I am saddened to read comments below from doctors who have practiced medicine for many years - even decades - to say this is old news.
Why have they not done something.
I am an engineer who worked 40 plus years in the oil industry. If I had taken bribes from a salesman - and then found out - I would be gone in a N.Y. minute.
Now, turning to this Dr. Kapoor. I spend my winters in india. And there is something about india and its doctors, medical practices, pill factories that is less than ethical and symptomatic.
Newspapers here report horrendous stories, callous treatments, outright negligence and worse, sheer incompetence.
Medicine here is such a business that is simply hard to comprehend in a country where daily wages is still a few dollars at best. But government programs are very generous.
Indian pharmaceutical companies led the world in generics. Yet, newspapers here report that these companies who became rich selling in America - started cutting corners to make even more profits.
FDA shut down many imports because of shoddy manufacturing that did not meet it's standards. And worse is the greediness of founders who outright swindled the stock market here.
A well known company Ranbaxy - a darling of stock market - does not exist anymore. Another company for which a Japanese company paid way above market is now embroiled in a lawsuit - for having been cheated.
And it just goes on and on.
And this Dr. Kapoor is adding more shame to India.
2
Doctors should get information about prescriptions from an online source funded by the government that would include a representative sample of experiences of those taking the drugs, and also any bad side effects however rare. Pharmaceutical sales reps, if they still existed, should be limited to advising doctors that there was interesting new stuff on the database they might want to take a look at.
Honest doctors see pharmaceutical sales reps as nuisances, sources of information of dubious reliability, and at best givers of free samples. It would be better for the medical profession, the quality of medical care and its affordability if they did not exist. News about advances in drugs and treatments should come from sources that have no reason to mislead -- or that will be quickly penalized if misleading happens. If the purpose of medicine was to heal rather than make money, there would be no sales reps and a few people who would visit doctors with accounts of the latest products and methods and their advantages and disadvantages. These people would have to be employed by someone with no financial interest in what they recommended -- a someone who would be immediately destroyed, silenced, or otherwise marginalized by those in the business of medicine.
What sources for that news would you have under your system? The New York Times which accepts advertising money from the pharmaceutical manufacturers?
1
This story illustrates that our oversight of pharmaceutical companies is inadequate. It is inadequate because our legal system is inadequate.
If doctors were legally required to be up to date on research on what they are prescribing, the defense of ignorance would not work. It would not be necessary to prove that the doctor knew harm was being done, but only to prove that information about the harmfulness was generally available, which would be proven by publication of the information in medical journals and magazines widely read in the speciality. Instead, the responsibility to know these things is moral only, and is safely ignored.
The way the law works, suits are too expensive and risky for the harmed patients to undertake. The law has been designed so that the powerful can get away with stuff rather than making justice available to ordinary people. If doctors had been sued by the patients they turned into addicts (or their relatives), and those suits were easy to bring and win, the problem would be small.
Investors are no help. Most of them are interested in the profitability of companies rather than their morality or the long-term effects of their behavior. They ride a successful scam until it starts to fail; with good timing they can make a bundle.
1
It’s unclear why there’s no mention of the Sackler Family in an article about the opioid crisis. Their ruthless lobbying, marketing, deception and greed has created millions of opioid addicts, while simultaneously making them one of the richest families in America. They pushed for the release of OxyContin in 1995, predating the events in this article by many years.
https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-e...
6
You can have all the intelligence and education in the world but greed makes you stupid.
3
A huge feature story on a drug with 95 million dollars in sales. That's a rounding error for the big brands in the industry. If the NYT wants to go after pharma at least they should go after the heavy hitters and not a farm team with an obscure little used product.
1
Nice reporting.
You see the commercials on TV..one drug after another..it's out of controll
the vast majority of TV advertisers are drug companies, insurance companies and some car companies..
We've become numb to the warnings that this or that drug may cause you to grow a second head.. I think the US and New Zealand are the only countries where it's legal to peddle drugs to the public on TV..
It's the new world. We get our medical advise from watching Wheel of Fortune, and long gone are the days of Speedy, the Alka Seltzer Man..
2
Every profession has bad actors. This article indicts every physician in every specialty in a very unfair way. A disappointment seeing this kind of bias in an article from the times.
