FYI, there is a new episode on american greed which pretty much shows how these type of operations worked. Insys basically gave the kickbacks by having the doctors give "speeches" but it turns out no speeches were given and the doctors got the checks anyways.
> it turns out no speeches were given and the doctors got the checks anyways.
True, but it's not like if they did, the situation would be that much better. In a way for them they screwed up because the actually didn't bother playing the bribery sham all the way through like say political candidates do. For example, Hillary Clinton made $3M from speeches to large banks in just 2 years: https://theintercept.com/2016/01/08/hillary-clinton-earned-m... but they were actually organized enough to have "speechs". I remember the transcript of one was leaked, and you'd think they'd be some really deep insights and strategy laid out for the future that's worth $600k. But it was mostly "you all great, thanks for creating jobs etc etc". It is legal of course, but everyone know what it really is.
It’s not clear what it really is. People pay hundreds of thousands of dollars to Hollywood celebrities for appearances too, with no expectations of political favors.
I mean, I'm in EO and our chapter spends about $150k/year on appearances from popular speakers. We're not buying influence or lobbying, and they're private appearances, yes. They're on a variety of topics from a variety of people that the organization thinks we'll find valuable, and the market has set a pretty steep price for some of the better speakers. /shrug
Seems like paid speeches (and charities) are a form of bribery vehicle, not sure which English-speaking country this was first pioneered, but American politicians seem to be most active users of this method. [1]
Greed and stupidity. A regular "speech" isn't that hard to organize. It's like the leading edge of medical-pharmaceutical industry has devolved from the legal corruption of payments informally coupled to favors to the illegality of payments directly so tied out of laziness and impatience. Perhaps these folks are sampling their own wares too much.
As a side project I sorted the doctors based on opioid prescribe count. It isn't hard to see who the pill shops are -- I am sure the DEA can do a sql command. IMHO they (DEA) prefers kicking down doors in poor areas.
As bad as pill mills are, wouldn't 'Pain Management' clinics rate high in this query since they give out pills to manage legitimate pain?
I have multiple herniated cervical disks and am going in for surgery soon because the pain is debilitating and unbearable. Among other specialists, I saw a pain management doctor to understand my non-surgical options. Many people with my condition choose to not get implants or disk fusions and instead opt for steroids, epidurals, and opioids.
Legitimate doctors at pain management clinics will rank high on these lists if they have a lot of really sick patients who don't want neurosurgery.
Yes! 'Pain Management' would be a high subscriber. But being the top 5 in the US? Maybe, but that is pretty strange - definitely worth a DEA trip. 'Family Medicine' in the top 40? Hm....
"A DEA trip" is not a small thing. It's a terrifying thing. It can be the end of your livelihood if you're a doctor, even if you've done nothing wrong. There is no shortage of stories about that happening (and what about the hundreds of patients who are suddenly left stranded with debilitating chronic pain?)[1]. I wouldn't call for you to have an "IRS trip" or some other jack-booted government agency, nor do I think you should call for the DEA to visit other people. It's this type of attitude that is literally killing pain patients [2].
But then again, I don't think it is any of my business what other adults want to put into their own bodies, so even if some doc office were a pill mill I wouldn't care.
Really? A Dentist recommends 16311.0 opioids during an epidemic and someone shouldn't at least check receipts? I don't think people should loose livelihoods, but, let's at least look at an excel sheet right? Check out the office make sure people are not piled into the streets waiting for drugs?
There's absolutely nothing wrong with prescribing opioids to people who may benefit from their use. What's wrong is putting the interests of big pharma above your patient. This kind of corruption damages the trust that people place in the medical profession. That's why the doctor lost his license. The article even says:
>You in effect sold your medical license to a pharmaceutical company
The DEA should have nothing to do with this. Treating doctors like potential drug dealers is going to make them extremely anxious about prescribing any kind of drug with high abuse potential. They invested hundreds of thousands of dollars and years of their life on their medical license and residency programs; do you think they're going to risk it with the threat of the DEA busting them?
The DEA getting involved is going to directly harm patients with chronic pain (opioid users) and people with ADHD (amphetamine users).
I hope you at least tried steroidal epidurals. I had 2 fully herniated lumbar disks and was unable to even get off the floor for 6 months but I've gotten mostly back on feet without surgery.
A doctor who specializes in pain management for late stage cancer patients will prescribe thousands of times more opiates than a family doctor. More context is needed
Interesting, though a bit dangerous to look just for outliers. Medecine advances by having physicians trying new things. You don't really want to end up with fully standardised prescriptions.
