The family that built an empire of pain  

“The Sackler dynasty’s ruthless marketing of painkillers has generated billions of dollars — and millions of addicts. An addiction specialist said that the Sacklers’ firm, Purdue Pharma, bears the “lion’s share” of the blame for the opioid crisis.”

According to Forbes, the Sacklers are now one of America’s richest families, with a collective net worth of thirteen billion dollars — more than the Rockefellers or the Mellons. The bulk of the Sacklers’ fortune has been accumulated only in recent decades, yet the source of their wealth is to most people as obscure as that of the robber barons. While the Sacklers are interviewed regularly on the subject of their generosity, they almost never speak publicly about the family business, Purdue Pharma — a privately held company, based in Stamford, Connecticut, that developed the prescription painkiller OxyContin. Upon its release, in 1995, OxyContin was hailed as a medical breakthrough, a long-lasting narcotic that could help patients suffering from moderate to severe pain. The drug became a blockbuster, and has reportedly generated some thirty-five billion dollars in revenue for Purdue.

But OxyContin is a controversial drug. Its sole active ingredient is oxycodone, a chemical cousin of heroin which is up to twice as powerful as morphine. In the past, doctors had been reluctant to prescribe strong opioids — as synthetic drugs derived from opium are known — except for acute cancer pain and end-of-life palliative care, because of a long-standing, and well-founded, fear about the addictive properties of these drugs. “Few drugs are as dangerous as the opioids,” David Kessler, the former commissioner of the Food and Drug Administration, told me.

Purdue launched OxyContin with a marketing campaign that attempted to counter this attitude and change the prescribing habits of doctors. The company funded research and paid doctors to make the case that concerns about opioid addiction were overblown, and that OxyContin could safely treat an ever-wider range of maladies. Sales representatives marketed OxyContin as a product “to start with and to stay with.” Millions of patients found the drug to be a vital salve for excruciating pain. But many others grew so hooked on it that, between doses, they experienced debilitating withdrawal.

Since 1999, two hundred thousand Americans have died from overdoses related to OxyContin and other prescription opioids. Many addicts, finding prescription painkillers too expensive or too difficult to obtain, have turned to heroin. According to the American Society of Addiction Medicine, four out of five people who try heroin today started with prescription painkillers. The most recent figures from the Centers for Disease Control and Prevention suggest that a hundred and forty-five Americans now die every day from opioid overdoses.

Andrew Kolodny, the co-director of the Opioid Policy Research Collaborative, at Brandeis University, has worked with hundreds of patients addicted to opioids. He told me that, though many fatal overdoses have resulted from opioids other than OxyContin, the crisis was initially precipitated by a shift in the culture of prescribing — a shift carefully engineered by Purdue. “If you look at the prescribing trends for all the different opioids, it’s in 1996 that prescribing really takes off,” Kolodny said. “It’s not a coincidence. That was the year Purdue launched a multifaceted campaign that misinformed the medical community about the risks.” When I asked Kolodny how much of the blame Purdue bears for the current public-health crisis, he responded, “The lion’s share.”

“I don’t know how many rooms in different parts of the world I’ve given talks in that were named after the Sacklers,” Allen Frances, the former chair of psychiatry at Duke University School of Medicine, told me. “Their name has been pushed forward as the epitome of good works and of the fruits of the capitalist system. But, when it comes down to it, they’ve earned this fortune at the expense of millions of people who are addicted. It’s shocking how they have gotten away with it.”

Read the entire article. It’s almost 13,000 words long, comprehensive and thorough.

The drug industry’s triumph over the DEA  

“Amid a targeted lobbying effort, Congress weakened the DEA’s ability to go after drug distributors, even as opioid-related deaths continue to rise, a Washington Post and ‘60 Minutes’ investigation finds.”

In April 2016, at the height of the deadliest drug epidemic in U.S. history, Congress effectively stripped the Drug Enforcement Administration of its most potent weapon against large drug companies suspected of spilling prescription narcotics onto the nation’s streets.

That was despite the fact that “by then, the opioid war had claimed 200,000 lives, more than three times the number of U.S. military deaths in the Vietnam War,” and with no “end in sight.”

A handful of members of Congress, allied with the nation’s major drug distributors, prevailed upon the DEA and the Justice Department to agree to a more industry-friendly law, undermining efforts to stanch the flow of pain pills, according to an investigation by The Washington Post and “60 Minutes.” The DEA had opposed the effort for years.

