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PaperclipPerfector  2mo ago (text post)   28302 thread views

Culture War Roundup for the week of June 24, 2024

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I guarantee that you, the plaintiff, the FDA, nobody has any sort of rigorous line on when it is "necessary".

As Armin pointed out what counts as "necessary" is dependent upon the situation, patient etc.

But, while it appears you have read the article, you didn't read the links contained within it. I don't blame you for not doing so, legal documents are really long and boring, but that's what you're actually looking for. The meat of the accusations is in fact contained within them. So when you make a comment like

And it's not like their marketing is ever going to be like, "Hey doctors, you should prescribe a higher dose even when your patient responsibly wants a lower dose,"

We can actually turn to the prosecution and see what they were doing.

Together, these drug manufacturers (the “Manufacturer Defendants”) collaborated to falsely deny the serious risks of opioid addiction generally, and high-dose opioid prescriptions specifically. At the same time, they created and promoted the concept of “pseudoaddiction”—a made-up term designed to re-cast familiar symptoms of addiction as signs that patients needed more opioid drugs. They falsely claimed that their opioid drugs could be counted on to improve chronic pain patients’ function and quality of life, and that their extended-release opioid formulations would provide effective pain relief for 12 hours, when they knew there was no scientific support for those claims. And they misleadingly suggested that other pain relief methods were riskier than opioids, while falsely claiming that opioid dependence and withdrawal could be easily managed and effectively prevented with unproven screening tools and management techniques.

Each Manufacturer Defendant spent millions of dollars over the following decade to push these fraudulent messages. They pushed their own name-brand drugs by “detailing” their sales representatives to target susceptible doctors with in-person visits, flooding medical publications with deceptive advertisements, and offering consumers discount cards to entice them to request treatment with their products. And they collaborated to promote the overall expansion of the opioid market by sponsoring misleading Continuing Medical Education (“CME”) seminars and manipulating seemingly independent organizations (“Front Groups”) that the manufacturers funded and disguised as “unbiased” sources of cutting-edge medical research and information. Both the Front Groups and CME seminars depended on co-opted doctors—so-called “Key Opinion Leaders” (“KOLs”)—that the manufacturers recruited and paid.

They were, in fact using aggressive marketing techniques and deception to convince doctors to prescribe higher doses when their patient responsibly wanted a lower dose. They took the symptoms of addiction and claimed that they were actually signs of a condition which required more opioids!

But in any event, what does your magic, yet-unknown line of "necessary" have to do with addiction? What's the model connecting this completely unknown thing to rates of opioid addiction?

There's nothing magic about the opinion of a medical professional. There's nothing unknown or mysterious about the idea that a trained medical professional or doctor would know the appropriate amount of painkillers to give to their patient. Purdue Pharma interfered with this and produced fraudulent research which gave both large financial incentives and a figleaf of justification to encourage inappropriately high doses of opioids (see the Pseudoaddiction concept above). That's the connection, and it is outlined clear as day in the charges against Purdue and the Sacklers.

you didn't read the links contained within it.

I did, indeed, read the links contained within it. I'm a legal nerd, and a voracious consumer of text.

They were, in fact using aggressive marketing techniques and deception to convince doctors to prescribe higher doses when their patient responsibly wanted a lower dose.

The bolded part is nowhere in there. Not in your block quote, either.

There's nothing magic about the opinion of a medical professional. There's nothing unknown or mysterious about the idea that a trained medical professional or doctor would know the appropriate amount of painkillers to give to their patient.

Ok, great! Quick question, though... how come Scott talks about adjusting the dose of various medications up/down, depending on how it's going? He's a doctor, and a trained medical professional to boot. Shouldn't he like, just "know" the appropriate amount of whatever drug to give to his patients?

Purdue Pharma interfered with this

I mean, no? Did they, like, jump into the exam room, and when doc was "just knowing" the "appropriate" amount, they interfered and somehow made him increase it?

produced fraudulent research

I mean, also no? They produced (maybe just promoted?) a concept that may, indeed, be wrong. I don't actually know if it's wrong, and there's not enough information in the indictment to know, either. But they didn't actually produce any fraudulent research. It needs to be a hell of a lot closer to "we made up fake data to put in a paper that we submitted for publication" to be considered 'fraudulent research'.

which gave both large financial incentives

What large financial incentives? Come on, man. Stop hiding the ball.

And remember, the thing you're trying to show is that they "were ultimately responsible for and made substantial profits from a legal and corporate structure that heavily encouraged and even induced addiction in cases where it wasn't necessary". So, I'd definitely like to hear some things about their legal and corporate structure.

Ok, great! Quick question, though... how come Scott talks about adjusting the dose of various medications up/down, depending on how it's going? He's a doctor, and a trained medical professional to boot. Shouldn't he like, just "know" the appropriate amount of whatever drug to give to his patients?

