Tag Archives: OxyContin

Online death dealers

Yes, it sounds ominous, but it is no JK Rowling, it is no fabrication of the H Potter variety. This is healthcare. And it woke me up when I saw the advertisement on Google YouTube today. You see, the advertisement sounds dangerous right off the bat. And the weird part is that the warnings at ABC are two years old. They gave us (at https://www.abc.net.au/news/2020-02-05/instant-online-prescription-app-raises-medical-safety-concerns/11925700) ‘‘Instant’ prescription providers prompt warnings from GPs and pharmacists’. There we see “Doctor and pharmacist peak bodies are voicing concerns about online services offering “instant” prescriptions to people who fill out a digital questionnaire, arguing they heighten the risk to patients.” In addition we get “Instant Scripts is one of several online platforms offering immediate prescriptions for medications such as pain management, steroid creams and anti-depressants by having patients fill out a digital questionnaire.” So first we get the entire Oxycontin issue, and now they let an online setting handle pain management? How long until someone gives the people the setting if you need Drug A, you need to answer the following questions (and so on). So how dangerous is this setting?

I personally believe that it is very dangerous. The fact that a patient (optionally an addicted one) can circumvent both doctor and pharmacy is likely the most dangerous one of all and I reckon the makers covered themselves with “You must always be completely honest” or something of that effect. Yes, because a written warning always helps when the person is addicted. So when we get to “But the Royal Australian College of General Practitioners (RACGP) and the Pharmacy Guild of Australia are both concerned a growing number of companies are trying to shake up traditional healthcare in the name of convenience.” I wonder whether it will be convenience or profit that some companies will adhere to. 

As such I have issues and perhaps they are hot valid ones, but the ABC supported my train of thoughts hours ago on the 5th of February 2020. Whatever we call it, an algorithm, a script that leads to a prescription, the only one who can do it safely is the GP of the patient and I have seen several options from my GP so wonder how essential that ‘instant’ part is. And when the issues start, when the complications start, where will the app builders be? Where will the people be who signed of on this? Simple questions that the greed driven will avoid and counter with some claim that is likely to have little foundation in reality. Is an app like this valid? If we take away the ‘instant’ part yes. In rural settings this app could do a lot of good, take away the stress from several parties, least of all the patient, but the ‘instant’ part makes it dangerous. It to some effect reverberates in another statement I saw today. “We cannot get rid of guns, but what if a citizen needs to be over 25 to own one?” I feel that this idea has merit. We cannot control the immediate, so what happens when we set the age, just like voting and alcohol? And it is the same for this app. ‘Instant’ is not acceptable, but the app itself could do a lot of good, if only it goes via a GP for approval, and this GP has to sign off on it. Suddenly ‘instant’ no longer applies, is no longer valid. Consider the doctor signing off on a prescription that has lasting damage? This is one issue the doctor cannot avoid, one the pharmacist cannot avoid. And there is reason for this. How many pharmacists selling Oxycontin have gone to prison? I wrote about it as early as 2019 (before the ABC article) in ‘A larger failure’ (at https://lawlordtobe.com/2019/10/13/a-larger-failure/) A stage that was even dealt with in 1978, a reference to ‘When in doubt’ (at https://lawlordtobe.com/2019/08/31/when-in-doubt/) So well over a year before there is a clear setting that gives pause to anything offered ‘instantly’ and now you want to do away with GP’s and pharmacists (to some degree)?

With them in place there was still a gap to sell 76,000,000,000 opioid pills. How many will the ‘instant’ marker allow for? And the moment the people see the Google advertisement and figure out that certain combinations guarantee certain ‘solutions’ how will this not go from bad to worse?

On the other hand, if we can get rid of 35% of the population this way, go right ahead, it will benefit nature in other ways. So have a good thought of what you want and how you want it.

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That first step

We have all heard it, the first step is admitting you have a problem. There is of course debate on WHAT the problem is. I am not any different. I hate stupidity, hypocorism and bot to mention short sighted issues. One of these issues is ‘Tax the rich’, we see all these stupid people screaming ‘tax the rich’ whilst the system is set, there is a tax system, there are tax laws and instead of all screaming to adjust the tax system we see the empty gesture to tax the rich, the rich do not care, they adhere to tax laws, so these laws will PROTECT them. Another issue was seen in ‘Greed and Law helping each other’, I wrote it on July 9th 2021 (at https://lawlordtobe.com/2021/07/09/greed-and-law-helping-each-other/). There I set out the short sighted setting of the Oxycontin setting. I wrote “Yes, there are culprits in this story. You see some sources give us that in 1996 316,000 prescriptions were dispensed, it grew to an impressive amount topping over 14 million prescriptions with an estimated value of $3,000,000,000. The issue we see everyone painting over is ‘prescriptions dispensed’, this is not something that a person can get, it needs a doctor and it needs a pharmacist.” You see there are laws and rules, and they were massively broken by doctors and pharmacists. So when do they go to court? 

