
Pharma Execs Arrested Over Fentanyl Rackateering - blawson
https://www.justice.gov/usao-ma/pr/pharmaceutical-executives-charged-racketeering-scheme
======
another_account
Back when i was in active addiction to heroin I knew that the brief time i
spent messing with fent was the end of the road. The step past speedballs. At
that point I wanted to, and was actively trying to, die. I understood its
power.

To push this onto an unknowing general public is, imo, evil. These people
should be sentenced like Heroin importers. Fent withdrawals, whilst short, are
unadulterated hell. I have never felt a combination of physical, mental and
spiritual pain like it and i have been through spinal fussion in my youth. The
type of pain that changes a person for life.

~~~
velox_io
As someone who is currently prescribed Fentanyl (for complex pain syndrome).
The patches are very different to the product mentioned here, spay.

Not everyone on Fentanyl is an addict and it does have many valid use cases. I
would argue that under prescribing pain meds is just as bad as over
prescribing, maybe I should do an AMA from the other side of the fence..

~~~
velox_io
Wasn't sure about doing this, but here goes!

[https://news.ycombinator.com/item?id=13168314](https://news.ycombinator.com/item?id=13168314)

------
rblatz
Interestingly Insys donated $500k against the marijuana legalization measure
(prop 205) on the ballot in Arizona.

[http://www.azcentral.com/story/opinion/op-ed/ej-
montini/2016...](http://www.azcentral.com/story/opinion/op-ed/ej-
montini/2016/09/12/montini-proposition-205-fentanyl-legal-marijuana/90251526/)

~~~
verbify
Whenever I hear something like that (e.g. the alcohol industry donated to
anti-cannabis legislation, or your example above), it makes me wonder what
they're thought process is.

Let us assume it profit motivated, and they've calculated their potential
losses as a result of legalization (let's call it pl for potential lossses),
they've calculated the probability of it passing without a $500k donation
(let's call it pnd or probability no donation) and the probability of it
passing with a $500k donation (pwd for probablity with donation). Then, they
can make the following calculation:

If pl x pwd - pl x pnd > $500k then the $500k is money well spent. Otherwise
it's a poor bet. This leads to interesting conclusions:

* Proposition 205 was close (51%-49%). So it seems likely small events could swing it * $500k is in context of a $3m campaign, so it seems again likely that their donation had an impact. But compare it to the 1 billion spent on the general election, and how many more people would be turning out because of the general election, it seems less likely it had an impact * I have no way of knowing what their potential losses are from legalisation, but let's assume they're high.

Let's say the difference between pwd and pnd is a 2.5% chance that their
donation swung the election (which seems overly generous, elections usually
aren't that easy to swing). That means they are assuming losses of
approximately 20 million in Arizona from legalisation.

Generally though, I'm not convinced they made this analysis, and instead were
trying to demonstrate that they were opposed.

~~~
raverbashing
Bean counters now just need to learn how to factor karma in their calculations

~~~
drvdevd
Yes. The scale of the irony here is "smack you in the face" level, whatever
reason Insys had for donating.

------
Hondor
“Causing the unnecessary use of opioids by current and retired U.S. military
service members shows disregard for their health and disrespect for their
service to our country,”

Why does any problem affecting veterans become disrespecting their service?
Maybe they're just an easy target more likely to get addicted to painkillers
than normal people.

~~~
noir_lord
Because the US has a weird fetishistic thing going with their vets, all that
"fighting for our freedom" when you are the biggest richest and most heavily
armed country on the planet your freedom (from external threats) was never
under doubt.

A lot of it I think is an over reaction to the way returning troops from
vietnam where treated.

In either case, strong reverence for the military is one of the criteria for a
fascist state.

EDIT:
[http://www.rense.com/general37/char.htm](http://www.rense.com/general37/char.htm)

Since someone called what I said inflammatory I posted where I read the
military reverence thing.

~~~
ihsw
> In either case, strong reverence for the military is one of the criteria for
> a fascist state.

Just to provide a contrarian viewpoint -- strong disdain for the military is
one of the criteria for a weak state rife with degeneracy and malignancy.

The military serves an important function in society and personally I think it
deserves far more recognition than profit-seeking hounds with low moral
standards (ie: the scum referenced in the article).