"Rosenberg’s son was an Insys sales representative for a year and made “substantial commissions” from his father’s willingness to prescribe the drug, according to prosecutors. The son wasn’t charged in the case."
A not-so-bright outlook for actually holding Insys's CEO responsible. Why were charges not brought on middle level employees especially if the father-son relationship could be an easy access route to bribery.
EDIT: Even the court document does not list is full name, Rosenberg's son is simply referred to as Insys Rep A.R.
I have this entirely unscientifically-gathered impression that could be erroneous, but it certainly appears there is not just a divide in justice between rich and poor, but also across professions. Someone on Mars would swear there is an unwritten law in the US that doctors be held to higher standards than average. And some are held to lower standards, such as police officers.
Perhaps this isn't true, but it certainly seems like it based on the events I've come across in my life, and in the news.
That just means we should treat low level criminals humanely. Four years is plenty.
The thing where decade plus sentences are fairly common is unique in the first world: only in America. It’s barbaric and embarrassing.
The science is pretty unambiguous—a high likelihood of being caught and punished is a better deterrent than a low-probability but larger punishment.
So I don’t want to see this doctor get a 40-year sentence. I’d rather see lots of doctors who accepted gifts from opioid manufacturers get one-year sentences. Most important is that the pharma executives go to jail, too.
Criminal justice should never be about retribution. In this case, the purpose is to keep future patients safe.
The deterrent and long term way to keep patients safe is not just the 4 years in prison, it is losing his medical license in perpetuity throughout the USA. Not sure if his sentence includes this but it should be in public records. My PCP in MA was busted for a different charge and lost his ability to practice medicine FOREVER throughout the USA. Way to throw all those years of med school in the dustbin!
The longer he’s in prison, he’ll be closer to full retirement age, meaning he’ll collect a higher social security benefit (62 is the bare minimum, waiting until 70 gives you the highest monthly amount).
True, I merely mean that he may be used to a much higher annual expense than he'll be able to afford in retirement. Which is fine, he ain't gonna starve if he worked that long as a doctor.
I was thinking of dealers selling heroin in particular, since that feels like the appropriate thing to compare fentanyl-pushing MDs to, but in a broader sense, your point is if course correct.
Ironically, fentanyl is more dangerous than heroin and a large amount of heroin overdose have supposedly been because fentanyl was mixed in with the heroin unbeknownst to the user.
It's more dangerous in street drugs because it is potent at extremely low doses, so poorly mixed drugs can contain fatal doses very easily.
In a controlled setting, where the dose is precisely known, that is not an issue. I did some reading of fentanyl vs. morphine a while ago, and found that fentanyl is often preferred for acute pain due to faster onset, shorter duration (which may make controlling adverse reactions/overdoses easier), fewer side-effects and less histamine release. Specifically:
> When adverse event rates were counted across both the out-of-hospital and ED phases, morphine's and fentanyl's safety levels were extremely close, erasing even the suggestion of a trend toward safety in one drug or the other. Our data do not suggest that further work should be done to try to determine which drug is safer: The low absolute rates and small difference between the two drugs make it unlikely that this difference would become either clinically or statistically significant, even with a larger sample size.
I don't believe the notion that fentanyl is per se more dangerous, rather than being dangerous when misused/poorly handled, is supported.
Fentanyl is also far more addictive due to its rapid onset and short duration of effect. Not that they give that stuff to anybody other than cancer patients and those undergoing anesthesia. But in theory it’s more dangerous.
It’s more dangerous because you don’t know how much you’re getting on the streets. In a prescription, it’s a regulated medicine that is exactly the amount the label says.
I’m not defending the doctor but the point being made doesn’t apply.
It’s really not. Four years is hardly a deterrent. It’s barely a slap on the wrist considering the number of lives destroyed by that plague.
What’s makes this particularly heinous is the trust we place as a society in medical providers. The vast majority of people will take whatever medicine a doctor prescribes. No questions asked. Abusing that position of power is sickening.
> Four years is hardly a deterrent. It’s barely a slap on the wrist considering the number of lives destroyed by that plague.
This is the exact kind of emotional thinking that makes it so easy to jack up sentencing to an unreasonable degree. It's why we spent so many millennia of human history insensitive to the torture and abuse of our fellow man so long as he could be labeled a criminal.
First, you're comparing a single doctor's sentence to the entirety of the misery caused by a crisis caused by many, many people and systems.
Second, what makes you think four years isn't a deterrent? Maybe it is, maybe it isn't, but we should be using evidence to decide that, not knee-jerk emotional reactions.
This. Deterrent effectiveness is quantifiable and repeated psychological studies show that increasing the expected chance of getting caught is a much higher deterrent value than increasing the expected number of years behind bars.
