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When half a million Americans died and nobody noticed (theweek.co.uk)
293 points by gruseom on May 10, 2012 | hide | past | web | favorite | 164 comments

Still happening today with sedative hypnotics (e.g. xanax, ambien), where a recent study estimated that these drugs were killing 300,000 - 500,000 Americans each year:


This is despite the fact that the government recommends against prescribing them for longterm use since all the research shows that these drugs have zero efficacy (in fact negative efficacy) after the first ten days or so. And yet most doctors hand out longterm prescriptions for these drugs like candy since they either have no idea about this research or simply don't care. In fact they are some of the most widely prescribed drugs in the US.

(Note that it's not entirely clear that they really are killing 300 - 500k Americans each year, as other studies find no excess deaths, but what is clear is that the longterm use of them is terrible for you and that they have zero longterm efficacy in the first place.)

The world health organisation has some information about the Z drugs.

People in France steal prescription pads - zopiclone is in the top ten list for medications that are obtained with stolen pads.

Dublin drug and alcohol clinics are reporting more people having trouble with zopiclone. People suggest that zopiclone is as addictive as diazepam (valium).

"Addiction" is a technical term, and zopiclone doesn't meet that definition, but people should be a bit careful when taking these meds. Especially if they're taking them long term.

Sleep hygiene is important, and even though there's plenty of information about it anecdote suggests people aren't often given that information.

Also, unfortunately, the best (evidence based) treatment for most insomnia -cognitive behaviour therapy (tailored for insomnia)- is hard to find.

Just over 2.4 million Americans died in 2010 (source: http://www.cdc.gov/nchs/fastats/deaths.htm).

So basically, this study is making the claim that prescription sleeping pills are responsible for 12-20% of all deaths in the U.S.

That sounds like a rather extraordinary, and probably exaggerated, claim.

  > a recent study estimated that these drugs were killing 
  > 300,000 - 500,000 Americans each year
Looks like sloppy epidemiology to me. The only way to nail a claim like that down would be to establish a control group with very similar life stressors, something you couldn't do from medical records. People take sleeping pills because they're under stress bad enough to keep them from sleeping, and that has an impact on survival rates.

  > what is clear is that the longterm use of them is terrible
  > for you and that they have zero longterm efficacy in the
  > first place.)
This is interesting. What's the evidence?

"This is interesting. What's the evidence?"


The actual book (Anatomy of an Epidemic) explains it better, but those are just some quick links. They're also vastly more addictive than heroin. While the worst of heroin withdrawals are over in less than a week, benzo withdrawals can literally last over a year, with people unable to sleep and in severe pain that entire time:


This cannot be stressed enough. Benzodiazepines are insidious because people get used to taking them when they have trouble sleeping, and when they try to stop, they cannot sleep properly for a very long time. I have seen this happen with two of my friends, and it is painful just to watch. Not being able to sleep is a crippling enough horror that people go right back to consuming. To paraphrase Fight Club: NO, what you NEED is some exercise, good food, and to relax.

The Z drugs are not benzos.

To claim that the Z drugs are "vastly more addictive than heroin" is, frankly, ridiculous.

Rebound insomnia is nasty; and the Z drugs should be treated with respect; and sleep hygiene should be tried first; but it's stupid to scare people with nonsense like "addictive as heroin".

... and chew valerian root :) Fight Club is full of useful information, by the way (the book, too).

> This is interesting. What's the evidence?

I'd be interested to see the evidence for "terrible for you".

Hypnotics just make you sleep - they don't treat the cause of the insomnia. (For some people they're great at kicking you back into a routine.) There's evidence that long term use can create rebound insomnia.

Here's a guide for general public stating the need for using the meds short term:-


Here's a slightly more technical document with links to the evidence that they used:


Here's a guide aimed at clinicians with many links to good evidence:


Epidemiology specifically does not and can not nail down claims, but rather provides probabilities of possible causal relationships.

It is a collection of statistical methods based on interpretation of available data, usually from public health records.

Anyone who complains that it doesn't prove anything outright has no idea of what it is, how it works or what it tries to achieve.

they either have no idea about this research or simply don't care

Alternatively, perhaps their patients have no idea about the research (or simply don't care)? Of course, a doctor does not have to bend to his patients' demands, but perhaps if they are pestered enough...

I can actually see how this would be difficult to spot. Look at the graph of American death rates from the CDC:


If you know where to look, there is indeed a small spike from 2000-2005, corresponding with the availability of Vioxx. The rise in 2000 is barely noticeable, but the drop in 2005 is fairly striking. This makes sense: the drug would have been taken up gradually by the market, but its cessation was virtually overnight.

The reason this would be difficult to spot, however, is because death rates did not really increase. Rather, they stayed more or less constant, when they might otherwise have gradually decreased. In hindsight, this looks plausible -- but at the time, saying that death rates would be decreasing were it not for Vioxx would have been an extremely difficult counterfactual argument to make.

Sure but it doesn't matter and isn't the issue at hand.

Merck knew about Viox' problems from the research they suppressed.

The data matters mainly to retrospectively determine how bad the situation was and looks like it was really bad.

I think you've seriously gotta squint to make the data you're talking about look like anything other than noise.

That's not right. Correlations with data this large can be proven quite conclusively even if the signal is low. There are a lot of deaths every year, so even fairly small relative signals are resolvable.

What's interesting here though is that this is not a small signal, precisely because it shows up against the background without any correlation work at all. FTA:

> "We find the largest rise in American mortality rates [in the last 15 years] occurred in 1999, the year Vioxx was introduced, while the largest drop occurred in 2004, the year it was withdrawn," says Unz.

That statement, however, doesn't seem to correspond with the CDC's graph, which shows a much larger rise in death rates occurring in 1993.

(Source article for that graph: http://www.cdc.gov/nchs/data/databriefs/db88.htm -- would that they distributed the actual datasets behind the graphs!)

1993 was 19 years ago. Though I'd be curious what that effect was too.

Flu outbreak?

EDIT: URL removed. The link I included appear to be written by an idiot. Sorry.