Anywhere money is involved predatory people who have no scruples will see a tasty morsal and dive in-most doctors do not fall into that category and want to help people. Just like a lot of nurses, techs, aides, and other staff in HC.
4
As an Arizona resident, I can tell you about Insys. This company donated half a million dollars to the anti-recreational pot ballot measure in Arizona in 2016, while at the same time developing a synthetic marijuana drug called Syndros. The measure failed to pass by a slim margin, thanks to TV ads blaring out lie after lie about how marijuana kills innocent white people. The measure would have provided much-needed educational funding that today goes wanting, which has in part led to the current Arizona teachers' strike.
This past year, Insys received preliminary approval from the Drug Enforcement Administration for Syndros, their new synthetic marijuana drug.
2
Good grief. The drug makers are in the same league as Mexican cartels. The cartels use street kids and junkies as dealers whereas the pharma companies use ethically challenged doctors as dealers. It all boils down to profit ----show me the money. Sad.
7
Just another White Collar Crime which goes unpunished as it causes death and destruction. Let's face it, we are powerless to defend ourselves from the corporate-lobby and paid-off politician cabal.
4
Man, too bad there isn't a good guy in this story. We could have them fight on a Chicago hospital roof and call it a wrap.
3
Perhaps if the Federal Government got its leprous fingers and minds out of medicine, then the rest of us who are in desperate need for drugs of all kinds could get on with our lives, more cheaply.
Has Obamacare lowered the prices of drugs? No. Has ANY government action actually lowered the prices of drugs? No. Why? Because government only ever increases the prices of stuff - that's all it can do. If you think your drugs are cheaper because the government has done "something" the truth is that while your drugs may be cheaper, some other American's drugs are more expensive. There is no such thing as a free lunch - something the NYT, the government, and no Progressive/Democrat/Liberal/Conservative/Republican has ever learned.
4
What is the difference between the characters featured in this article and your average drug dealer? Not a thing.
8
America , the country where medicine is ONLY for profit .
This article is true and real , but deeply disgusting, revolting, nauseating.
Poor Americans and poor American patients .
US healthcare is in the hands of crooks of Wall Street , politicians and big Pharma have given away the health of a nation to a bunch of unscrupulous dons , who only care about their profit and don’t give a hoot about the health status of a society as a whole .
This said , why aren’t Americans protesting this cruel and criminal behavior ?
Why are Americans subjugated to pay unreasonable high prices for any prescription drug ?
In Europe it’s the opposite, it’s quite difficult to obtain opioids , there is much more government control on prescribing these drugs and protecting the well being of the society.
Are Americans simply ignorant or always in immediate need to curb instantaneously any pain ?
I still believe that a society handing over its responsibility to a bunch of for profit crooks , at the end will be overwhelmed by the negative outcome and must redirect its goals towards a more just and inclusive state .
6
The legal system failed when Purdue Pharma was allowed to settle their case by paying fines instead of jail sentences. Knowing what we do today, the guilty parties should have received a death sentence or life in prison, instead, they paid a few million dollars and were then free to enjoy the rest of their ill-gotten gains while 10's of thousands of people paid the ultimate price for their greed.
1
Capitalism 101: The only thing matters is increasing profits. As Edward Abbey said about Capitalism, "Growth for the sake of growth is the ideology of a cancer cell."
4
Wow!!!! What a lack of meaningful news here. The dope business has been bribing doctors for decades. And I'm not just talking about pain killers. It's through the entire pharmaceutical spectrum. And occurs at all levels. The reps not only regularly take the top doctors out for fancy meals as well as "speaking" engagements. They also spend plenty on advertising collateral as well as goodies for the practice staff. Making it sound like the pain killer peddlers are the only one's doing this is incredibly disingenuous.
3
And what these doctors get from pharmaceutical manufacturers pales besides what surgeons get from device manufacturers many of whom are allowed in operating rooms to encourage them to use more of their products. People don't hear about this because your asleep when this is occurring.
3
I am a fan of graphic novels, but using similar illustrations for important reporting like this undermines the journalism, making the whole package appear fictionalized and gimmicky.
3
The puerile pulchritude ploy was painfully obvious years ago when I was in private solo practice, and became worse as the years went by. My (all female) staff noted it also, and found it repellent.