It is Reuters who give us today (at https://www.reuters.com/legal/transactional/sacklers-near-deal-contribute-more-opioid-settlement-purdue-pharma-bankruptcy-2022-01-31/) the story of ‘Sacklers near deal to increase opioid settlement in Purdue bankruptcy’, I personally do not believe that members of the Sackler family who own Purdue Pharma LP were completely innocent, yet that is not the setting is it? SOMEONE handed a paper to dispense Oxycontin, a pharmacist handed over the drugs. Yet nearly all of them banked the money and did not ring the alarm bell (some really did that) and those who cashed in on 14,000,000 prescriptions? Why are they not in court? Members of the Sackler family cannot hand over prescriptions, they cannot dispense drugs to people, they can merely distribute to pharmacies. So I do not believe that they are completely innocent, but to go after them and not after the doctors and pharmacies is (as I personally see) immoral. 

Yes, I know that in Torts you go after the money.

So in that setting: “Jeff Bezos, I do believe you owe me $50,000,000 post taxation, pay up please!

But is any of that fair? You might say that fair has nothing to do with it and it is not incorrect but it is wrong. So when Reuters gives us “An agreement involving members of the Sackler family and several state attorneys general could potentially end a legal challenge that has prevented Purdue from exiting bankruptcy, and clear the way for a plan aimed at helping to abate the opioid crisis” my personal thoughts are wondering how many of these state attorney generals went after the doctors and the pharmacies? Justice handed in August 2021 a verdict, ‘Doctor Sentenced To More Than 15 Years In Prison For Conspiring To Distribute Thousands Of Oxycodone Pills Illegally’, there is no way in hell that only ONE doctor did that, so how many are serving 15 years? 

It is U.S. Attorney Audrey Strauss who gives us “Dr. Emmanuel Lambrakis wrote medically unnecessary prescriptions for thousands of oxycodone pills – an addictive and potentially fatal opiate.  Instead of abiding by his oath to ‘do no harm,’ Lambrakis pumped deadly drugs into the community.  Lambrakis put his own greed before his duties as a medical professional, and for that he will now spend a lengthy term in federal prison.” And as stated before, there is no way that there was merely one doctor guilty of that, in addition, there are truckloads of pharmacies that require the same amount of attention and that too is not being done to the degree it had to be done, it is my personal opinion that some state attorneys general’s were lazy and decided to go after the money, go for the easy conviction. Yes, the Sackler family benefitted, but who prescribed? Who handed them over? I see close to nothing on that. It is a simple tax the rich approach to a failing in law and a failing to observe the law and there are clearly a vast amount of doctors and pharmacies more guilty than any of the Sackler family. But we do not get to see that, do we?

As I see it, it started with that first step and the law has a problem, it cannot properly dispense justice to the wrongdoers. It merely went to the richest person and found them guilty. So what happens when it becomes about something more problematic? What happens when someone figures out that any Ponzi scheme can be done online handing the mess to Apple or perhaps Epic systems? So what happens when the hackers find the weakness in something like Nvidia’s GeForce Now service? What happens when 300,000,000 people lose $10-$35 and Epic goes ‘Not my Problem’, and Nvidia goes ‘We know nothing’? Who will end up with that bill of $3,000,000,000-$9,000,000,000 because the people will demand payment and as I see it the Justice departments will be globally clueless on how to proceed. The nice part here is that the court setting makes Apple automatically innocent, they had to open up the system and the people will merely lose their money. 

How a spindled world wide web we weave.

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Greed and Law helping each other

I have written about it before, it is my point of view and my conviction. It is my setting that gives rise to what you could see, and gives rise to what you could know, you already did, but you seemingly decided to ignore it, you decided to enable the greed driven and all parties are smitten by greed, they call it different, yet as I see it, it is mere greed.

How it ends
The end is shown by the BBC (at https://www.bbc.com/news/business-57770557) with “It marks the first step towards the OxyContin painkillers maker paying out $4.3bn (£3.1bn) to settle cases related to the opioid crisis”, it was always about the money. There is an old saying “μυστήριον, Βαβυλὼν ἡ μεγάλη, ἡ μήτηρ τῶν πορνῶν καὶ τῶν βδελυγμάτων τῆς γῆς;” The book of revelations 17:5. Did anyone consider it could optionally reflect on Attorney General Letitia James from the state of New York? We might see and take notice of “While no amount of money will ever compensate for the thousands who lost their lives or became addicted to opioids across our state or provide solace to the countless families torn apart by this crisis, these funds will be used to prevent any future devastation”, will it though?

