The editors of the Washington Post are outraged that no one associated with Purdue Pharma is going to jail for the epidemic of OxyContin deaths that began a couple of decades ago, at least in part due to the malfeasance of the drug company:
Now comes the Justice Department to announce retrospective accountability for Purdue Pharma, the pharmaceutical company whose heavily promoted OxyContin product probably did more than any other to start the first wave, and without which there probably never would have been the other two. Purdue has agreed to plead guilty to misleading the Drug Enforcement Administration in ways that resulted in otherwise-impermissible amounts of its drug reaching the market, and to paying doctors and others kickbacks for helping increase sales. These felony admissions, which cover conduct over the decade ending in 2017, come with an agreed-upon $8.3 billion worth of fines and other payments that also resolves potential federal civil complaints against the company. Members of the Sackler family — the owners for many years of the closely held Purdue — will be required to pay a $225 million civil fine.
noting that little of that money is likely to be collected. Purdue Pharma filed for bankruptcy a year ago and proving actual knowledge by members of the Sackler family would be very difficult. Civil suits are probably as tough as DoJ can get.
If you don’t like the outcome—blame Congress. They’re the ones who wrote the laws under which the company and the Justice Department are operating. If you don’t like the enforcement of the law, the blame would appear to be bipartisan, with the Bush Administration (2 years of the period in question) and the Obama Administration (8 years of the period in question) both at fault.
Lots of blame to go around. Purdue lied to lots of people and was clearly criminal in their actions. Certainly Congress gets a big share of the blame. However, a lot of it is something you did not mention. Our wealthy people are nw so disproportionately wealthy that they can keep investigations going for many, many years. Our legal system is so skewed towards the interests of large corporations and the wealthy, and it just got worse this week, that it is almost impossible to prosecute them in any timely fashion. Unfortunately I think this also reflects a roader cultural change ie anything you can do to make money is OK as long as you dont get caught or cant lawyer your way out of it. That has always been around to some extent but now it is much more accepted and in some circles even praised.
Steve
Executives at Purdue have a fiduciary responsibility to the Sacklers.
I wouldn’t be surprised if they were out of the loop.
Are Doctors aware that such kickbacks are illegal?
We could or sit back and the sharks of the legal pool (and late night TV ads) dig in. There is a monster size class action suit pending maybe bigger that the tobacco suit, which plenty for every one except for that dude under the bridge with all the needle tracks.
Steve does have point, compare the legal actions around the Weinstein case vs a smuck with a public defender/court appointed counsel who is charged for drunken groping of a cheerleader. Who got the better defense? Are we willing to pay for everyone to that level of defense?
Let me stipulate that kickbacks are bad and people know they are illegal, but that totally misses what happened with Purdue. This was a planned systemic effort to promote their drugs, much of it totally legal. It was Purdue that was behind making pain the 5th vital sign. They sponsored a lot of the research that claimed to show their drugs were not addictive. (One of the reasons it is always important to know the provenance of a study. For example, the recent study showing a huge drop in Covid mortality came from NYU. Based on my personal knowledge of NU staff I am always suspect of their studies. They could be good but I like to see it confirmed.)
Then we have doctors being paid, legally, to promote drugs and devices. This sometimes runs into 7 figures. This is capitalism at work. The markets doing their thing, and in medicine there are sometimes good consequences and sometimes bad.
So please note that this was something that went on over many years. Purdue used bad research to create a market, then they paid people to promote a bad product and to promote the need for their bad product. Is it believable that the people running the company didnt know about this process that went on for many years? I doubt it, bu tif they did tell me again why CEOs deserve those big salaries.
Steve
I was going to point out an issue was expert opinion was a contributing factor in the case.
For what I mean, here’s a quote from the Mayo Clinic (https://www.mayoclinicproceedings.org/article/S0025-6196(17)30923-0/pdf)
“In 1980, a 1-paragraph letter to the editors of the New England Journal of Medicine challenged the practice of using
opioids only for relief of acute pain. The authors of the letter, after a retrospective review of their records, stated that only 4 of 11,882
patients who had pain and were given opioids became addicted to them. Subsequently, this 5-sentence letter was referenced over 600
times in support of using opioids for chronic pain.
A number of physicians and pain organizations, including the World Health Organization, began advocating for more aggressive use of opioids for pain control for anyone who had “pain“…”
I’m not familiar enough with Purdue and the Sackler families on whether they sponsored that letter; through they are the very least guilty of taking advantage of the shift in expert opinion caused by that letter. But when expert opinion shifts on a subject like the risks of opioid, it is unlikely the FDA will resist since the FDA itself relies on said expert opinion.
I agree that medical studies need to pass more rigorous reviews; especially if it is for a prestigious journal like NEJM. Extraordinary claims require extraordinary proof.
One of the larger, more popular journals did a review on the opioid issue that included that 1980 letter and if I can find it I will link it though I think it is probably behind a paywall. The article I do link to here isn’t as thorough but it is not bad. That 1980 letter was not a formal study and it specifically referred to inpatients. For inpatient narcotic use only it might even be largely correct. I think there is evidence that using the long acting drugs as an inpatient causes problems but not everyone agrees.
That article didnt get a lot of attention for a while since it referred to only inpatients. However, Purdue, among others, cited it to justify using narcotics as an outpatient on a much broader scale. So Purdue actively distorted that letter to promote selling its drugs to outpatients.
But others also cited that article people will say, and that is true, however a number of those people we found out later were funded directly or indirectly by Purdue and were influenced by the research that Purdue was funding. Somehow Purdue never noticed that they were sending huge amounts of drugs to tiny pharmacies in rural areas? In short, Purdue really was evil. It is a shame a bunch of them are not going to jail.
https://www.theatlantic.com/health/archive/2017/06/nejm-letter-opioids/528840/
Steve
Sounds like a lot of people were making a lot of money.
Human nature being what it is……
On the other hand, pain is real. My 40 year old cousin used a gun in her mouth as a solution for fibromyalgia. It wasn’t a knee jerk reaction, she’d contemplated that for years.