All it did, at least in my office, was make for a hostile encounter: especially since most of the lovely reps knew only what was bottle fed to them, and virtually none could answer a legitimate medical or scientific question about their products.
Not like the really old days when many drug reps were pharmacists.
7
Bob, my experience, too. Five inch heels and tight skirts can move a lot of drugs. Not on the streets, but by sales reps visiting physicians’ offices.
2
There may be corruption in the pharmaceutical area, but my personnel experience with opioid addicts and my learning lessons buts the blame on the user. NO ONE CAN STOP BUT YOU, DEAL WITH LIFE
3
Excellent reporting - despicable behavior. How are the actions of these executives and sales reps and different from drug dealers? They are out to make a buck, no matter who it harms. Hurrah to the state and federal prosecutors who have taken these villains on; the misery and pain that they have inflicted upon innocents (and their families, I might add, as the mother of an opioid addict) is horrifying. They deserve every bad thing that the law can throw at them.
2
The Sackler Family/Purdue scam is on a far more galactic scale and there has been grevious damage done with possibly 100,000s fatalities but unlike school shootings. etc., no one seems to be keeping an exact count. Also, like counts for our drone escapades, there is no measure of collateral damage to immediate family, friends, communities. But I would add that there has been some outstanding reporting about this and in more detail here at the NYT.
"The Insys defendants not only face criminal prosecution but stand accused of racketeering under the RICO Act, a law more commonly invoked against organized-crime families and drug gangs. The industry will be paying attention."
In my humble opinion, the people and companies described in this article are organized-crime families and drug gangs-- they are just new ones.
1
To this octogenarian reader, learning that myriad doctors accepted blood money in this manner deeply affected my few remaining idealistic beliefs about medical doctors who treat patients. Anger now replaces the regret I was experiencing and I wonder whether any doctor or journalist similarly affected by reading about these atrocities has sent, or will send a letter of inquiry to the American Medical Association asking how they intend to stop this hideous, unethical prescription
practice and then to publish the responses from the A.M.A.
1
If it were left up to me, I would not provide articles for pharmaceutical reps to use in promotion of a drug due in part to the manipulation of the article's information and data for their own product enhancement and support.
Look no further than Porter and Jick’s very brief letter in a Jan 10, 1980 issue of the NEJM that was taken completely out of context by Purdue Pharma for the promotion of their Oxycontin opioid.
But you overlook the fact that Purdue couldn't have misrepresented what was in the letter if physicians had bothered to actually read it.
For a long time now the venerated profession of medical doctor has borne an amazing similarity with the worlds oldest profession.
1
The graphics clearly show an FBI special agent standing by during an apprehension and holding a firearm with his finger inside the trigger guard. Why do NYT artists portray things so unrealistically?
1
I've been saying it for years now, the opioid epidemic which has been going on now for a good twenty plus years, was started, not by drug gangs or cartels, but by collusion between white collar pharmaceutical MBA's and CEO's and their smug, fancifully MD embroidered scrub top physician partners in crime who are more than happy to do their patient to physician dirty work for them at a high enough price.
Physicians and Big Pharma playing fire with so many lives. It makes me want to run and take a long hot shower.
What bothers me even more about this particular story, is the fact that Steven Chung, MD is a CORNELL med school grad. Who at CORNELL taught this creep. Absolutely- appalling. Needless to say, my respect for CORNELL no longer exists.
The lives that these selfish, money grubbing men have ruined and their refusal to admit their roles in creating this epidemic of waste and death can never rectified. In a hundred years.
Keep up the good work, Prosecutors.
6
And you have what to support that? DEA and CDC reports REPEATEDLY note that “opioid [hysteria] epidemic” overdose deaths are over 90% due to illicit drugs, “mostly IMF [illicitly manufactured fentanyl] and heroin.” If reporters and politicos did their jobs and READ these reports instead of press releases from the NarcoNazis (the agency’s NN-in-chief just happens to be a former director for a McDonald’s of pain rehab clinics, surprise!) at the CDC perhaps drug addicts wouldn’t be dropping dead on the streets from IMF and pain patients wouldn’t be committing suicide in droves.