The method
We see ‘OxyContin is one of the most commonly abused prescription drugs’, and we see that it belongs to the Sackler family, the members who own Purdue Pharma, privately held. They are not guilty, yet they are also not innocent, greed drove them towards their billions, yet they are not the demons we all paint them to be, to not be innocent and to be a demon is to be a different cattle of fish and any Attorney General could tell you that, but they have the money and they all wanted the money, the real demon.

Culprits
Yes, there are culprits in this story. You see some sources give us that in 1996 316,000 prescriptions were dispensed, it grew to an impressive amount topping over 14 million prescriptions with an estimated value of $3,000,000,000. The issue we see everyone painting over is ‘prescriptions dispensed’, this is not something that a person can get, it needs a doctor and it needs a pharmacist. The top 5 are Walgreens Company, CVS Health, Walmart, Rite Aid Corp and Krogers company. They own a little over 25,000 stores and around 113,000 pharmacists. There are ere players in the game. Yet how many Oxycontin did they hand out? How many doctors did these prescriptions?
You see, the interesting side is not what we see, but what we saw on TV in 1978, it was an episode of Lou Grant and that episode (season 2 episode 1 “Pills”) shows us the larger station that plays here and THEY gave the people (government also) the goods 20 years earlier. We all want one demon, but there was not one, there were a truckload of them, but the US government cannot fill their pockets there.

Innocence
It is the first fatality in any war, there is no exception and this is not different. The Sackler family is not innocent, but they are not the guilty demons that the media and the flaming screamers claim them to be. It was simple and it was out there. 14,000,000 prescriptions and only doctors can make them. Yes, we see “lawsuits regarding overprescription of addictive pharmaceutical drugs” yet it is given out by doctors and it is handed out by pharmacies. Yet the New Yorker in 2020 gives us “Purdue Pharma played a “special role” in the opioid crisis because the company “was the first to set out, in the nineteen-nineties, to persuade the American medical establishment that strong opioids should be much more widely prescribed—and that physicians’ longstanding fears about the addictive nature of such drugs were overblown”, I get that and we should understand that, yet in this (at https://www.justice.gov/opa/pr/opioid-manufacturer-purdue-pharma-pleads-guilty-fraud-and-kickback-conspiracies) we also get “Purdue also paid kickbacks to providers to encourage them to prescribe even more of its products”, so who were those providers? Who received these kickbacks? We are not likely to see those are we, we will merely see words like ‘settlement’ and ‘undisclosed parties’, innocence was the first victim to fall, none of the players were innocent. And the government is equally guilty. The NPR (at https://www.npr.org/2020/12/22/949309266/doj-sues-walmart-over-unlawful-distribution-of-controlled-substances) gave us in December 2020 “The Justice Department is suing Walmart. In a civil suit filed today, the Justice Department alleges that the company’s pharmacies and warehouses helped fuel the opioid crisis. Walmart’s pharmacy chain dispensed billions of opioid pills, including OxyContin and other highly addictive medications. And this lawsuit claims that the company broke the law hundreds of thousands of times”, so that took a decade? And when we consider ‘broke the law hundreds of thousands of times’, how come that store is still open? And it is Brian Mann who gives us “according to the DOJ, Walmart did exactly the opposite, filling huge numbers of unsafe and illegal prescriptions, allegedly doing so for years without alerting the government”, and there we have it, the crux of the Lou Grant episode, the evidence that set the caper in motion in 1978, but that is not all, the article also gives us “NPR has been looking into this. And we found that some of the company’s own former pharmacists tried for years to raise the alarm about allegedly illegal activity. Ashwani Sheerin (ph) is a pharmacist who worked for Walmart in rural Michigan. He told NPR he saw real red flags”, not all pharmacists are evil, but we see the stage of revenue pushing, it is greed in action and when we see ‘tried for years to raise the alarm’ we see that the Justice department is not innocent either and the media is not innocent either. A stage where they all love revenue, circulation and ringing the bell loudly was apparently not an option. So whilst we see “had reached an agreement with Purdue that would see its owners, the wealthy Sackler family, pay an additional $50m”, I wonder where Walmart is in this and with them a whole range of pharmacies. Because it was never Walmart alone, not with an annual 14,000,000 prescriptions.