No? Regular supervision and adjustment of the dosage is part and parcel of responsible medical care. If he gets it right on the first go, great, and if he doesn't part of his job is adjusting the dosage or even pulling the patient off the drug. Sometimes the patient's condition can change as a result of medication and they don't need as much of it as they recover - a patient recovering and thus not needing as much of a certain medicine as they did before is not evidence that they were never sick and never needed medication.

I mean, no? Did they, like, jump into the exam room, and when doc was "just knowing" the "appropriate" amount, they interfered and somehow made him increase it?

And because it covers the same ground...

What large financial incentives? Come on, man. Stop hiding the ball.

There's no need for scare quotes. Doctors are in fact legitimate medical professionals, and making decisions about dosage is part of their professional responsibility and skillset. There's nothing magical about an anaesthesiologist determining the appropriate level of painkillers for someone based on sex/weight/pre-existing conditions. But yes, they did actually interfere. To quote from one of the legal documents involved...

Purdue’s most powerful tool of deception was sending sales representatives to promote opioids to Massachusetts doctors, nurses, and pharmacists face to face. During sales visits, Purdue reps made false and misleading claims directly to the professionals who care for Massachusetts patients. Purdue assigned reps to specific territories in Massachusetts and gave them lists of Massachusetts doctors to visit.

They sent people out to lie to medical professionals in order to encourage them to sell more Purdue pharmaceuticals.

Each of these in-person sales visits cost Purdue money — on average more than $200 per visit. But Purdue made that money back many times over, because it convinced doctors to prescribe its addictive drugs. When Purdue identified a doctor as a profitable target, Purdue visited the doctor frequently: often weekly, sometimes almost every day. Purdue salespeople asked doctors to list specific patients they were scheduled to see and pressed the doctors to commit to put the patients on Purdue opioids. By the time a patient walked into a clinic, the doctor, in Purdue’s words, had already “guaranteed” that he would prescribe Purdue’s drugs. Purdue rewarded high-prescribing doctors with coffee, ice cream, catered lunches, and cash. Purdue has given meals, money, or other gifts to more than 2,000 Massachusetts prescribers.

And they were actually just paying and bribing doctors who prescribed large doses of opioids. Literal kickbacks! They actually made up fake case profiles and patients in order to convince doctors to hand out oxycontin even when it wasn't necessary or dangerous.

Purdue trained its reps to show doctors charts emphasizing Medicare coverage for its opioids and use profiles of fake elderly patients, complete with staged photographs, to convince doctors to prescribe opioids. As a Massachusetts sales rep observed, a fake patient profile “brings the heart into it” and helps get the doctor to say: “Yes, they need this medication.”

I mean, also no? They produced (maybe just promoted?) a concept that may, indeed, be wrong.

Could it be possible that they made an accurate and true scientific discovery while faking data in order to sell more of their product? I doubt it. The core idea of their marketing was that drug addiction was actually just something that happens to "untrustworthy" people when exposed to drugs, and that "trustworthy" people can be prescribed whatever dose of painkillers you want without any risks. They created numerous bodies to create the misleading impression that pseudoaddiction was a real concept and convince doctors to ignore their actual training. Furthermore, they knew they were lying!

Purdue knew its campaign to push higher doses of opioids was wrong. Doctors on Purdue’s payroll admitted in writing that pseudoaddiction was used to describe “behaviors that are clearly characterized as drug abuse” and put Purdue at risk of “ignoring” addiction and “sanctioning abuse.” But Purdue nevertheless urged doctors to respond to signs of addiction by prescribing higher doses of Purdue’s drugs.

And remember, the thing you're trying to show is that they "were ultimately responsible for and made substantial profits from a legal and corporate structure that heavily encouraged and even induced addiction in cases where it wasn't necessary". So, I'd definitely like to hear some things about their legal and corporate structure.

The Massachusetts document is the best source for that.

Regular supervision and adjustment of the dosage is part and parcel of responsible medical care.

Ok, great. So you agree with Purdue's materials.

During sales visits, Purdue reps made false and misleading claims directly to the professionals who care for Massachusetts patients.

What false and misleading claims?

in-person sales visits

...like what is done for literally every other drug out there? You say that this is 'literal kickbacks'. Prosecute that shit for any of the hundreds of other drugs where they do similar in-person sales visits, and then I'll think about believing you.

show doctors charts emphasizing Medicare coverage for its opioids and use profiles of fake elderly patients, complete with staged photographs

So, like, a training mock-up?

Could it be possible that they made an accurate and true scientific discovery while faking data in order to sell more of their product?

Dawg, you skipped the part where you were supposed to show that they faked data in research.

Ok, great. So you agree with Purdue's materials.

This doesn't even reach the level of a bad faith attempt to understand my position or argue with the ideas I actually hold. If you think that's an honest estimation of my views on the topic then I don't think there's any point talking anymore because we clearly aren't communicating with each other.

I think it's an honest estimation of the words that you are saying and how they map to the materials in question, mostly because it doesn't seem like you've actually read the materials in question. It's supposed to invoke the idea that there is a wide gulf between what your position is/the ideas you actually hold and the words that you are using/what is in evidence. Like, the narrative you think you have going on in your head is just totally disconnected.

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