~~~
pjc50
"degeneracy and malignancy"? Can you unpack that into some slightly less 19-th
century English please?

~~~
eli_gottlieb
A 19th-century mindset can't really be unpacked into 21st-century words.

------
Animats
This was a story last year.[1] At that time, the Insys CEO, John Kapoor, was
prominently mentioned. But he's not in the group arrested.

[1] [http://www.cnbc.com/2015/11/04/the-deadly-drug-appeal-of-
ins...](http://www.cnbc.com/2015/11/04/the-deadly-drug-appeal-of-insys-
pharmaceuticals.html)

~~~
wu-ikkyu
Maybe he made a deal with the authorities to testify or provide evidence?

------
7sigma
Not really related, but I noticed the name of the prosecuting attorney: Carmen
M. Ortiz.

She's the one who prosecuted Aaron Swartz IIRC

~~~
Ericson2314
Oh boy here comes the congestive dissonance

~~~
athenot
I know HN is not the place for 1-line witty quips but _congestive dissonance_
made me laugh out loud. Thanks for the laughter!

Back to the topic, real life is complex. The same person fighting against us
on one issue can be working with us on another one. The "good guys/bad guys"
narrative is deeply anchored in our storytelling arts but it's also a gross
caricature of reality.

In the business realm, consider Apple and Samsung who both collaborate on
projects and actively sue each other.

------
sfifs
Some of these execs are being charged under RICO. That's going to be brutal.

I was under the impression Prosecutors generally avoid RICO due to higher
burden of proof. I guess this sets an example for the Pharma industry to watch
out.

~~~
epistasis
It seems that laws around healthcare actually have teeth as they should.
Criminals in this industry actually go to jail and are punished, unlike, say,
the financial industry. Clearly the pharma lobby hasn't had as much success in
detoothing law enforcement.

------
finid
_The medication, called “Subsys,” is a powerful narcotic intended to treat
cancer patients suffering intense episodes of breakthrough pain. In exchange
for bribes and kickbacks, the practitioners wrote large numbers of
prescriptions for the patients, most of whom were not diagnosed with cancer._

Nowhere in that article did I read anything about arresting/charging the
"practitioners" who actually wrote those prescriptions, or did I miss it?

------
wallace_f
Use of the word racketeering here is interesting. Wikipedia's definition is:

> A racket is a service that is fraudulently offered to solve a problem, such
> as for a problem that does not actually exist, that will not be put into
> effect, or that would not otherwise exist if the racket did not exist

But it sounds like they were engaging in illegal bribing, not racketeering. I
don't know, am I misunderstanding?

~~~
azernik
Racketeering here refers to a specific law - specifically, RICO (Racketeering
Influenced Criminal Organization). This was built to deal with mafia groups in
the 70s, but explicitly written to include white-collar crime. RICO basically
created a special class of crime to cover the commission of multiple less
serious crimes in pursuit of an "enterprise", i.e. an organized criminal
conspiracy.

So when the Justice Department says racketeering, and then mentions RICO
farther down in the press release, it means that these are basically
conspiracy charges that include a few different items on a list of thirty-
something crimes that RICO includes.

~~~
wallace_f
Thanks for the info

------
trhway
i wish it were a prosecution for real crimes, yet so far reading it it looks
like a typical way prescription drugs are pushed in the US, and the
prosecution here may be just a scapegoating of those typical pharma-pushers
just because of all the high attention the fentanyl abuse got recently, and
thus government has to show action and Ortiz jumped at the chance to look
good.

~~~
matt4077
If "In exchange for bribes and kickbacks..." is "a typical way prescription
drugs are pushed" then I'm happy that "Ortiz jumped at the chance to look
good" and hope others take her lead. Just because something is common doesn't
mean it's legal.

~~~
trhway
(IANAL) it is my understanding that kickbacks from drug companies to doctors
are pretty legal in US - or there is a very technical line between legal and
illegal kickback in pharma/doctor relationship that regular people like us
don't recognize it.

And don't get me wrong, i'm not against sending a bunch of pharma execs to a
country club - i just think that so few of them are sent there that situation
looks more like politically motivated selective enforcement of the law than
full fledged justice.