“IMF production and distribution began increasing in 2013 and has grown to unprecedented levels in 2016...DEA has not reported a sharp increase in pharmaceutical fentanyl being diverted from legitimate medical use to illegal uses (4). Given the strong correlation between increases in fentanyl submissions (illegally manuf fentanyl) (3,4) and increases in synthetic opioid deaths (primarily fentanyl deaths), and UNCORRELATED stable fentanyl prescription rates, it is hypothesized that IMF is driving the increases in fentanyl deaths. https://emergency.cdc.gov/han/han00384.asp
Although pharmaceutical fentanyl can be diverted for misuse, most cases of fentanyl-related morbidity and mortality have been linked to illicitly manufactured fentanyl and fentanyl analogs, collectively referred to as non-pharmaceutical fentanyl (NPF).
For profit health care is possible only with a for profit Congress.
If we disconnected the money from politics -- i.e., with public campaign financing -- we'd get a government that works for the people and not for the money.
6
The practice of bribing physicians, directly or indirectly. has been common for many pharmaceutical companies for a long time.
12
I find it shocking that my doctor can be bribed as easily with a wall clock, or a pen, or some scratch tablets. Whenever I see these branded products in my doctor's office, I'm aware that he/she is on the payroll of the drug companies.
8
BlindStevie,
I wonder if you also refuse to enter hospitals whose executives are receiving hundreds of thousands of dollars per year to sit on the boards of pharmaceutical companies. Take a look at the boards of any pharmaceutical and medical device manufacturers and you will see plenty of those people.
1
"authorities were trying to confine opioids to a select population of pain patients who desperately needed them"
Well, that is a falsehood. By the time Insys joined this criminal enterprise, the well had already been poisoned. The Sackler Family of Purdue had taken long acting synthetic opioids, a 30Million/year "mature" product previously reserved for the management of end of life hospice and inoperable cancer management and marketed it into a 3 Billion/year blockbuster.
6
Is anyone surprised? My doctor has on occasion prescribed me additional Ambien even though I have specifically told me I don't need more. "Have an Ambien party", he told me.
1
Jason, It's time to find a new doctor.
1
American medicine is a criminal enterprise. Who knew? Besides everyone?
9
Kapoor is one of the biggest funders of the (narrowly) successful campaign to deny the citizens of Arizona access to recreational marijuana. Isn't that special?
Discount Tire's founder was the other big whale in the no on recreational marijuana side. At least his objections weren't a conflict of interest, that we know of.
6
Great reporting. The U.S. medical care system has become a greed-based free for all, with myriad "providers" banking cash as fast and furiously as they can. It's so pervasive that a sudden halt to the scams would cause a major stock market crash, which is why Obamacare was set up to "phase in" national Medicare. Either we set up systems to end the profit taking or we continue to subsidize health care until it bankrupts the nation.
10
It seems that many over-prescribing physicians, except for the most blatant, do not seem to think that they are part of the problem... which is a problem.
7
People still insisting that the problem is just weak people who become street drug addicts.
When it was an enormous corrupt campaign to get the population at large addicted.
7
So why did it work so well in places like West Virginia?
West Virginia and places like it were targeted. Hundreds of millions of oxycontin pills continued to be dumped there despite warnings by States Attornies General that there was widespread diversion and people were dying in great numbers. Purdue simply made an "end run"arount the Attornies General and directly incentivized the Pharmacy Benefit Managers. This was a calculated business strategy which has now killed over 300,000 people. Nobody cared when it was just Appalachia. Now, the chickens have come home to roost.
2
If you lived in West Virginia or other parts of addicted Appalachia you would not have to ask. Rotten climate.. in the shadow of the big Eastern States and rather hopeless... before it was alcohol -- moonshine and plenty of traffic deaths often foggy or super rainy driving conditions... The awful weather conditions -- dark cloudy damp weathers may lead to lots of depression. These drugs are not for pain... they are treating depression with the high... and also tranquilizing people. Go visit W.Va...the mountaineer state.. (endless peaks and valleys... -- a tough place to live -- limited agriculture -- maybe tobacco -- no jobs except mining (but not that anymore) esp. now that American corps. have outsourced jobs to China and India.
The obesity epidemic plays a big role here healthwise as well. And weight can lead to all kinds of pain -- knees, back -- as does aging in general.. The young uns I know less about... most would seem to suffer from depression.
