I focus on issues surrounding the promotion and marketing of controlled drugs and their regulatory oversight. Compared with noncontrolled drugs, controlled drugs, with their potential for abuse and diversion, pose different public health risks when they are overpromoted and highly prescribed. An in-depth analysis of the promotion and marketing of OxyContin illustrates some of the associated issues.
.. When Purdue Pharma introduced OxyContin in 1996, it was aggressively marketed and highly promoted. Sales grew from $48 million in 1996 to almost $1.1 billion in 2000.1 The high availability of OxyContin correlated with increased abuse, diversion, and addiction, and by 2004 OxyContin had become a leading drug of abuse in the United States.2
.. The promotion and marketing of OxyContin occurred during a recent trend in the liberalization of the use of opioids in the treatment of pain, particularly for chronic non–cancer-related pain. Purdue pursued an “aggressive” campaign to promote the use of opioids in general and OxyContin in particular.1,12–17 In 2001 alone, the company spent $200 million18 in an array of approaches to market and promote OxyContin.
.. From 1996 to 2001, Purdue conducted more than 40 national pain-management and speaker-training conferences at resorts in Florida, Arizona, and California. More than 5000 physicians, pharmacists, and nurses attended these all-expenses-paid symposia, where they were recruited and trained for Purdue’s national speaker bureau.19(p22) It is well documented that this type of pharmaceutical company symposium influences physicians’ prescribing, even though the physicians who attend such symposia believe that such enticements do not alter their prescribing patterns.20
..One of the cornerstones of Purdue’s marketing plan was the use of sophisticated marketing data to influence physicians’ prescribing. Drug companies compile prescriber profiles on individual physicians—detailing the prescribing patterns of physicians nationwide—in an effort to influence doctors’ prescribing habits. Through these profiles, a drug company can identify the highest and lowest prescribers of particular drugs in a single zip code, county, state, or the entire country.21 One of the critical foundations of Purdue’s marketing plan for OxyContin was to target the physicians who were the highest prescribers for opioids across the country.1,12–17,22 The resulting database would help identify physicians with large numbers of chronic-pain patients. Unfortunately, this same database would also identify which physicians were simply the most frequent prescribers of opioids and, in some cases, the least discriminate prescribers.
.. A lucrative bonus system encouraged sales representatives to increase sales of OxyContin in their territories, resulting in a large number of visits to physicians with high rates of opioid prescriptions
.. In 2001, in addition to the average sales representative’s annual salary of $55 000, annual bonuses averaged $71 500, with a range of $15 000 to nearly $240 000.
.. Purdue paid $40 million in sales incentive bonuses to its sales representatives that year.19
.. A consistent feature in the promotion and marketing of OxyContin was a systematic effort to minimize the risk of addiction in the use of opioids for the treatment of chronic non–cancer-related pain.
.. Purdue trained its sales representatives to carry the message that the risk of addiction was “less than one percent.
How the Reformulation of OxyContin Ignited the Heroin Epidemic
We attribute the recent quadrupling of heroin death rates to the August, 2010 reformulation of an oft-abused prescription opioid, Oxycontin. The new abuse-deterrent formulation led many consumers to substitute to an inexpensive alternative, heroin. Using structural break techniques and a difference-in-differences analysis, we find that opioid consumption stops rising in August, 2010, heroin deaths begin climbing the following month, and growth in heroin deaths was greater in areas more likely to substitute from opioids to heroin. The reformulation did not generate a reduction in combined heroin and opioid mortality—each prevented opioid death was replaced with a heroin death.
