Tuesday, January 23, 2018

More on the Opiate Abuse Epidemic: Where Again Does the Finger Point?

In a recent blog post we pointed to conservatives' efforts to implicate Medicaid funding as somehow causative of, or at least promoting, the opiate "crisis." After all, funding for medications means people will use, and sometimes abuse, those medications. Meds they might otherwise ill be able to afford. (Implied solution: cut Medicaid.)

We also alluded to some of the logical fallacies in such thinking. Here, though, let's take it to another level: the blame game, where does it lead? Where does the finger point? Those who agree with Ronald Reagan that government is the problem, not the solution, fall into the trap of blaming public action and civic institutional development for the ills of our society.

But gosh, why is it that private actors get a bye? Isn't it possible that something other than public action could end up being the culprit? What creates this blind spot?

For one thing, those (they're discussed in the blog link above) who point fingers at Medicaid overlook inconvenient truths. Take the state-by-state data. True, West Virginia is among the top states, as it happens, for both Medicaid and addiction rates. But then look at New Hampshire. With Ohio, it is a close second for addiction but affluent enough to be near the bottom of states receiving Medicaid/CHIP. Somehow the great conservative logicians seem to miss data like this.

For another thing, when you go from the "faceless bureaucrats" to the families that run things in this country, there's the matter of privacy. There's a queasy feeling about ratting out your private "friends," even when they're not really friends at all. Even when they're polluting your environment or selling you (in our new parlance) some newly slavered S on toast. And private actors, once in the, well, let's say billionaire realm, can manage to protect their brand even while working behind the scenes to ruin--allegedly--people's health through false advertising. Turns out New Hampshire doctors prescribe opiates at about double the national rate, responding not to government but to private (Big Pharma) signals.

Such private matters have been the case, allegedly, with the family that brought you all the flavors of the pharmacologic gift that keeps on giving: oxycodone. We know this is the case especially, more recently along with fentanyl, with this drug in its most controversial form, Oxycontin. Oxycontin was brought to your local pharmacy by the still barely-known Sackler family. It's a dramatic story of a family out of Brooklyn by way of the medical schools of Glasgow and then the boardrooms and development offices of some of this nation's most prestigious citadels of culture.

Two recent discussions of the Sacklers point to their possible culpability in spreading a false gospel of SOAP: a Safe Opiate Administration Policy. Last fall we considered blogging on the first of those discussions in The New Yorker. But it's hard to access some literature hidden behind paywalls, so we held off. Now, however, a shorter and in a number of ways more accessible piece on the Sacklers now emerges in The Guardian.

The New Yorker piece, by investigative reporter and staff writer Patrick Radden Keefe, shows how this family of physician-entrepreneurs built an "empire of pain," as he styles it, starting as far back as the mid-20th century. This was the era of Estes Kefauver's aggressive committee hearings. But even congressional inquiry was no match for the aggressive advertising tactics and casuist hyperprofessionalism--hiding behind the degree--tactics of an Arthur Sackler, who "caught Kefauver in an error," notes Keefe, "and said, 'If you personally had taken the training that a physician requires to get a degree, you would never have made that mistake.'”

In related fashion, for health care the Sackler Brothers were among the first to use the megaphone of social media as a tool, in its primitive mid-century form, for disseminating messages to a gullible medical profession. They were sales geniuses, understanding the nudge-value of throwing money around. They created Medical Tribune, one of the most successful and impactful of what came to be known as throwaway journals These throwaways hit doctors' mailboxes on a daily basis. (Medical Tribune was biweekly but there were lots of others.) Conflict of interest? Why do you ask? Potentiating the message that opiates were safe, especially when there was a "clear need" for such agents? Question answers itself.

Toward the end of the last century, the story of the Sackler family and opiates took two other important turns. In 1995 OxyContin received FDA approval for moderate-to-severe pain. (Not long after, in the great tradition of the Revolving Door, the very FDA official who oversaw the drug's approval left the agency and went to work for the Sacklers at Purdue.)

Some of us recall that that was about the time an alarming tsunami of patients began to flood through our doors. Their complaint was stereotyped: months or even years after a mild-to-moderate injury, long after full healing could easily be documented, "If I don't take this medicine I get my pain back." Awareness of addiction was just about as conspicuous in its absence for us and our patients alike.

Some time also in the mid- to late-twentieth century, Sackler family largesse in the funding of the arts became an international phenomenon. While family names appeared conspicuously on galleries in prestigious institutions around the world, on the company website they equally conspicuously disappeared from the list of directors--up to eight in all.

This past week, New York journalist Joanna Walters, in The Guardian, related the story of Nan Goldin, a renowned Brooklyn artist-photographer. Goldin went from a case of tendinitis to a full blown OxyContin addiction that turned her into a recluse for three years. It is accessible with no paywall and makes intriguing reading. We watch Goldin out herself as an addict and valiantly seek to mount a counter-messaging movement. Goldin's verdict: "I don't know how they live with themselves."

And so here we are. Private actors buy their way forward into the benign and beneficent ranks of the cultured plutocracy. They do so while covering their tracks backward as the real vectors of an epidemic. (See Arthur Sackler's fascinating 1987 obituary in his own journal, extolling the "Renaissance Man" and implying he received medical school training at NYU.)

Meanwhile, the logicians in Washington, DC, still parrot Ronald Reagan that "government is the problem." No, Wisconsin Senator Ron Johnson, government, of which you are allegedly a part, is not the problem. Unless you're it. Those whom you protect with your flawed logic and equally flawed ideology are the problem. We suppose it's no wonder that last year, at an event in the state that both you and the Speaker of the House call home, Donald Trump kept calling Paul Ryan "Ron."

1 comment:

Anonymous said...

This example is much broader than covered in this piece. After a recent health scare my wife was approached by a doctor that he had the solution to my health problems. The red light should have been when my doctor did not support this doctor’s testing ideas.
I agreed to the test and walked out angry that I had been taken advantage of and my insurance company had to foot the bill for what was obviously a scam. A few weeks later I received a call from the doctor demanding to know why I had not appeared in his office. The first problem was all of my medical contact was through my attorney wife.

Second was when I informed this doctor I was not coming back he then proceeded to make veiled threats about taking action to have me forcibly brought into the hospital. Confronted, he stated that if I made any public comments about his practice he would take legal action. Given the non-response of some other doctors I have to believe he had done this in the past.

My wife is dealing with a doctor I have questions about. She is being treated with office visits, blood draws, and low dose aspirin for a condition that may appear in the future. Her doctor states that other doctors would ignore this situation. One thing I learned many decades ago is a scam artist will tell you they are taking advantage of you.

The bad news is my wife has bought into this and now believes she needs this doctor’s attention.

She is already returning to her old OB/GYN 125 miles away after some labs were mistakenly sent to her local doctor and they called demanding she take additional test for what is an obvious problem.
Medicine is changing in my state as three large medical centers expand their reach and will soon control all of the medical practices from scheduling down to prescribing and therapy. The change cannot happen fast enough for me.

Steve Lucas