lawyers were clamoring for it. Those lawyers could very well be paid for by people with another agenda. Why should the Sacklers be left with anything? The main guilty parties in their family are dead - now we're arguing with the people who are inheriting the proceeds of the crime. Why argue? Just seize it all; the damage far outstrips their worth, and their worth isn't even from their own labor, it's inherited.
Meanwhile, the descendants of slaves are mocked over 400 years of stolen wealth. And we can't even take the proceeds of the most horrific crimes from people who don't even work for a living, and will likely be left wealthy if every dime of that inheritance is taken away.
I blame the doctors too. I was a teen in the early/mid 2000s and even I knew about the addictiveness of oxycodone. It wasn't called hillbilly heroin for nothing.
nice
I find the Supreme court decisions to be fascinating reads and overall much more interesting and complicated than most news services make them out to be.
They're also eminently readable, which (to me) shows the massive skill of whoever writes these. The fact that I, a layman, can easily understand them speaks to the quality of the writing.
Or to how unexceptionally average most of the judges actually are.
If you're willing to entertain these are skilled brilliant jurists with some kind of mystical levels of elucidation, maybe they're actually just people who failed upward into a job with a fancy robe
The difficulty of understanding a text isn't proportional to how skilled the person is at their job (I think it's inversely proportional, if anything), but to how familiar a field is.
It doesn't take a good developer to describe a system in a way that nobody can understand it. It does take a great one to describe a system in a way that a layman can understand it.
If you've been around the valley long enough to hear pitches, you've surely met some remarkable bullshitters who can convincingly describe with clarity and crispness something that is actually nonsense and simply is not real.
There's a group of attorneys that host a podcast on SCOTUS that present a pretty convincing case for this interpretation, at least to me. Here's the most recent episode
https://podcasts.apple.com/us/podcast/5-4/id1497785843?i=100...
or
https://player.fm/series/series-2622019/garland-v-cargill
Especially since this 5-4 decision didn't follow the "conservative" or "liberal" split at all.
How they voted(Name and the party of the administration that picked them):
Majority
Neil Gorsuch (Rep.)
Samuel A. Alito Jr (Rep)
Clarence Thomas (Rep)
Ketanji Brown Jackson (Dem)
Amy Coney Barrett (Rep)
=======
Minority
John G. Roberts(Rep)
Sonia Sotomeyer(Dem)
Elena Kagan(Dem)
Brent Kavanagh(Rep)
Whats really surprising is how Gorusch is quite the wildcard, he also authored the majority decision that said that 1/2 of Oklahoma belongs to Native Americans - https://www.npr.org/2020/07/09/889562040/supreme-court-rules...
Kavanaugh can also be a bit of a wild card. Been surprised by him quite a few times. many of the others are entirely predictable.
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Pretty much. He also authored an opinion today against the EPA's good neighbor rule. Directly continuing the work of his mother, who was head of the EPA during the early Reagan years until she was forced to resign as even within that administration she was flagrantly unwilling to do her job of enforcing regs to prevent pollution while also illegally utilizing the power of the office for personal politics.
Always strikes me as weird that the clear through line from her time in power to his own jurisprudence on environmental issues doesn't come up more.
Its almost like they arent just a political body.
Nah… thats unthinkable
Either that, or it's almost like politics have more dimensions than party affiliation.
And honestly, while we like to lump them into "conservative" and "liberal" camps for simplicity, it's easy to get the correlation wrong. Like anyone else, their moral and legal philosophies might make them lean one way or another politically, not the other way around. Even for the most extremely political justices, to hear them expound on the legal principles of federalism or human rights is very fascinating.
It's easy to forget that, while they are political appointees, they have to have fairly long careers as acting judges to even qualify for the appointments.
Save for at least one current sitting Justice: Amy Coney Barrett. They only had ~3 years of experience being a judge, Seventh Circuit Court of Appeals (2017–2020), before being nominated to the Supreme Court. Yes, they have experience in other law related roles, however your comment explicitly stated, "...fairly long careers as acting judges...," so that is what I'm speaking to.
Fair point!
Liberal vs. conservative has always been the wrong take. The stronger dividing line is textualism vs pragmatism.
In fact Scalia famously said this coming from a textualist perspective which I think most people can agree with even if they hate him: “ If you’re going to be a good and faithful judge, you have to resign yourself to the fact that you’re not always going to like the conclusions you reach.”
This seems absolutely correct, but when is the last time ypu ever saw a commentator observe this? Critique has been reduced to “i dont like the effect so the interpretation of the law is wrong.” Put the other way, a fair observer must eventually say “i really hate the conclusion but they got it right.”
>The stronger dividing line is textualism vs pragmatism.