.. OxyContin is a name-brand opioid pain killer marketed by Purdue Pharma.13 The active ingredient in OxyContin is Oxycodone, an opioid that has been in clinical use since 1917 (Kalso, 2005) and is the active ingredient in such pharmaceuticals as Percodan (Oxycodone and aspirin) and Percocet (Oxycodone and Tylenol). OxyContin is an extended-release formulation that allows for up to 12 hours of pain relief and hence there is typically a high milligram (mg) content of Oxycodone in the pills.14 Since its release in 1996, OxyContin has been one of the most successful pharmaceuticals of all time with worldwide sales totaling $35 billion.15
.. OxyContin was introduced at a time when the medical profession was beginning to re-evaluate its use of opioid-based pain killers. Historically, opioids were reserved for those with acute pain such as postsurgical and cancer patients. Given the limited use of opioids, pain from chronic conditions often went untreated. This was viewed by many as a failure of the medical profession. In the middle 1990s, a number of physicians began to argue for much greater use of opioids for patients with chronic pain. In the 1995 presidential address of the American Pain Society, James Campbell introduced the notion that pain is the “5th vital sign.” Campbell (1995) argued that “Quality care means pain is measured. Quality of care means pain is treated.”
.. an important study used by Purdue Pharma in their advertising materials, Porter and Jick (1980), reported that of “11,882 patients who received at least one narcotic preparation [opioid], there were only four cases of reasonably well documented addiction in patients who had no history of addiction.”
.. This “study” was in actuality a 100-word letter to the editor in the New England Journal of Medicine, the entire substance of which is contained in the quote above.
.. in 1996, the FDA allowed Purdue Pharma to claim that addiction was rare if opioids were legitimately used in the treatment of pain.
.. Between 1996, when OxyContin was released, and 2003, sales of OxyContin increased from $44.8 million to $1.5 billion per year (United States General Accounting Office, 2003)
.. The movement to an abuse-deterrent formulation made OxyContin less desirable for recreational use.
.. Of confiscated heroin, 79 percent is now from Mexico
.. The price has fallen from more than $3,000 per pure gram in 1981 to less than $500 in 2012
.. Groups like the Xalisco Boys have transformed the supply of heroin to suburban and rural US markets. Within their distribution network, independent “cells” within a city are operated by cell managers and each cell is supplied with high-quality Mexican heroin by the cell’s owner. The cell manager employs a telephone operator who receives orders and then relays those orders to the drivers. A driver meets the client at a designated spot or delivers the drugs directly to the customer’s location. Each cell operates almost completely independently and constantly cycles through lower level employees to help prevent detection by authorities.
.. 30 years ago, the typical heroin user was an urban resident. Heroin use in the 1990s and 2000s has now “spread to users in suburban and rural areas, more affluent users, younger users, and users of a wider range of ages. There is no longer a typical heroin user.” The entry into heroin is now much easier because of the purity level. In the 1970s, heroin was mostly an injected drug. Because of increased purity, the drug can now be smoked or inhaled, decreasing the cost of drug initiation
.. the costs of the opioid crisis seem to be driven primarily by the costs associated with mortality. Inocencio et al. (2013) put the total costs at $20.4 billion in 2011 dollars, but 89 percent of these costs, more than $18 billion, are due to lost earnings from higher mortality. Although we do not do a formal cost-benefit analysis, the fact is that Purdue Pharma’s abuse-deterrent formulation of OxyContin was unable to affect the vast majority of the crisis’s costs.
.. While some individuals die from heroin overdoses shortly after initiation, on average, it takes between 5 and 10 years for a heroin user to overdose and die
Trump’s top economist offers solution to unemployment: More government jobs
In the latest edition of the ‘POLITICO Money’ podcast, Council of Economic Advisers Chair Kevin Hassett discusses tax policy, drawing Americans back into the workforce and his ‘Dow 36,000’ prediction.
President Donald Trump’s top economist has an unusual idea for dealing with the problem of long-term unemployment: Just have the government hire people.
.. Kevin Hassett, the conservative chairman of the White House Council of Economic Advisers, believes some Americans are so disconnected from the workforce that the best idea to get them working again could be a federal jobs program that would ultimately lead to private-sector employment.
