Monthly Archives: October 2017

Dealing in Death

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Last week President Trump declared opioids a national public health emergency. You may know the depressing statistics. More than 183,000 opioid-related deaths in the last sixteen years, the number of heroin overdoses tripling in just a few years, 78 opioid-related deaths per day in America alone. About 1,000 people are treated by hospital emergency departments every day for using opioids in a manner not prescribed by a doctor.

On any given day about 3,900 Americans initiate the use of non-prescription opioids and 560 use heroin for the first time. Oddly, these statistics are related.

You should also know that about 650,000 opioid prescriptions are dispensed in the United States every day, and that number has increased tremendously during the last 25 years. In fact, American doctors write about 80% of the planet’s opioid prescriptions. We are apparently a country in a great deal of pain.

You know that quite often what happens is that someone will be prescribed an opiate following surgery or another medical procedure, and the prescription includes enough medication to addict the individual (I came home with a couple of bottles of pills following arm surgery but one pill was enough for me; I hated the way it made me feel). Then the doctor cuts the patient off and will not renew the prescription. The addict has two choices: She can either begin doctor shopping to find other doctors to prescribe the opiates or she can turn to a cheaper opiate called heroin. In some areas a heroin fix can be bought for about $10.  So a good many folks use heroin for the first time each day because their opioid prescription ran out.

This is all depressing stuff. A while back I wrote about our son’s heroic and successful struggle with opioid abuse, so at a visceral level I understand how depressing it is. To date he has buried at least nine friends and most died from opiate overdose. The ones I knew were good kids. Really good kids.

Here is the thing: Greed and profit are a large part of this problem. Two examples should suffice.

The first example comes from this week’s The New Yorker magazine.

As explained by New Yorker, OxyContin was developed by Purdue Pharma, a company in Connecticut. OxyContin contained oxycodone, a poppy-derived drug that was already being sold as Percodan and Percocet. But OxyContin took it to the next level because it was pure oxycodone (not mixed with aspirin or acetaminophen) produced in doses of up to 160 milligrams. Just so you know…that is a lot!

When Purdue consulted doctors prior to releasing OxyContin the doctors expressed concern about the potential for higher levels of addiction but Purdue released the drug without any research on its addictive potential. The FDA allowed the release of OxyContin and even stated that the drug was less addictive because of its patented time release formula. And, by the way, the FDA administrator who released that statement left the FDA and, you guessed it, took a job with Purdue Pharma.

OxyContin was prescribed for both severe and moderate pain levels. Within five years the drug was producing a billion dollars a year for Purdue Pharma.

Within a short time some abusers began to realize that OxyContin could either be ground into a powder and snorted or added to liquid and injected, thus overriding the time release agents. This as more and more doctors prescribed the drug in large quantities leading to a black market for those selling the pills they didn’t use. Some doctors began prescribing the drug like it was M&M’s.

Rather than taking responsibility for producing a highly addictive drug and promoting its wide distribution, Purdue began a campaign blaming OxyContin addiction on the addicts.  Purdue’s ads stated that the drug provided twelve-hour pain relief, but that wasn’t always the case so patients took more than prescribed. And when patients began reporting itchy feelings and other symptoms of addiction to their doctors, Purdue coined the phrase “pseudo addiction”, again blaming the patient.

When Purdue Pharma came under attack by the medical community and others because people were crushing and snorting OxyContin and because of its high addiction rates, Purdue reformulated the drug making it more difficult to crush. Good idea, right? Well…except that the patent on OxyContin was about to expire and changing the formula kept generic options of the drug from being distributed. The company profited from the formula change. And the higher price of the reformulated drug drove those who could not afford it to heroin. In fact one academic paper found that the current heroin crisis is a result of the OxyContin reformulation. The correlation between the new formulation and rising heroin deaths is almost indisputable.

The bottom line is that in spite of evidence that OxyContin was extremely addictive, the pharmaceutical company profiting from it kept producing it, aggressively marketing it, and blaming negative consequences on the consumer. Mike Moore, Mississippi’s attorney general, said it best when he stated that tobacco companies and Purdue Pharma were similar because “they’re both profiting from killing people”.