They should be doing what is right for the American people. There are clearly laws on the books today which infringe on individual freedoms (abortion), harm society as a whole (citizens united), etc.
The 'justice system' is supposed to be the government branch protecting the little guy from powerful elites. I've not often seen that. I see the opposite. If the legal system won't deliver justice, well, people are going to take things into their own hands whether that's 'justice' or not. If you bury your child, and you see the people ultimately responsible get away with it, I'm not sure I could really blame them.
> The 'justice system' is supposed to be the government branch protecting the little guy from powerful elites
The justice system. Not necessarily the courts. Our courts definitely weren’t designed to be a political body.
Strong but respectful disagree from me. Justice is supposed to be blind. And if right and wrong were so clear cut there would no need for democracy at all.
The court is not a democratic institution and exists to uphold the textual rule of law as determined by lawmakers. If a pragmatic ruling by the court can circumvent a politically logjammed congress, so be it. But the courts deciding what is right or wrong for the American people is a very slippery slope that leads to disaster. And a court that just rules against the (existing) elite every time is a junta.
This is exactly it.
Both sides have their merit, but some people want to have it both ways - do you want pragmatic judges or more democracy? They can often be mutually exclusive.
The country gave up on change through legislation a long time ago so now it's down to trying to sway the court.
> The stronger dividing line is textualism vs pragmatism.
Except when it came to "textualism vs pragmatism", I've seen that the "textualist" judges have, in many cases, no problem being "pragmatists" when it suits their desired outcome on an issue.
For example, when Scalia dissented in some famous gay rights cases (I'm thinking of Lawrence v Texas specifically) his basic disgust at the thought of same sex relations was laid bare. Ironically, in Lawrence v Texas his dissent was basically correct - striking down laws against sodomy was a step towards gay marriage - but the gist of his argument was that gay marriage was such a god awful, horrible, unthinkable thing that any decision that allowed it must be prima facie wrong. He was basically warning "This decision will force us to allow gay marriage" as if, instead of that being a good thing, it was akin to allowing the apocalypse.
Scalia also authored the 5-4 decision in District of Columbia v. Heller, a major second amendment case that held, for the first time, that individuals had a private right to own guns (not just "a well-regulated militia"). Read up on that case, as tons of "conservative" judicial scholars argued that it was "pulled from thin air" just as much as Roe v Wade was. From the Wikipedia page:
> Richard Posner, judge for the United States Court of Appeals for the Seventh Circuit, compares Heller to Roe v. Wade, stating that it created a federal constitutional right that did not previously exist, and he asserts that the originalist method – to which Justice Antonin Scalia claimed to adhere – would have yielded the opposite result of the majority opinion.
>> The text of the amendment, whether viewed alone or in light of the concerns that actuated its adoption, creates no right to the private possession of guns for hunting or other sport, or for the defense of person or property. It is doubtful that the amendment could even be thought to require that members of state militias be allowed to keep weapons in their homes, since that would reduce the militias' effectiveness. Suppose part of a state's militia was engaged in combat and needed additional weaponry. Would the militia's commander have to collect the weapons from the homes of militiamen who had not been mobilized, as opposed to obtaining them from a storage facility? Since the purpose of the Second Amendment, judging from its language and background, was to assure the effectiveness of state militias, an interpretation that undermined their effectiveness by preventing states from making efficient arrangements for the storage and distribution of military weapons would not make sense.
> It's easy to forget that, while they are political appointees, they have to have fairly long careers as acting judges to even qualify for the appointments.
This is objectively false. There are no requirements like this and there have been several appointees throughout history without many, if any, qualifications for the role.
Amy Coney Barrett only served 3 years as a judge - that doesn't seem very long at all.
I totally agree. I have also been captivated by the oral arguments. To the extent that I find myself pre-researching some of the cases' background beforehand. Makes for compelling entertainment when you have a sense on why the justices approach questioning the way that they do. Beats any podcast I know.
We detached this subthread from https://news.ycombinator.com/item?id=40811187. Nothing wrong with your post but I wanted to pin https://news.ycombinator.com/item?id=40811187 to the top of the thread, and this subthread is a bit generic.
I added the SCOTUS oral arguments to my podcast feed. They are a great listen!
Try listening to the audio recordings of the arguments on https://www.oyez.org/
I studied international politics in college and as a result I read not only a ton of news, but often the primary sources they were based on, and I was shocked by the amount of omissions and oversimplifications. I've never understood people who don't "trust" the news given that it is provably accurate and factual nearly all of the time. But I've long despised the arrogance from mainstream media wherein they confidently decide what to print and what not to print with no explanation or accountability on those decisions.