.. To Hassett, long-term unemployment often leads to family breakdown and descent into addiction and other maladies. “People who have been unemployed for more than a year very often don’t ever reconnect to the labor force,” he said. “And very often they fall into sort of downward spirals of personal despair where they end up abusing substances and have a higher risk of divorce. Some of the literature in this area is just absolutely disturbing.”.. Hassett remains convinced that the tax cut bill now emerging on Capitol Hill that would slice the top corporate rate from 35 percent to 20 percent will in fact add at least $4,000 in increased wages per household over the next several years.. Hassett called the idea “iron-clad” based on studies of other countries cutting their corporate rate. And he said he believes the increase could be even greater... He argues that a lower corporate rate and more immediate expensing of capital investments will lead to greater productivity among workers and thus higher wages without big inflationary pressure... “If you have a supply-side stimulus precisely now, we can get capital deepening back to where it used to be, then you could add a percent to GDP growth,” he said. “And that will increase labor productivity and increase wages but not in a way that’s inflationary.”.. Hassett, an affable economist with friends on both side of the partisan aisle, also spoke about his often-lampooned 1999 book with James Glassman, “Dow 36,000,” that predicted stocks would hit that mark by 2004. Instead, the dot-com bubble burst and stocks tanked.Hassett described the title of the book as a bit of a “youthful indiscretion” that was also somewhat unfairly maligned. “The point was that people who buy and hold stocks for the long run tend to do well, but that stocks go up and down a lot and it’s scary.”
Study: Blacks’ Median Wealth Will Be Zero in 2053
That racial stereotyping hides the real cause and scale of economic damage to blue-collar and white-collar Americans families amid the rising wealth of the technocratic globalized elite which dominates the Democratic Party and at least half of the GOP.
.. That government failure is exemplified by the housing bubble, which destroyed a huge percentage of wealth held by black Americans.
A 2011 report by the Pew Research Center showed that the median wealth of black American households dropped by 53 percent because of the property bubble. The mid-point median of black American wealth crashed from $12,124 in 2005 to just $5,677 in 2009, according to the Pew report.
.. White Americans suffered far less from the bubble because many had already paid off their mortgages, because their debts were a small percentage of their income, and because whites had more assets in the stock market and other sectors outside the housing market. Still, the median wealth of white households also dropped by a huge 16 percent, from $134,992 in 2005 to $113,149 in 2009.
.. Meanwhile, wages for all men have remained flat for the past 44 years since 1973, according to the Census Bureau.
.. when Obama settled into the White House during the housing implosion, his economic policies helped very clever people invest their way back up to more wealth. The New York Post described the process:
The years 2008 through 2015 should be known as the Great Fleecing.
During that time, the greatest transfer of wealth in the history of the world occurred. Some $4.5 trillion was given to Wall Street banks through its Quantitative Easing program, with the American people picking up the IOU … Who did this help? The 1%, and pretty much only the 1%.
.. The report does not discuss how technology is concentrating wealth among higher-skilled people, and it omits any talk of globalized outsourcing. It also avoids family stability and it ignores the topic of immigration, which has flooded the nation’s marketplace with cheap labor that effectively imposes a 5 percent tax on labor — and then transfers $500 billion a year to company owners and investors.
.. the report then lists a series of unrealistic demands, including a massive tax increase on the wealthy, a massive financial grant to children that could be spent when they become adults, more house-buying aid for poor people, a higher minimum wage, and “a federal jobs guarantee [that] would function similarly to the Works Progress Administration of the 1930s.”
.. But many people of all colors who cannot get through college are falling behind because technology, work, and business are becoming more complex. This increasing complexity ensures that an increasing share of income and wealth goes to people who are smart enough to arbitrage the increasing social and technological diversity, regardless of color.
.. the Democratic elite prefers to import foreign voters rather than accept the equal social status of all blue-collar Americans... four million Americans turn 18 each year and begin looking for good jobs. However, the government imports roughly 1 million legal immigrants to compete against Americans for jobs... That Washington-imposed policy of mass-immigration floods the market with foreign labor, spikes profits and Wall Street values by cutting salaries for manual and skilled labor offered by blue-collar and white-collar employees. It also drives up real estate prices, widens wealth-gaps, reduces high-tech investment, increases state and local tax burdens, hurts kids’ schools and college education, pushes Americans away from high-tech careers, and sidelines at least 5 million marginalized Americans and their families, including many who are now struggling with opioid addictions.