
In India’s Slums, ‘Painkillers Are Part Of The Daily Routine’ - adeel_siddiqui
https://khn.org/news/india-slums-painkillers-chemists-opioid-culture-drug-laws-ripe-for-misuse/
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dillondoyle
Mundipharma is owned by the Sacklers, aka Purdue. This makes me incredibly
angry to read they are repeating the same playbook in Asia, paying doctors and
using incredibly misleading and flat out false marketing to get patients
addicted.

They just offered to sell Munipharma... But feels too small to me. I won't
believe justice is done until every penny is recovered from them personally as
they've already syphoned out billions in profit. And ideally face criminal
consequences if litigators can prove they broke laws - whether false
marketing, bribes, RICO, whatever it takes.

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sersi
> In the Mankhurd slum in Mumbai, where the average life expectancy is 39

I wish articles didn't use life expectancy which is always misleading and
confusing since it's severely affected by infant mortality. What would be more
interesting would be 2 numbers, infant mortality and life expectancy at age 5.

~~~
C1sc0cat
So the death rate before 5 doesn't matter - I am sure it matters a LOT to the
parents of those kids that die very young.

~~~
foota
It's not so useful if you're looking at the overall health of an area though,
since infant mortality is a slightly different beast.

~~~
saiya-jin
well overall health of some area can't be that great if you have high infant
mortality

~~~
foota
They're likely correlated. Might be interesting to look at the outliers
(places with low child mortality and low life expectancy after 5 and places
with high child mortality and high life expectancy after 5)

~~~
sersi
I would naively say (and this is why I made that point about having two
different numbers) that life expectancy after in later years is also
influenced by Violence, Wars and Addiction whereas infant mortality might be
more influenced by health conditions, sanitisation, presence of germs and so
on...

Regardless, in an article, saying that the life expectancy is 39 years old
will make people think that people die at an extremely young age when often
it's mostly due to infant/child mortality. Which is why separating it would
make things clearer.

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distant_hat
Indian medical system is something that one can't even imagine living in the
Western world. The vast majority of 'doctors' are actually quacks. I learned
that my maid used to go for weekly 'steroid shots' to some quack in her
neighborhood. Her reasoning was that everybody did so. I offered to pay her to
visit a regular doctor but she refused. She was also significantly
malnourished and would drink sugar solution occasionally so she didn't faint.
I again told her she could have a breakfast at my place and she did when
desperate but refused when not citing that her family would be upset if they
learned of it. It is anecdotal, but her lifestyle was entirely unremarkable.
The poor in India are like this. India has the largest number of indentured
servants in the world. The poor in India live short, brutal, miserable lives.
Let them have their painkillers.

~~~
Vinnl
If you were willing to pay for her doctor and breakfast, but she wouldn't
accept it, wouldn't if have been an option to just raise her wages?

~~~
gambiting
I can only imagine that she's not eating a breakfast not because of lack of
funds but because her quack doctor told her that drinking sugar water and
injecting yourself with steroids is healthier than eating. There are "doctors"
like this in the west too.

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adeel_siddiqui
Part 1 of the story: [https://khn.org/news/india-burgeoning-chronic-pain-
market-us...](https://khn.org/news/india-burgeoning-chronic-pain-market-us-
drugmakers-stand-to-profit/)

------
aedron
In the subcontinent most clinics are commission salesmen for pharmaceutical
companies. They have a deal with them that every prescription should include
the company's products (painkillers, antibiotics), and they get a commission.
Sales reps call on the clinics constantly to push the products. It is
horrible.

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DanBC
> If there is a precursor to an American-style opioid epidemic in India, it is
> tramadol, a painkiller that became available here in the early 1990s.
> Drugmakers — often citing studies they had funded — touted tramadol as less
> addictive than other painkillers.

> “Tramadol information would come to every single clinician,” said Dr. Bobby
> John, a Delhi-based health expert. “Why? Because there is some drug
> salesperson sitting outside your door saying, ‘Hey, there’s a new drug. It’s
> non-addictive.’ Standard playbook.”

It's really important that people have easy access to opioids at the end of
their life.

Tramadol is a terrible medication and is almost always the wrong choice of
med.

[https://emcrit.org/toxhound/tramadont/](https://emcrit.org/toxhound/tramadont/)

~~~
C1sc0cat
I have taken it in Hospital (UK) after a major opp (25 plus staples in the
main wound site) and stopped after a day or so as it was making me vomit.

