Pharma Execs Arrested Over Fentanyl Rackateering | Hacker News Reader

Pharma Execs Arrested Over Fentanyl Rackateering

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141 pointsblawson96 comments

Back when i was in active addiction to heroin I knew that the brief time i spent messing with fent was the end of the road. The step past speedballs. At that point I wanted to, and was actively trying to, die. I understood its power.

To push this onto an unknowing general public is, imo, evil. These people should be sentenced like Heroin importers. Fent withdrawals, whilst short, are unadulterated hell. I have never felt a combination of physical, mental and spiritual pain like it and i have been through spinal fussion in my youth. The type of pain that changes a person for life.

They should be charged with at the least institutional and organized manslaughter. My area had 24 over dose deaths in one weekend due to fentinal in the heroin just this year.

I agree.

Can you define what an 'area' is for you? Thanks.

Probably a county or metropolitan area, this stuff has been happening all over the nation as of late in pretty drastic rates.

That's my guess as well. I am seeking to at least somewhat contextualize the probability.

I live in a city of 120,000 and so my area is the metropolitan area which includes the suburbs. I think more drugs are consumed in the suburbs then in cities contrary to popular belief. Drugs cost money and there is certainly more money in the suburbs then in most rust belt cities.

https://www.drugabuse.gov/publications/research-reports/hero...

Thank you for the clarification and illuminating link.

As someone who is currently prescribed Fentanyl (for complex pain syndrome). The patches are very different to the product mentioned here, spay.

Not everyone on Fentanyl is an addict and it does have many valid use cases. I would argue that under prescribing pain meds is just as bad as over prescribing, maybe I should do an AMA from the other side of the fence..

Wasn't sure about doing this, but here goes!

https://news.ycombinator.com/item?id=13168314

I feel for you, addiction is hell... But it sounds like you're saying all fentanyl is bad.

Despite your experiences, it's a highly effective acute analgesic. Bad prescriptions should be fixed, sure, but making it unavailable would be much worse.

Interestingly Insys donated $500k against the marijuana legalization measure (prop 205) on the ballot in Arizona.

http://www.azcentral.com/story/opinion/op-ed/ej-montini/2016...

I don't know if he's responsible for the commercials that aired, but they were incredibly embarrassing. I suppose they can be quite effective against an uneducated electorate.

Whenever I hear something like that (e.g. the alcohol industry donated to anti-cannabis legislation, or your example above), it makes me wonder what they're thought process is.

Let us assume it profit motivated, and they've calculated their potential losses as a result of legalization (let's call it pl for potential lossses), they've calculated the probability of it passing without a $500k donation (let's call it pnd or probability no donation) and the probability of it passing with a $500k donation (pwd for probablity with donation). Then, they can make the following calculation:

If pl x pwd - pl x pnd > $500k then the $500k is money well spent. Otherwise it's a poor bet. This leads to interesting conclusions:

* Proposition 205 was close (51%-49%). So it seems likely small events could swing it * $500k is in context of a $3m campaign, so it seems again likely that their donation had an impact. But compare it to the 1 billion spent on the general election, and how many more people would be turning out because of the general election, it seems less likely it had an impact * I have no way of knowing what their potential losses are from legalisation, but let's assume they're high.

Let's say the difference between pwd and pnd is a 2.5% chance that their donation swung the election (which seems overly generous, elections usually aren't that easy to swing). That means they are assuming losses of approximately 20 million in Arizona from legalisation.

Generally though, I'm not convinced they made this analysis, and instead were trying to demonstrate that they were opposed.

You need to add to the calculation that if a few states changes, there will be a momentum for more to change.

(That said, for drugs I only use Dark Souls, coffee and a few beers now and then. Maybe a glass of wine sometimes, mostly because I am swayed by the health propganda.)

Bean counters now just need to learn how to factor karma in their calculations

Yes. The scale of the irony here is "smack you in the face" level, whatever reason Insys had for donating.

You're forgetting the need to position themselves as the "good" drug of choice for getting altered. Good marketing.

The press liked to push the point that Insys made a fentanyl-based drug, but I believe it has far more to do with Insys's efforts at making marijuana-based drugs[1][2]. If marijuana became widely available, their efforts at marijuana-based prescription drugs would likely have a smaller market.

[1] http://syndros.com/

[2] Cannabidiol in development http://www.insysrx.com/products/in-development

“Causing the unnecessary use of opioids by current and retired U.S. military service members shows disregard for their health and disrespect for their service to our country,”

Why does any problem affecting veterans become disrespecting their service? Maybe they're just an easy target more likely to get addicted to painkillers than normal people.

Because the US has a weird fetishistic thing going with their vets, all that "fighting for our freedom" when you are the biggest richest and most heavily armed country on the planet your freedom (from external threats) was never under doubt.

A lot of it I think is an over reaction to the way returning troops from vietnam where treated.

In either case, strong reverence for the military is one of the criteria for a fascist state.

EDIT: http://www.rense.com/general37/char.htm

Since someone called what I said inflammatory I posted where I read the military reverence thing.