Great reporting, thank you. I pray that many of these criminals see many years in jail, or worse.
My son Austin Lindsay died of an opium overdose in August of 2011. He was brilliant but lazy young scholar, and petty drug dealer. His new love of opiates apparently came about because of his struggles with obesity. A "friend" stole a bottle of 100 opiate based tablets from a pharmacy, and gave them to my son, who found that they created a nausea that cut his appetite. He lost 70 or 100 pounds, and on the outside, he regained normalcy. But, apparently, he had a new craving, that didn't go away as fast the the pounds that he had lost.
After reading this article, for the first time, it occurred to me to be possible that the pharmacy allowed bottles of opiates to be stolen. I'm probably just a bitter, heart-broken parent, but this story awakens a new set of questions.
David Lindsay Jr. is the author of "The Tay Son Rebellion, Historical Fiction of Eighteenth-century Vietnam," and blogs at TheTaySonRebellion.com and InconvenientNews.wordpress.com, where his topics include The Drug Wars.
16
David, so sad for your loss. Thanks for the cite. Western powers, including USA, were involved in China drug trade.
1
What's the difference between the neighborhood dealer and those 'hustling' prescription opiates? One goes to jail and the other does not.
Same with an addict who gets their fix from the streets as opposed to those who get theirs from their doctor. One goes to prison while the other goes to 'Promises' in Malibu.
14
Good Lord, don't blame the addict or the patient!
The more things change the more they stay the same. This reads like the Robin Cook novel "Mindbend," but it is not fiction. Pharmaceutical firms a without scruples.
2
I see all these ads in the Sunday papers for yachts and multi-million dollar houses, and I say to myself I wonder who's buying these things.
16
Same ol' men who've always defined themselves by money and dying with the most toys = Big Banking and Wall St. execs, which includes Big Pharma, Big Tech, Big Oil, Big Government.
1
Rotten to the core, these scrip happy quacks are right up there with politicians. Seem money can buy you anything even a conscience.
1
What is shocking is that this drug is indicated for an extremely narrow subset of patients: patient with cancer pain, where other pain medications no longer work--the worst of worst pain. Yet, these were prescribed for anything but...
3
An unfortunate effect of the increasingly moralistic war against the "opioid epidemic" is that opioids have become labeled as "bad". If fact, they can be and are widely misused and offenders must be pursued. But they also meet an essential legitimate need for patients with severe pain. Legislators have appointed themselves as de facto prescribers and the result is that people in such pain are finding it increasingly difficult to obtain the relief that they need. Interested researchers, not surprisingly, are accommodating the movement by arguing that there are adequate substitutes such as Tylenol and meditation. Also not surprisingly, suffering patients and their doctors do not agree.
It is tragic that public interest campaigns will characteristically overshadow personal needs, but I can only hope that I do not eventually become part of the collateral damage in this war.
5
Hard to comprehend so many corrupt doctors.
3
Really? Sheez, how naive. When my kid was in 5th grade, we sat down for a short history of greed and power through the ages.
3
The American pharmaceutical industry is the most dangerous, sociopathic group of drug dealers the world has ever known, far more dangerous than any Columbian cartel, Mexican gang or Afghan warlord. And as usual in the US, the richer you are, the more crime pays.
33
Paid speaking as a tool of corruption, where have I heard that before???
7
When are you folks, law enforcement, the courts going to take "business" off its pedestal and recognize it for what businessmen always say it is (often in defense of lighter-weight transgressions): concerned with one thing only, profit.
Not innovation, not service, not customers or country.
Businesses are leeches evolved specifically to rid people of their cash, nothing else.
We have decided business walks a golden road, saviors and engines that make America great. But they have now a decades-long record of heinous behavior and billion-dollar crimes and must, finally, be held to account.
Not to say all businessmen are evil or selfish, but far too many of the biggest among them are.
Having ceded our politicians, our courts, our law enforcement to the wealthiest and egregiously self-centered; having converted religions into congregations worshiping financial success as the sure stamp of God's approval, it still must be done or we are finished.
This crisis is artificial, created for profit, sustained early-on by criminal behavior you describe here. Not to say every doctor (certainly not yours) is a malefactor, or every dose of opioids must be seized and patients left to suffer.