Solution
There might not be one, but us all recognising that Justice reacted well over a decade too late, that is as I personally see it, the FDA dropped the ball, likely more than once, especially as this has been going on for years, optionally well over a decade. And it is Attorney General Letitia James with “prevent any future devastation” who has the ball now, I wonder if she drops it, or hands it over to someone else, as NPR gives us pointing the finger at Walmart, but they are not alone and the records of the FDA are also in question. When I look into ‘Federal Regulations for Clinical Investigators’, I wonder if it helps investigations, or slows them down.
You see Oxycontin is a schedule 8 drug and we get “Doctors must follow state and territory laws when prescribing oxycodone and must notify, or receive approval from, the appropriate health authority”, you see this matters as pharmacies need a doctors prescription, so which doctors were behind the 14,000,000 annual prescriptions? 

So there you have it, I made no claim that the Sackler family was innocent, they are not, but they are not the demons we see them to be, this is a much larger problem and it was left unchecked for well over a decade, or there was at the very least a decade of inaction and too many filled their pockets and yes the Sackler benefitted, but they were not alone, Walmart was part, but there too they were not alone and the doctors who prescribed these pills, what is their price for a prescription? As I personally see it, the law enabled greed to continue for too long, the law and greed enabled each other, and the end is still not in sight, no matter what Attorney General Letitia James and in this she is not alone either, doesn’t San Francisco, Los Angeles, Chicago, Boston and Philadelphia not have any Attorney Generals? Where were they in the 2000-2021?

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A larger failure

The Washington Post had an investigation, it had been published months ago (at https://www.washingtonpost.com/investigations/the-opioid-crisis-15-percent-of-the-pharmacies-handled-nearly-half-of-the-pills/2019/08/12/b24bd4ee-b3c7-11e9-8f6c-7828e68cb15f_story.html) and I did look at a few sides of what was happening, yet the larger failure was never looked at. The fact that the DEA has failed its nation to this degree is almost too weird for words.

The headline might give us: ‘As overdoses soared, nearly 35 billion opioids — half of distributed pills — handled by 15 percent of pharmacies‘, there was a clear need to investigate the pharmacies and the FDA who had been a failing regulator in all this, yet the Washington Post gives us that there is enough blame to go around. When we see: “The DEA has maintained this database for roughly two decades but did not regularly mine the records to identify pharmacies buying unusual quantities of opioid pills, according to current and former DEA officials. The agency relies on drug companies and pharmacies to monitor and report suspicious purchases“, we see more than mere stupidity and laziness, the DEA shows that there is a systemic failure in America. The mere mention of ‘The agency relies on drug companies and pharmacies to monitor and report suspicious purchases‘, shows just how stupid the DEA has been, a stage where a commercially driven enterprise will monitor itself has in all of history never ever worked. Looking at the top 15, the three pharmacies in Kentucky sold enough opioids to hand every citizen in Kentucky 3 tablets each, that is merely the three pharmacies in that list, and there are close to 300 (as far as I have been able to count them). The simplest stage that I could have shown the DEA using IBM modeller/IBM statistics in less than one hour (providing the data was transferred).

The DEA and the FDA failed to this degree. A stage that could have been addressed half a decade ago, it was never mined; that is the size if what I will plainly call incompetence. Even as the New York Times gave us Yesterday: ‘Judge Orders Pause in Opioid Litigation Against Purdue Pharma and Sacklers‘, we see (at https://www.nytimes.com/2019/10/11/health/purdue-bankruptcy-opioids.html) that there is another stage, it is not about the “mounting costs of litigation”, I see that there is a larger systemic failure and whilst we accept that the people can go after Purdue Pharma and its owners, the Sacklers. There is a clear stage where the FDA and the DEA should have stepped in half a decade ago, they did not!

Even as politicians and law makers are giving rise to the option “They would also give up ownership of Purdue, which would be restructured into a new company, overseen by public administrators. The new company would continue to sell its signature opioid, OxyContin, as well as other medications, but all profits would go to pay the cities, counties and states for the costs of the opioid epidemic“, that sounds nice, but in the end the problem is larger than one company and the failure of the DEA is out in the open and left alone, untapped and not really investigated, the same can be said for the FDA in all this. Large companies had too much hold on these institutions and now that the dam is build, this can all happen again. Sanitation of the DEA and FDA will be essential in all this.