One's subjective feeling of deterrence is strongly influenced by one's natural subconscious desire for mob revenge. Cultural change away from mob revenge starts with changing the dialogue.
The cost to society is roughly linear in the number of years behind bars, and the deterrent factor gets dramatically sub-linear pretty quickly as number of years behind bars increases. That money spent on guards, etc. and opportunity cost (including lost taxable income) of having a potentially productive member of society behind bars are better spent on better monitoring and other measures that increase the likelihood that offenders are prosecuted. Increasing publicity of convictions would presumably also be a pretty cheap way to reduce crime by increasing the perceived chances of getting caught.
I would really like to see it be a common thing for criminals to cut plea deals including recording public service announcements publicizing that they got caught. Though, this would also probably make it harder for reformed ex-convicts to escape their pasts.
I have to agree. It's not "a slap on the wrist" at all. A criminal record is a massive hurdle to overcome in finding work or keeping standing with any professional association. Not to mention the damage to reputation, personal relationships, finances, and family dependencies. Purely emotional thinking does not help the problem.
This is absolutely correct and should not have been downvoted.
It is the abuse of a position of trust that aggravates this crime relative to that of a simple outlaw street dealer.
Commenters who are concerned with the effect on the convict's reputation and future employability are simply not in touch with reality....this was a grave breach of the basic ethics of the medical profession and seriously harmed the innocent patients involved. There is no return to work after something like this...any more than with a scientist who falsifies data, a teacher who sleeps with minor students, a lawyer who steals from escrow, etc.
I find it highly disturbing that there is more discussion in this thread as to the effect on the doctor's return on investment from his medical degree rather than on the individuals who bodies were damaged by someone they were supposed to be able to trust.
Nobody is "concerned" about the convict's reputation and future employability. You are misreading people's statements and thus misunderstanding their points. Namely, that the justice system serves a greater purpose than simply making you and me feel better and causing harm to perpetrators.
What point is there in discussing the so-obvious-it-goes-without-saying good-bad polarity of this situation? If we myopically give in to our emotions, rather than dispassionately examine the best course of action, then we'll miss an opportunity to improve the system and deter future incidents.
Stated another way, by attempting to redirect the course of this conversation, you are saying that virtue signaling by pitying current victims and demonizing the perp is more important than preventing future victims. If anything is highly disturbing, it's that.
You're missing the point because you don't understand the gravity of the crime.
A minimum wage fast food worker is constantly observed by a phalanx of cameras that will incriminate her should she attempt to steal five dollars from the till, but a surgeon in an operating room performs an infinitely more consequential task with nary a recording device in sight. Why? The immense trust and responsibility invested by society in medical doctors.
There is a common misconception that a medical license is basically just a reward for a demonstration of technical mastery, much as a developer job flows from passing a coding interview. But in reality the technical aspect is only secondary; the primary purpose of all those years of training is to ensure that the student understands the fullness of the obligations associated with the profession and is properly disposed to accept them.
In a case like this, the person understood and accepted those grave obligations, as well as all the privileges that came with them, only to toss them out the window when the opportunity arose to make a few extra dollars. That is what is being punished here. Four years is hardly too long, or cruelly retributive.
Well you yourself said it reflected the same kind of "emotional thinking" that led to millennia of "torture and abuse". What I am trying to show is that there are plenty of good reasons for this kind of punishment (whether or not one accepts a retributive component to justice). It is not simply a knee jerk insensitive reaction.
I never complained about the punishment, nor did I equate the punishment itself to emotional thinking. What I called emotional and dangerous was the unsupported claim that the punishment wasn't enough to be an effective deterrent and should therefore be increased.
And that is the claim I was contesting. You seem to have an odd intuition that a line of argument that does not reduce to a computing problem is "emotional". Even if one does not believe in retributive justice at all, an adequate deterrent is still going to be in proportion to the seriousness of the crime. It's not something that admits of a resolution by facts and figures alone.
What you are saying here is an order of magnitude milder in its certitude than koolba's assertion that the given punishment was "hardly a deterrent" and "barely a slap on the wrist." In addition, you are comparing this doctor's punishment to the seriousness of this doctor's crime, whereas the koolba unreasonably compared this doctor's punishment to the sum total of the harm caused by an entire epidemic of which this doctor played only a negligible part.
So yes, I stand by my claim that the original poster's point was an emotional reaction.
Had koolba instead said something like, "An adequate deterrent should be in proportion to the crime committed, and I believe 4 years in prison falls below that standard for reasons X, Y, and Z," then I would not have called that a knee-jerk emotional reaction. But he didn't.