Interestingly, I stumbled upon a second example published on the CNN website   yesterday. A story similar to that of OxyContin but involving Endo Pharmaceuticals and its drug, Opana ER, a very addictive pain killer.

In 2012, according to CNN,  Endo actually pulled Opana ER off the market because it was so addictive and because it was being crushed and snorted and was killing people. Endo also sued the FDA to keep a generic version off the market, ostensibly for the same reason (addictive and killing people). Very altruistic, right? Well…not so much.

As you may anticipate, Endo actually reformulated Opana ER with a hard shell to make it difficult to crush and snort. The new formula also included a few other new active ingredients. Addicts figured out how to bypass the crush/snort conundrum by liquefying and injecting it with a needle.

This summer the FDA found that reformulated Opana ER was no safer and, uncharacteristically, pressured Endo to stop selling it. I wish this had a happy ending, but it doesn’t. The FDA order only impacted the reformulated drug with the hard coating, not the original crushable/snortable version. You can probably guess what Endo did. The company contracted with another company to begin producing the original formula under a generic name. So Endo will be making a profit off a drug that in 2012 it said was too dangerous for patients. And Endo will now be responsible for a generic version of Opana ER, something it sued the FDA to keep off the market.

Endo has earned between $160 million and $380 million in annual profits from Opana ER.

I’m generally in favor of economic competition. Our cars, phones, clothes, and groceries are higher quality and less expensive because we have choices. Back when Ma Bell controlled almost all the phone services and phones, for example, they were still connected to walls with wires and did nothing but, you know, make calls. Because of competition my phone does much more. The same is true of other goods and services and the competition means less government regulation is necessary (though some is still required).

Competition doesn’t work with pharmaceuticals. Greed and profit cannot determine what drugs are released onto the market. Remember Martin Shkreli increasing the cost of Danaprim from $13.50 to $750 per pill? Remember the six-fold increase in the cost of the lifesaving Epi-Pen in a ten year period? Then think about the stories I just shared.

Saving lives and managing pain should not be based entirely on profits because the temptation to sacrifice lives for money is apparently just too great for some folks and companies.

 

 

 

Living Like There is No Tomorrow II

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Several months ago I lost what I thought was a long time friend when I posted a comment on our seeming willingness to destroy the only planet on which we may currently live. I’m still baffled that this issue is controversial, especially so controversial that it ends friendships. How can anyone not be concerned about clean air, clean water, and leaving a stable environment for our children?

I just can’t seem to let this topic go. Guess I’ll jeopardize more friendships.

The Government Accountability Office (GAO) is a non-partisan arm of the United States Congress that audits and evaluates government programs. GAO audits how the government spends money, among other functions. A few days ago a report from the GAO further validated my earlier post expressing concerns regarding the environment. This report recommends taking climate change seriously and finding ways to address it because failure to do so will result in consistently increasing costs passed on to the taxpayers. Extreme weather likely resulting from a changing climate, says the report, has already cost billions of dollars during the last decade and will cost much more in the future.

And GAO isn’t the only agency reaching this conclusion. Most American scientific research on the topic has been conducted by NASA, and that agency reports that global temperatures have increased by 2 degrees since the late 19th century, that carbon dioxide levels in the atmosphere are at their highest level in 650,000 years, and that arctic ice is shrinking by 13.2% per decade. NASA also calculates that there is a greater than 95% probability human activity is causing this drastic change.

And even the U.S. Military is concerned about  and preparing for national security related issues related to climate change. A 2014 report by The Military Advisory Board which is composed of 16 retired flag-level officers from the various branches of the military wrote that “The potential security ramifications of global climate change should be serving as catalysts for cooperation and change. Instead, climate change impacts are already accelerating instability in vulnerable areas of the world and are serving as catalysts for conflict.” 

Did you know that large portions of Australia’s Great Barrier Reef are already dead because of rising ocean water temperatures? This is occurring about 30 years earlier than scientists had predicted.