The law was the crowning achievement of a multifaceted campaign by the drug industry to weaken aggressive DEA enforcement efforts against drug distribution companies that were supplying corrupt doctors and pharmacists who peddled narcotics to the black market. The industry worked behind the scenes with lobbyists and key members of Congress, pouring more than a million dollars into their election campaigns.

” The chief advocate of the law that hobbled the DEA was Rep. Tom Marino, a Pennsylvania Republican who was “President Trump’s nominee to become the nation’s next drug czar,” until this story broke and he fell out of favor. “Marino spent years trying to move the law through Congress. It passed after Sen. Orrin G. Hatch (R-Utah) negotiated a final version with the DEA.”

For years, some drug distributors were fined for repeatedly ignoring warnings from the DEA to shut down suspicious sales of hundreds of millions of pills, while they racked up billions of dollars in sales.

The new law makes it virtually impossible for the DEA to freeze suspicious narcotic shipments from the companies, according to internal agency and Justice Department documents and an independent assessment by the DEA’s chief administrative law judge in a soon-to-be-published law review article. That powerful tool had allowed the agency to immediately prevent drugs from reaching the street.

Political action committees representing the industry contributed at least $1.5 million to the 23 lawmakers who sponsored or co-sponsored four versions of the bill, including nearly $100,000 to Marino and $177,000 to Hatch. Overall, the drug industry spent $102 million lobbying Congress on the bill and other legislation between 2014 and 2016, according to lobbying reports.

“The drug industry, the manufacturers, wholesalers, distributors and chain drugstores, have an influence over Congress that has never been seen before,” said Joseph T. Rannazzisi, who ran the DEA’s division responsible for regulating the drug industry and led a decade-long campaign of aggressive enforcement until he was forced out of the agency in 2015. “I mean, to get Congress to pass a bill to protect their interests in the height of an opioid epidemic just shows me how much influence they have.”

Feeling isolated as an asexual in a sexualized society  

“When Stacey wrote about her experience of not wanting to sleep with anyone, even her husband, dozens of readers sent emails saying that they too were asexual. Many described feeling isolated in a sexualised society.”

Here are two of the emails, one from a woman, the other from a man:

I am in my sixties and have had two failed marriages, but I have never initiated or enjoyed sex with another person. As a teenager it was easy to refuse sex, it was expected of a “good” girl, but family pressure meant that I was married at 21 and suddenly had no more excuses. I loved my husband and wanted to please him, but I felt no sexual desire and hated the experience of a physical relationship. I never initiated sex with him, and was almost glad when he eventually had affairs because the pressure was no longer on me to satisfy his needs. I felt overwhelming guilt for being so cold and took all the blame for my first marriage ending. I couldn’t understand how I could love someone so much but dislike being touched by them… I married an older man 10 years ago who had led me to believe that he also was past sexual desire. Unfortunately this wasn’t the case and he took my reluctance to have sex with him very badly. He forced me to perform sexual acts and I ended up hating him for it. We are going through an acrimonious divorce. In hindsight I should never have married again.
Gill, London

I am a 35-year-old man, and have only just realised I am asexual. I have always been attracted to people, form romantic feelings very quickly and have always dated. I would fancy someone, enjoy the kissing and physical contact, but when it came to sex, my body would just switch off. I thought it could have been performance issues and I kept trying – it caused huge embarrassment and destroyed my confidence for years. I am desperate for a relationship and had completely resigned myself to being alone and childless forever. But recently I have seen a lot of articles about asexuality, and I can’t begin to describe the relief that I am now able to label what it is about me that is different. I can even begin to dream about finding someone who could understand.
Matt

Read more letters.

Drug companies make eyedrops too big — and you pay for the waste  

If you’re like me, and use eyedrops every day — in my case for dry eyes — you probably don’t think twice about the excess that spills down your cheeks every time you instill the one or two drops vouchsafed in the directions on the bottle’s label.

Well here’s an eye-opener for you (pun intended). The “medicine you wiped off your face is wasted by design — and it’s well-known to the drug companies that make the drops.”

From ProPublica:

Eyedrops overflow our eyes because drug companies make the typical drop — from pricey glaucoma drugs to a cheap bottle of Visine — larger than a human eye can hold. Some are so large that if they were pills, every time you swallowed one, you’d toss another in the garbage.