> A CDC review of mortality patterns in 1993 states: “the decline in life expectancy likely reflects increases in death rates for chronic diseases during the two influenza outbreaks in 1993.” [Morbidity Mortality Weekly 45 (08), 161-64, March 1, 1996] Some increases in chronic disease (diabetes, heart disease, COPD) were “the result of the two influenza epidemics of 1993,” said the report. [Monthly Vital Statistics Report, Volume 44, No. 7(S), page 9, Feb. 29, 1996]

Crikey, that was 19 years ago already? No wonder I've got a stiff neck!

Apologies -- I'd misread the OP to say that it had been the largest jump in 15 years -- meaning the 15 years prior to 1999.

"Besides," says Unz laughing, "it shows the stupidity of our political leaders that they didn't seize upon this great opportunity. They should have just renamed Vioxx the 'Save Social Security Drug,' and distributed it free in very large doses to everyone, starting on their 65th birthday. Maybe they should have even made it mandatory, three times per day. At sufficiently large levels of national consumption, Vioxx could have almost singlehandedly eliminated all our serious budget deficit problems. 'Vioxx - The Miracle Anti-Deficit Drug'."

That's so morbid. This is the kind of dangerous idea that I'm sure many people have, but are afraid to voice publicly.

A lot of people unfortunately subscribe to the Malthusian ideology that all problems are caused by overpopulation. In fact, I'm pleasantly surprised when I meet someone who does not believe that overpopulation is the cause of most of the world's ills.

Well met then, sir or madam.

Malthusians have been predicting gloom and doom for years, and yet, continuously been proven wrong.

Anyone who believes otherwise has usually just not actually read what Malthus wrote in his books. His main hypothesis has at least been rejected for the time periods concerned, as the food supply has vastly outgrown population growth. Now, that doesn't mean everyone has food, but it does mean that the human population as a whole has an overabundance, quite contrary to what he predicted would happen.


At current population growth rates (exponential), within 10,000 years the number of human bodies would be expanding faster than our light cone (polynomial).

Population growth is not constant, further more the rate of growth itself has slowed down, and there is nothing to show that the slowdown won't continue, but lots of evidence that it will.

So population can continue to grow unchecked without stressing resources?

Where are you hiding your storehouse of infinite supply??

You're going to be very rich when the fossil fuels run out, oil for plastics becomes a luxury, when heavy metals relied on for batteries and magnets get more scarce, when water tables fall even lower, as helium runs low, ...

But no of course more and more people demanding all these things and ever increasing power usage can't possible reduce per capita availability?!?

The resources are created by the population. Metals are infinitely recyclable. So is water (distribution is the problem, not existence, and distribution can be solved if you have people who need it and are willing to do the work).

You don't need oil to make plastic - you can literally make it out of air (although it's harder, all the atoms necessary are in air).

All types of energy are more or less interchangeable, If one runs out, switch to a different one.

Animals use resources they find. Humans create those resources.

Yes but at some point there will be a physical limit. Earth's energy income will always be limited by the Sun's energy output. So no, not infinitely. (I imagine making plastic out of air would take a lot of energy.)

Before you tell me how much energy the Earth gets compared to how much we use, I'm going to pre-emptively reply "Exponential growth".

> I imagine making plastic out of air would take a lot of energy.

Not much more than you are otherwise loosing by using the oil instead of burning it. The hard part is getting carbon - not a lot of CO2 in the air.

> I'm going to pre-emptively reply "Exponential growth".

But we are not having exponential population growth right now. And even if we were, the universe is big REALLY big, stupendously unimaginably big. Even just the Earth is enormous, and we are nowhere close to filling it up.

Yes I know the universe is REALLY BIG but infinity is INFINITELY bigger. I am saying population cannot grow, infinitely. There will be a limit.

How do you know? No one knows if the universe is infinite or not. And even exponential growth takes time - if it takes longer than the heat death of the universe (assuming a finite universe in both time and space) to fill it up, then it doesn't matter if it's exponential.

And to bring things back to this earth, this isn't going to be a problem for such a long time that predicting anything whatsoever about it is futile.

>> And to bring things back to this earth Let's end this with a Asimov short story. http://www.multivax.com/last_question.html

> Earth's energy income will always be limited by the Sun's energy output.

This seems to discount tidal, wind, and geothermal energy sources. Wearable devices that capture kinetic movements are a possibility too. As technology progresses, efficiency increases.

While what you're saying seems theoretically possible, it also seems a long way off (perhaps several millennia).

Wind energy is solar energy, indirectly.

I'm often shocked at how people think history started at some point in the last 200 years.

Malthus was completely right and all the historical data we've been able to gather has validated his views, going back tens of thousands of years. The exception is post agricultural revolution, meaning the last 150 years, which might as well be a rounding error. It won't last.

Malthus was right: population is limited by food supply and any increase in food supply results ultimately in a higher population with a roughly constant standard of living.

> Malthus was right: population is limited by food supply and any increase in food supply results ultimately in a higher population with a roughly constant standard of living.

That's the funniest thing I've read in a long time.

You're asserting that we have roughly the same standard of living as people 200 years ago? 1000 years ago? 10,000 years ago?

Well, that kinda depends on how you define standard of living of course. We live very different and longer lives today as opposed to 200 or 1000 years ago. But on a basic day-to-day level, do you think you live a significantly happier and more fulfilling live than a random someone from a 1000 years ago?

Yes. This is so indisputably true I wonder how you can possibly think otherwise.

Even putting aside what must be something like 30 or 40 years worth of life expectancy at birth, and probably a decade or so of life expectancy as a 20-something, the median inhabitant of Earth a thousand years ago was engaged in backbreaking labor from sunrise to sunset, ate an unvaried, subsistence diet and was almost completely illiterate.

The current median inhabitant might be working in a Foxconn factory, but he or she has massive health and lifestyle advantages over his or her 1000 AD counterpart.

I was under the impression though that the 30-40 years average life expectancy is commonly misunderstood?

The mean life expectancy at birth might well have been 35 years but that's dragged down by massive infant and child mortality in the first 5 years of life - if you made it to adulthood, you had a reasonable chance of making it to 60.

I'm not sure claims about a topic such as happiness can ever be "indisputably" true.

