
DOJ: Billionaire pharma owner fueled the opioid epidemic with bribery scheme - rbanffy
https://arstechnica.com/tech-policy/2017/10/doj-billionaire-pharma-owner-fueled-the-opioid-epidemic-with-bribery-scheme/
======
alkonaut
I trust this guy will get what he deserves, but surely there should be other
people falling here?

Usually it's the _taker_ of bribes that is the biggest criminal. Any doctor
who can be shown to have given addictive opioids to people that aren't
terminally ill should be investigated.

This is completely regardless of whether it was the "standard practice" at the
time, or whether some pharmaceutical sales rep told them it was a good idea.

If just a couple of hundred doctors would lose their license and a few dozen
end up in jail, that would make some headlines and perhaps make other doctors
think twice before prescribing oxycodone to someone with normal back pain.
Doing that is like amputating someone at the hip for toenail fungus.

~~~
pakitan
Fast forward 10 years. Top story on HN is "I'm in excruciating pain and my
doctor is refusing to prescribe me a painkiller because he's afraid of losing
his license". Top comment: "This is ridiculous! Why are all these regulations
preventing people from getting proper health care instead of actually helping
them?"

No, the solution is not putting doctors in jail. No, the solution is not
piling regulations on top of more regulations. Only thing that's needed is
educating people and providing less addictive alternatives. If the pack of
pills has "Warning: this is highly addictive! Use only in emergency!" in big
bold letters, then people will think twice about taking them.

~~~
jasonlaramburu
They tried this with cigarettes. It did not really work:
[https://www.rand.org/blog/2014/09/graphic-warning-labels-
on-...](https://www.rand.org/blog/2014/09/graphic-warning-labels-on-
cigarettes-are-scary-but.html)

~~~
pakitan
The cigarette warning labels are working just fine. The point is to warn
people of the dangers and practically every smoker is already aware of those
and yet they choose to smoke anyway. That's perfectly fine in my book - as
long as one is making an informed decision, they should be able to pick the
poison that kills them.

~~~
GordonS
I don't know about the US, but in the UK at least I reckon it's the _taxes_
that work better than the labels (the price of a pack of cigs has risen
dramatically over the past 15 years or so)

~~~
orf
They also banned small 10 packs, and 7.5g pouches. This seems to really stop
people from buying a small pack for a night out, at least it stopped me.

That is until you buy a larger pack and have some.left over the next day that
is.

------
shams93
They certainly went after many medical cannabis providers with a vengeance and
refuse to reschedule cannabis. I know someone who was able to quit a fentynal
pump. Rather than jailing doctors we need to allow them to access cannabis for
their patients as a far safer alternative, but Sessions is hell bent on
forcing chronic pain patients into a choice between agony and suicide. What
kind of kickbacks is Sessions getting from the drug cartels to start a war on
medical cannabis?

~~~
stevenwoo
I think you should specify when you write drug cartels if you mean traditional
drug cartels in Central/South America/Asia or if you meant big pharma in USA.

------
pxeboot
Something is really wrong with the system when billionaires have their bail
set at 1 million. If he wanted to flee and forfeit his bail money, his net
worth would be impacted about the same as the average American getting a
parking ticket.

~~~
jsmthrowaway
Bail is to guarantee appearance to respond to the _crime_ , not insure against
the _accused_ , and reflects the seriousness of the crime and how much the
state would care if you don’t answer for it. That’s why if you go in on
multiple sets of charges you have multiple bails. That’s also why your DUI
bail was five figures or less. In most places there is a table for bail
amounts that can be stiffened, softened, or denied entirely at the judge’s
discretion, but it is all based _on the crime_ and flight risk only.

$1 million is a fairly high bail, generally in the ADW/manslaughter/sexual
assault neighborhood. A court is not set up to handle a $1 billion bail, as
you’re suggesting. That sort of money isn’t just moved around like that ($1
million is difficult enough), and the court would almost certainly mishandle
it.

~~~
charlesdm
Probably not, but for someone with a net worth of $1bn it seems extremely low.
Just like said bail is extremely high for someone with a close to $0 or
negative net worth.

How about setting it at $100m? That doesn't sound unreasonable given the
situation.