Even as there is in the most extreme some validity to the claim by B. Douglas Hoey, chief executive of the National Community Pharmacists Association when he gives us “There are legitimate reasons small pharmacies can have outsize volumes” so far his words do not sound true. The fact that three in Kentucky and the list of 15 pharmacies where the smallest transgressor prescribed 65 pills per person with a total of 1,294,890 pills (in Oklahoma of all places), we see a large failure and the rods by Hoey come across as hollow. In this the National Community Pharmacists Association should have mined its data as well, that was seemingly never done to any degree. I would have needed less than an hour to see initial top line results and raise red flags all over America. The idea that someone in West Virginia prescribed 70 pills per person and in total prescribed 13,168,350 pills should be out in limelight, none of the three ever gave this, none of them decided to arrest the people in Strosnider in Mingo County and prosecute them (after investigations) regarding the prescriptions of opioids.

When we get the results where over 6 years 15% of the pharmacies received 48% of pain pills is a metric that is too unacceptable and Hoey hiding behind “The numbers don’t always tell the whole story” clearly implies that he needs replacement, in addition the entire facilitation towards pharmaceutical companies must change. In addition, when the Post gives us “Many of the high-volume pharmacies had annual double-digit growth in pain pills and bought far more opioids than competitors in the same counties. The analysis also considered proximity to urban centers“, I feel certain that there is a lot more in those numbers and beyond the need for greed there is no valid explanation forthcoming any day soon. A systemic failure that is now the driver behind an addiction pandemic. The disbelieve merely grows when we are confronted with: “A judge recently ordered the release of seven years of database records, which expose the paths of more than 70 billion pain pills distributed to about 83,000 pharmacies“, this gives us an average of a little over 843,000 pain pills per pharmacy over 7 years, making it 120,000 pills per pharmacy per year. A simple search via:

SPLIT FILE PER YEAR pharmacy.
FREQUENCIES
/NOTABLE
/STATISTICS=mean.

It would have given us the results of something that would have knocked over any junior analyst making that person push every red alert that this person could lay their hands on. One hundred and twenty thousand pain pills per pharmacy per year is a massive result! The fact that the DEA and the FDA fell short of something I typed in 14 seconds shows just how large the failure is (processing that amount of data takes additional time). I reckon that if I started this in 2013, with a monthly dashboard, I feel 99.5% certain that the phones of the top brass of the FDA and the DEA would be red hot from every politician that saw those results.

If I had changed it towards:

SPLIT FILE PER YEAR STATE pharmacy.
FREQUENCIES
/NOTABLE
/STATISTICS=mean MIN MAX STDDEV.

I would get a lot more to work with, in addition as those who do not prescribe pain pills would not be part of the numbers, the results would be rather interesting to read and this is merely top line results, when we start digging into the numbers and start looking into the specifics like Kroger Pharmacies (KY) and Walmart Pharmacies (KY) and look at them per state (merely examples) we will get an even more descriptive stage of the data involved, so when B. Douglas Hoey stated: “The numbers don’t always tell the whole story” he ended up being more wrong than you could ever imagine, it is not merely the numbers, it is about asking the right questions, but he did not offer that point of view, did he?

The failure of the DEA becomes a larger issue when we see: “A DEA spokesman said he could not provide a complete list of all enforcement actions by the agency against pharmacies nationwide for violations of the Controlled Substances Act“, this shows a failure in logistics and organisation, In all this the National Community Pharmacists Association has a larger role to play, if the quality of a pharmacy is everything, any association would need to remain aware of any legal and prosecution issues playing, not merely because it is a prosecution or an action, but it is up to the association to make sure its members are aware of issues that play in the legal and enforcement field in all this, so there is a carpet hiding a truckload of trash, even as we point at the DEA, the failure is actually larger and involves pharmaceutical corporations, the FDA, the DEA, the Pharmacy association, as well as optionally accounting, bought and sold pills should be in the audit, something this big would have had to show up, unless the books were designed to keep such numbers out of view, yet when one player (Strosnider, Mingo County, WV) sells 13,168,350 pills whilst prescriptions are set to $6 per pill, that one place has to book $13 million dollar per year on pain pills only, and that was NOT noticed?

Go cry me a river!

The failure is large, the stage that the Washington Post gives us is merely one side, the NY Times gives another part, but the overall failure where the US government collects all data and does nothing is the real largest failure. As the NY Times gives us: “the eight individual Sacklers who are typically named in the litigation argue that because they have been sued for their roles with Purdue, Purdue’s protection in bankruptcy court should cover them too“, yet the US government (specifically FDA and DEA) had the data and for the longest time they apparently did nothing, in a stage of such a systemic failure, will anything ever get resolved?