Would you not even entertain the possibility that your "median inhabitant 1000 years ago" was actually quite happy with her unvaried subsistence diet, since it was a little bit more varied than her that of her poorer neighbour, and not much less varied than her much richer cousin's?

I doubt he would feel unhappy or unfulfilled for being illiterate - in his sphere of existence, what would he have read? To whom would he have written? Do you feel constantly unfulfilled though being unable to communicate with dolphins, or through being unable to interpret Tibetan Prayer Flags, or (perhaps more topically) through not regularly listening to oral poetry passed down from bard to bard? I suspect not - because you have no expectation of being able to do these things.

It's not just about food or population.

Currently, the (exponential) economic growth is tied to an ever growing consumption of resources, some of which are not renewable.

Malthus will ultimately be proven right unless we abandon growth or manage to dissociate it from resource consumption.

The first solution won't happen (prisoner's dilemma), and the second one is far on the horizon.


Edit: I knew that this post would not be popular, but I would like to hear a rebuttal to my argument, rather than getting downvotes (two at the time of writing).

The first one won't happen because it is good for literally no one. That's not prisoners dilemma. That's not even a dilemma.

The second one is happening full speed and has happened throughout the history of humanity. If you'd looked at wood usage 200 years ago, we looked doomed. If you'd looked at whale oil around the turn of the last century, it was all over.

We're shaking off oil now. It's taking a while, but every time the price of oil goes up, the profit for replacing it gets higher. 100 years from now, our 20 billion descendants will have more than enough of this curious mineral oil stuff for whatever archaic activities such might be used for then.

Past performance is no guarantee for future results. Other civilizations have failed in the past for mismanaging resources.

Your argument optimistically assumes that we'll be able to cope with the environmental changes that our activity is causing. Supply is only one part of the equation. For example, our CO_2 emissions, whether or not they cause global warming (that's mostly controversial in the US AFAIK), are causing ocean acidification, which could have a massive impact on marine life.

In dynamic systems as complex as the earth, tipping points are impossible to predict. That being said, we've never been pushing as hard for one.

Regarding growth, I have a hard time understanding how an exponential growth of our activity can be sustainable, especially in terms of energy requirements, which should be proportional (AFAIK). I believe that the current system is tautological. We need growth to sustain growth, but it hardly benefits people anymore. Wealth and happiness are related up to a point we reached in western countries in the 1960's IIRC. And after the last downturn, the economy restarted, but it didn't bring the jobs back.

I hope that there are alternative economic models. That's why I was talking about the prisoner's dilemma. I think that we're stuck on a bandwagon in a headlong rush.

I know that I'm very pessimistic about this, but I'm genuinely concerned. I can only hope I'm wrong.

Wealth and happiness are related up to a point we reached in western countries in the 1960's IIRC.

I think you're confusing absolute well-being with emotional satisfaction. The latter is often relative: Humans judge themselves in comparison to others, and are often happiest when they perceive themselves to be at the top of the pile. No amount of wealth is likely to change that. As our more "basic" needs of food, health and shelter are increasingly easy to acquire, yes, we'll focus more on that kind of emotional satisfaction.

But again, it's a relative phenomenon. If you think you'd be just as happy after being transported to the 1960's as you are today, I think you're fooling yourself. You'd miss all sort of features of the present day that our massively greater wealth has facilitated (and you'd miss a few years of life expectancy, too). Your absolute well-being is almost certainly much higher, and while that might not lead to emotional satisfaction, it's certainly worth pursuing. Better to be Socrates dissatisfied...

Objective well-being is an oxymoron. You can take all the objective indicators that you want, when it comes to happiness, subjectivity trumps them. Try to convinced someone undergoing depression that he's got everything to be happy...

> Better to be Socrates dissatisfied...

That quote refers to intellectual curiosity, not material wealth.

What new energy source are you relying on to support such an 'optimistic' prediction. What's going to replace plastics? What are you going to feed your 20 billion?

I can sort of see this working if fusion can be made to work in the next few years. But for the sake of the rest of the eco-system I hope man doesnt get anywhere near to that population.

How about solar satellites beaming energy down to the earth. We get hit by a very minor amount of sunlight from the sun.

Only 0.000000724654% of it reaches the Earth. That’s 7.24654 billionths of the Sun’s total light.

the earth receives about 274 million gigawatt-years of solar energy

Put another way, the solar energy hitting the earth exceeds the total energy consumed by humanity by a factor of over 20,000 times.

And thats only only 0.000000724654% of the suns output. Now once we start harvesting our relatively unlimited power source food will no longer be a problem. Build 100 story greenhouse's etc.

I am hardly concerned about our future growth, considering we now have plans to start mining bodys in space. Perfect launch spot for providing our future energy needs. In fact I wouldn't be supprised if the energy is the main factor in planetary resources future plan to add trillions of dollars to the gdp.

>considering we now have plans to start mining bod[ie]s in space //

We need new resources in the next couple of decades (at the outside IMO, ie eariler would be better). Do you realistically see us harvesting a varied collection of minerals from space in that sort of time-scale.

> energy source

Algae based bio fuels sounds promising.

> replace plastics

If we stop using oil for fuel, there's plenty left for plastics. Oh, and carbon fibre is promising.

> What are you going to feed your 20 billion?

Food. There's plenty of unused room for it, and even then, there's hydroponics. Solve desalination, or hook up a cheap abundant energy source to what we already have, and there's even more room.

The mention of Malthus always inspires me to recommend the best book I've read in the past few years:


tl;dr: Malthus was right.

Malthus was right about what? He was wrong about nearly every single main hypothesis he made! What are you saying he got right?

http://www.economist.com/node/11374623 http://wmbriggs.com/blog/?p=1837

Have you actually read Malthus' works?

The book I referenced basically says that western civilization is an aberration caused by a unique set of characteristics, and that the vast majority of people in the world still live in subsistence conditions. Also that the west could easily slip back into those conditions.

But what does that have to do with Malthus?

The book says that many 3rd world countries are in a "Malthusian trap" - any increase in income levels results in a population increase that overwhelms the higher income. Bangladesh is a good example.