Not mishandling is easy: you put it in a locked escrow account and don't touch
it. It the depositor had to borrow against assets to secure the deposit, then
let reasonable interest accrue against the principal and deduct.

~~~
jsmthrowaway
Bail is set independently of net worth considerations and in a relatively
impartial manner, which is the point. Judges do not have the flexibility to
set a bail that high. Destitute murderers get $5 million+ bails all the time,
which we would have to revisit if we started factoring in net worth (think
about it).

~~~
mikeash
Bail is set independently of net worth, but is that how it should be?

There are tons of poor people stuck in jail awaiting trial for relatively
minor crimes because they can't afford what would be a trivial bail amount to
most HN readers. A rich person who commits a much more severe crime gets to
sleep at home, or can flee if they think they don't have a good chance of
winning without a big financial impact. Is that just?

~~~
jsmthrowaway
Should we adjust criminal justice or adjust wealth? What you describe is a
well-known inequality that comes with being wealthy; bail is built for the
99%, and being rich is a good, unfair way to remain in control of such a
situation. But is altering the impartiality of several elements of the
criminal justice system to pursue the occasional unjust rich guy the right
answer? I don’t know. Is there any country in the world that does bail that
way?

It seems like there could be a lot of unexpected drawbacks to such an
approach, since on the other end it’s harder to justify a high bond for a
destitute, transient murderer, for example. If you’re okay with $100 million
for this guy, it follows that you’d also have to be okay with $10 for _him_.
Otherwise justice is partial and biased, even more so than it is now. Ignoring
net worth seems safer, but again, I don’t know.

~~~
mikeash
It's not just about the 99% versus the 1%. There are tons of poor people stuck
in jail awaiting trial because they can't pay a bail that middle-class people
could afford. Many end up pleading guilty for a crime they didn't commit
because it gets them out of jail faster than waiting for trial.

Assuming that $10 is high enough to ensure that the destitute, transient
murderer will show up for trial, why _shouldn 't_ I be OK with it?

~~~
jsmthrowaway
I’m aware and do not need explanation, because I was one of them. I could not
afford $80,000, even with a 10% bail bond, and I plead guilty to a crime I did
commit to get out of jail faster (I was in about five months). I realize that
it might be startling to hear me argue for the status quo having been in that
very position.

What you allege, that people happily plead out while innocent, does not
happen. It just doesn’t, and it’s something I’ve heard repeated a lot by
people who haven’t been inside. I was in a position to advise dozens of
inmates on their cases during my time, and not once did that ever happen.

The truly innocent folks (and it’s hard to tell) were _happy_ to sit to get
their day to prove it or wait for the charges to get dropped. I’ve seen
inmates rip up a plea bargain and throw it in the prosecutor’s face after
sitting in county _three years_. Inmates are not dumb cattle looking for the
first door. They understand what signing a plea bargain does. Even beyond
that, innocent people are almost never arrested in the first place. There are
very, very, very few innocent people in jail. I hate to break it to you,
because I know it undermines liberal sensitivity and view on the world (which
I know because I’m liberal, I’m not critiquing). You’re also coming at this
from the perspective that assumes everyone should be able to bail out, which
isn’t true. Would you revisit total bail denials, too?

Re: $10, how can you make that assumption? It’s disappointing that I’m being
downvoted so heavily for pointing out that a seemingly minor change which is
reactionary to one case could have implications far beyond intention. Being
upset and changing things because of one billionaire is the very definition of
mob-style reactionary grievance. There’s more to consider than just him, _and
I agree it sucks_. This is a complicated issue and the easy engineering fix is
very likely not the right one.

~~~
mikeash
"innocent people are almost never arrested in the first place"

Oh, I see. Guess this conversation is pointless, then.

~~~
jsmthrowaway
It’s an important conversation to have and I was disputing your
characterization that people routinely plead out when innocent, which is a
tenuous claim and strongly argues for reform which perhaps we should be slower
to adopt. It’s a key point. I’m trying to remain civil and substantive, and I
wish you’d extend me the same courtesy.

(Edit: I’m out of posting quota for today, but I at no point said what you’re
claiming I’m trying to tell you in even the most uncharitable interpretation.)

~~~
mikeash
It's tough to do that when you throw such ridiculous statements at me.

The felony conviction rate in the US is around 70%. That doesn't sound to me
like "innocent people are almost never arrested in the first place."

The rate of false convictions for people on death row is about 4%. That's for
by far the most scrutinized cases out there.