It is to say its time to recognize our error in making healthcare generally and prescription medication manufacturers specifically, profit machines. We need to grow up.
Sadly the news industry has undergone the same corporate conversion; there's little hope such things will come to pass.
8
worshiping it enough to go into debt for it. Gleaning all one's personal pride and satisfaction from stuff, including lifestyle drugs and other escapes from real life, is soul sucking and always comes with a different result than self-aware choices.
1
Greed fairs well!
Just just another battleground, where unregulated capitalism takes its toll.
I really wonder how long it takes, until people realize this root cause. A society build on greed, selfishness and raw survival instinct is not sustainable and doomed to fail.
9
Regulators are not law enforcement officers, but they work to ensure law-based regulations are followed. While your point of inadequate regulatory resources is valid, don't expect them to enforce the law. This article illustrates the gaps in laws and regulations that allow criminal behavior to thrive, until greed results in the creation of a crime too big to go unpunished.
Doctor, oh doctor how many scripts can you write per hour?
Add more examination rooms and watch your bank account flower!
Doctors should stay away from all pharmaceutical bribes, small and large, even pens. Make a line in the sand and make it for all to see. No lunches, no conferences, no pens, no clocks, nothing if the money behind it is from a drug company wanting influence. Common sense. They would not spend the money if it did not work and doctors should be influenced by science, not by greedy companies. Enough!
20
The plague of incentivized pushing of drugs by sales reps and some doctors will not be contained until there is a political will to do so. Since Republican lawmakers are much more averse to regulations, voters have one more urgent reason to vote for Democrats.
8
As Claude Rains said about gambling in Casablanca "I'm shocked." Who knew that there were unethical companies in the U.S. seeking to maximize products and unethical doctors seeking to maximize their income.
However, the main reason for the overprescription of opioids isn't because physicians are getting paid off to do so. The reason is that many doctors have believed the misinformation of pharmaceutical companies about opioids because so many docs have little training in pain management including the proper use of opioids.
I know stories like this are more sexy but if The Times really wanted to tell the truth abut the matter it would be publishing articles about that lack of training. I've seen several articles in it already on Insys. I can't recall when if ever it published one on the issue of training.
10
I witnessed this sales rep phenomenon as a young pharmacy tech in the early 90s. The whole pharmacy was loaded with branded freebies: pens, notepads, "legit" prescription pads with brand names on them, stress balls, keychains.
We were just living the high life with all this free junk. The new, young pharmacists were friendly and receptive to these reps, but the old, experienced lady pharmacist would not address them at all. Lesson learned.
7
In the mid-2000s I sought treatment for migraine and fibromyalgia at a university-affiliated pain clinic. The physician put me on hydrocodone, then added morphine, then added fentanyl lollipops (brand name Actiq). She gave me a coupon that allowed me to get half a dozen free fentanyl lollipops from the pharmacy. Drug-dealers call these "tasters."
Within 2 years I was on such a high level of opioids that my period disappeared, and so did my personality, gradually enough I didn't understand I was becoming addicted, and my doctor did not assess me for that risk. Then she switched me to fentanyl patches. My life was all fentanyl, all the time. For almost 4 years she prescribed the largest patch every two days.
After almost 7 years on heavy-duty opioids I hired another doctor to detox me. At my next visit at the pain clinic, my doctor yelled at me in the exam room that I had no right to quit the drugs she was prescribing me without consulting her first.
"A single patient can produce six figures of revenue," this story says. Well, by the time I detoxed, the market price of my fentanyl was $2,500 per month. Multiply that by 4 years, and you get six figures.
Meanwhile, I'm alive—thank goodness.
43
As a pain management physician myself, I can tell you that your doctor didn't know what she was doing.
Long before the time you state, we knew that opioids were ineffective for fibromyalgia and migraines and were not indicated for these conditions.
If what you say is true either your doctor was unethical or, more likely, didn't know what she was doing.
2
They work great for a lot of things - including fibromyalgia, a poorly understood set of symptoms that cause immense suffering. Not everyone can take Lyrica and a lot of chronic pain patients are helped by opiates -- clearly Jen from Pittsburgh was overdosed, but to state 1) that you are a pain doctor and 2) that opiates don't work for chronic pain conditions like fibro or migraines, is profoundly unsettling. None of what you say is in the least bit true.