Up until 1800, Malthus was spot-on -- any advance in technology that was greeted by population increase would snap back to an equilibrium, with war|disease|hunger inflicting the correction. Gregory Clarke goes into great detail, with statistics on caloric consumption, lifestyle, etc.. that show that the average person at the pre-dawn of the industrial revolution did not experience conditions much more favorable than those of Roman times.


Malthus thinks that population grows like the dark gray line in [0]. Verhulst, and pretty much everyone else who has studied population dynamics [1], thinks population grows like the light gray line (though perhaps with more complexity.) Notice the actual population data following the light gray line.

[0] http://www.growth-dynamics.com/articles/Kurzweil_files/image...

[1] http://en.wikipedia.org/wiki/Logistic_function#In_ecology:_m...

This thread triggered a memory of a couple of amazing TED talks Hans Rosling presented:

http://www.ted.com/talks/hans_rosling_shows_the_best_stats_y... http://www.ted.com/talks/hans_rosling_on_global_population_g...

Oh joy, he has a new TED talk posted in March that I haven't seen yet. Thanks!

No... no he wasn't...

Would you care to elaborate. Which of hypothesis was Malthus right about and which was he wrong about?

"No... no he wasn't..." adds no value to the discussion.

At the simplest level, Malthus predicted that the population would outpace food production by the mid 19th century. So, on that level, he’s objectively wrong.

The main problems are the assumption that food production grows linearly and that population grows geometrically. For food production, scientific advances have kept food production growing far faster than linear. With future advances in technology, I could believe a 10x increase in food production in my lifetime. No one is predicting a population of 70 billion any time soon.

Also, the population isn’t growing geometrically. For the trivial answer, the growth has been more exponential. However, there have again been scientific advancements that Malthus simply couldn’t have forseen. Effective birth control keeps the population count lower. The switch from agrarian to urban culture has eliminated most of the advantages of producing large families and heavily rewarded producing smaller ones. In terms of hard facts, the world population growth rate has been declining since 1963. The UN’s medium projection of population growth predicts a population downturn by 2050.

At the basest level, he was right that the population can’t grow indefinitely. However, most claims that are more specific than that haven’t panned out.

So he was wrong because he had a too narrow view of the problem. I live in China, overpopulation means something here but even then any plane trip over any part of the world will show you, if washe weather allows, that humanity is not the cancer some describe.there is still plenty of room.

It reminds me exactly of "A Modest Proposal" by Jonathon Swift, circa 1729. http://en.wikipedia.org/wiki/A_Modest_Proposal if you've never read it.

I remember reading it as a child as an example of satire.

http://www.gutenberg.org/files/1080/1080-h/1080-h.htm For the original article.

Edit: Added a link to the original article by Jonathon Swift.

What do you think is in a KFC family bucket?

> This is the kind of dangerous idea that I'm sure many people have, but are afraid to voice publicly.

Really? Do tell, who might those people be?

I wonder why that joke was included in the piece in the first place, it throws the feel of the entire thing.

Especially when a lot of today's 65+ year olds are more useful to society than most teenagers...

"Today's"? I think that is true in general :)

I think he meant historically, when we were still either hunter-foragers or early agrarians. Elders were idle mouths that needed feeding, but provided minimal tangible benefits to the tribe at hand.

He was obviously being satirical.

Yeah, that's morbid all right. I'm reminded of "Quietus" in Children of Men.

Truly the best sci-fi movie of the past decade. Not only the lifting of taboo, but the commercialization of euthanasia was perhaps the film's most hauntingly powerful sign of how despairing society had become without reproduction.

A lot of religions object to contraception - there aren't many that object to killing people.

Every religion objects to killing folk.

Every religion has exceptions to the rule.

This is a rational accommodation. Religions that don't make those exceptions run out of followers real quick.

"Every religion has exceptions to the rule."

Typically = the set of people that don't belong to that religion!

Let's address the 'major' religions (none of which I claim membership in, though some ideology overlap occurs).

Christianity - This one is somewhat interesting, because we might be discussing the Ten Commandments or we might be discussing the philosophies of Jesus. Let's stick with Jesus. He made it pretty clear that killing (possibly even in self-defense?) was verboten. Turn the other cheek, and all that.

Islam - I found this interesting, because I didn't know it until I looked it up. Apparently the verses in the Quran that 'condone' murder against pagans and such are actually referring to a very specific period of Muslim history where peace treaties had been violated by neighboring pagan tribes. The Quran apparently directs Muslims to maintain peaceful relations with neighbors (regardless of religion) but not to fall victim to 'oppression', which is worse than death, because we should be like (the Muslim interpretation of) God, who is 'Oft-forgiving, Most Merciful...'.

Buddhism - This one is pretty obvious. Buddhism condemns the killing of all living beings.

Judaism - Let's now go with the Ten Commandments version. So some interpretations say that the commandment is 'Thou Shalt Not Kill', while others say it is 'Thou Shalt Not Murder', and the distinction between those two is apparently 'self-defense'.

So, no, try again. 'Typically', it appears, the source material of the major religions does not condone killing 'nonbelievers', as much as you would apparently like it to. Many seem to actually try promoting peaceful relations and forgiveness of transgressions, even when that might be costly to the members of that religion.

Now what the religion says and what we get are often different, but that's not really surprising, now is it?

Quite correct - religion isn't a problem, it's only those that believe in them that cause any sort of difficulty.

If God wants to stop gay marriage or contraception or abortion then that's fine - all he has to do is appear in the clouds and say so.

it's only those that believe in them that cause any sort of difficulty.

And the golf course would be a beautiful place if it wasn't for the damned golfers.

You can't abstract God away from the church, the religion, man. Any one is meaningless without the other.

You're just going to have to put up with the religious and our noisy, imperfect, interpretations of the Truth.

You know, when I posted the comment about Children of Men, I was worried the topic might veer off into film critique.

I was amazed he was so forward and glib. Is The Week known as a "yellow journalism" style of UK publication?

Have you read the novel Boomsday?

Why do you think we subsidize tobacco farmers and HFCS ?

