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  1. #21
    Join Date
    Nov 2007
    Location
    Vermont
    ^ "in part due" to marketing? I think that's something of a gigantic understatement...Purdue pushed OxyContin beyond any reasonable limit. That's why they're forking over billions now (not that that's sufficient).

  2. #22
    Join Date
    Jan 2010
    Location
    Outside Philly
    Quote Originally Posted by WillJ View Post
    I don't want to defend the particular McKinsey statement, but economists like me always want to remind people that the optimal number of bad things happening is often not zero.

    Consider speed limits for cars. About 40,000 people died in the U.S. last year in car accidents, the global total is a large multiple of that, and most of these deaths are young people in good health. It's a terrible tragedy. We could greatly cut down on those deaths if we reduced speed limits substantially. Why don't we do that? It seems that we have, collectively, made the judgment that we're willing to trade off the time savings and convenience of faster travel for thousands more deaths each year. There's nothing intrinsically wrong with that collective decision.

    More controversially, consider Covid restrictions. We could drive the infection rate close to zero if we all stayed in our house (which is what I'm pretty much doing myself), but opinions vary about whether that's worth the cost. Behavior in epidemics are involves a wider range of ethical issues than do speed limits (though there, too, my behavior affects others' risk), but it's still not clear that we should drive the risk of infection to zero.

    With respect to drugs, what if there are drugs that offer very substantial benefits, including added years of life, that also cause death in a small fraction of the treated? If the adverse reaction rate is .00000001 percent, we'd probably say go ahead with the medicine. If the adverse rate is 50 percent, then it's a different story. The general point is that there are tradeoffs to be considered, and that it's possible to underdistribute or overdistribute a medication. Profit motives may lead to over-distribution, but excessive risk aversion by policymakers might lead to under-distribution.

    All that said, the opiod epidemic has been a disaster, and they were obviously wildly overprescribed in many parts of the U.S., in part due to overzealous drug company marketing.
    True. Related to my chemical company example above, the EPA has set all sorts of acceptable risk thresholds for cancer- and other harm-causing levels in the air, water, etc.

    The trouble, as in this this case, is that the company often knows it is either exceeding acceptable risk or knows there is no regulation for a significant risk and doesn't tell anyone, then claims regulatory innocence when it comes to light (Exxon w/ CC, the chemical industry with CFCs, big tobaccos, etc). While often true that technology outpaces regulation, there are some moral, non-economic questions that many companies often fail to ask.

    I won't go into the details but I've been in at least one room where a sticky situation was being discussed in a big company about a supply chain sourcing issue that had moral and human rights implications and the question was asked, "what if we did the most economical thing?" And then that's what the company did...until it came to light through a curious shareholder that submitted a resolution on the matter.

  3. #23
    Join Date
    Sep 2007
    Location
    Bethesda, MD
    Quote Originally Posted by budwom View Post
    ^ "in part due" to marketing? I think that's something of a gigantic understatement...Purdue pushed OxyContin beyond any reasonable limit. That's why they're forking over billions now (not that that's sufficient).
    I say "in part" because there are other culprits, too: irresponsible pharmacies; specific MDs that wrote prescriptions by the bushel to their own profit; the medical profession in general, which underweighted the side effects of opiods; the FDA which did a lousy job of regulation; and of course the individuals who sometimes abused the drugs quite knowingly. Purdue deserves to pay, but allocating them full blame seems, to me, inappropriate.

    Also, remember that prescription opiods are only one prong of the three-prong opiod epidemic - the other two being heroine and fentanyl. The growth in heroine addiction is only partly due to those who gained exposure via prescriptions - drug cartels, mainly from Mexico, expanded their distribution networks in the 2000s to include rural towns that had previously not had easy access to heroine. The Mexican cartels make for less convenient villains, at least in some people's mind, but they have played a huge role in the increased rate of opiod-related addiction and death. See Sam Quionnes' Dreamland. Fentanyl is even scarier in that it can be - and is - distributed by mail and delivery, and the villains in that story are mostly criminals in China, Mexico and, increasingly, India. Going forward, it's fentanyl and heroine that are the main problems.

  4. #24
    Quote Originally Posted by WillJ View Post
    Fentanyl is even scarier in that it can be - and is - distributed by mail and delivery, and the villains in that story are mostly criminals in China, Mexico and, increasingly, India. Going forward, it's fentanyl and heroine that are the main problems.
    Absolutely, fentanyl is much less expensive and easy to acquire by mail. It’s much more powerful and much harder to control dosage. Most people who are ODing on pills are actually taking bootleg pills made from fentanyl. Some bootlegs can be 20 times as strong as a prescription pill.

  5. #25
    Join Date
    Nov 2007
    Location
    Vermont
    Quote Originally Posted by WillJ View Post
    I say "in part" because there are other culprits, too: irresponsible pharmacies; specific MDs that wrote prescriptions by the bushel to their own profit; the medical profession in general, which underweighted the side effects of opiods; the FDA which did a lousy job of regulation; and of course the individuals who sometimes abused the drugs quite knowingly. Purdue deserves to pay, but allocating them full blame seems, to me, inappropriate.

    Also, remember that prescription opiods are only one prong of the three-prong opiod epidemic - the other two being heroine and fentanyl. The growth in heroine addiction is only partly due to those who gained exposure via prescriptions - drug cartels, mainly from Mexico, expanded their distribution networks in the 2000s to include rural towns that had previously not had easy access to heroine. The Mexican cartels make for less convenient villains, at least in some people's mind, but they have played a huge role in the increased rate of opiod-related addiction and death. See Sam Quionnes' Dreamland. Fentanyl is even scarier in that it can be - and is - distributed by mail and delivery, and the villains in that story are mostly criminals in China, Mexico and, increasingly, India. Going forward, it's fentanyl and heroine that are the main problems.
    Fair enough...but what Purdue did was truly remarkable in its scope and irresponsibility. Horrific. You can't read this and avoid an urge to barf: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/

    A 1% chance of addiction eh?

  6. #26
    Join Date
    Sep 2007
    Location
    Bethesda, MD
    Quote Originally Posted by budwom View Post
    Fair enough...but what Purdue did was truly remarkable in its scope and irresponsibility. Horrific. You can't read this and avoid an urge to barf: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/

    A 1% chance of addiction eh?
    All true. There are problems with the way that prescription drugs - not just opiods - make their way to consumers. The "talk to your doctor" mantra works a lot of the time, but the ability of practitioners to wade through the studies and the marketing bs is limited. There is a lot of not-best-practices prescribing out there, and some of it is fueled by irresponsible drug company marketing.

    All that said, it's still true that, as a whole, the drug industry provides remarkable benefits at relatively low cost. Healthcare is exceptionally expensive in this country, but it's mostly not the drug companies.

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