Maureen,
I challenge you to find a guideline published by any legitimate medical organization that recommends opioids for either fibromyalgia or migraines.
As a pain doctor, I happen to know the literature and believe medicine is supposed to be practiced based on research. You apparently don't.
3
So everyone here basically gets away with it while lower-income people and people of color languish in prisons for lifetimes behind cases involving truly miniscule amounts of drugs and unreasonable mandatory sentencing.
36
Sounds about right.
1
Subsys? Seriously? That's the name of this drug?! Orwell couldn't have come up with a better name. Subsist on Subsys. Wow!
3
Pain is big business.
4
So if you are a kid, especially a kid of color, from a low-income neighborhood and you get busted for selling heroin you go to jail for the rest of your life (if you don't get shot seventeen times during the arrest), but these guys do the same thing, only worse, and they can get to get rich?
They need to be prosecuted, convicted and sent to jail for life. They are horrible drug pushers of the worst kind.
18
Perhaps you never heard of the old phase created when railroads were the biggest corporations in the country and wealthy financiers used underhanded tricks for gaining control of them:
"Steal a loaf of bread, you're a thief. Steal a railroad and you're a businessman."
So nothing knew about this.
3
I think the usual quote is "Steal a loaf of bread and they hang you, steal a land and they'll make you king." Or steal a railroad, get elected Senator. And we certainly have plenty of those kinds of senators around.
2
I have been a practicing physician for more than 30 years. In medical school, we were taught that all opioids had potential for addiction. This basic fact has never changed. Any physician who thinks otherwise missed some major lessons in pharmacology. I have never spoken to drug reps in my practice. I have always been of the belief that they are salesmen, not scientists. Sales has no place in medicine, whether by reps or ads on TV telling patients to demand new products from me. Until we stop advertising drugs, either by reps or in the media, the cost of drugs will be high and abuse will be rampant. Physicians are apparently just as susceptible to advertising and bribery, despite efforts to screen those individuals out from medical schools and post doctoral training programs.
48
that's sales. for everyone like you who won't see the reps, others will because the extra money will help pay for the better college, car, rolex, etc. With the money big pharma makes, they hire lobbyists who do the same thing with senators and congressmen who won't outlaw these practices. It happens in every profession/occupation.
1
The probably is most doctors receive little training in pain management so were too ignorant to know when pharmaceutical companies deceived them about opioids.
2
Or maybe the doctors wanted to relieve the agony their patients were in.
1
Mr. Hughes seems to miss the larger point. There is rampant corruption in the entire medical field, extending from the pharmaceutical and medical devices firms through physicians to pharmaceutical benefit managers and health insurers.
Every firm uses "thought leaders" to market product to other prescribers. Top "thought leaders" are invited to participate in Stage IIB, III and IV clinical trials. Pharmaceutical benefit companies are given "rebates" in order to encourage them to place products on formularies. FDA regulators can leave government service and become "regulatory compliance officers" advising firms how to stay sufficiently close to legal boundaries to avoid prosecution and conviction. There are thousands of “prior authorization specialists” working for other pharma and device firms. Drug and device prices in the unregulated American market are high to cover the costs of this legal corruption. The Office of the Inspector General at HHS is overwhelmed by the extent of fraud.
The flow of money through the American health system is so more corrupting than the excesses in the Insys story, which can be used in business schools as a case study as how not to practice corruption in the American health system. The rest of the pharma and device firms will now recalibrate their "thought leader" “prior authorization specialists” and programs to avoid legal problems.
21
Stories like this illustrate the need for strong oversight on medical and pharmaceutical providers. Think about how many lives have been lost, and how many more have been ruined by these schemes, to say nothing of the financial cost to everyone who pays more in taxes and insurance premiums so companies like this can make billions. This is also why deregulation and so-called "pro-business" softening of regulatory agencies under the current administration is so dangerous. If these companies, who are in the sworn business of helping people can go so far in the name of profit, how far will other companies, with no such mantra, go to make a profit?
26
Perhaps it wasn't such a great idea in 2009-2010 for the Obama admin to let the medical and pharma industries help write the Affordable Care Act that no Democrat in Congress read before passing into law.