And those who do point out the dangers of these drugs to the elderly are written off as tin-foil hat-wearing kooks who believe in "death panels".

There is a big difference between premeditated adulteration of a product people already use, like milk; and sweeping studies under the rug[1] about a new product.

If nothing else, a huge amount more people needed to know about the malamine scandal. How are we shipping so much milk with so few cows? Why am I dumping this unmarked 50lb bag of powder into the milk?

[1]: After looking at http://en.wikipedia.org/wiki/Vioxx, I don't see any allegation that Merck actually withheld raw data from the FDA, or provided it with false raw data. That's the great thing about a vague analogy like "sweeping under the rug": you can imply that something happened that didn't, without actually lying.

In a 2030 version of Hackernews someone will point out that a lot of people must have known about coordinated efforts to dump fluoride into our water and everyday products, pasteurize cow's milk to produce a liquid substance that does not exist in nature and then push it as healthy and essential. That thousands of people sprayed produce with toxic chemicals. That thousands of people stood behind a counter and sold people a product that kills half a million of them every year along with 50,000 of their acquaintances (cigarettes) and that America's greatest investor pushed Coke and its evil twin Diet Coke to millions of people who later abused it as part of their path to obesity and heart attack.

The micro-organisms usually present in stagnant fresh water are much more harmful than low levels of chlorine or fluoride that are added to kill them. Diet Coke does not promote obesity. Pasteurized cow's milk is fairly nutritious and is much less likely to harm you than unpasteurized milk (although the regulations in the USA are too strict IMHO).

I thought fluoride is put in water for its teeth/health benefits.

It is. Chlorine is what is used for disinfecting the water supply.

Indeed, it's supposed to protect teeth of people unable to afford toothpaste. Whilst it actually just causes cancer. In a similar way to how X-raying everyone who wants to get on a plane protects us from non-existent terrorists.

Do you have a source for your first statement? Not that I'm implying you are lying. Certainly it's added as a mineral fortifier, but to protect the teeth of people unable to afford toothpaste? That is news to me.

Flouride additions to water was started in the 1960s or 1970s as a public health initiative to fight tooth decay, a significant health problem. It was not added as a "fortifier" in the same way that vitamin D is commonly added to milk.

Fluoride is not a nutrient. It is added to drinking water for the same reason it is present in toothpaste: to convert tooth enamel from hydroxyapatite to harder and more acid-resistant fluoroapatite. For details, see https://en.wikipedia.org/wiki/Fluoride_therapy http://books.nap.edu/catalog.php?record_id=11571 http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm.

Oh yeah, my mistake.

which makes as much sense as putting soap in our milk to keep us clean.

name one person in this day and age that does not brush their theets with a fluoride tooth paste.

Is the benefit only for those who don't brush? Isn't it meant to provide the body with the fluoride it needs for the teeth?

> Diet Coke does not promote obesity.

I don't have a good source* on me but aspartame likely increases appetite and feeling of hunger so I don't know about promoting but it may be contributing.

* see this for example though http://www.ncbi.nlm.nih.gov/pubmed/2359769

There's a difference, subtle though it may be to some, between common legal practices in food and drug production and conspiring to criminally poison consumers for profit. Many of the items you mention are likely bad for the long term health of our species--but I would compare them more readily to medical practices in the dark ages than the short sighted and improperly structured health / regulatory environment we have today.

I'm deeply concerned about the world my children will inherit, but it's difficult for educated mainstream individuals to take the issues you point out seriously if they are presented from a paranoid and conspiracy theory embracing perspective. Even taking a giant leap and supposing any of the conspiracies exist to the extent some claim, the presentation still suffers because of a lack of willingness by the populace to embrace such a dark view of a society that they participate in.

This kind of post does not belong on Hacker News. We appreciate data and reason, not conjecture and appeal to emotion.

IMO grandparent provides an interesting perspective.

I would suggest that it's not that American lives are cheaper, it's that old people's lives are cheaper. (I don't think it should be that way, just that it is that way.)

That, and the public has a much more visceral reaction to food and beverages that kill people than medications that kill people.

It's worth calling-out the original article http://www.theamericanconservative.com/blog/chinese-melamine... (Oh my gosh! A nasty right-wing publication.) You need a right-wing and a left-wing to fly. Or, to go from the abstract to the concrete, you should inform yourself from a wide range of sources. Another notable health scandal (in California) first exposed by the conservative, aka right wing, press was MTBE. See http://www.calnews.com/archives/morgan03.htm and http://www.nature.nps.gov/hazardssafety/toxic/mtbe.pdf (search for KSFO).

These kinds of scandals are not consequences of the free-market. This is crony-capitalism. It could just as easily happen under crony-socialism. And as the MTBE scandal demonstrated, progressive politicians are perfectly capable of foisting this kind of stuff on the public.

I hesitated over whether to post Unz's original piece or Cockburn's linkbaity rehash. In the end the rehash won, because I don't think the comparison to China is the interesting part and because it would likely have sparked a dumb political argument.

Very interesting. I am very passionate about this topic, and I happen to know the author of the paper that took on Merck. The statistics in that paper are exceedingly convincing, since the study was conducted on a controlled set of patients, some whom received Vioxx, and some whom did not (a control group). This article points out a very interesting correlation between Vioxx being taken off the market, and a drop in death rates. Yet proving Vioxx as the causative agent will be very difficult.

Since you know the author of that paper, could you find out for us what he/she thinks of this new information about death rates?

Proving causation would be a high bar, of course, if not impossible. But I'm curious to know what further investigation could be done with this.

I don't agree with the conclusions in this article at all. Also consider that Celebrex (same drug family) is still on the market. If these drugs were truly a grim reaper, I don't think Celebrex would still be around.

If anything, this should be seen as a reason to not allow the pervasive advertising of prescription drugs and aggressive peddling of drug swag - Vioxx was peddled in the most ostentatious way -- my doctor STILL has Vioxx clipboards and other junk in his office. I'm sure that this constant brand awareness and patient nagging helped drive sales (ie. encourage potentially unnecessary or inappropriate scripts).