… the US has a weird fetishistic thing going with their vets … In either case, strong reverence for the military is one of the criteria for a fascist state.

Please don't introduce inflammatory language like this unnecessarily into a thread. It's quite off-topic for the submission.

Edited to expand and clarify.

That's not "inflammatory language", it's just a well known fact.

http://www.rense.com/general37/char.htm

Nothing inflammatory about pointing out something a respected academic said.

If you think its inflammatory read the full list and compare it to contemporary democratic states.

https://www.amazon.com/June-2004-Laurence-W-Britt/dp/1884962...

Laurence-W-Britt seems to be an author. I can't find him so I can't say for certain he's not a doctor but I don't think he is.

Also your link is from rense (a white supremacist/conspiracy site), it doesn't seem to have been the origin(originally from a humanist magazine) and may have been republished without consent but it does undercut your point.

Isn't that list borrowed from Umberto Eco? It's certainly a very weird site to link to.

Yeah I think I saw the list elsewhere the first time and my google-fu failed, I'd swap the link but I'm outside the edit window, which is irritating as always.

It's not inflammatory if it is demonstrably true.

> A lot of it I think is an over reaction to the way returning troops from vietnam where treated.

Cultural concern for veterans coming home and being treated poorly, or being unable to readjust to civilian life, definitely predates the Vietnam war.

Consider "The Best Years of Our Lives"[0] from 1946, set after WW2.

[0] http://www.imdb.com/title/tt0036868/

> Cultural concern for veterans coming home and being treated poorly, or being unable to readjust to civilian life, definitely predates the Vietnam war.

"Johnny I hardly knew ye" was first published in 1867 and echoes similar concerns.

https://en.m.wikipedia.org/wiki/Johnny_I_Hardly_Knew_Ye

Minority War veterans and the shabby treatment was a big argument for the civil rights movement and allied politicians. They can die next to a white man in Korea but they couldn't buy a sandwich at a lunch counter next to them. Many veterans coming back from the war refused to be oppressed anymore and became civil rights leaders.

https://utpress.utexas.edu/books/rivas-rodriguez-texas-mexic...

http://www.huffingtonpost.com/2013/11/11/felix-longoria-affa...

The Felix Longoria affair in which a Mexican-Texan veteran was denied who died in the war was denied burial by the local funeral. The American G.I. Forum an association of mexican american vets helped organize a protest and sent a letter asking help from Senator (and future president) LBJ, who arranged to have him buried in Arlington and initially publically supported the veteran but later ducked and covered from the conservative backlash. The G.I. Forum would become a powerful civil rights organization over the years.

https://en.wikipedia.org/wiki/Isaac_Woodard

Isaac was an African American World War II veteran who was beaten while still in uniform (hours after an honorable discharge) until he was blinded (because he had talked back to the bus driver when the bus driver refused to let him use the bathroom. the driver called the cops on him). This was a major scandal that helped inform the nation and especially President Truman about the evils of Jim Crow but he couldn't pass civil rights laws past the senate. All he was able to do was desegregate the army and federal goverment by executive order.

They're still in a foreign place risking their lives and getting shot at

I agree there's an idealized view but it's easy to complain when one is not involved

On the other hand they are a volunteer army who chose to sign up, I'm not attacking them just pointing that out

I'd be a lot more sympathetic to conscripted soldiers who didn't have a choice.

These days its hard to say anyone signs up for the military in the major democracies without realising what they where signing up for.

Eh, tell that to the broke kid from Centre(sic), Alabama who has the choice between working at the 711 and probably getting a nice meth addiction (or watching most of his high school deal with their own), slinging meth himself eventually ending up doing 5-10 in the state pen, or the Army. The Army recruiters promise college, which he damn well can't afford in three lifetimes, training, a sense of honor, and a trip out of a red neck suck hole that took his dad, brother and most of his buddies so deep they can't see sun.

It's "volunteer" in the sense that you technically make the choice. But for a lot of kids signing up those choices are sleeping on the couch in the trailer park, a prison cell or an Army cot.

While the choice for volunteers is bad, the state has a much better option - divert some of that money spent on the military and spend it on improving many aspects of society that need it.

I recall a situation from around the early 1990s when there was a proposal to spend about $2 billion on public education. The reaction from lawmakers was like this: Where the heck are we going to get all that money from?

That was just $2 billion! Funding Operation Desert Storm was no big deal.

>These days its hard to say anyone signs up for the military in the major democracies without realising what they where signing up for.

The British armed forces recruit children from the age of 16. I don't agree that 15/16 year olds in their final year of compulsory education know what they are signing up for when the army recruiters come to their school.

There are campaigns to change this, but as far as I know they haven't achieved much support.

For example: http://battlefieldcasualties.co.uk (the powerful video on this site is also relevant to the wider points being discussed upthread about the treatment of ex-military people and how it compares to the fetishisation of the military in other contexts)

The US does this too. I think schools are legally obligated to provide contact information for students.