ProPublica has been documenting the many ways health care dollars are being wasted. We’ve shown how hospitals throw out brand new supplies, nursing homes flush tons of unexpired medication and drug companies concoct costly combinations of cheap medication. Recently we described how arbitrary drug expiration dates cause us to toss safe and potent medicine.

Often, large swaths of the medical and pharmaceutical communities know about this waste — even about solutions to it — but do nothing. Those who end up paying the bill, in one way or another, are consumers.

Liquid medication is squandered every day. Beyond eyedrops, liquid cancer drugs are frequently packaged in oversized single-use vials that contain more of the drug than most patients need. This guarantees that a quantity of life-saving medication is tossed — and its cost tacked onto patients’ bills.

Both eyedrops and cancer drugs are sold by volume, and we spend billions of dollars every year on them. Chemotherapy drugs can run thousands of dollars per infusion. Crucial eye medications to treat conditions like glaucoma may cost hundreds of dollars for a small bottle that only lasts a month, making the waste of even a drop a problem for low-income patients.

Last year, drug companies brought in about $3.4 billion in the U.S. alone on drops for dry eyes and glaucoma drops, according to the research firm Market Scope.

With both eyedrops and cancer drugs, pharmaceutical companies have done research showing that it’s possible to waste less — and save consumers money. Some of that research has been around for decades.

“If it spills out, it’s just wasted,” said York, who has a doctorate in pharmaceutical chemistry and is now retired. “It’s not doing any good.”

So his team created a 16-microliter drop — a microdrop — that was about a half to a third of the size of most drops on the market today, he said. They used a standard bottle with a latex dropper tip that wouldn’t cause injury if it touched the eye. Then they recruited 29 glaucoma patients to test the tiny drops. Glaucoma, a leading cause of blindness in the United States, is characterized by increased pressure in the eye, which can damage the optic nerve. Daily use of medicated eyedrops preserves sight by reducing the pressure.

The patients tried different formulations of the same medication in both micro- and regular drops, which were about twice as large, for a week at a time. The researchers tracked the patients’ eye pressure and side effects, such as burning, stinging, itching and dryness.

Their results were conclusive: Microdrops worked as well as larger drops to lower eye pressure. They also reduced some of the uncomfortable side effects of larger drops. And all the patients preferred using them.

York and two of his Alcon colleagues published their results in 1992 in the American Journal of Ophthalmology. Robin, who consulted on the research, was the principal investigator.

“The microdrop delivery system worked,” York said recently. The drop “was manufacturable. It reduced stinging and the amount of drug needed to produce the same biologic effect. Excess drug draining out of the eye would be significantly reduced.”

But his innovative solution ground to a halt when it came to getting it on the market.

The bottom line was that the innovation reduced profits, and therefore anathema to the pharmaceutical companies.

As Santa Rosa hospital staff’s own homes burned, they kept saving lives  

From the San Francisco Chronicle:

Santa Rosa Memorial Hospital stayed open even though 51 of its doctors lost their homes. It stayed open even when twice as many patients as normal crowded into its emergency room, coughing and gasping. It stayed open and delivered 36 babies.

The 51 doctors who lost their homes showed up for work. So did 83 caregivers and five volunteers. When you work for a hospital, even one with 450 staff and affiliated physicians, that’s what you sign on for.

Cambria Reese, a 25-year-old nurse, was on the night shift. She looked up the affected areas on a staff computer. She found that the her parents’ address was on the list. They had just gotten back from a trip to Italy. Reese kept doing her job.

“There was a time of uncertainty, for sure,” Reese said. “It was chaotic at the hospital, and stressful not knowing. I cried a lot and kept working. A lot of people felt hopeless. I was focusing on work and someone else’s health to get through.”

Two hours passed before Reese got a phone call. Her parents were OK, but their home was lost.

Congressional candidate claims aliens took her on a spaceship  

Just when you thought you’d heard it all, now there’s this politician who swears blind she’s been aboard a spaceship crewed by extraterrestrials.

And she’s running for Congress — no kidding.

From the Miami Herald:

Florida has a U.S. senator who once flew aboard the Space Shuttle.

A congressional candidate from Miami can go one better: Bettina Rodriguez Aguilera says she’s been aboard a spaceship too. But this one was crewed by aliens. As in extraterrestrials.

