https://twitter.com/sama/status/656892679817527296
The point of business is to create a customer. For that to happen, there has to be someone out there who has voluntarily decided they want to use (and ideally pay for) your product. The same goes for political movements - to build a mass political movement, you need a critical mass of people who voluntarily decide that this cause is worth investing time and money into.
By definition, addiction means that your voluntary choices are going to serve the furtherance of your addiction. So there's no customer there, and no profit potential, unless you're a drug dealer. Social interventions like drug treatment clinics could perhaps work, relying on the desires of loved ones, but it's very hard to help someone else unless they make choices to help themselves. When your brain chemistry has been altered so all it wants is more of the drug, that's not a given.
It's a hard problem. Unfortunately history hasn't been kind to populations with mass drug abuse; when I think of countries with a societal drug problem [1][2] or even subpopulations within a larger nation with widespread drug abuse [3][4], the cultures involved all basically collapsed. For countries, the general pattern involved top-down reforms -> military defeats -> revolution -> conquest by another power. For subcultures within a larger nation, it's the total marginalization of the group in question, assimilation into the larger population of the remaining productive members, and then long-term decay and blight on the remnants of the subculture.
[1] https://en.wikipedia.org/wiki/Opium_Wars
[2] https://en.wikipedia.org/wiki/Drug_policy_of_Nazi_Germany
[3] https://en.wikipedia.org/wiki/Crack_epidemic
[4] https://en.wikipedia.org/wiki/Alcohol_and_Native_Americans
And this is what government and regulation are for in my view.
That's no different than people going blind/dying from wood alcohol during prohibition.
The solution is to legalize and regulate, but I'm not holding my breath.
The opioid crisis seems like a symptom of our social problems (hopelessness in the rust belt, unscrupulous over-prescribing of pain meds) that has fatal consequences.
Short of a drug that provided a permanent cure for opioid addiction itself, I'm not sure what sort of solutions can be pursued by scientific/tech research, as opposed to addressing the root social causes.
I'm interested in what ideas others might have though.
I'm not from the US, but I think there is enough people already, all pointing out in the same direction:
http://www.motherjones.com/politics/2016/09/opioid-lobbying-...
Over the past decade, pharmaceutical companies have spent more than $880 million on lobbying and political contributions at the state and federal level. That’s more than eight times what the gun lobby and more than 200 times what those advocating for stricter prescribing rules spent over the same time period. The makers of prescription painkillers have adopted a 50-state strategy that includes hundreds of lobbyists and millions in campaign contributions to help kill or weaken measures aimed at stemming the tide of prescription opioids
[1] https://www.statista.com/topics/1719/pharmaceutical-industry...
I'm not parent, but I'm sure this is intentional as the consequences of such a scenario are easy to extrapolate...
> The US market is where pharmaceutical companies expect to recoup their R&D costs.
They could do this in two ways - having high margins on their drugs, and/or selling a lot of drugs. It is no surprise to see pharma lobbying against tight laws on prescriptions, or anything that gets in the way of the 'market' getting access to their products. Not coincidentally, the opioid crises means they get to sell more drugs.
On the other hand in my home country we had some big pharmaceutical companies (compared to the size of the country) exporting drugs world wide. I thought that for example the pain killers I knew as I child would be used everywhere on the world. When I moved to Germany I realized that I was wrong. There are tons of different drugs for the same purpose with the same ingredients sold by different producers. Therefore only becasue you in the US buy some expensive - and highly addictive - pain killers you are not automatically financing the R&D of pain killers sold in Europe by Europian companies to the Europian people.
Let me be a smart ass and improve your calculation:
45% of drug revenue is generated by 5% of earth's population:
45% / 5% = 9
but you do not compare this number to 1 but to
55% of drug revenue is generated by 95% of earth's population:
55% / 95% = 0.58
So a US citizen spends 9 / 0.58 = 15.54 more on drugs as a non US citizen. Even if price difference is a valid argument, this number is still too high.
http://www.nybooks.com/articles/2009/01/15/drug-companies-do...