 

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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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Go cry me a river

OK, at times it is important to keep a moral foundation towards the actions we take. Some people (the non-Germans) were hesitant to be named a recipient by Adolf Hitler. There are Africans that did not consider accepting any honours from Idi Amin Dada; there was opposition by some towards the grants from Muammar Al Gadhafi, even if he looked like Jeffrey Ross. Many have been in a place where question marks are held high. Yet I think that we have taken the left to a whole new level (of stupidity) when we see: ‘Austerity forcing arts institutions to accept gifts from billionaires‘ (at https://www.theguardian.com/culture/2019/mar/22/austerity-forcing-arts-institutions-to-accept-gifts-from-billionaires). The setting here is: “More than £100m of government cuts to annual arts funding has forced the nation’s top art galleries, theatres and opera houses to accept gifts from billionaires, including the controversial Sackler family, which made a fortune from the deadly opioid painkiller crisis“, I am not in a financial happy place, so when the Sackler family gives me a £5 million grant, I will bow, smile and say “Thank you very much!” You see, the question is not what their morality allowed for, the question becomes, were criminal acts done?

It is important to take another look at https://www.theguardian.com/us-news/2019/mar/21/sackler-family-500-cities-counties-and-tribes-sue-oxycontin-maker, where we are introduced to: ‘Massive lawsuit says Sackler family broke laws to profit from opioids‘, even as we see the word ‘lawsuit’, that does not imply that the law was broken. There we see: “accusing members of the Sackler family, who own the maker of the opioid painkiller OxyContin, of helping to create “the worst drug crisis in American history”“. I am also very aware of the state of accusation that is given with: “Court documents accuse the eight family members of purposely playing down the dangers of the prescription painkiller OxyContin, which is more potent than heroin or morphine. They are accused of deceiving doctors and patients and directing sales and marketing techniques that drove huge over-prescribing and ever stronger doses for many patients who should never have been prescribed the pills in the first place“. In that text the two words that matter are swept under the carpet. The part ‘prescription painkiller‘ is at the centre of that part and there we see a clear shift. In this he first issue becomes the GP, or medical professional that prescribed the painkiller in the first place. Then we get the FDA (the US Food and Drug Administration) who should have put an initial stop to the issue if there was one. Was this done? As we now see the claims like ‘House Democrats Want More Information On Sackler Family’s Role In Opioid Epidemic‘, and a whole range of other accusations, we need to take a larger look. The FDA gives the direct part: “Get emergency help right away if you take too much OXYCONTIN (overdose). When you first start taking OXYCONTIN, when your dose is changed, or if you take too much (overdose), serious or life-threatening breathing problems that can lead to death may occur. Never give anyone else your OXYCONTIN. They could die from taking it. Store OXYCONTIN away from children and in a safe place to prevent stealing or abuse. Selling or giving away OXYCONTIN is against the law.

In addition we find information like: “Oxycodone is used for managing moderate to severe acute or chronic pain when other treatments are not sufficient.” again we see ‘when other treatments are not sufficient‘, now we see the crying of a collection of bitches whilst the direct investigation on these patients has optionally not been done. When we look at the history of these people and to what was initially prescribed we are likely to find a whole range of crying whiners who shouted and screamed for the strongest painkillers neglecting other alternatives, I feel certain that with all the data I would be able to find well over 10% failing the case from the very start. There is documentation on OxyContin going back to 1996, and NOW we see an optional case? 22 years later? I believe that there is a much larger issue in play. I believe that responsible parties have given in towards whining patients for decades, so is the Sackler family to blame for any of that? I do not believe that to be the case.

In addition we see: “Among the eight Native American tribes suing the Sacklers are parts of the Cherokee, the Chippewa and the Sioux, the Oneida Nation and the Blackfeet. Drug overdoses now kill more than 72,000 people in the US a year, according to government figures from the Centers for Disease Control and Prevention, and 49,000 of those are caused by opioids.” We see the facts, yet who prescribed these drugs? The direct and simplest of questions and none of the articles give a correct or decent answer, the direct application of the failing of the Unites States through lawsuits that will not go anywhere ever. I am decently certain that when the doctors are called to testify and they describe the harassing and badgering patients that needed more and more and stronger painkillers, we will see a prescription failure to a much larger degree. In this light it is important to take the Native American Tribes into view as well. From my point of view there is a whole different range into the need of medication between rural (Native American or not) and metropolitan medication needs. That too must be taken into account. In addition, such an overload of opioids also puts the pharmacies into view. They have a duty to report such an increase of prescribed of opioids, as well as the physicians prescribing them. I will give you one better, the TV show Lou Grant (1978-1982) actually had one episode focused on that issue, an issue before OxyContin was in existence. A systemic failure brought into the limelight by a TV series and well over 13 years before there was OxyContin, so at this point, is there a clear directive to take a much larger view before you merely throw your lawsuit needy fingers towards the Sackler family?

