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In India’s Slums, ‘Painkillers Are Part Of The Daily Routine’ (khn.org)
36 points by adeel_siddiqui 52 days ago | hide | past | web | favorite | 73 comments



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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Mods please ban this user. Textbook anti Semitism.


Just a suggestion, what seems to work best here is to simply flag the comment and move on. No need to post a reply asking the mods to ban the user and explain why.

As you can see (if you have 'showdead' enabled), the offending comment is already flagged and dead after only 15 minutes. The mods do pay attention to these flags and will take it from there.


I think the limitations of the mobile app I use for Hackernews hindered me here. I do remember looking for a report/flag option.


emailing the mods is the best way to get their attention about things like this.


[flagged]


Highlighting Jewish heritage when it is not relevant in this context, thus insinuating that it is relevant in this context, is anti-semitism.


[flagged]


If you post like this again we will ban you.

We've banned the account above, for obvious reasons.


The reasons aren't obvious to me, but I'll try to keep this in mind.


Anti-Semitism is poison and not allowed here.


> 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.


I don't remember exactly, but it seems to me that some official statistics I saw did not include dead in first year of life in life expectancy. Just as arbitrary as 5 years, I think.


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.


No, the point is that if you say that life expectancy is 39 that makes it sound like the average 10 year old will live to about 39. But the actual figure will be a lot higher because the overall figure is brought down by high infant mortality.


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.


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


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)


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.


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.


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?


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.


Wages were not an issue, her knowledge was. She'd regularly buy expensive, overpriced trinkets. Also, she had two older brothers who got priority, so paying her more wouldn't necessarily go to her. She was still living with her parents.


I also learned about this.

There is a guy I met in gym who was asking me why I take protein shakes when they are so expensive.

He told me he takes some protein injected into bloodstream which is more effective and produces better results than fake optimum nutrition protein I get from Amazon.

So I asked him to show that protein, guess what, it was anabolic steroids. Sure did it produce amazing results and he thinks side effects are because Rahu in his Kundali.



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.


> 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/


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.


Well, it's good for a third line painkiller, after NSAIDs and codeine and oxycodone are not enough. And something like levetiracetam or pregabalin or other SNRI is not appropriate.

But calling it non-addictive is criminal. It should be, at least. This thing very much is.


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.


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.


Seems like you are still addicted to heroin and just trying to rationalise things. Lets play devils advocate, lets say the problem really was cost and difficulty of procurement. Then rich people should have no issue with it, no? They have enough money and they usually have a trustworthy dealer around. In fact one can practically say that rich people live in world very similar to a world where drugs are legal, because (a) they can afford them and (b) the police do not bother rich people with drug searches nowadays. Should be great.

Of course what really happens is that a rich person takes more and more, gets more and more addicted and thus must take more for the same effect, until they take enough heroin to literally turn off their heart and they die, usually in their bathtub. How many people die from a tylenol overdose.

If you make heroin legal you just ensure the same fate reaches many more people. Perhaps we can make heroin legal for people already addicted but lets not kid ourselves that is just kind of a prolonged assisted suicide.

I have no doubt that you feel miserable and you felt much better on heroin, but that is a product of your addiction rather than anything else. Healthy people can feel mental and physical clarity without drugs.


> 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.


>This is ridiculous

It's somewhat true. The amount of paracetamol needed to reduce severe pain can cause many health problems, while a low dose of opiates would manage the pain. With opiates, prolonged use is more of an issue.

So an opiate would be the safer option while getting a tooth pulled, but Tylenol would be safer for the recovery period.


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).


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


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


The same applies to comments on HN.


This sounds awful but i would say somewhat believable because many middle class people do coke regularly and apart from usually, picking a few kilos, they still look OK and keep their careers, families and the stuff. For sure it's not nearly as bad as if they were drinking. My ex is a writer and she was mostly writing on coke, she's as far from being a lost in life drug-addicted person as it gets, honestly i'm a lot closer to there with my alcohol abuse.


From my personal observations, I don't think coke is quite comparable to heroin. Heroin takes over a person's life in a much more scary way than coke. Heroin becomes the number one thing every day, before food, family, or any other concern. Granted, you can easily be a high functioning heroin addict, if the expense and acquisition are not concerns, but at a point, heroin merely makes you 'normal', and even slightly outside that window is a steep descent into withdrawal hell.

Coke is both better and worse. Not quite as addictive, but it seems to damage people more than heroin does (particularly mentally).


Isn't it only 10% of heroin users that become addicts?