Three blond, big-bodied beings — two females, one male — visited her when she was 7 years old and have communicated telepathically with her several times in her life, she says. (Sen. Bill Nelson served as payload officer aboard the Space Shuttle Columbia in 1986. All seven people aboard were from Earth. As far as is known.)

Rodriguez Aguilera, 59, a Republican who is running to replace retiring Miami Republican Rep. Ileana Ros-Lehtinen, recounted her experience with the ETs during a 2009 television interview.

“She described ‘going up’ inside the spaceship,” adding that unlike airplanes, the spaceship was controlled by “some quartz rocks.”

Yeah, right.

How one woman’s drug addiction cost her everything  

From the New York Post:

Two days before last Christmas, Beth Stephens was full of plans and promise. The brilliant, 39-year-old scientist who had studied in Paris, completed a Ph.D. in microbiology and had worked as a researcher for the federal government seemed to be getting her life back together.

The slim, fun-loving brunette who enjoyed outdoor concerts, afternoon chats over strong coffee with friends and showing off her soccer moves to her 9-year-old nephew, Lincoln, was determined to move out of a dark place.

“I’m out of the shelter now. Plan to put in a few online job apps and follow up w another,” wrote Stephens in a series of texts to a friend, studded with exclamation points, happy faces, and chatter about plans for Christmas Eve.

Hours after she sent that text, she lay dying in the lobby of a garbage-strewn Bronx housing complex. Police answering a 911 call rushed her to nearby Lincoln Hospital, where she was pronounced dead on arrival.

Read the rest of the article

Cop who roughed up and arrested Utah nurse has been fired  

From the DailyMail.com:

A Utah police officer who was captured on body-cam footage arresting a nurse who refused to draw blood from an unconscious patient was fired on Tuesday.

Detective Jeff Payne was axed after an internal investigation found he violated department policies when he arrested nurse Alex Wubbels and dragged her screaming from the hospital, a police spokesman [said].

In a disciplinary letter, Salt Lake City Police Chief Mike Brown said he was ‘deeply troubled’ by Payne’s conduct, which he described as ‘inappropriate, unreasonable, unwarranted, discourteous, disrespectful’ and said brought ‘significant disrepute’ on the department.

And Payne’s supervisor, Lt James Tracy, has been demoted to officer:

Tracy made an impulsive decision in ordering Payne to arrest Wubbels without first taking time to understand the facts of the situation and the law, Chief Brown wrote in his disciplinary letter.

He said the order created chaos and unnecessarily escalated the situation.

‘Your lack of judgment and leadership in this matter is unacceptable, and as a result, I no longer believe that you can retain a leadership position in the department,’ Brown said.

What’s living longer, or even forever, going to be like?  

With the advancements longevity scientists are working on, and likely to make significant breakthroughs in the near future, the prospect of living longer, or even forever, is in the cards.

But here’s the thing:

There’s just one problem: More life doesn’t necessarily mean a better life. At a certain point, parts of the body stop working properly, making it difficult to enjoy the time you’ve got. Medical conditions like Alzheimer’s, cancer, diabetes, heart disease and arthritis can make the final years of one’s life an exercise in suffering. Living for 1,000 years isn’t much of a boon if only the first 80 — or even the first 900 — are physically pleasant.

But then again:

Luckily, there are also scientists working to extend the amount of time during which a person is healthy. Some interventions seem more realistic or pragmatic than others, but it’s becoming clear that getting sick with age is anything but inevitable. These approaches might even change the way we think about the very concept of getting old.

So, if you had the option to live a lot longer, or even forever, would you go for it? Or would you turn it down, based on the prospect of eventually suffering intolerable existential fatigue?

Resurgent wild turkeys running amok in human neighborhoods  

Although “considered a major success story for wildlife restoration” by conservationists, a lot of people aren’t exactly jumping for joy over the return of the game birds.

Wild turkeys that were practically wiped out from New England in the 1800s have stormed back with a vengeance — with the emphasis being on VENGEANCE.

Reportedly, the birds have become rampant “in Boston and its suburbs over the past three years,” destroying gardens, damaging cars, chasing pets and attacking people.

“Boston city officials say they received at least 60 complaints last year, a threefold increase over the year before. Nearby Somerville, Belmont and Brookline have seen similar upticks, combining for a total of 137 turkey gripes since the start of last year.”

There’s a moral in this story, but I’m not going to stick my neck out on the chopping block, by articulating it here.