Did you know that about 40% of animal and plant species that are tied to a specific geographic range have shifted more during the last 30 years than at any time in the last 10,000 years? They are being forced to move because they are dependent on certain temperatures, rainfall, and other environmental factors, and the acceptable range is shifting.

Did you know that plants rely on “seasonal cues” in the spring and fall that determine when they begin to grow or go dormant, and that during the last 30-40 years many plant species have begun taking their seasonal cues from 15 to 20 days early?

Did you know that warming temperatures could extend the range for mosquitoes thus making the spread of mosquito-borne disease more likely? It is possible that last year’s spread of the zika virus to 23 countries was an early example of what our future holds.

The Intergovernmental Panel on  Climate Change is composed of hundreds of scientists across the planet and the Panel releases a report on climate change every few years assessing literature on climate change. The last report was released in 2014 (the next will be released in 2021 or so) and analyzed more than 30,000 scholarly papers on climate change. The report, written by 800 authors, concluded that “human influence on climate change is clear”, and that we “have the means to limit climate change and build a more prosperous, sustainable future”.

These facts are overwhelmingly accepted by the scientific community. They are primarily rejected only by corporations and others benefitting from the status quo. Sure, it is possible to find “reports” debunking these conclusion, but close attention to the sources of those rebuttals is important. How many of those reports concluding that climate change isn’t real are published in academic journals and withstood a rigorous approval process prior to publication?

And even if the scientists are wrong, why is promoting a clean environment a bad idea?

And even if the scientists are wrong shouldn’t we err on the side of caution if our children’s future may be in the balance?

Those opposing governmental action often argue that switching to renewable energy would have a detrimental impact on our economy. The truth is that more jobs are created by converting to renewable energy than by continuing to use fossil fuel. It is estimated that three times more energy-related jobs would be created by 2025 if we moved toward renewable energy. Moving away from coal and natural gas would also reduce “breathing problems, neurological damage, heart attacks, and cancer” associated with fossil fuels.

Oh, and that GAO report I mentioned earlier? It strongly recommended specifically that the Trump administration immediately begin formulating a serious response to this threat. A logical response is supporting renewable energy and moving away from fossil fuels.

But if you want to know what the Trump administration has actually done regarding the environment you can read this article released yesterday by National Geographic. I doubt you will be surprised.

No other issue facing the human race is as significant as is this.

 

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The Constitution’s 2nd Amendment

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I often become amused and/or frustrated when I read people’s comments about “Constitutional rights” when they likely have never read the Constitution and almost certainly don’t know it’s history. People say stuff like “my right to (fill in the blank) is protected by the Constitution” when, in fact, that right is often never mentioned or implied. A few years ago Newsweek polled 1,000 Americans and found that only 30% knew that the Constitution was the supreme law of the land. In a previous post I mentioned the dismally low number of Americans who could name a single First Amendment right, who knew that the Constitution provides three branches of government, or who could name one branch of government.

But Americans still feel comfortable relying on their “Constitutional rights” when doing so supports their cause. Suddenly everyone becomes a Constitutional scholar!

“Constitutional law” is an area of study that covers what is actually written in the United States Constitution and how that document’s passages have been interpreted, primarily by the Supreme Court, since the 1790’s. Anyone familiar with this body of law knows that 1) much of the Constitution is vague and inapplicable to contemporary society because it was written in a different era (it requires states to pay debts using gold or silver coin, for example), and 2) the Court has interpreted the document’s passages thousands of times in the last 220 years BECAUSE those passages are vague and inapplicable to contemporary circumstances.

Here are a few examples of Constitutional passages and how they have changed:

1st Amendment

The first amendment in the Bill of Rights protects freedom of speech, press, religion, assembly, and the right to petition the government for redress of grievances. Are these rights absolute? Do I have unrestricted freedom of speech and religion, for example? Obviously not.

  • I have freedom of speech but that doesn’t mean I have the right to slander another person’s reputation.  And as stated by Justice Oliver Wendall Holmes, freedom of speech does not give me the right to yell “fire” in a crowded theater.
  • I have freedom of religion but I cannot use that freedom to justify smoking marijuana or ingesting peyote in my religious ceremony or to justify human sacrifice.
  • I have freedom to assemble but that doesn’t give me the right to block busy streets or sidewalks or to damage property with my assembly.