And the clear part is that I am not stating that they are innocent, I am showing that there are at least three iterations of optionally guilty parties and involved players that should find themselves defending their actions in the courts before there is even a remote chance to have a go at the Sackler family and the FDA might be in court long before the Sackler members are.

So whilst you want to have a go at la dottore Raymond Sackler, be aware that those trying to make that jump will lose funds and cash by not doing their homework form day one and it took me a mere 187 seconds to realise that after these two articles were read. The biggest part is seen with: “This nation is facing an unprecedented opioid addiction epidemic that was initiated and perpetuated by the Sackler defendants for their own financial gain, to the detriment of each of the plaintiffs and their residents. The ‘Sackler defendants’ include Richard Sackler, Beverly Sackler, David Sackler, Ilene Sackler Lefcourt, Jonathan Sackler, Kathe Sackler, Mortimer DA Sackler, and Theresa Sackler,” this week’s lawsuit states“, no mention of the FDA approval, no list of hundreds of physicians prescribing the substance and no mention of a properly investigated medical history of the victims, all that got the limelight from the mere mention of ‘prescription painkiller‘. The fact that a TV Series like Lou Grant took an episode to show the failing of some physicians in such a situation was merely the icing on the cake called: “Laughingly created Court failure“.

As stated, I am not stating that they are guilty, not merely as they are presumed innocent, especially in light of the failed required elements in all this, the fact that some articles are loaded with emotion absent of 22 years of evidence that never required to await the court date is the added bonus that makes this all an optional failure, the application of common sense wins again!

In addition, consider the quote: “Court documents accuse the eight family members of purposely playing down the dangers of the prescription painkiller OxyContin, which is more potent than heroin or morphine“, yet I see no mention or any accusations towards the FDA, are they not the authority that people should turn to? Where were they in all this? Where are the approving physicians in all this? All direct questions, all without any answers. So when we consider the statement: “Drug overdoses now kill more than 72,000 people in the US a year, according to government figures from the Centers for Disease Control and Prevention, and 49,000 of those are caused by opioids.” How many of those are merely junkies looking for a fix? How many were due to illegally obtained drugs and painkillers? I wonder what remains of these numbers when we take a deeper look at that part of the data cake sliced on those influencing factors. When we do that those numbers might dwindle down for up to 80% making this a non-case and a non-event from the very beginning.

Good luck to those who shout: ‘prosecute’ whilst ignoring common sense of the matter at hand.

 

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The wrong claim to make

I have been taking a much larger interest on the entire Facebook and Cambridge Analytica issue. Not because of what was done, but because of what US politicians are about to try. In that view it seems to me that the media is assisting the US government. Pretty much every media publishes ‘Zuckerberg on Tuesday faced a variety of questions from 44 senators‘, yet not one gives us that list of these 44 senators. Online publication Vox had a list of 103 which was equally useless. So why are the readers not getting properly (read: more completely) informed?

As I have a promise to keep (to myself at least), let’s take a look at the first one who really pissed me off. The person in question is U.S. Representative David McKinley, not even a senator. Yet with the quote “Your platform is still being used to circumvent the law and allow people to buy highly addictive drugs without a prescription. With all due respect, Facebook is actually enabling an illegal activity and in so doing, you are hurting people. You’d agree with that statement?” he opened himself to all kinds of issue. So let us take a look. CNN gives us (at http://money.cnn.com/2018/04/11/technology/mark-zuckerberg-questioned-over-facebook-opioid-sales), with the additional quote “Google agreed to pay $500 million to the Department of Justice for showing prescription drug ads from Canadian online pharmacies to U.S. consumers. It stopped the practice in 2009 once it became aware of an investigation by a U.S. Attorney’s office. But sellers are still finding ways of posting about drug sales on platforms like Facebook and Instagram, which critics have accused of being reactive, largely waiting for activists, or the press, to surface issues and help police their platforms“, so the issue is a lot larger and has been around for a long time. So the US representative is not opening legal avenues attacking the Canadian Online pharmacies, no it is attacking Facebook and Google. The issue here is hypocrite on several levels. You see we see part of that evidence (at http://www.cbc.ca/news/opinion/oxycontin-in-canada-1.4607959), even as the investigation into Purdue Pharma is underway, the issue is a lot larger. We get one part from ‘OxyContin was aggressively marketed as a revolutionary painkiller. But many patients became addicted, leading to a country-wide class action lawsuit against its maker‘, the other part is seen in the NPR event “Doctors In Maine Say Halt In OxyContin Marketing Comes ’20 Years Late’“, so we see the news that is given in February 2018. These facts alone give rise to the geriatric dementia dangers that are possibly within business man David McKinley, a man currently elected as a U.S. Representative. In addition to that part, the fact that the US government failed its citizens is open to discussion in the 2015 release of “the Food and Drug Administration. (FDA) approved, in August 2015, extended-release oxycodone for use by children between 11 and 16 years old with “pain severe enough to require daily, around-the-clock, long-term opioid treatment for which alternative treatment options are inadequate“, so there is a much larger failure in play. The fact that the FDA approves (for specific reasons mind you) the use of OxyContin and the fact that it is FDA approved makes it a much larger issue.