Just give them the opiates for free in supervised facilities and let them have otherwise normal, albeit constipated lives. It works and costs very little.
What people don't think about is the extra societal costs associated with drug addition: thefts/violent crimes, prison costs, unproductive time from seeking the next high, etc. Cutting out the middleman would solve a great deal of these issues, and save the taxpayer money too.
It seems the moral issue of giving "free drugs" to addicts is just too much to bear, unfortunately.
By cutting out the time and money needed to "feed the beast" while providing professional help, they can break this cycle and move towards bettering themselves when they don't have the nagging of addiction voicing itself at every turn.
Of course its not simple and perhaps there will be people who refuse to better themselves. My biggest point is that it not only will save money from going underground, but allow potentially productive members of society to have a means to break the cycle.
When I had my wisdom teeth pulled and was prescribed an entire bottle of Vicodin, when I didn't even need a single one, that wasn't a greater issue in my life. That was medical malfeasance and a just society would execute the principal architects of it.
Going off on a tangent, what my country might have a problem with, is benzos, however. They're prescribed like psychiatric vitamins.
I agree that there is a problem with over prescription of opioids, but this problem isn't solely due to a simple conspiracy of drug makers. I think that sort of rhetoric is unhelpful.
https://www.google.com/amp/s/amp.theguardian.com/world/2013/...
From my reading (and I will admit I do not see the logical reasoning at all, which I think is why the case was later overturned) the judge thought that they were guilty not of failing to predict it, but of giving an inadequate message. Presumably, to me this implies some sort of laziness, or intent to not make more of an effort despite knowing better.
I will admit that I am biased being a doctor dealing with this daily, but I think that blaming this solely on the pharmaceutical companies is easier to do than looking at what is happening to our culture, expectations of pain, the way we deliver healthcare, how we grade healthcare (for example read about Press Ganey's Fifth Vital Sign).
This is not how opioid pharmacology works. Tolerance to the desired effects (analgesia) increases but so does tolerance to the problematic effects (respiratory depression).
Opioid use -- even chronic and long-term use -- is not a death sentence. The phenomenon of so many opioid-related deaths referred to as the "opioid epidemic" is an extremely recent one (compared to the timescale that humans have been using opiates for pain relief) and is a product of drug policy/enforcement, not of the inherent evil of opioids.
People have actually been trying vaccine approaches to opioid addiction for a while, but it's tricky since opioids are small molecules which inherently don't give you a lot to work with as far as antigen presentation.
Apparently there has been some promising evidence recently though. See Derek Lowe's blog below for details.
http://blogs.sciencemag.org/pipeline/archives/2017/06/26/a-h...
Along with its therapeutic cousins Cannabis and MDMA, look what else we have on the list of substances for which federal research funds are banned (Schedule I):
Yea. That doesn't necessarily sound good:
> Clinical studies of ibogaine to treat drug addiction began in the early 1990s, but concerns about cardiotoxicity led to termination of those studies. There is currently insufficient data to determine whether it is useful in treating addiction.
I'm not really sure this is some sort of miracle drug that the establishment just doesn't want us to know about.
The thing is, it doesn't matter if you're "sure" or not, because while it's on Schedule I there can be no federal funds used for research into whatever degree it may be a "miracle" (nirvana fallacy) drug. I hope we can agree that therapeutic substances have been derived from harmful ones.
I'm not sure there is an ethical way to find out.
This. The AIDS epidemic in the 1980's was the same. Tens of thousands of people dying every year, with more than forty thousand per year at jts peak, and more than 600,000 dead to date. Because of homophobia, the public at large didn't care about the victims - most people, if they took notice at all, only expressed groundless fear in catching HIV just going about their business.
Opiate addiction isn't a disease in the sense that there's a biological virus or bacteria that can be transmitted from person to person, so "normal" people think they can't "catch" it. And so without public sympathy for the victims, no wonder there isn't some mass political movement trying to get Congress to fund a proper response.
Maybe his point of view was out of date, but I recall that he saw kicking any of these problems was something that came from within. You had to want out strongly. My friends moment was when his kids didn't want to see him.