4th Amendment

This Constitutional provision protects us from “unreasonable search and seizure”, meaning the government must have a warrant to search our property. This was written at a time when almost all property was fixed in a certain location, so our houses were easy to identify for search. But:

  • The authors of that provision could not have imagined automobiles, trains, airplanes, or other such “movable property” that can be hundreds or thousands of miles away before a warrant can be secured and served.
  • The authors could not have imagined searching through someone’s urine for illegal drugs as a form of search.
  • They could not have imagined using drug sniffing dogs to find illegal substances being transported in cars or luggage.
  • And using airplanes or helicopters to search for marijuana fields was beyond the authors’ comprehension.

8th Amendment

This passage protects Americans from “cruel and unusual punishment” at the hands of the government. The authors could not have imagined waterboarding, over crowded prisons, refusing meals to inmates, or contemporary forms of torture. The authors probably had things like the rack and thumb screw in mind (of course those were pretty nasty as well). The Court has expanded the 8th Amendment to prohibit any severe punishment that is inflicted arbitrarily, so it has been used to prohibit some forms of execution, overcrowded prison cells, denying prison inmates adequate food, etc.

I could continue because almost every major Constitutional passage has been interpreted over time to make those passages conform to contemporary circumstances.

Which brings us to the 2nd Amendment: 

“A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear arms shall not be infringed”

Before I begin I should let you know that I am a gun owner and that I enjoy shooting; mostly shooting “at” skeets and targets because I tend to miss more often than not.

There is little doubt that when the 2nd Amendment was passed the authors intended for every citizen to have the right to possess firearms because all citizens could have technically been a part of the militia. Since there was no real standing Army that was the way we defended ourselves against invasion.

There is also little doubt that many of that period’s leaders wanted an armed citizenry as protection against an overzealous or oppressive government. Richard Henry Lee said “To preserve liberty, it is essential that the whole body of the people always possess arms and be taught alike, especially when young, how to use them.”  Being taught how to use firearms was also something the Founders expected.

But…here is another Constitutional passage that is often overlooked by those arguing against gun control.

“The Congress shall have Power … To raise and support Armies, but no Appropriation of Money to that Use shall be for a longer Term than two Years; To provide and maintain a Navy; To make Rules for the Government and Regulation of the land and naval Forces; To provide for calling forth the Militia to execute the Laws of the Union, suppress Insurrections and repel Invasions.” 

Why is this important? Because the Founders stated that standing armies could only be authorized for two years but a Navy could be “maintained”. They knew that a Navy was our first line of defense against invaders but a standing Army could be used to oppress the people. So their intent was for a militia to serve the purpose served by an Army (except in extraordinary circumstances when an Army would be formed). And the militia’s responsibility was executing laws, putting down insurrections, and repelling invasions that got past the Navy. They wanted to be certain no Army could oppress or suppress the public. They also wanted to be sure that all able males owned a gun for the purpose of putting down insurrections (there had been a few by that time) and repelling invaders.

The 2nd Amendment was not intended to give citizens the right to own weapons for personal self defense.

Also, as the well known argument goes, the weapons the Founders had in mind were mostly flint locks, blunderbusses, and single shot carbines. They were not the rapid fire, high caliber weapons capable of killing 58 people and wounding more than 500 in eleven minutes. I’m fairly confident the Founders NEVER considered this possibility.

So here is the question:

If we know freedom of speech, search and seizure, cruel and unusual punishment, freedom of the press, freedom of assembly, freedom of religion, and every other Constitutional provision of the Constitution (many such as the Commerce Clause, the Guarantee Cause, the Presentment Clause, and countless others too complicated to discuss in a 1200-word blog post) have evolved over time to meet contemporary circumstances, why is there resistance among some Americans to doing the same with the 2nd Amendment? There is absolutely no doubt the Founders’ view of “arms” was quite different from those available today.