You mean articles with headlines like “ Supreme Court Nukes Hunter Biden Laptop Conspiracy in Brutal Ruling” arent actually substantive? https://newrepublic.com/post/183140/supreme-court-hunter-bid...
I’m surprised that wasn’t
“Supreme Court NUKES Hunter Biden Laptop Conspiracy in BRUTAL Ruling” (with “NUKES” and “BRUTAL” in obligatory red font.)
Yes, indubitably. It's easy to lose sight of (if one doesn't read the rulings regularly) the fact that SCOTUS's job is to come to rational and deliberate rulings grounded firmly in textual and common law dating back over a thousand years. Even when one doesn't agree with the conclusion, one rarely sees a ruling that isn't reasonable (though sometimes seeing the reason involves entertaining a fact pattern other than the one you believe to be true!).
This is going too far I think.
There are some partisan hacks on the bench and the institution’s legitimacy is in pretty bad shape.
But in this case they got an issue that didn’t have as much partisan alignment so maybe they did some good work.
Most of the current legitimacy damage stems from a perception that the Court has members that are arbitrating law over bribery while simultaneously engaging in behavior that looks suspiciously coercive. I think that's a major issue, but it's a bit orthogonal to the question of whether they use sound judgment to arrive at rulings like, say, US v. Rahimi 22-915.
(The other source, to my eyes, of questions of legitimacy is that the appointment of three judges in a narrow amount of time under one party's dominance of Congress and the Presidency has fundamentally shifted the "flavor" of the way the Court interprets law. Rather than bringing their legitimacy into question, that's rather the point of the process by which the US appoints Justices and the length of their term; the Court's "personality" is stable over long stretches of time, but it can shift and it does go through eras. People complaining about the new era don't seem to realize that for many Americans, the previous era was strange times that called to question in their minds the legitimacy of the Court).
Lol, they're also quite ideological. Don't fall for the trap that these people are enlightened philosophers. They have a lot of flaws in their own right.
Ask good lawyers about their thoughts on SCOTUS Justices, it's not always peachy.
Even if they are ideological, they are not usually political hacks (cough Thomas cough).
Honestly though, for as much flak as this current court gets, there is at least a certain consistency where they at least mostly stick to arguments about the letter of the law. In previous courts you would see some truly wild written arguments about how, like, a specific word in the Commerce Clause or whatever could mean whatever you wanted it to.
> one rarely sees a ruling that isn't reasonable
Not so true of this incarnation of SCOTUS. It's amazing when they dont delay or rule (by majority) via ridiculous interpretation.
The interpretations break with precedent but they are rarely ridiculous.
As detestable as I find the outcome, Roe v. Wade built a right to privacy out of whole cloth where none existed before, and whether that was good law has been hotly debated ever since it was decided (https://scholarship.law.missouri.edu/cgi/viewcontent.cgi?ref...). It's within the purview of SCOTUS to go "This was bad lawcraft done by our predecessors, and we reverse it based on this reasoning..."
We can disagree with their reasoning, but my main point is you rarely see a ruling from SCOTUS that is nakedly "Because I said so," even though that's de facto the power they have. The initial Roe decision was shaky. "That was a shaky decision, so we have reversed it" was at most equally shaky. It's hard to argue that one is well-reasoned and the other not (though I think there's room to disagree on what facts the two Courts considered).
Yet, during oral arguments they use some of the most juvenile thought experiments to prove their 'slippery slope' opinions
Nonsense.
Oral arguments are the lawyers making arguments. The justices ask questions and collect answers. Their proofs are in their opinions.
Please make your substantive points without swipes or calling names. This is in the site guidelines: https://news.ycombinator.com/newsguidelines.html.
Your post would be fine without that first bit.
Haha. Sure. Like when they make up Qualified Immunity which is a completely made up special status/protection given by the Courts, not by law or common law but abusing the concept of Judicial immunity and expanding it to all governmental officials.
See Pierson v. Ray (1967)
Please make your substantive points without swipes (like "haha sure"). This is in the site guidelines: https://news.ycombinator.com/newsguidelines.html.
My bad. I can no longer edit/delete my comment to fix it.
I haven't responded that way in the past but was responded to that way a couple of days ago and guess it took hold. I can see why you have to clamp down on it, it easily spreads.
Thank you. For my purpose as a reader it is editorial incompetence that the article neither provided that link, nor the name of the case to make it easy to lookup.
This is my gripe with regular news. Science paper? No link. New law bill? No link. Someone made an hour-long speech? 30 second cut, no link to the full speech. Is it almost as if they'd rather we didn't see their sources?
All of those things take you away from their platforms. They don't want you to leave, period.