The other thing to consider is quality of life. I began suffering by a sudden onset of what was eventually diagnosed as a degenerated disc in my back -- at age 25. I went through some intensive physical therapy to try to avoid surgery (ultimately an unsuccessful effort), and Vioxx was the only thing that allowed me to function without narcotic pain relief (which I refused to take for more than a week at a time). It was that good at reducing chronic inflammation.

If I were a 75 year old man with severe, debilitating arthritis having difficulty walking or living a decent life, I'd happily volunteer to take a drug like Vioxx to improve the quality of my remaining time here, even knowing that I was at a higher risk of a heart attack.

Your argument seems to be one of simple personal disbelief, that one drug "in a family" can have effects that others don't? That doesn't seem to be borne out by history or logic... Even your own anecdote seems to argue against it: Vioxx worked for you pain, but Celebrex doesn't.

I never tried Celebrex, as I had surgery in early 2004 that eliminated the need for any medication.

I'm not a pharmacist, but the story regarding this drug is more nuanced. Doctors prescribed the two drugs differently, as folks with other drug sensitivities were not good celebrex candidates, and the risk factors associated with vioxx were not known. Vioxx was the more heavily marketed, "safe" choice.

I've heard this from countless other people as well (including many doctors). Apparently, it was a fantastic pain drug for many people.

Should Merck have disclosed the increased risk of heart attack and stroke? Absolutely.

But, part of the problem is the incentives fostered by a bureaucracy like the FDA. If you know that your new wonderfully effective pain medication increases the risk of heart attacks from 4% to 6% (or whatever the numbers were), are you going to disclose that to the FDA, knowing it essentially spells doom for the billion dollars plus you spent on development?

Wouldn't it be nice if pharmacies could just publish all these finding and let people decide what to put in our own bodies. I know they argue that we aren't doctors and therefore shouldn't be forced to make those decisions, but with the aid of a doctor and true transparent facts I'm pretty sure I would have no problem going, okay this drug is twice as good at helping with my terrible pain, and the side effect is that I'm more likely to die of a heart attack. I'd go, well maybe I don't want to take that risk since I'm at risk already for a heart attack, or I could go oh I'm young and have no family history of heart failure, I should be alright the risk is worth the gain.

I can't for the life of me figure out why we can't just do that. Anyone around care to enlighten me?

The majority of patients have ZERO ability to evaluate the risks and benefits with pharmaceutical intervention. The best example I can provide is patient compliance (do they take their drug as prescribed?). You'd be hard pressed to find a rate higher than 50% for any disease (other than the immediately life-threatening ones).

I don't see how the example you list is relevant to my argument that with proper disclosure and warning of risks people won't be able to decide if the risks out-way the gains.

Example I listed: That with full disclosure I can make an educated choice as to what goes into my body.

Example you listed: That over 50% of people that get prescribed something decide to take that something the wrong way as opposed to as directed.

They don't seem to be the same. (for one, using a drug in a matter different then what you've been told to is just gross negligence.)

Sorry, I should have been clearer.

My argument is this: If you can't count on people to take a drug that will drastically reduce their likelihood of dying, how can you trust them to accurately determine the trade-off between efficacy and safety?

Most patients don't display the ability to figure out risks and trade-offs now (and relatively simple trade-offs at that). Do you think they'll be able to figure out what "45% increase in the risk of heart-attacks (41.2 - 48.8%, 95% confidence interval) in populations who have had a transient ischemic attack in the last 180 days, excluding those who have diagnosed atherosclerosis" means to them?

I think the real problem is that many doctors also lack the capacity to translate statistical data into a rational evaluation of risk.

Consider the infamous 'mammogram statistics problem' as an example. So what do you do then, when nobody in the decision-making chain can be trusted to understand the data?

Yes, yes I do.

Especially if the alternative is denying other people loads of relief (not only in the form of proven effective drugs that are taken off market, like Vioxx, but all the drugs that aren't even investigated because they fit in a class of drugs with known negative side effects).

Edit: misread your post. Yes, I do trust people to make decisions on efficacy v. risk. This would be even easier if we had a system that promoted the discussion of this information rather than one that effectively prohibited it. Merck should be able to openly say, "Hey guys, we have this great drug that is really effective at managing pain, plus it's non-narcotic. The only downside is, it increases your risk of heart attack by 50%. Talk to your doctor about it."

"Do you think they'll be able to figure out what "45% increase in the risk of heart-attacks (41.2 - 48.8%, 95% confidence interval) in populations who have had a transient ischemic attack in the last 180 days, excluding those who have diagnosed atherosclerosis" means to them?"

That's why I stated earlier that your doctor is and should explain to you what those words and statistics mean in laymen. Your example is full of the exact opposite of what I was saying.

People are typically very poor judges of risk, even while they think they're good at it. If I take this pill I'll lose ten pounds for my class reunion, but I'll probably need a new liver? Sounds good, sign me up!

People are more than sufficiently educated about the risks of drunk driving, but it's still a problem, because bad outcomes only happen to other people.

"If you know that your new wonderfully effective pain medication increases the risk of heart attacks from 4% to 6% (or whatever the numbers were), are you going to disclose that to the FDA, knowing it essentially spells doom for the billion dollars plus you spent on development?"

Did Merck not disclose something? http://en.wikipedia.org/wiki/Vioxx seems to indicate they did disclose the increased risk over naproxen, but tried to explain it away without further investigation.

Both tylenol and marijuana are in the same family of drugs (CB2 agonists), but tylenol kills hundreds of Americans per year whereas marijuana doesn't. The fact that they are vaguely in the same family doesn't mean they have comparable risk profiles.

One of the most toxic pain killers (Acetaminophen/Paracetamol) is also one of the most common over the counter medicines!

Tylenol is usually fine if you stick to the recommended doses. Usually when someone has serious problems with it, they've been taking handfuls at a time (which will completely destroy your liver).

Anything is fine if you stick to the recommended dose!

The problem with this drug is that 16-20 tablets can be a fatal dose - which isn't that many taken 2 at a time.

Even water is toxic if you ingest too much too quickly.

IIRC Tylenol (ie Acetaminophen/Paracetamol) is the leading cause of deaths due to drugs.

