US body count around 200k vs. opioid epidemic

Cory Doctorow

With its US body count around 200k, the opioid epidemic may seem like small potatoes next to the slaughter of the bungled covid response, but it’s a still-suppurating wound on the body politic, a ghastly reminder of America’s regulatory forbearance for plutocratic murder.

2/ How did the opioid epidemic burn through the country so ferociously? Blame Big Pharma, who have perfected the art of throwing gas on fires, bribing doctors with ruses so transparent and obviously harmful that they constitute existence-proof of the complicity of US regulators.

3/ Maybe it’s finally changing. The Department of Health and Human Service’s Office of the Inspector General has issued a “special fraud alert” on “Speaker Programs.” Maybe ‘speaker program” and “fraud” don’t suggest an obvious connection, but hoo-BOY.

4/ If you’re a pharma giant, your profit margin is largely dependent on the willingness of doctors to prescribe – and overprescribe – your products. Doctors often don’t want to do this, so you need to “align incentives” to make the magic happen.

5/ Lucky for Big Pharma, docs have a “continuing education” requirement to keep their licenses current. This creates a vacuum. Pharma companies pay the expenses of docs who write a lot of scrips for their dope to attend “seminars” in fancy resorts, flying in their families.

6/ For the writin’ doc whales who top the overprescription charts, pharma companies have an even sweeter deal: they get to PRESENT at these “seminars” and pull down six-figure “speaking fees” on top of the all-expense-paid family junket to a luxury tropical resort.

7/  The memo details the results of OIG and DOJ investigations into these practices and concludes that they are exactly what they appear to be: potentially lethal scams.

8/ They find that: * docs who’d been tapped to speak at events were told that their slot (and fee) was contingent on meeting a prescribing quota for a given kind of dope

9/ * the events were held at entertainment venues or during recreational events or otherwise in a manner not conducive to an educational presentation (e.g., wineries, sports stadiums, fishing trips, golf clubs, and adult entertainment facilities) * or at $500/plate restaurants

10/ And that the attendees were the same docs, over and over again, all getting the same “educational seminar” while their spouses and kids played in the pool, got spa treatments, etc.

11/  The memo reminds doctors and pharma companies that the US has an anti-kickback statute that creates civil and criminal liability for this behavior, with both the briber and the bribee facing fines of up to $100k and 10 years in prison.

12/ They call out junkets as scams, a means of “inducing or rewarding” prescriptions. They say that if a doc wants to learn more about a med or a device, they can attend a webinar, read the paper packaging insert, or subscribe to a medical journal.

13/ They warn that future junkets will invite scrutiny under the anti-kickback statute, especially: * if “little or no substantive info is presented” * there’s free booze or expensive food * the same seminars are offered repeatedly

14 / * companies hold seminars for products that haven’t been updated or where there has been no new research of note * the same docs go to the same seminars repeatedly * pharma companies comp family members, lovers, etc * the speaking fee is excessive

15/ All this follows on the heels of this summer’s massive bribery scandal involving Novartis: though it’s not clear whether that’s the inciting event.

The best part of their coverage is the Dollars For Docs search-engine, that lets you see how much money your doctor has taken from pharma reps:

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