At least it is for SCOTUS decisions to find the decision quickly (https://www.supremecourt.gov/opinions/slipopinion/23 has a list of all opinions from the current time, updated live as they are announced).
It's really painful when you've got coverage of state court cases where you have neither the case name nor the court it was filed in nor the docket nor any document nor anything that would let you figure any of this out.
as a non US-person who recently wanted to look at some cases: is there a free way to do this? Or do you have to sign up to the weird ePACER?
Every document at SCOTUS level is freely available, although you have to know the docket number to get all of the briefs correctly. SCOTUSblog in practice is a more accessible interface to the docket, since you can easily look up by case name: https://www.scotusblog.com/case-files/terms/ot2023/, e.g., the full docket for the case in this article is here: https://www.scotusblog.com/case-files/cases/harrington-v-pur...
If you want to deal with non-SCOTUS federal cases, your choices are to use PACER or to use RECAP (https://www.courtlistener.com/recap/), where the documents may be available. E.g., the appeals court docket for this case is at https://www.courtlistener.com/docket/67448481/in-re-purdue-p..., note that many documents aren't available because no one made it free via RECAP.
If you want to deal with state courts... good luck! Every state has a different system with different level of pains to track down.
You do not have to sign up for anything. SCOTUS opinions are freely-accessible public record.[0]
[0] https://www.supremecourt.gov/opinions/opinions.aspx
Yeah SCOTUS is pretty good about putting their decisions out there. Sometimes too good at it ;)
For SCOTUS related news I always hit up SCOTUSblog:
https://www.scotusblog.com/
They do a good job of linking to or posting quality articles.
A more cynical take is that it isn't editorial incompetence, it's an editorial decision. Once you notice it, it's hard not to notice how often you aren't given the sources or ways to further confirm stories, especially those that might be controversial.
Deliberate. Someone makes more money as a result.
This is why I so often just go to the AP and look for their article - https://apnews.com/article/supreme-court-purdue-pharma-opioi...
(We detached this subthread from https://news.ycombinator.com/item?id=40811187.)
Discussed here: https://news.ycombinator.com/item?id=40810767
(we merged that thread hither)
There will be people like Sacklers until we start putting them away and throwing away the key. We do need to put rich people in jail at least every now and again, if for no other reason than to demonstrate we're not a banana republic.
Unfortunately, this is no longer possible to a great extent.
"Purdue flourished under brothers Mortimer and Raymond Sackler, who died in 2010 and 2017, respectively."
I’m sure it was a lot more than just two people
We detached this from https://news.ycombinator.com/item?id=40811921.
It's best to avoid generic tangents in HN threads, especially generic flamewar tangents. They tend to make discussion more repetitive and therefore more tedious and eventually more nasty. This particular one has been repeated hundreds if not thousands of times in the past.
> We do need to put rich people in jail at least every now and again, if for no other reason than to demonstrate we're not a banana republic.
... you do know that banana republics did this exact thing all of the time?
I suspect you misinterpreted what they said. We should be putting guilty people in jail, even if they're rich and powerful.
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"Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith."
https://news.ycombinator.com/newsguidelines.html
> I know of no other way to read this other than lock away people because they are rich whether they are guilty or not.
Is there a reason you omitted the first sentence from that quote?
The first sentence didn't contain his rationale?
You're attacking a strawman, try steelmanning the argument to "rich people who commit crimes should go to jail every now and then". I think we can all agree.
Are you a part of the Sackler family? Otherwise I don’t see how you could have misinterpreted what I said.
Tell me, how many rich people went to jail for the fraud that caused the 2008 financial crisis? See what I mean now?
Please don't cross into personal attack regardless of how provocative another comment is or you feel it is.
Edit: Could you please stop posting unsubstantive comments and flamebait generally? It looks like your account has been doing this repeatedly. It's not what this site is for, and destroys what it is for. If you wouldn't mind reviewing https://news.ycombinator.com/newsguidelines.html and taking the intended spirit of the site more to heart, we'd be grateful.
"Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith."
https://news.ycombinator.com/newsguidelines.html
Unfortunately, vermin like the Sacklers have access to top lawyers. The two founding brothers are dead, so you won't be able to put them away; they are already put away, permanently.
However, their despicable offspring managed to flee the country with their ill-gotten gains; good luck finding them now.
My biggest beef with this case has been that people should not be allowed to just "buy" themselves out of jail. The US does not have a concept of "blood money" in its legal code (at least, not yet anyways). This agreement amounted to blood money, practically. Blood money != justice.
Three brothers! The dynasty origin and eldest brother is Arthur Sackler.
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They’ve knowingly killed a ton of people. That’s not a “political point”, and it’s really well established
>"We do need to put rich people in jail at least every now and again, if for no other reason than to demonstrate we're not a banana republic."