Honestly, if you could make $10M as a mid-level distributor, squirrel most of it away tax-free, with the downside risk being only four years in the pen, that would be a massive rational win for most people.
Of course, the only reason you can make millions of dollars illegally at this racket is because it's illegal in the first place, so never mind. Drug laws cause far more harm to society than the drugs themselves ever could. Any argument to the contrary can trivially be resolved to a special-pleading fallacy.
For reference, the doctor in the story "pleaded guilty to taking more than $188,000 in kickbacks disguised as speaker fees." As a result, he "lost his medical license and was ousted from his post as a Brown University professor, … the judge sentenced him to 51 months and ordered restitution of $754,000," and I'm sure he's gotten a heap of public shame and humiliation.
Is it possible he has enough cash hidden away to make this all worthwhile? Yes, but I'd bet against it.
Street dealers, "low level" or not, do actually kill their clients.
Prison sentences for dealing hard drugs should be in line with prison sentences for murder, otherwise the implication is that the lives of drug users are much less valuable than the lives of regular people.
If I buy drugs from a street dealer I know what I'm getting into. If I get prescribed opioids from a supposedly trained professional whom I'm supposed to be able to trust I don't. So as far as I'm concerned adults should be allowed to take whatever drugs they want. However, it should be illegal to bullshit them into taking them. Especially as a medical professional.
Don't worry, we've so over-corrected this thing as a society due to our knee-jerk emotional reactions and mob mentality, you won't be getting any opioids prescribed.
Fourth stage cancer patients are now having a hard time getting them. Chronic pain patients that have been stable for decades are being heartlessly dropped by doctors that now fear the DEA. We are turning our backs as a society on the most vulnerable among us.
Totally agree. After decades of drug wars and putting people in cages, I think it's time to admit prohibition doesn't work (I thought we learned that in the 1920s, but I guess not). I tend to believe that education is the answer. I'd love to see us give that a try.
Manslaughter is different from murder.. selling someone something that they use to kill themselves, is different from selling something stronger than they anticipated, is also different from pulling the trigger yourself. Intent matters in the eye of the law.
You would fall under 'trafficking' which is federal (Schedule 1 or 2 depending). Schedule 1 that is up to 20 years in federal prison. You would probably plea down maybe get 14. There is no good time in federal prison so you do the full 14 years. Schedule 2 maybe 15 years plea down to 9 years. THAT is if things work out and you don't get a crazy federal prosecutor that wants to file multiple charges (unlikely). This is federal prison (traffickers, embezzlers, wire-fraud) so it isn't that bad compared to state (state is where they keep murders and rapists). EG Guys in for trafficking can probably hold a good game of chess and discuss current world events.
BUT then you might face state charges for possession if the DA wants to bother.
Not really comparable. The street dealer is not likely to get 40 years, although many may have gotten it (Assuming that a street dealer doesn't have 400 kilos of coke in his stash house. If he does, he's no street dealer)
Also the doc loses his license and every single penny he has, between lawyers, years without being able to make a penny, and court fines. When you make a certain amount of money the trend is to live up to it: mortgages, fancy cars, club memberships, schools for kids and so on. When the money stops coming in, guess what happens?
> When the money stops coming in, guess what happens?
You drop to the status of a boring working person who never took kickbacks to sell opiates? A fate worse than death, I guess.
The street dealer is also not likely to get 4 years. That's the point - 40 years was a number picked to illustrate a sentencing discrepancy argument. The fact that a 10x factor seems almost reasonable is the argument.
> a street dealer doesn't have 400 kilos of coke
What do you think Resenberg's prescriptions added up to, by weight? It's probably not fair to compare a street dealer to him.
Crikey! If I'd been caught with everything that went through my hands as a small scale dealer I'd be screwed. Over ten years it certainly adds up! Kilograms of methamphetamine, thousands of ecstasy tables, tens of thousands of LSD tabs, a few hundred grams of pharmaceutical grade heroin.
Yeah, they don't look favourable upon those sorts of quantities.
Fortunately I only got caught with about five days worth of merchandise.
I'd bet that many rich people would rather spend 4 years in prison than lose all of their assets, especially if the prison is one of those minimum-security summer camps the white collar criminals normally end up in.
>>Are you implying that being bankrupted is worse than going to prison?
He's getting both. And he's losing everything: money, status, possibly family, ability to get another decent job... So he might rather do 10 years in jail but return to what it had before.
This is getting down voted but I don't think that's fair, it's not off topic. Trump said yesterday he's in favor of the death penalty for drug dealers because they are responsible for the death of others. It's a fair question to ask if there should be a distinction between street dealers and these doctors and executives.