People shun addicts to survive, not out of cultural conditioning. The addiction comes first, and the addict will hurt anyone to get it.
Methadone clinics, rehabs and other places like that, however, do profit off of addicts' recovery and may even have genuine intentions of helping (it seems to vary from place to place). Those profits are minor compared to the profit off of addicts' misery and death, however, and their efforts are not usually talked about much in the press. Laws also hold back such institutions from providing good treatment and dehumanize the addicts trying to stay clean. In many places, addicts are treated horribly and made to suffer intentionally by the staff, often having to wait around sick for hours just to see a doctor before getting a dose of methadone even though they've been on the program for years. They are made to line up daily or weekly for a dose when a regular prescription would do just fine, even after they've been on methadone for years. At many of these clinics, it's a wonder that anyone stays clean. There is no professionalism. Doses are messed up when addicts travel and they are left without their methadone. Staff end up stealing either money or methadone. There is no accountability. Not all clinics lack compassion and treat addicts badly, but many do. It's no wonder these places try to fly under the radar while the good clinics and rehabs are too busy helping addicts to be in the press or make much noise. If cancer or heart patients were treated this way, you can bet your ass there'd be a national backlash, but our society has been conditioned to have no compassion for addicts. This is the result. It's ugly and nasty.
On the matter of self-driving car investment, vs opiate addiction treatment - car makers need to turn a profit, so they need something new to sell. A lot of people also commute daily, and don't enjoy doing so. So in the (distant) shiny future where your car drives you to work, they are building something that I think a lot of people will be willing to pay for, or use as a service.
[0] Addendum - it also avoided the public eye because of where addiction was happening, and who to. A lot of it started in smaller towns, often those struggling economically. The kind of places that don't get a lot of attention.
So while the public at large may be ignorant of this crisis (and honestly, on how many issues is even the most educated of us truly knowledgeable about?) the States' representatives that have these problems back home appear to be taking it very seriously.
Rather, "several" out of 52 GOP senators are taking it seriously. Or do I misunderstand you?
1. The opioid crisis is getting a lot of airtime in the media outlets that I read.
3. The opioid crisis is one of the biggest reasons why the Senate's Trumpcare bill is now dead, and was also a major topic of discussion in the weeks leading up to its unexpected loss this week. In short, its drastic cuts to Medicaid would have decimated opioid treatment in some of the states hit hardest, and Senator Capito of West Virginia, at least, would have voted against it because the $40-odd billion dollars that Mitch McConnell would've specifically allocated to opioid treatment would have been a 'drop in the bucket.' Here's some earlier discussion of this point: http://talkingpointsmemo.com/dc/capito-says-opiod-treatment-...
So, all said, maybe find some new sources of news and discussion?
edit: here's a new wire article from the AP that just crossed my RSS reader: http://talkingpointsmemo.com/news/democrats-trump-action-opi...
I remember seeing a Vanguard episode on the "pain management" industry in Florida called the Oxycontin Express [1] back in 2009 (won a Peabody). And yet it's only in the last year or so that I've actually heard about it being addressed more publicly.
If you're telling me that I'm wrong and that actually more people, dollars, and attention are going toward saving people from opioid overdose than automobile accidents and gun crime, then I would be happy to be wrong and would want to see numbers.
Otherwise it sounds like you're telling me to tune my news inputs so I hear stories in a proportion that would please me better?
Talked about, from my perspective, it is. Addressed, no, it most certainly is not being addressed.
Actually, it is the opposite. Gun violence, opioid crisis, etc are given too much attention.
The deaths of opioid crisis and gun deaths are minuscule compared to the deaths cause by obesity, sedentary lifestyle, cancer, heart disease, etc.
Take the top two killers in america - heart disease and cancer ( about 600K deaths each ) vs gun violence + opioid crisis ( about 30K each ).
Heart disease by itself kill 10X more people than gun violence and opioid crisis combined.