And to that end, the USA must demonstrate that it's totalitarian and abuses people's rights?
"Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith."
(squidbeak's reply is a nice example of following this guideline - https://news.ycombinator.com/item?id=40812196)
https://news.ycombinator.com/newsguidelines.html
I think the poster means those rich who have committed offences, but enjoy softer penalities thanks to their wealth.
Is rule of law totalitarian? Wealth is not be a get out of jail free card, and imprisonment is not inherently an abuse of rights. While the US prison industrial complex is vile and abusive, the cushy white collar prisons aren’t where those abuses are happening.
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There’s a big difference between:
> We should put rich people in jail to prove we can.
And
> We should put guilty people in jail even if they are rich.
[dead]
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Force?
Edit: "Force to trust"? Because everyone answering didn't read ops comment.
If your boss tells you you'll lose your job if you don't have sex with him, and you quit to avoid that, would you disagree with the statement that you were forced to quit?
No, words have specific meanings that should accurately reflect the nuances of the situation at hand.
Force:
>violence, compulsion, or constraint exerted upon or against a person or thing[0]
Compell:
>1. to drive or urge forcefully or irresistibly
>2. to cause to do or occur by overwhelming pressure[1]
[0] https://www.merriam-webster.com/dictionary/force
[1] https://www.merriam-webster.com/dictionary/compel
So? "Force to trust" like op wrote made absolutely no sense.
the choice to have sex with someone or be fired is not a legitimate choice and framing it as one is also illegitimate. do you have a better suggestion for a term you would prefer?
It is choice. That's the whole point of the discussion you might not like the choice you would have to take but it still is. If you want to convey that you get extorted do so but use the right words.
Force does not mean "no choice."
>to make something happen or make someone do something difficult, unpleasant, or unusual, especially by threatening or not offering the possibility of choice[0] (notice or here)
>If someone forces you to do something, they make you do it even though you do not want to, for example, by threatening you.[1]
>to make someone do something that they do not want to do
>I was forced to take a taxi because the last bus had left.[2]
[0] https://dictionary.cambridge.org/us/dictionary/english/force
[1] https://www.collinsdictionary.com/us/dictionary/english/forc...
[2] https://www.oxfordlearnersdictionaries.com/us/definition/ame...
Yeah, still nobody can "force you to trust" anything. They might force you to comply with something but they can't force you to trust. That's just nonsense.
I didn't commend on that. I commented on you replying "no" to the question "If your boss tells you you'll lose your job if you don't have sex with him, and you quit to avoid that, would you disagree with the statement that you were forced to quit?" after which you edited all your previous comments. The first of which originally just read "force?" (a single word) which leads me to believe, along with your original response to the point I initially commented on, that you didn't have that point in mind. Also, "tust" in "force people to trust the medical industry" clearly means something along the lines of "to commit or place in one's care or keeping."[0] But that point is irrelevant because you made up that point after my initial response.
[0] https://www.merriam-webster.com/dictionary/trust
I edited my first comment to clarify and nothing else and YOU commented on that.
We can throw dictionaries on each other however we want for me it still stands as long as you have agency over yourself nobody can force you to do anything. If they take away your agency we can talk about your arguments. But looking at your last comment you are not arguing in good faith so the discussion is over me.
>I edited my first comment to clarify and nothing else
You edited "No, words have meanings" to "No, words have specific meanings that should accurately reflect the nuances of the situation at hand." You also edited "So?" (single word) to 'So? "Force to trust" like op wrote made absolutely no sense.'
>for me it still stands as long as you have agency over yourself nobody can force you to do anything.
It can and often does mean that though. Here's a list of 170,000 books using the phrase "forced to trust"
https://www.google.com/search?tbm=bks&q=%22forced+to+trust%2...
Both edits are for clarity and don't change the meaning of the comments... and both edits are not in our comment chain. You seem to have another agenda here and I really won't entertain it anymore. We have different views of what force means. One is rather clear and the other one is nitpicking to get an agenda across. Nobody forced anyone to get vaccinated and nobody forced anyone to blindly trust medical professionals. There are billions of people who didn't get vaccinated. You might want it to be but it's not the reality we live in.
Reality is what doesn't change if you stop believing in it.
>both edits are not in our comment chain
The first edit I mentioned is in this comment chain and the second one was in response to my post in a different chain.