The fact that there is ample evidence that US politicians were sitting on their hands for close to 2 decades gives rise to the thought that U.S. Representative David McKinley should give up his seat in what I personally would see as too old to hold any public office position, perhaps at 71 he no longer sees the need to correctly set the dimension of information of any issue. His attack, the fact that this is a lot more complex, in part because the US government chose to not act for 2 decades is also decent evidence to add in this case. In addition, we see that the reformulation to make it harder to abuse opioids (which is an act that makes perfect sense), gave way to ‘Making opioids harder to abuse led to a spike in heroin overdoses‘ (at https://www.axios.com/opioids-heroin-overdose-deaths-1523481019-63cfb423-e1fc-4925-9a80-3406625389b5.html). Here we see “Adapted from Evans et. al., 2018,  “How the Reformation of OxyContin Ignited the Heroin Epidemic”, The National Bureau of Economic Research; Note: “Opioids” includes all opioid related deaths aside from those that are exclusively attributed to heroin“, so basically the junkies and their facilitators found another way to get high and they died in the process (serves them right). It seems that as I found all this evidence in less than 30 minutes and there is almost 20Mb of unread text for me to go through, shows just how lame (or is that blatantly idiotic) U.S. Representative David McKinley is showing himself to be. There is an accepted issue that in some cases non-US advertisements have no business being shown in the US, yet in that situation, my e-mail wad been flooded with the options for silicone tits, 14 inch sausages, Viagra and Cialis for well over a decade from US sources, so how much ‘policing’ did these US senators opt for from 1996 onwards to ‘protect’ non US citizens from these ‘illegal’ drugs? It seems to me that this is an almost perfect example of ‘sauce for the goose, sauce for the gander‘, yet we can feel decently certain that U.S. Representative David McKinley will not see it that way. In addition to that CNN gives us “More than 63,600 lives were lost to drug overdose in 2016, the most lethal year yet of the drug overdose epidemic, according to a new report from the National Center for Health Statistics, part of the US Centers for Disease Control and Prevention. Most of those deaths involved opioids, a family of painkillers including illicit heroin and fentanyl as well as legally prescribed medications such as oxycodone and hydrocodone. In 2016 alone, 42,249 US drug fatalities — 66% of the total — involved opioids, the report says“, this has been going on for a while; this was not merely some Facebook advertisement issue. The CDC shows data going back to 2000, long before Facebook became the behemoth entity it is now. So whilst everyone is kicking up every stink in the place, the issue remains that the FDA approved Purdue Pharma to start making it, so even as U.S. Representative David McKinley could have been visiting their office in Stamford, Connecticut, USA. It is now shown that kicking it on the soul of Mark Zuckerberg is much more personally rewarding for him. In that his quote “why Facebook hasn’t done more to remove posts from sellers offering illicit opioids“, in equal measure does not show the efforts that the FBI has done to crack down on the sellers either. You see, if he had done that we would have ended up (at https://www.cbsnews.com/news/opioid-fentanyl-darknet-drugs-fbi/), showing just how easy it is to the evidence we see here: “Attorney General Jeff Sessions said darknet vendors are “pouring fuel on the fire of the national drug epidemic” and this year doubled the number of federal agents working on those cases. It’s part of the Trump administration’s tough approach to the drug crisis that has focused on harsh punishments for dealers. Critics say the overall strategy resembles a return to failed drug-war tactics and that the record $4.6 billion included in the spending plan the president signed last month is not nearly enough to establish the kind of treatment system needed to reverse the crisis“, it does not absolve Facebook, but it shows that when you are in a house without a roof, blaming the faucet for all the water is just as stupid as it gets. So with this small article I introduce the honourable U.S. Representative David Bennett McKinley, who should, as I personally see it, be up for replacement at the next election.

And may he be replaced by someone who truly takes a proper look at the dimensionality of events and present them equally correct and fair. So we will leave that consideration up to the people who are part of the West Virginia’s 1st congressional district. I reckon that with a population of 615,991 (2010) there is at least one other person who is up for the job.

Now, let’s take a look at the data of the next elected numbskull, have a great Friday all!

 

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