According to this article, it's believed that somewhere between 2% and 8% of
convicted felons are innocent people who pled guilty:
[http://www.nybooks.com/articles/2014/11/20/why-innocent-
peop...](http://www.nybooks.com/articles/2014/11/20/why-innocent-people-plead-
guilty/)

Maybe we have a disagreement over what number constitutes "almost never"?

I'm trying to talk about the real problems bail causes in the justice system,
and you're trying to tell me that it doesn't matter because basically everyone
who gets arrested is guilty anyway. That's not substantive, and it's only
superficially civil.

------
monktastic1
And then there's the Sackler Oxycontin story: [http://www.esquire.com/news-
politics/a12775932/sackler-famil...](http://www.esquire.com/news-
politics/a12775932/sackler-family-oxycontin/)

> You’re aware America is under siege, fighting an opioid crisis that has
> exploded into a public-health emergency. You’ve heard of OxyContin, the pain
> medication to which countless patients have become addicted. But do you know
> that the company that makes Oxy and reaps the billions of dollars in profits
> it generates is owned by one family?

There's big money in opioid addiction.

------
fjsolwmv
Why hasn't the local sheriff's office seized that billion dollars like they do
for anyone suspected of handling street drugs?

~~~
21
For the same reason that you never see a SWAT team breaking down a rich
criminal's door to arrest him, even if he has body-guards or registered
firearms, or is accused of a violent crime.

(Yes, I know, someone will find such a video on youtube to prove me wrong).

~~~
MertsA
[https://www.youtube.com/watch?v=pMas0tWc0sg](https://www.youtube.com/watch?v=pMas0tWc0sg)

------
calvinbhai
As a healthy 30 something person, I feel fortunate that I'm not in pain, nor
do I have any addictions to these potent addictive pain killers.

But it is just more salt on the wounds for me because the monthly insurance
premium I pay is huge, and people (after I asked around) consider my health
insurance scheme to be very good. And yet every doctor visit, test etc means
more bills to pay.

It forces me to conclude thus: The healthcare system in the US is totally
unfair to hardworking people of America, and the blame is not on the
doctors/physicians. It lies squarely on this Pharmaceutical/Insurance Industry
complex of creating more sick people, keeping costs artificially high to
fleece more money as premiums from hardworking people, while making it easy to
get prescriptions for such drugs.

EOD, it feels like my money is feeding this drug addiction epidemic. And
politicians on the left, right and center in US are doing zilch to fix this.

w.r.t this article, I hope this owner gets a fair trial, and if convicted, I
hope that he drags down every single person who was part of this scam, with
him.

------
rudedogg
"NSAIDs are stronger pain medications than opioids" \-
[http://www.nsc.org/RxDrugOverdoseDocuments/evidence-
summary-...](http://www.nsc.org/RxDrugOverdoseDocuments/evidence-summary-
NSAIDs-are-stronger-pain-medications-than-opioids-with-IFP.pdf)

~~~
scott_karana
"...for dental pain".

------
zaroth
I don't see any numbers on the scale of the operation... How many
prescriptions, net reimbursement per prescription, how many dollars?

Also, if a doctor is writing an inappropriate script based on a kickback are
their licenses getting suspended?

~~~
mikeash
A lot of doctors didn't know that they were writing inappropriate
prescriptions, because they were evaluating the tradeoffs based on information
from the drug company that said these drugs were much less addictive than they
really were.

~~~
astura
It was in one of the linked articles that doctors are required to undergo
special training from the FDA before they are allowed to prescribe fentanyl.
So they absolutely should know.

~~~
mikeash
Was the information in that training based on the bad data from the drug
company?

~~~
astura
The training is provided by the FDA and the medication is only FDA approved
for breakthrough cancer pain.

So almost certainly not.

------
acqq
In case anybody missed, the fentanyl overdose is officially what killed the
musician known as Prince.

------
solotronics
find and prosecute those responsible for importing fentanyl from China these
are the biggest killers of American youth. I know a handful that died from
heroin laced with fent or from straight fentanyl from the darkweb. Legalize
opiates and treat addiction as a medical condition.

------
phkahler
Tell me again why fentanyl isn't a schedule 1 drug and totally illegal.

~~~
leggomylibro
Because it has legitimate uses for clinical short-term pain management, which
should really put it in schedule 2.

With cannabis up in 1, though, I guess those scheduling guidelines don't
_actually_ mean a damned thing.