>Nobody forced anyone to get vaccinated
Really? This is trivially false. For example vaccination was extensively mandated in several countries by law, for example some provinces in China.[0] In the US certain states require proof of vaccination for certain activities. For example in New York vaccination is required to go to school.[1] Perhaps you meant "not all people were forced to get vaccinated?" That is not being debated here. In any case I never even made an argument about this point until now. And in any case I don't feel too strongly about whether "force" is the right word to describe vaccine mandates. My only points were that if your boss tells you you'll lose your job if you don't have sex with him he has forced you to quit (assuming you cannot get him fired, for example if you have no proof he said that and will continue harassing you) and secondly that "forced to trust" is not complete nonsense.
>You seem to have another agenda here
You're the one that tried to say that a boss extorting sex isn't considered forcing you to quit your job in order to maintain your position. My point was actually fairly clear and not even about vaccination.
>One is rather clear and the other one is nitpicking to get an agenda across.
I would agree except you're not even nitpicking you're just claiming that whatever you decide "force" means is the one that OP must hold by as opposed to "throwing dictionaries" at the problem.
[0] https://doi.org/10.2147/RMHP.S336434
[1] https://www.health.ny.gov/prevention/immunization/schools/sc...
If your boss sexually harasses or extorts you, you take legal action immediately, you don't quit.
China? Really? ¯\_(ツ)_/¯
I won't delve into the possibility that you might have experienced inconvenience had you not been vaccinated. It appears that you're primarily concerned with your own interests and failed to grasp the broader implications during the COVID-19 pandemic, a perspective you seem to maintain even now. The choice was yours*.
*Except if you were residing under totalitarian regimes. Where they might actually forced you to get vaccinated.
There's a commonly understood definition of "force" among the general population, which you and op are attempting to distort by cherry-picking definitions from various dictionaries, often focusing on the less common usages found at the bottom of these entries. (If you go back and think about your china argument you might just understand this.)
As I previously stated, engaging in further discussion with you is unlikely to yield any meaningful results. bye.
>If your boss sexually harasses or extorts you, you take legal action immediately, you don't quit.
It's a hypothetical.
>China? Really? ¯\_(ツ)_/¯
You mentioned billions of people. So your argument was clearly not limited to the US. Or you just didn't make the point well.
>which you and op are attempting to distort by cherry-picking definitions from various dictionaries, often focusing on the less common usages found at the bottom of these entries.
One of the dictionaries is an ESL dictionary. It gives words as they are used and it gives the usage I quoted as the first definition.[0] The reason that the usage in the other dictionaries have the usages I quoted at the bottom is becasue they all give the noun form of "force" first.
[0] https://www.oxfordlearnersdictionaries.com/us/definition/ame... (force_2 being the verb form as opposed to the noun.)
Eg, https://www.abc.net.au/religion/human-rights-and-mandatory-c...
Or pick your favourite country; policies requiring arbitrary vaccination were quite common.
Words have specific meanings that should accurately reflect the nuances of the situation at hand. You can write your comment without emotional exasperation or maybe not...
Words do indeed have specific meanings.
If someone didn't get vaccinated then the government would start basically attacking basic human rights. In particular rights of freedom work, assemble, free travel, freely to participate in the cultural life of the community, to practice a religion, etc (and to maintain their own health I might add) which turn up in some pretty hefty documents like the UN Declaration of Human Rights. Once those things are bargaining chips that you get to have for following a government policy, the policy is forced. This might make you uncomfortable. Indeed, it probably should.
Freedom means you don't have to trust hastily developed medical products. They can't have done any long term studies on the COVID vaccines yet because not enough time has passed for one to happen yet.
You wrote "force to trust". That's highly different from what you are writing now.
If someone doesn't trust the vaccine providers they shouldn't be forced to take it. You could have figured that out by analysing the specific meanings that the words have. That position on the topic of vaccines is neither rare nor subtle.
And the sentence still looks fine to me, I don't know why you think that phrase isn't kosher.
As trust is fundamentally a voluntary act. Trust involves choosing to rely on or have confidence in someone or something. By its very nature, trust cannot be forced.
1. Trust is a personal choice: It's a decision made by an individual based on their own judgment, experiences, and perceptions.
2. Trust requires vulnerability: When we trust, we willingly make ourselves vulnerable, believing the other party will not take advantage of that vulnerability.
3. Trust is built over time: It's typically developed through consistent positive interactions and experiences, not through coercion.
4.Forced compliance is not trust: If someone is compelled to act as if they trust something, it's not genuine trust but rather obedience under duress.
5. Trust can be withdrawn: Because trust is given voluntarily, it can also be taken away by the person who gave it. No one else can remove your ability to trust or distrust.
Sorry, but it makes no sense at all.
Ah, well circling back to the "words have meaning" point, that isn't a comprehensive understanding of what trust means - you're overly loading it on one aspect of the word. For example, Cambridge dictionary includes the meaning "to hope and expect that something is true" [0].