You could go further and say brain death is the leading cause of death, affecting 100% of Americans. Let's put more effort into transferring our consciousness into computers so we can survive it! Again, it would be nice but seems tolerable to carry on as we are.
https://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd...
http://www.kff.org/other/state-indicator/opioid-overdose-dea...
From your own link:
"According to the Center for Disease Control, in 2015 52,404 people died from drug overdoses in the United States. 33,091 of those deaths involved opioids. In comparison, 35,092 people died in auto accidents in 2015 (Department of Transportation), and 12,195 people died from non-suicide firearm-related injuries in 2014 (CDC, 2015 data not yet available)."
I'm not surprised at all, and the only emotion I feel is complete disgust, directed at politicians that refuse to work together. It started the second Obama was elected POTUS and the opposing party declared they would not work with him, and that lasted the full 8 years.
Even neglecting that, crash victims are more worthy (on average) than overdose victims, as they come into their fate largely on accident, while overdose victims largely make an informed choice to roll the dice. I don't like saying this; it sounds judgmental and it certainly won't be popular, but this is the logical conclusion. Fortunately, the choice between self-driving cars and combatting the opioid epidemic doesn't remotely hinge on this point.
Don't most people develop an opioid addiction after being prescribed insufficient pain medication by their doctor? After that, sure, once they realize that getting more opioids - much more than they ought to, medically or legally - is literally the only way to stop the daily pain?
What do you want to see? What would you consider an ideal world here?
I know how you feel. It's utterly ridiculous that a society should so heartlessly abandon the most vulnerable among us who struggle so needlessly. We should do better! We can do better! We MUST do better! It's a moral imperative.
Yet, for all that, it's possible that resources are limited. And when resources are limited, questions of sustainability, achievability, returns, and cost-effectiveness become relevant. This is particularly true when there multiple goals to be chased - would you be happy if all Medicare funding for the elderly was stripped away in favor of treating opioid addiction?
If corporations found it profitable to ensure everybody was happy and living well, I can guarantee you that the vulnerable would be taken care of very well.
It is just a matter of perception. By graviating towards money and profit, we undermine the worth of all humans and hence you asking "would you be happy if all Medicare funding for the elderly was stripped away in favor of treating opioid addiction?".
Of course nobody would be happy! :)
You're right! Resources are unquestionably plentiful! However, it's possible that plentiful might be slightly different from unlimited. If I wanted a billion PhD-educated engineers to colonize Mars tomorrow, I might run into limits, no?
It is just a matter of perception. By thinking about how to best utilize plentiful-but-limited resources, considering the value and independence of all humans, we think about how best to create a system in which all these wonderful and infinitely valuable humans self-organize for what's best for them. That way we can gravitate towards happiness and wellness!
I'd glad we agree on the value of humanity. I see human labor, human love, and human affection as valuable at all times and places. I also see that humans are plentiful-but-limited, time is plentiful-but-limited, and resources are plentiful-but-limited.
> Of course nobody would be happy! :)
Yeah. That's because it's obviously a bad way to distribute plentiful-but-limited resources like human labor and human love and human-run biochemical production facilities to make the greatest number of people as happy and well as possible.
"..and we will do better, and we will start this moment today!"
It's the same for basically every issue. Humans can be altruistic, but organizations rarely are.
Simply: change happens when expending power leads to a greater expected increase in (relative) power than doing nothing for a sufficient amount of power-brokers to overcome costs of change and opponents(those who expect to lose from the change). This is a structural issue, not human nature.
Blaming the addicts helps to reduce the cost of doing nothing. The good(?) news is that this is tending to hit wealthier people than past epidemics and so is getting correspondingly greater attention.
Rejoice! The problem is far worse than these sad, bullshit excuses.
I think you're right but the reasoning is one step removed from the conclusion.
Drug addition is a poor people problem (in part because it takes resources and support to break the cycle).
Opiod (and meth for that matter) addiction skews rural and therefore white.
A lot of people take the attitude that poor rural white trash are poor white trash because they live in a dying town with no industry and refuse to relocate to somewhere they can more easily scrape by. The catch is that the people making these judgements generally have a very different set of values than the people they're judging.