~~~
danso
It is OK for doctors to have financial relationships with companies, for
example, to be a paid speaker or consultant. But I don't think those are
"kickbacks", and there's a distinction between those relationships and what
the Justice Dept. is prosecuting here

[https://projects.propublica.org/docdollars/](https://projects.propublica.org/docdollars/)

~~~
mirimir
It's a very subtle one, IMHO.

~~~
3131s
So subtle you might call it a "loophole".

~~~
mirimir
:)

 _The Truth About the Drug Companies_ by Marcia Angell (Random House, 2004)

[http://www.nejm.org/doi/full/10.1056/NEJM200410073511522](http://www.nejm.org/doi/full/10.1056/NEJM200410073511522)

------
dacox
Wow. I realize this is about prescription Fentanyl, but my area (Vancouver BC)
is getting hit really, really hard by this drug.

[http://news.nationalpost.com/news/canada/b-c-declares-
public...](http://news.nationalpost.com/news/canada/b-c-declares-public-
health-emergency-after-fentanyl-overdoses-kill-200-people-in-three-months)

It seems to have made it's way into a variety of drugs, not just heroin, so
the demographic of those affected by the deaths has shifted from "junkie" to
"recreational user".

------
jsjohnst
I'm glad they put an end to this, but man, I can't help but think there's a
serious problem with our government based on how many agencies were involved
to do it.

~~~
matt4077
It appears that most of these agencies were involved in a role closer to that
of a witness than an investigator. These are government agencies that provide
healthcare benefits, so they were paying for the prescriptions and therefore
victims of this fraudulent scheme.

There were probably dozens of private employers and/or insurance companies
involved in similar roles, but they're not listed in this press release.

------
partycoder
Well, this has been going on for decades in the case of opioids, resulting in
a national catastrophe, and no one has been arrested yet.

~~~
paulajohnson
Actually there have been a lot of arrests, but so far they have been of the
doctors and staff prescribing the pills, rather than the Mr Bigs. Google "pill
mill arrests" for examples.

~~~
partycoder
Yes, but at a macro level it has been just a slap on the wrist.

------
Graham24
There was an article in the Observer about this the other day.

[https://www.theguardian.com/global/2016/dec/11/pills-that-
ki...](https://www.theguardian.com/global/2016/dec/11/pills-that-kill-why-are-
thousands-dying-from-fentanyl-abuse-)

------
paulajohnson
It will be interesting to see how the plea bargains come out. There won't be a
trial of course.

~~~
_steve_
When opiates are killing more people then guns in America as they did over the
last 12 months, there is a very serious problem at hand. Good to see reason
prevailing, assuming the charges stock and they do hard time

~~~
paulajohnson
The way it generally seems to play out in the USA, especially for white collar
defendents who can afford plenty of lawyers, is something like this. They are
charged with crimes that carry a decade or two in prison, but are then offered
a plea bargain. Going to trial is risky for both sides: conviction means a
decade or two in prison, but acquittal is very public egg on the face of the
lead prosecutor. In a case like this it mostly depends on who the jury feel
sorrier for; the hard-working family men who overstepped an obscure rule, or
the unfortunate addicts who were suckered into it by a bunch of unscrupulous
bastards.

So a plea deal is very likely, which means a sentence of under a year, quite
possibly suspended, and a stonking big fine to the company (which hits the
shareholders rather than the managers who made the decisions).

------
devilsAdvocaat
Just to be contrarian:

    
    
      Innocent until proven guilty.

~~~
mikeyouse
Right, that works for the justice system. Fortunately, we are humans with free
will and cognitive ability to make our own judgements.

When the company's entire senior leadership team is caught bribing physicians,
many of whom were themselves arrested[1] for over-prescribing the drug in
question, and is caught defrauding insurance companies to push their drugs ---
We can wholeheartedly believe they are guilty. I wouldn't want them to go to
prison until they have a trial by jury, but I don't have to give them the
benefit of the doubt.

[1] - [https://www.nytimes.com/2014/11/28/business/drug-maker-
gave-...](https://www.nytimes.com/2014/11/28/business/drug-maker-gave-large-
payments-to-doctors-with-troubled-track-records.html)

------
londons_explore
Wait - I thought all US healthcare was done on the basis of kickbacks, perks,
benefits, and free lunches from drug salesmen to physicians?

How is this any different?

~~~
cmdrfred
Somebody must of forgot to kick up the vig.