Trust doesn't require a personal choice built up over time. Some types of trust do, but that isn't a factor here as you can detected from the context. Trust is actually quite a flexible concept - you can catch some other interesting applications in security with ideas like "trusted systems" which people also may not trust in the personal sense even though they will agree that the system is trusted. That leads to awkward situations where a system can be a trusted system even if it is known to be compromised. You also get interesting things like "Trust" in the legal sense that showcase a similar flexibility.
Just to preempt a possible next comment, if you identify that one reading of a word doesn't make sense in context, the reasonable thing to do is to try the alternate readings to see which ones fit.
[0] https://dictionary.cambridge.org/dictionary/english/trust
2008 - Too big to fail
2021 - Too big to doubt
It is negligent to conflate the impacts of an addictive drug with a vaccine.
I agree but at the same time I understand why people have become skeptical too.
I will just annotate that with the observation that at the equivalent point (~4 years) into oxycodone's history I doubt it was well known to be addictive. Wiki suggests it was a "Miracle Drug of the 1930s" and they didn't get nervous about it until the 1970s [0].
And I doubt OxyContin came with the liability waivers that I seem to recall the COVID vaccines having.
[0] https://en.wikipedia.org/wiki/Oxycodone#History
I can say with a pretty high level of confidence that we aren’t going to be a seeing an epidemic of vaccine addiction in the coming years.
That is a fairly safe base case - but would you have seen the opioid epidemic coming that resulted in this Supreme Court lawsuit? These things are being proscribed by reasonable doctors as painkillers and appear to have done more rather serious damage.
I will cheekily note that you wouldn't have been following the science if you did, these things were safe, effective, FDA approved and administered by the experts.
The addictive drug was also an effective painkiller, just one with risk. Similarly a novel vaccine also comes with risks, which are only coming to be better understood years later: https://www.frontiersin.org/journals/immunology/articles/10....
Interestingly the same kinds of tactics used to push opiates on the general public are still being used to push amphetamine analogs - but the death rate from amphetamine addiction/overdose is much much lower (>1000X lower) than that from opiate addiction/overdose so it doesn't really hit the headlines, and arguably is not as much of a concern.
From a libertarian point of view, mood- and mind-altering substance use should be the citizen's choice, but for this to not result in an epidemic of addiction, it would require a well-educated public who understands that whatever short-term apparent benefit a drug (including alcohol and nicotine and caffeine) delivers, there's always a tax that must be paid afterwards, and use must be kept below the addictive threshold, meaning if you start needing more of the drug to get the same effect, the only rational thing to do is to stop using the drug until your tolerance goes back to zero.
This of couse goes against consumer society norms, where the concept of 'less is more' is almost a heresy.
The problem with mind altering substances is they can short circuit your rational thinking. So you can start with the most well-considered decision process ever and still end up addicted. In fact, this doesn't even require a substance. Gambling is plenty addictive to many.
There's a kind of fallacy to thinking that sufficient education can counter biological human desires and impulses in all cases.
That's the authoritarian view - people don't know what's good for them, so their behavior needs to be controlled by the state as informed by a small group of elites who themselves are somehow free from the influence of those biological human desires and impulses... which is why drug testing as a condition of employment was never implemented for political candidates, heads of bureaucratic government agencies, or corporate CEOs.
>a small group of elites who themselves are somehow free from the influence of those biological human desires and impulses...
They don't need to be. A person addicted to drugs is perfectly capable of creating laws prohibiting drug use.
The "impulse" equivalent for a lawmaker would be that once they feel withdrawal, they will spontaneously pass a law allowing drug use again.
Since (luckily) passing a law is far too complex to happen spontaneously, this scenario cannot occur.
ETA:
>which is why drug testing as a condition of employment was never implemented for political candidates, heads of bureaucratic government agencies, or corporate CEOs.
If drug use is "only" prevented for the 99% of people who do not fill these roles, that is still a massive improvement.
I guess I'm not sure what the point of the comparison is. If the death rate from opioid addiction were 1000x lower, I would happily bite the bullet and say Purdue did nothing wrong. Chronic pain is real and terrible - it would be great to have a solution where the downside risk is no worse than an Adderall dependency.
In my experience, people who use amphetamines (and cocaine) regularly start making very bad decisions, and heavy use leads to amphetamine psychosis. A very public example of this was the behavior of the SBF / FTX / Alameda operation, where by several accounts regular amphetamine use was the norm. That doesn't mean it should be illegal, but I'd avoid associating with anyone I knew had an amphetamine or cocaine dependency.
Difference is the death rate from prescription ADHD meds is zero, and they’re not addictive like opiates.
