Legally dopey dealings

We all know people who are out and about, some are out for dope, others are merely dopey. As such we have all kinds of checks and balances in place (or so one would think). It was there for a little surprising to see: ‘Johnson & Johnson responsible for fuelling opioid crisis in Oklahoma, judge rules‘ (at https://www.theguardian.com/us-news/2019/aug/26/johnson-and-johnson-opioid-crisis-ruling-responsibility-oklahoma-latest). I was of the mind that this would not happen. Not because I like the firm, not because I like the product Pledge (for my furniture), and optionally I use other materials by Jay & Jay, I merely am unaware of it.

I am also not debating the events, or the guilt of Johnson and Johnson, I merely have a lot of other questions, questions that as far as I can tell are not answered. To get there, we need to see the accusation: “the giant drug maker helped fuel the deadly opioid epidemic in the state“, first of all, there is a larger failing. When we focus on the ‘deadly opioid epidemic‘, we need to see that this does not go over the counter. So when we look at the words of AG Mike Hunter “a “cunning, cynical and deceitful scheme” to ramp up narcotic painkiller sales alongside other opioid manufacturers by using their huge resources to influence medical policy and doctor prescribing“, I wonder who these prescribing doctors were. Did they not study medicine? The fact that thousands of doctors prescribed opioids is a larger issue, it does not make J&J less guilty, it makes others a lot less innocent. J&J should not be standing there alone. The claim “selling as many narcotic painkillers as possible” calls for an inclusions of the doctors giving out the recipe and the pharmacy accepting that doctors kept on prescribing the drug. We also need to look at the FDA who approved the drug in the first place. Here we are looking at three guilty parties, with two groups consisting of thousands of people involved. Yet the article shows merely a J&J in the dock, having to shell out $572,000,000. This leads to questions that do not add up.

In addition we see: “Oklahoma resolved claims against Purdue Pharma in March for a settlement of $270m and against Teva Pharmaceutical Industries in May for $85m“, it calls for additional questions and they are not given, it seems that the essential questions are not even asked in the article. Even the CDC has questions to answer. This part is given with: “Opioids were involved in almost 400,000 overdose deaths from 1999 to 2017, according to the US Centers for Disease Control and Prevention“, there is already a clear case on how these opioids were prescribed, yet we see nothing of that. And as the article continues with: “Since 2000, some 6,000 Oklahomans have died from opioid overdoses“, this implies 300 deaths a year and we see nothing demanded from doctors and more important on how dosage had this effect. All elements that might be attributed to J&J, but it took a doctor to decide on the medication, is that not the case?

The truth of that is seen at the very end of the article by John Sparks, Oklahoma counsel for Johnson & Johnson. “Not once did the state identify a single Oklahoma doctor who was misled by a single Janssen statement, nor did it prove that Janssen misleadingly marketed opioids or caused any harm in Oklahoma“, I would phrase it: “Not once were doctors and their pharmacies called to explain these numbers, the total numbers who got prescribed these opioids and not once do we see any alerts to the CDC on any of this“. The evidence in this is that the 22,500 overdoses a year should have rattled the CDC no later than 2003, so where are the actions shown that there was an issue? The American pharmacy system failed on several levels and even as no one denies that Johnson and Johnson had a role to play, the FDA and the CDC should have clearly intervened no later than 2005 that is seemingly not the case, because the cadavers kept on stacking for at least another decade.

It took me less than 600 seconds to see this truth; as such Mike Hunter is actually dealing with a massive systemic failure that goes all the way to his own office.

And as we read: “cunning, cynical and deceitful scheme“, it seems more apt to accuse the office of the Attorney General for inaction, complacency on a matter that endangered the lives of hundreds of his state constituents every year and his office has remained inactive for well over a decade, it seems to me that his office should equally be investigated for reckless endangerment of people. In all this the pharmacies and doctors need to be heard on how and why these patients were prescribed. My view was supported in July 2019 when we were told (by the Guardian) “The company has previously acknowledged delivering 5.7m opioid pills between 2005 and 2011 to the small town of Kermit, West Virginia, with a population of just 380 people“, this shows the larger extent of pharmacies and their distributors. More important, who was prescribing these opioids?

We can argue that Johnson and Johnson is guilty or innocent, yet the truth is that this reckless abuse system is a lot larger than the pharmacy creating the opioid containing medicine, it is a much larger greed driven setting and I believe that Oklahoma and specifically Mike Hunter failed the American people. He might feel all happy and joy joy that he won the case, yet I believe that it is merely part in covering up a much larger crime that goes all the way to the top of the CDC, as well as a national pharmacy failure. The article does not give us that, does it?

It gets to be even a little wilder when we consider a 1978 episode of Lou Grant (season 2 Episode 1 – pills). In that episode we get a similar setting, more important, in the dialogue at the end we hear: “246 kids went to the same three places. Druggists are obliged to report any doctors who are prescribing abnormal amounts of dangerous drugs, the state pharmacy board had not received a report from any of the three“, now I accept that this is the text from a TV series, a drama series. Yet the premise remains, is there a legal premise in the US (still) in place that this reporting needs to happen? If there isn’t why was this never done? The danger of substance use disorder has been around for decades, this failing cannot be held over the head of a pharmaceutical company. There is a clear indication of violations on local, state and federal level, it is a systemic failure and we might large applause that a large pharmaceutical gets the bill, but the failing is much larger and because of that there is an injustice in all this.

I believe that Johnson and Johnson has a much larger role to play and they are not innocent, yet the failing is systemic, as such there is every chance that their appeal will have large consequences on a national level in America.

I wonder if Ed Asner, Robert Walden and Mason Adams ever considered that they would be part of a stage where they pointed out a much larger American failing 4 decades before it went to court. I remember the series as I was almost 18 (just two years short of that) and It was my dream to become a wartime photo journalist (a younger Daryl Anderson). It was not meant to be, but I never lost my passion for photography.

This case is more than we see and I reckon that jurisprudence papers will soon enough fill up on the systemic failings that Mike Hunter is eager to avoid in the court room.

Even now, we see another article from the Guardian that is almost an hour old. There we see: “It was also revealed that Johnson & Johnson hired the consultants McKinsey, which recommended the company’s sales force should focus on doctors already prescribing large amounts of Purdue’s OxyContin”, there is a level of validity of looking into that practice, yet the part linked to all this, the doctors prescribing the medication in the first place, they had a duty of care towards their patients. A marketing strategy might be debatable, it might also be immoral, yet in the end the doctor is the one acting, so is the pharmacy handing it out again and again, where are they in all this?

It is in that article where we see a two sided issue (at https://www.theguardian.com/us-news/2019/aug/26/johnson-and-johnson-opioid-crisis-ruling-responsibility-oklahoma-latest), with: “Sabrina Strong, one of the trial lawyers for Johnson & Johnson, said the ruling was flawed. The company argued that the drugs it sold were approved by federal regulators and that they could not be tied directly to any deaths in Oklahoma”, we see that Sabrina Strong is opening two doors, one bad one. Yes, we can agree that they were approved; the error was ‘they could not be tied directly to any deaths’. Were all hundreds each year all vetted? That is the flaw, because that data could also reveal which physicians prescribed them and which pharmacies filled the prescription. That evidence was not covered by the media, and as this goes over almost two decades, how did the CDC cover this? 300 deaths a year in one state is too large to ignore, especially when it is part of a larger failing. That is the part that Johnson and Johnson have seemingly not covered. I feel certain that the appeal will cover it and it will make life for Mike Hunter a much larger problem than he realises.

 

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