Both accidental, because the fatal dose is relatively low compared to the therapeutic dose and because deliberate overdoses are far more likely to be fatal than say sleeping tablets.

Is an increased risk of heart attack preferable to narcotics? To my understanding, something simple like morphine has few side effects, beyond the obvious risk for addiction/abuse.

Narcotics don't have negative health side effects, but there are still the issues of:

- Do they actually work to relieve pain?

- Are people able to function normally on them, or are they stuck in bed all day while unable to walk, with severe brain fog, profusely sweating, and nauseous.

- Is it easy to accidentally OD even if you're taking the prescribed dose? (Which is the case with fentanyl patches... accidentally role over in bed or step into a hot shower without remembering to take it off first and there's a good chance you're dead.)

Narcotics also aren't an anti-inflammatory so they're not actually fixing the problem at all, they're just covering up the pain, and often not even very well. That's why medical marijuana is so much better for back problems, because it's a strong anti-inflammatory, and also because the analgesic dose is much lower than the psychoactive dose so you can get relief from your pain without being left unable to function. Especially since you can now get high-CBD marijuana, which is basically non-psychoactive to begin with, but with even stronger anti-inflammatory properties than regular marijuana.

From my personal experience with prescribed narcotics for things like wisdom tooth extraction, kidney stones, etc., is that they don't do much in terms of pain management.

That is interesting about marijuana being anti-inflammatory...I did not know that.

I find the value of human life comparison between China and the US somewhat ludicrous, since societies obviously tend to react much more strongly to babies with strange acute symptoms (kidney stones), than to elderly people passing away from typical reasons (heart disease).

Oh yes, because 6 dead babies have more "value" than half a million dead elderly. How dare the author make such a comparison!

Half a million Americans died in the last 80 days, most due to aging. Nobody really paid much attention to that either - or the same number in the preceding 80 days, and the 80 days prior to that, and so on. One can ponder what that says about humans.

If we could pull "aging" off the market than we would. Unlike aging, this one drug can be removed from public consumption. Aging, while some day "curable" is nowhere near that today.

Worth noting that Celebrex is very similar to Vioxx (COX-2 inhibitor), and that researchers do not know if Celebrex has the same issues as Vioxx- they've avoided repeating this study.


This isn't true. When the FDA held their hearing about Vioxx, they also evaluated Celebrex as well.

Vioxx was found to have serious CV risks associated with it at ALL recommended doses. Celebrex was found to have CV risks associated with only the highest dose.

The FDA made the call that Vioxx should be gone and that Celebrex can stay (with an updated label that describes the risks). Same with Naproxen.

One point no-one else has raised here, is that (as far as I can tell) no employee of Merck was punished for this. How can Merck the company plead guilty to a misdemeanor, but no individual be held even partly responsible? "Under separate criminal proceedings, Merck plead guilty to a federal misdemeanor charge relating to the marketing of the drug across state lines, incurring a fine of $321.6 million." From http://en.wikipedia.org/wiki/Rofecoxib .

It frustrates me that people in big companies have no deterrent from acting unlawfully. The same thing happened in Wall Street companies in the GFC.

Contrast that with what happened in China.

Liked the article up until the point at the end where he attributes our deficit to Medicare and not the wars.

The US death rate is about 2.5 million/year. Seems like somebody would have noticed a 20% jump due to a single drug. Can this 500,000 deaths/year number really be close to correct?

Edit: duh, not per year. Oh well, there may still be some little nugget of validity in there somewhere.

it was 100,000 per year for five years.

The article mentions that people did notice when it was dropped down, but doesn't mention anything about when deaths/year went up.

"We find the largest rise in American mortality rates occurred in 1999, the year Vioxx was introduced, while the largest drop occurred in 2004, the year it was withdrawn"


"Vioxx was almost entirely marketed to the elderly, and these substantial changes in the national death-rate were completely concentrated within the 65-plus population."


"The FDA studies had proven that use of Vioxx led to deaths from cardiovascular diseases such as heart attacks and strokes, and these were exactly the factors driving the changes in national mortality rates."

yes, but those were noticed years later. As far as I know, no "Mysterious death spike" articles were published in 2000 because of the extra deaths in 1999.

The drug did not gain widespread adoption in a single year.

It's 500,000 in total, not per year.

I wonder if the blowout in the rate of healthcare cost expansion under Bush and the deceleration of late can both be ascribed, at least in part, to the end of Vioxx.

The article tells us that lives in the US were valued at $4.85 billion. So what was the payoff for victims in China that permits the conclusion that 'American lives are quite cheap unlike those in China'?


The fact that NO AMOUNT OF MONEY could save you from prosecution in China maybe?

In fact, the American Conservative can point to several dead Chinese 'Boardroom types' to make a quite convincing argument that no amount of money could even save them from execution in China.

Or maybe the people who were executed are the ones who didn't have enough money.

Anti-corruption campaigns are very common in China. They'll go through and execute a few hundred people at a time. But they don't make a dent in actual corruption, because the only people to get executed are the ones without connections.

Sick that a country that most people would agree doesn't have strong human rights values /executed/ people for a similar scandal while we don't even slap their wrists.

Money over positively everything.

"a similar scandal"

It was not similar. In my opinion, it's so different that it's not even worth comparing.

An analogy is not an argument. It only illustrates your argument, if you have one.

post hoc ergo proctor hoc

'Correlation does not imply causation, but it does waggle its eyebrows suggestively and gesture furtively while mouthing "look over there".'

I'm sure their loved ones noticed.

So the American media lied. What's new?

I bet the only people who really cared are those that you would have written off as "conspiracy theorists" before you came to realize the grisly truth.

And yet the majority of HN users still trust big pharma that vaccines are safe. You are being lied to over and over and just never learn.