I’m open to discussing the underlying problems that push people to take ADHD meds. Like the insane work life required to just maintain the same standard of lives as our parents generation, or modern devices eating our attention spans.
But limiting access to ADHD drugs is just going to affect the most vulnerable and the positive outcome is just for the benefit of Calvinist pushing their world view on the rest of us. Hey, while we’re at it let’s make caffeine a scheduled drug. It’s actually addicting, it’s long we half-life makes it more likely to effect sleep, and its vastly over consumed by everyone starting in middle school.
>Hey, while we’re at it let’s make caffeine a scheduled drug. It’s actually addicting, it’s long we half-life makes it more likely to effect sleep, and its vastly over consumed by everyone starting in middle school.
Yeah, let's do that.
[dead]
Another thing to note is that the scheduling of the substances you speak of (and other non-scheduled like ozempic for example) merely puts them behind a prescription paywall--the wealthy have easy access to beneficial medicine and few to no consequenses from their use, whether that be criminal (possession or behavioral problems under the influence) or the cost of resulting health and addiction issues. Resulting in the non-wealthy suffering exponentially more.
It's very important that these societal and monetary debts are not only paid out, but go to the right people.
I don't understand the hatred directed at the Sacklers. Oxycodone is, just like all other opiates, highly effective at suppressing pain, potentially addictive, and deadly in large enough doses. This has been common medical knowledge for millennia. Why do so many people believe that they are responsible for overdose deaths?
Because they marketed an opioid as an "extended release" form when they knew from their own internal studies that the pain relief only lasted the standard 6 hours instead of the 8 hours that were claimed. As a result, people would find themselves taking more to stay on top of their symptoms and the resulting ramp in use would leave people debilitated.
It was also pitched as abuse resistant (something about it being hard to grind up the pills), which they also knew to be untrue.
This provides a good overview of how Purdue accelerated opiate marketing: https://www.newyorker.com/news/news-desk/the-sackler-familys...
> A recent study, by a team of economists from the Wharton School, Notre Dame, and rand, reviewed overdose statistics in five states where Purdue opted, because of local regulations, to concentrate fewer resources in promoting its drug. The scholars found that, in those states, overdose rates—even from heroin and fentanyl—are markedly lower than in states where Purdue did the full marketing push. The study concludes that “the introduction and marketing of OxyContin explain a substantial share of overdose deaths over the last two decades.”
This is a correlation study—I understand that increasing marketing efforts leads to an increase in physician prescription, but those overdose deaths were caused by a tiny fraction of patients refusing to follow the script as issued by their physicians. Whose fault is that?
It's especially tough for me because they clearly pushed their sketchy marketing and sales tactics because they honestly believed they were helping people, and in their lifetimes the medical industry lauded them as heroes for "safe" and affordable ways to ease suffering.
Right now people have no problem suppressing research they don't like about the negative effects of marijuana or anti-depressants or whatever their de jour personal treatment is - in 20 years if something bad really comes to light everyone is going to pretend that they knew all along and that everything was a smoking gun. Hindsight is 20/20 and history is written by the victors.
because the way they encouraged doctors to push it to everyone, regardless if they needed it or not. they aggressively marketed and pushed the drug in situations that didnt call for it
How much of this issue have you investigated already?
It’s worth skimming through the Massachusetts AG complaint about their actions, and the strategies employed by Purdue (of which the Sacklers always held the majority of board seats)
https://www.reuters.com/investigates/special-report/assets/u...
https://www.britannica.com/science/opioid
> Although a different formulation of oxycodone, manufactured by Merck & Co., was removed from the market in 1990 because of a high risk of addiction, members of the Sackler family downplayed the dangers of OxyContin, deceiving doctors into thinking that it was weaker than morphine and convincing them to prescribe the drug liberally
Because they marketed it as a non-addictive opioid because it was extended release and encouraged doctors always to prescribe the maximum amount despite internal testing showing the extended release was bogus and it was still addictive?
Exactly. It took the collaboration of many different people, all of which also profited from it, to bring about the opioid crisis.
The vendor who sells many different things seems to be at least a bit less culpable than the provider who sells just their thing while lying about certain effects of it. Yes, we can examine how we got into this situation where doctors take drug advice from the people who make the drugs but the people who lied for profit deserve the lion's share of the criticism.
In practice, even many of the general public knew that what the vendor was selling was addictive and dangerous -- there are some reports even in this thread. So it's hard for the vendor to claim ignorance, even more so when often they also stood to profit from the lie (repeat customers).
Seems like the justices missed a great opportunity here to rule in favor of the settlement and then receive $$$$$$ next year as a thank you gift.
Because buying government officials is now entirely legal.
https://www.scotusblog.com/2024/06/supreme-court-limits-scop...