3
This article is old news for doctors, and the processes described are employed by pharma companies not just for opiates, but for all new drugs. First comes the pizza for lunch in the doctor’s office. If the doctor prescribes more of the drug, then comes the invitation to “consult” for the company by meeting with other doctors in a local restaurant and reading pharma-prepared slides. Then comes the invitation to “speak” at a conference in the Bahamas. The doctors on both sides of the sales pitch know what’s going on, but the meals and travel are too good to pass up.
The future is looking better, since the American Medical Students Association is opposed to all pharma gifts and paid talks. As my Grandma used to say (paraphrasing): There are no bad people, just bad incentives.
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It's also worth noting that virtually every one of the major pharmaceutical companies and device manufacturers have the top people in academic medical centers and hospital systems on their board of directors where they are usually paid $200,000 or more per year for essentially doing nothing. I wonder why if a doctor takes a piece of pizza, he or she is dirty but one is still able to maintain one's ethics when taking a lot of money.
How come the American Medical Students Association doesn't do something about that?
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Old news? Hardly. Did you read the article? It’s a complete indictment of an illegal drug sales operation.
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David,
Trust me; I’m a doctor and have been for 39 years. This is old news. Intensive care specialists give talks on new antibiotics costing thousands of dollars per dose (even though older cheaper antibiotics are more appropriate). Psychiatrists reach for their prescription pads to prescribe that new depression drug and then trot off to the high-end steakhouse to read some slides. Back in 1980, even as residents, we received offers of weekends in NYC on big pharma’s dime to attend a one hour talk. I work at an academic center anmy peers tell me that they accept lower pay in academics because Ithe “consulting fees” from pharma companies are so lucrative.
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In the early 00's, my GP in the smalll town that I then lived, thought that I had a thyroid problem. He referred me to an endocrinologist in the big city nearby. When I went to see the specialist, as I waited in his waiting room for an hour, a steady stream of smartly dressed men and women pulling carry-on bag sized cases went in and out of his office. After the third or forth person disappeared behind the doctor's closed door, I turned to the receptionists and asked, "Who are those people?". "Drug company sales reps." was her reply. When I finally went in to see the doctor, he reviewed the blood-work that I'd brought with me and immediately started talking about how I needed this pill and that pill. I recall thinking, "Wow, he did not even suggest any alternatives like eating healthier or lifestyle changes. Just take a pill." Long story short, I never filled a single one of those prescriptions. When I returned home, I did a lot of research, changed my diet, increased my exercise routine, and quit smoking. Within the space of 6 months, my thyroid levels returned to normal and, as I've since become a total health nut, I've never had another thyroid problem. Looking back, I think it's obvious to me that doctors were given tremendous encentives to over-prescribe pills. The money from big-pharma was too much to ignore. To these eyes, the opiod epidemic is no surprise.
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This is an anecdote, not evidence of anything. Serious thyroid problems do not resolve with diet changes and the main medications used to treat them are generic and cheap. My doctor does not see drug reps herself and accepts nothing from them, not even a notepad. There is nothing to indicate that the majority of doctors are like yours, or like the one in this article. I would never seek treatent at a “pain clinic” not relted to a major academic medical center that abides by best practices.
Quitting smoking was probably the greatest contributor to your improved health. It’s fine to improve your diet--if it’s really bad, but comparing thyroid medication to the opioid epidemic is really a stretch.
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I, too, have been in the doctor's office when the dark suited pharma reps show up. Like vacuum cleaner salesmen, they are always pulling a "carry-on" sized tote full of goodies. I call them the "Men In Black".
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@Pundette: I can't speak for every place in the country, but the Cleveland Clinic -- a huge, reputable hospital chain in NE Ohio -- where I get a lot of my medical care, has doctors who are all on salary (hence, can take no kickbacks) -- they forbid kickbacks anyhow -- pharma reps cannot give out incentives or bribes. They can't even take the "swag" like pens, calendars, squeezy balls, etc. Nothing. So there are models of good behavior to follow.
On the other hand: my husband was just denied a refill of a prescription of a medication he had used safely and appropriately for YEARS, because the doctor is now afraid to prescribe ANY pain meds. So while the problem here is real and vast....the reaction to the problem has been extreme and fanatical, with no "happy medium".
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