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collyw
Anecdotally a friend who travelled a lot in India told me that most Rickshaw
drivers are take heroin.

It wouldn't really surprise me as it looks like a damn tough life that they
have.

~~~
mruts
I used to be addicted to heroin and honestly, the drug is amazing. The mental
and physical clarity it gives you is downright unbelievable. For me the
problem was never heroin itself (I worked harder on it, I was less anxious and
happier) but the cost and the risk of it’s illegality. If heroin was the same
price per pound as other agricultural products like beans or flour, I don’t
think I would ever quit. For me the problem lay entirely in the cost and the
difficulty of procurement if I traveled or something. I think people would be
surprised by the positive effects of heroin legalization on lifestyles and
outcomes of addicted people.

I’m not saying addiction is good or whatever, but opiates taken properly are
safer than Tylenol and without money being an issue I think would help a lot
of people. People on heroin look kind of shitty not because the drug is
hurting them, but because the cost is hurting them.

~~~
dlkf
> people would be surprised by the positive effects of heroin legalization on
> lifestyles and outcomes of addicted people.

This is true.

> opiates taken properly are safer than Tylenol

This is ridiculous.

~~~
collyw
Is it? I have seen Youtube videos mentioning large numbers of soldiers in
Vietnam being addicted and being able to come off relatively easily when they
got their normal life back.

(Saying that one of them might be one of the two Kurtzgesagt videos that they
decided to remove afterwards).

~~~
wtdata
Youtube videos aren't a source of truth or science.

~~~
loa_in_
YouTube videos might or might not be a source of truth and science

------
ewe3
Great video about the history of Oxycontin and the secretive Sackler family
behind it:

[https://www.youtube.com/watch?v=zGcKURD_osM](https://www.youtube.com/watch?v=zGcKURD_osM)

------
foobar_
People who haven't done drugs don't really have the right to talk about drugs.

It's like people who haven't done sky diving trying to make laws againt sky
diving.

Rich people do drugs too but it's always when poor people do it it's somehow
bad.

~~~
pvaldes
> People who haven't done drugs don't really have the right to talk about
> drugs.

This is an absurd argument, obviously. This would be like saying that
pedestrians hit by a car don't really have the right to talk about regulating
cars because they can't understand the power that you feel when you drove your
car. Drugs do not affect only to people doing drugs.

~~~
foobar_
When on earth have we had a conversation about regulating drugs?

Yes, cars should be banned. People who have sex make loud noises ... so sex
should be banned.

~~~
pvaldes
> When on earth have we had a conversation about regulating drugs?

A few lines above, when you put as example "would be like trying to _make
laws_ against sky diving without experiencing sky diving". Making laws =
regulating

I never talked about banning sex, or cars, I said that even people that do not
drive can (and will) have a word about _regulating_ car use, in their own
interest, and also for the public interest. Same for drug use.

Regulating is not the same as banning, so please don't put words in my mouth
trying to reduce the conversation to absurd. Is a cheap trick.

~~~
foobar_
Do you even have a point to make other than ... you don't really like people
doing them?

Drugs are not regulated but are illegal. If you don't understand the
difference between regulating and illegality ... you are so intelligent.

~~~
pvaldes
> you don't understand the difference between regulating and illegality

illegal ∈ regulated

> Drugs are not regulated but are illegal

Drugs are strongly regulated (ask your pharmacist) AND some of them are
strongly regulated AND are also illegal

Illegal by definition means that there was a regulation that created this
status. Those drugs would be alegal otherwise.

Regulated means that for some special cases the use is allowed, even if is not
ok for a recreational uses. A physicist can have solid reasons to give a
morphine derivative to somebody in a perfectly legal situation

~~~
AstralStorm
Yes, and heroin too, or fentanyl.

So they're not exactly illegal.

Some other classes of drugs are totally illegal for use in humans. (Limited to
research only with extra hoops.) Not opiates.

Examples include: LSD, MDMA (changing), PCP, Psylocybin, Psilocin, Muscarine,
a bunch of chemically similar drugs and a few other hallucinogens. THC and CBD
were in this class and are now legal in some countries and states of USA.

