Blogger Jubal Harshaw sent me this response to last week’s installment of the Escaping Paternalism Book Club last week. Reprinted with his permission.
Hey Bryan,
Today you wrote:
“4. Once again, I wish the book contained a detailed section on opioids. The usual view, of course, is that Big Pharma’s lobbying prevented wise regulation from paternalistically saving hundreds of thousands of American lives. This is clearly a public choice story, but not one in the spirit of Escaping Paternalism. So is the conventional story flat wrong – or what?”
Yes, the conventional story is flat wrong. It contains some elements of truth, but is pretty implausible for several reasons. I don’t know how this threads into your posts on paternalism, but there are some important fact that get omitted from the standard narrative on the opioid epidemic. Rates of opioid abuse and addiction were flat over the relevant period (early 00s to present) when opioid prescriptions did something like quadruple. Purdue Pharma was a small share of the market, so somehow the benefits of their marketing accrued mostly to other manufacturers. Most drug poisoning deaths involve multiple substances (they aren’t simply “opioid overdoses” but drug interactions, suggesting a more complex causal story), and a substantial fraction of drug poisoning deaths have various ailments and chronic illnesses listed on the death certificate (suggesting that many of these deaths might have had multiple causes, or might not have been opioid poisonings at all).
I have written quite a lot about this on my (pseudonymous) blog. I hope you find some of it interesting.
This one is a pretty comprehensive takedown of the standard story:
https://grokinfullness.blogspot.com/2017/09/debunking-standard-narrative-on-opioid.html
This one has some data on historic rates of abuse/addiction:
https://grokinfullness.blogspot.com/2019/07/prescription-opioid-abuse-trends-in.html
This one is an attempted take-down of a study that tells the standard narrative, blaming Purdue:
https://grokinfullness.blogspot.com/2019/12/interesting-study-on-origins-of-opioid.html
And this one is aimed at the book Dreamland:
https://grokinfullness.blogspot.com/2020/03/dreamlands-narrative-is-wrong.html
There’s a lot there, but you asked a big question.
READER COMMENTS
Keith K.
Aug 10 2020 at 11:17am
Another point which needs mentioning: the court system was at one time actually finding guilty doctors who did NOT prescribe sufficient amounts of opioids to patients. A rather important fact left completely out of the standard opioid narrative.
Eric Larson talks to Dr. Howard Grattan about this in episode 27 of his podcast The Paradocs.
EB
Aug 10 2020 at 2:51pm
Excellent point. Adding pain as the “fifth vital sign” put an impetus on doctors to fulfill their patients demands for opiates, without further justification needed. See paper link below–upshot is that good intentions do not equate to good policy.
Moving Beyond Pain as the Fifth Vital Sign and Patient Satisfaction Scores to Improve Pain Care in the 21st Century
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878703/
EB
Aug 10 2020 at 2:37pm
I am not familiar with Jubal Harshaw. Is he a reliable source? I am sympathetic to his argument, but you never know these days.
GregS
Aug 12 2020 at 9:03am
Hi, EB. Author of the Grok In Fullness blog here. I’m not sure quite what you mean by “reliable source.” I certainly never ask my readers to simply take my word for anything. I try to tell the reader where I’m coming from, where I get my data, how I arrived at my conclusions, etc. I try to lay everything out so my arguments speak for themselves, regardless of where they’re coming from. But please feel free to judge for yourself. If I have made an error somewhere, feel free to point it out.
Personally, I try to approach the internet as if nobody is a reliable source. Somebody’s argument stands or falls on its own, regardless of who is making it.
Kevin Dick
Aug 10 2020 at 3:36pm
I’ve read all of the GrokInFullness posts on this topic. From the perspective of using data to show convincingly what’s going on, it’s a very impressive body of work. Perhaps one of the best “somebody’s wrong on the Internet” examples available. Up there with Random Critical Analysis on health care spending.
Comments are closed.