When you take the attitude that the situation that leads one to easily become an addict is the fault of the addict then it's hard to have sympathy for addicts.
There's also a lot of (well meaning) "optimism to the point of stupidity" in assessing how effective firearms legislation is as an avenue to reduce violent crime and how easy it is to make a driver-less car that can effectively share the roads with vehicles operated by people
One of our biggest blockers has been the existing recovery industry. Addiction is so stigmatized that getting people to use an app on their phone, even after treatment, is problematic because they feel like the data could get out that they're an addict. This is another reason more research isn't done. These existing facilities literally don't collect data - much less use it in any relevant way.
Value-based payments and growing oversight from insurance companies is changing that somewhat. These facilities are starting to be required to report outcomes data - so from a business perspective we're good. But man this industry and it's privacy/secrecy are something else.
Self-driving cars actually would have a benefit for society in terms of higher durability for vehicle and optimal road selection leading to lower carbon emissions, lower traffic accidents, and less use of natural resources.
I am more annoyed by all the time and effort going into Google's and Facebook's ad-tech optimizations.
Wait, what? This is a "lobby"?
I thought the NRA with their even larger resources, backed by industrial interests, is the actual lobby. You know, the one who pushed forward those laws into insane directions, which you'll find almost nowhere else in the world.
[1]http://nautil.us/issue/49/the-absurd/why-your-brain-hates-ot...
Assuming that might have been misspeech, it's easy to see why autonomous vehicles have so much more interest. The interest isn't in preventing human death, the interest is there because not only is it a more fascinating problem to solve, but it saves everybody time and hassle. Lowering the number of deaths is just a great effect.
Focus on a problem isn't always about sheer concern, sometimes the focus is so much higher just because it's a problem more people feel they can contribute to solving. Parkinson's law of triviality...
Young black males are disproportionately the victims of gun crime, pretty sure that is a well-known fact that I don't need to look up. I also believe the data is in on young white males disproportionately being the victims of opioid overdose [1].
Are opioids a white problem and guns a black problem? Or are both actually related to a different condition and it's actually a young male problem? What about if we looked at the socio-economic class of these people ignoring age, sex and race? Something common there?
I think that the focus on the racial/ethnic/sexual/gender makeup of the victims is less useful than some people want it to be.
If anything I'd say it's an economic and community issue, this Kutzgesat video goes into it somewhere [2]. If there were better community support systems for people of lower economic classes then I think we'd see far less overdose and gun crime.
One thing I will say though, and it is addressed in the first link somewhat, is the way drug enforcement is (and has been) conducted differently in different communities. That certainly exposes much of the systematic discrimination in drug enforcement which I do hold as almost as serious a problem as these deaths.
[1] http://www.medscape.com/viewarticle/872062 [2] https://www.youtube.com/watch?v=ao8L-0nSYzg
And nobody with political power will admit it because it will make them the enemy of both camps on both issues.
They already are being profited from politically via the War on Drugs.
Addicts don't make good customers.
On a more serious note however, I understand what you mean. I think there's also the perception that significant cases of drug abuse, addiction and the crimes related to this are something that seems to happen far, far away for most people in a position to offer help. Something you see in movies and dramatic VICE documentaries, but not in your own backyard. If you're not confronted with the problem it's easy to not perceive it as one.
Billions of dollars of private research being poured into self-driving cars by our greatest minds and millions of dollars in lobbying against gun laws all in the name of preventing unnecessary human deaths... yet according to Ben Bernanke (and his references), opioid overdose killed more people in 2015 than automobile accidents and firearms related crimes combined [1].
I'm curious whether the disproportionate concern has more to do with the perception of drug addicts as weak and deserving of their fate or because they're not a group that can be profited from politically or commercially or is overdosing just not as easy to solve as gun crime or automobile deaths?
Personally, I find all those excuses to be sad and bullshit so I'm hoping it's something else entirely.
[1] https://www.brookings.edu/wp-content/uploads/2017/06/es_2017...