Source? I know a few people who tried but did not become addicted, but i thought of them as more of an exception.


They definitely wouldn't if they were taking coke with the regularity and frequency an alcoholic drinks though.


The thing is, coke is slightly more dangerous, but quite a lot more physically addictive. It's hard to quit once that holds, though it's relatively easy to keep steady dosage as the euphoric effect is short lived.

Unlike cocaine, opiates would hurt productivity in general. There was a time when many people were addicted in China to opium...

Wars were and are fought over best growing grounds of many drugs.


The addictive and tolerance building effects of opiates are pretty bad. Heroin may make you feel better, but the withdrawal effects are horrific. Heroin legalization would help people get off the addiction. But it should not be done to encourage people take more opiates.


I remember some addiction treatment centers in certain countries (was it UK?) were allowed to prescribe opiates including heroin as part of program to wean people off it.

Is that gone as part of some stupid war on drugs or other?


Still true-ish - it's methadone rather than heroin.

From https://www.nhs.uk/live-well/healthy-body/drug-addiction-get...:

> If you're dependent on heroin or another opioid drug, you may be offered a substitute drug, such as methadone.


No, actual, real heroin is prescribed legally to some people:

https://www.independent.co.uk/news/uk/home-news/heroin-addic...

It's also used legally in the UK in paliative care for cases where it's easier to administer than morphine.


Medical opiates are legal and taken on doctor's orders, so typically 'properly'.

Somehow it didn't turn out so well. (Google 'opiate epidemic'.)


How hard was it for you to quit? Did you go to rehab?


I quit my job as a developer (because I knew I would get fired if I kept my lifestyle the same), broke the lease on my apartment and moved to my parents house for a month and got a doctor to give me suboxone. Am I a lot happier person now? For sure l. But I’m still addicted to opiates. Really the only difference is that now my opiates cost $100/month instead of $6000/month. If I could have gotten heroin for the same price I would never have quit, and honestly, probably feel better.


You say you are happier now, so why do you think you would feel better on heroin?


Because not being able to sleep at night because you don’t know whether to pay your rent or get enough heroin for two weeks is stressful. It’s not about the drug, it’s about the cost.


I did Cocaine with my girlfriend to give her company, a few months maybe.

Then I convinced her to give it up after I did so myself. Now it's long time, and we are clean.

Why did we stop? I always knew drugs are bad for us, they promote neurotoxicity and damage brain. I tried to make her understand this many times but one time she nearly died with drug overdose after that she changed and we quit.

Few changes I noticed is that I became lot less combative in my arguments, became less concerned about my political and religious beliefs.

And more or less, I lost the anexity issue I used to have.

Bad see effects? I do not know of any, I've good long term memory and I do not notice any change in that either.

I understand drugs are mind altering substance and possibly neurotoxic which could be fatal for our brain.

Worst thing is that, many people get addicted to these and are never able to walk out of addiction. Luckily, that was not our fate.

So I think not all people are addicted to drugs and many can quit it at will whenever they want.

Legalisation would be better, although you can buy any drug in Europe but problem is that if you are caught with it or you overdose then how do you call ambulance? Many would be terrified if they overdosed and will die.

Talking with my doctor friend in EU, he says you can deny that you took drugs and claim that someone else put that in your drink or something and the case ends there but how many know it?


Just as in interesting sidenote - heroine(diamorphine) is actually used legally as pain relief in some countries, even UK uses it for palliative care.


I am aware of that. Apparently most of the damaging effects come from the crap it is cut with when buying street heroin. (Again just stuff I have read, no first hand experience).


Do you mean auto rickshaw, bicycle rickshaw, or hand rickshaw?


I assume he meant hand or bicycle rickshaws, but he didn't specify.


This is changing tho, now there is Electric Rikshaw, so you don't need stimulants.


Heroin is not a stimulant.


I thought that opiates were stimulant at lower doses. Sedative at higher doses.


Yes, you are right but the point stays. Now they'll not have aching body from hardwork.


Rickshaw also means motorcycle (usually cng) with a cabin, not just pedal powered.


I would have called that a tuk-tuk.


The place where I am in North India.

Those motor ones are called Vikram or Auto, and only manual one is called Riskshaw but now electric one is also called Rickshaw.


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

https://www.youtube.com/watch?v=zGcKURD_osM


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.


> 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.


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.


> 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.


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.


> 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


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.


Have you actually dealt with people on drugs? Do you know how it effects their families?


Doesn't really affect my rich friends much. They call it their youthful phase before they go onto better things in life.




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