I created an account just to respond to this. Vaccines have nothing to do with this article, and rejecting them goes against hundreds of years of medical knowledge. Vaccines and chemical drugs like Vioxx have very little in common. Vaccines come directly from our understanding of viruses and the immune system - we make a weakened or dead version of the virus we've found to cause a given disease, and inject people with it so their own bodies can build up immunity. This is a proven, effective method that has been used to eradicate a lot of really bad diseases (when was the last time someone you knew got smallpox, or polio?). Any claim to the contrary is ignorant of history. Chemical drugs like Vioxx represent a very different case: a small molecule is discovered that seems to be bioactive in a specific way that treats a condition, and tests and drug trials validate its efficacy and look for side effects. The reality is, we know don't know all the effects these chemicals can have on the body, which is why you can get bad side effects like with Vioxx. Maybe it means more rigorous testing should be required for drugs to be approved, but it's certainly no reason to reject huge unrelated swaths of modern medicine that clearly benefit society. So please vaccinate your kids, and stop making posts like this.

I can't speak for the majority of HN users, but I can speak for people who read serious medical research about vaccine safety and effectiveness (as I am one such person), and I can say for the record that there is plenty of evidence that vaccines have consistently resulted in reduced mortality and morbidity from a variety of diseases. Childhood death is now rare (it was once commonplace) largely because of improved sanitation and other public health measures around the globe but also because of vaccines.


The problem is that:

- The safety standards for getting new drugs approved are incredibly lax. All you need to show is that it helps the person in some measurable way for the first six weeks. You don't need to show that the drug is safe or effective for longterm use, even if the drug is designed for longterm use. And you don't need to show that the person's overall health and wellbeing is improved, just the one condition the drug is designed to treat. So if an acne drug causes liver failure it will still get approved as long as it's effective at treating acne.

- The government has been caught many times injecting political dissidents and others with fake vaccines, most recently in the case of the Bin Laden family.

- Most academics believe that the US government was responsible for starting the AIDS epidemic by running vaccination programs in Africa. [1] [2]

- The government has repeatedly shown that they don't take evidence of safety and quality problems seriously at best, and actively prosecute whistleblowers at worst.

[1] http://www.theglobeandmail.com/life/health/new-health/health...

[2] http://www.amazon.com/The-River-Journey-Source-AIDS/dp/03163...

"So if an acne drug causes liver failure it will still get approved as long as it's effective at treating acne."

Er, no.


"The goals of the New Drug Application are to provide enough information to permit FDA reviewer to reach the following key decisions: * Whether the drug is safe and effective in its proposed use(s), and whether the benefits of the drug outweigh the risks."

Also http://www.fda.gov/drugs/resourcesforyou/consumers/ucm143534... : "It's the clinical trials that take so long -- usually several years". I'm afraid I can't find any actual figures for the typical length of the clinical trials at present.


"Most academics believe..."

Absolute rubbish.

For one thing, you've cited only one academic (as "the River" is by a journalist, not a scientist), and he attributed it to "well-meaning European doctors and nurses"... so, er, not the US, and not the government.

But, more importantly, there's plenty more academics who think that theory is completely wrong:




Academic is not a synonym for scientist. Historians are academics, but they're not scientists. Journalists may or may not be academics, but I think it's pretty clear that he was acting as an academic in writing that book.

"But, more importantly, there's plenty more academics who think that theory is completely wrong: [cite] [cite] [cite]"


If you have access to those papers I'd be curious to check them out, just send me an email.

Two of those pages I provided have links titled "Free PMC Article". They lead to full-text PDFs:



The other, I Googled the title -- the fourth result (after some pages on nature.com) had a PDF of that one:


Interesting. I haven't read either of the original books so it's difficult for me to evaluate the quality of these papers. It's worth noting though that these papers are only the beginning of a long back and forth, which you can find on Hooper's website:



Also, while clinical trials usually do take 10 years or so, the actual patients don't necessarily receive the drug for more than a few weeks. The reason it takes so long is because you need to do preclinical research, secure patents, secure funding, get IRB and FDA approval for each study, design the methodology and acquire the resources you need, recruit hundreds or thousands of volunteers, wait for the drugs to get manufactured, run all the studies in each phase, analyze the data, get FDA approval to transition from phase I to phase II and from phase II to phase III, then wait for actual approval, etc.

I see.

Regardless, I maintain it's very far from the case that "most academics believe...". That's all.

Thanks for keeping this civil. Disagreement on HN remains a refreshing experience. :)

How exactly do you propose we evaluate new drugs for long term use? Should we just do a 50 year clinical trial of every single drug before approving it?

How about just not putting the drug on the market in the first place? High cholesterol? Stop eating meat and eggs and bacon with every meal. High blood pressure? Move your ass and eat your veggies. Chronic fatigue? Put that diet coke down and drink water. Joint pain? Cut the dairy out - your body is leaking calcium and you have been lied to for 60 years. Dairy is killing you. People are just dumb, that's the hard truth.

>High cholesterol? Stop eating meat and eggs and bacon with every meal. High blood pressure? Move your ass and eat your veggies.

The connection between cholesterol and fat intake is tenuous at best. You're likely to be able to cut your total cholesterol levels by less than 15 points through a low fat diet plus exercise unless it was ridiculous to start with. In my family a healthy diet results in a total cholesterol level of around 250, while a strict low fat diet will bring it down to 235 or so, far above the recommended level.

As far as blood pressure is concerned, nearly everyone develops hypertension eventually.

By "the drug" you mean "all new drugs"? Because that's what I was asking about.

I often wonder if people such a yourself realize that the people who conduct the so-called serious medical research will be out of a job if their studies turned out against the interests of Big Pharma. People also used to die from hospital acquired infections until doctors realized it may be a good idea to wash their hands between patients.

Oh wait, herd immunity? Right, so I'm supposed to inject my kids with chemicals for the greater good of other people? How about those people first breastfeed their own kids to protect mine from getting flu (we all know breastfed babies are healthier) and stop killing 50,000 people from second-hand smoke every year? People are scared of terrorism yet they kill themselves with the nasty $1 burgers government makes available thanks to subsidies.

People are so scared to lose their kids to Polio and measles but they're more likely to lose them to a drunk 16 year old or a driver busy facebooking. Or their own aunt chain smoking around their kids. Or give them cancer and diabetes by recklessly feeding them food dyes and artificial sweeteners. Fucking retards. Cigarettes, Coke and 80% of the crap you find in your local grocery store kill more people than whooping cough ever will, and they do so legally and with great pride.

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