Addiction is a possible effect of willingly taking drugs (as the person before you was stating). I'm not saying that people don't have demons and everyone has their own way of coping, but you need to take drugs to be addicted. That first step is taken willfully.
Funny enough, if I buy heroin on a street corner, the addiction is voluntary. If I get prescribed opioids and the doctor who I trust ensures me it's the right thing on my situation, I wouldn't call all cases "voluntary addiction".
Edit: I can buy a damn gun when I'm 18, but have to be 21 to drink beer and will never be allowed to buy LSD which is pretty safe and not addictive. WTF?! I blame religion and Puritan nut jobs.
Addiction is not voluntary, but addiction is a known, likely side-effect of many drugs. That first step is, to a large extent, voluntary (in most cases).
Sorry... but you're wrong. There are NA, AA, CA, CMA, HA and every other support group with an "A" you can think of that will help you in every step of the way, all you have to do is ask. If you want to get clean, you can and will get clean. Will it be a struggle? Sure it will, it will be the worst thing you will ever go through in your life, but you can and will get clean if you desperately want to. Yes... I went through it, and, yes it sucked, but I'm over 2 years, so, Yes, it can be done.
Bottom line is there are two people who I see who don't want to get clean: 1) the people that will never accept responsibility and want to blame everyone else for their problems. 2) the people who really don't have a desire or want to get clean. At least the second group is being honest with themselves and everyone else.
Yes, exactly. And I think we already know that the answer is no, he wouldn't support it. Trump has a very childish perception of the world, and a doctor undoubtedly does not fit his mental image of the drug dealer stereotype.
It's almost like politicians manage their perception and image in strategic ways where they lull their enemies into being emotionally caught up with minor character flaws rather than the tactics and orientation of their actions.
The smugness of people against Trump is even more worse than the smugness people had against George W.
They're not idiots. They're sharks who have a very clear aptitude at manipulating people and public perception. It's very bad strategy, and very human, to ascribe to your opponents victories as "luck" and to ascribe their mentality as "dumb".
I agree with you when it comes to most politicians, but I’m pretty sure Trump is actually dumb. He’s the only person I’ve ever seen contradict himself three times in a single sentence. When he speaks, he almost never displays any indication that there’s any understanding of the subject at hand.
W had a superficial dumbness that was largely cultivated. Beneath that he had at least a basic understanding of the issues.
Do you think he cares about you the coherence of his statements when they provoke a strong emotional reaction from a dumb population addicted to emotionally reacting and addicted to signaling alliegence to some vague social grouping?
You're taking his bait superbly by thinking that the truth wins you the game of democracy. To call him "dumb" is to severely underestimate the strategies potential president have used in their rise to power. Or in other words, did calling him an idiot get your side any concessions, any retaken ground?
Instead of taking Trump's bait, I'd highly recommend reading Robert Caro's books on Lyndon B. Johnson. You'll never look at politics the same way again.
Are you under the impression that I’m calling him “dumb” as some sort of political strategy? I’m just describing the facts as I see them. Pointing out that it works for him is not any sort of argument against what I’m saying.
Of course his dumbness has appeal. That’s why he won. That doesn’t mean he’s not an idiot.
Your facts is what he says to the public. That's not a "fact", that's taking politics at face value. I told you, such men are sharks. Not merely the men you back on your own political aisle.
I told you to read Robert Caro's series on Lyndon B.Johnson because it opens your eyes to the political process. Do you think Johnson campaigned as a Roosevelt man because he liked Roosevelt? Hell no, he was an opportunist.
I still don’t get what about this is supposed to contradict what I’ve said. And there’s plenty of evidence for Trump’s idiocy from stuff that wasn’t supposed to be public.
Whether or not he supports something is completely irrelevant to if he can force something to happen or if it's Constitutional. Trump has supported unconstitutional positions in the past, it's not out of character.
Shkreli got 7 years for financial fraud that didn’t end up costing anyone any money, and this guy only got four years for actually threatening people’s lives. Seems out of whack - what gives?
> [Doctor], who lost his medical license and was ousted from his post as a Brown University professor, pleaded guilty to taking more than $188,000 in kickbacks disguised as speaker fees and creating false patient records to dupe insurers into covering Insys’s Subsys pain medication...
> ... [his] son was an Insys sales representative for a year and made “substantial commissions” from his father’s willingness to prescribe the drug, according to prosecutors. The son wasn’t charged in the case.
Oh, gee, it's Purdue Pharma again, i.e. the Sackler family. How am I not surprised, and how are they not fined?
https://www.youtube.com/watch?v=h2WBKkyFpRo