Some veterans hate the "thank you for your service" thing. They say that rather than just saying TYFYS we should be holding politicians to account and making sure that military force is used when needed, or that we should be providing good quality medical care and support to move into civilian life.

Here's one flagged article about it: https://news.ycombinator.com/item?id=9089903

I remember seeing a lot of "support our troops: bring them home!" posters and bumper stickers in the mid 2000s.

Having been on the receiving end on that phrase numerous times, few genuinely felt sincere. It seems to have degenerated into a virtue signal more than anything else.

Only time I've ever said it was when I met a WW2 vet. Not that I don't support other vets it's just I feel that I actually had something to thank him for. I can't say my life would be all that different if we didn't invade Vietnam or Iraq. Everyone else I just buy them a beer and listen to their stories.

Yeah, maybe it's because I've got a lot of friends & coworkers that served or are active, but I just don't get the whole thanking thing. It's just another perfunctory statement.

I've kind of come around to the idea that asking some questions about the person's experience, and letting them tell some of their favorite stories is usually a better way of showing appreciation, even if it isn't openly stated. Everyone likes to be heard, and it's a rare veteran that doesn't have a bag of moving / funny stories to tell about being in the military, so everyone gets something out of it.

> In either case, strong reverence for the military is one of the criteria for a fascist state.

Just to provide a contrarian viewpoint -- strong disdain for the military is one of the criteria for a weak state rife with degeneracy and malignancy.

The military serves an important function in society and personally I think it deserves far more recognition than profit-seeking hounds with low moral standards (ie: the scum referenced in the article).

Just to provide a contrarian viewpoint -- strong disdain for the military is one of the criteria for a weak state rife with degeneracy and malignancy.

Uhm, no. For example, Liechtenstein, Palau, and Vatican City do not have a military and they do not seem to be "rife with degeneracy and malignacy" - well perhaps Vatican City, but not the other two.

"degeneracy and malignancy"? Can you unpack that into some slightly less 19-th century English please?

A 19th-century mindset can't really be unpacked into 21st-century words.

> Just to provide a contrarian viewpoint -- strong disdain for the military is one of the criteria for a weak state rife with degeneracy and malignancy.

Any evidence for this?

Rense is a conspiracy/racist site and if Dr. Lawrence Britt is an actual doctor I can't google him

Try some of the definitions of facism from https://en.wikipedia.org/wiki/Definitions_of_fascism some may meet your needs.

Glorification of war and wanting to support veterans after returning from war are two very different things. I'm from the US, and the attitude towards veterans has always been to support them almost in spite of the fact that they're being sent off to war.

I've never understood this. The US has a very peculiar perversion of military worship. It's very, very shallow. Respect the troops! But the Veterans Affairs is one of the most poorly run of the government departments. Underfunded and incompetently staffed.

So, the US has many private charities and organizations to help veterans. It seems silly. If there's one thing that a country so supposedly patriotic and morally superior ("exceptional") could do to show it, then it should be a 'no brainer' to try and live up to that and to take care of people who (now voluntarily signed up) to risk their lives for their country. This is more akin to North Korea's version--except the DPRK really is too poor to take care of them.

Its much easier to say "support the troops" than it is to actually support them, we have pretty much the same problem in the UK in regards to not supporting the troops properly after they get out/injured.

Whatever you believe about military forces and usage on a societal level we should look after them at least as well as everyone else.

> Its much easier to say "support the troops" than it is to actually support them

Kinda like how some people say "I'll pray for you" - rather than, you know, actually -doing- something to help...

While I agree praying doesn't do anything, you're overlooking that there are a lot of people that strongly disagree with us. To them, praying is an important act, and praying for you is likely something they will literally do because they think it will help. Granted, there are many people who say it as a platitude but don't actually do it.

> you're overlooking that there are a lot of people that strongly disagree with us.

No - I am not overlooking these people. I know very well that they exist, and I often find myself wondering about their thinking process. I say this also as a former person of faith (Wicca), as I often wonder about my own at the time, my own today, and the what/why of the changeover. I have yet to be able to answer that satisfactorily for myself.

> To them, praying is an important act, and praying for you is likely something they will literally do because they think it will help.

I understand that, but it also goes counter to published research which indicates that those who are prayed for do worse than those who aren't (I believe the study was in regards to patients recovering in a hospital, and that they were told whether or not they were being prayed for). The difference in rates of recovery were very minor (IIRC, less than 1 percent) - and other studies have shown the opposite. Ultimately, everything indicates that it is no better than random chance. I just wonder why people, despite being presented such evidence, choose fantasy over reality.

> Granted, there are many people who say it as a platitude but don't actually do it.

Those who do this, I hold in high contempt - above and beyond those who believe it will actually help. Because the true faithful are showing compassion toward the less fortunate (regardless of the actual outcome), while those saying it as a platitude are just doing so to gain some kind of "social points", likely knowing fully that their words mean nothing.

Separating the two classes, though, can be difficult or impossible, unfortunately...

It is not uncommon in a polite social life to encounter situations where literally nothing can be done (a colleague's parent dies; an acquaintance gets cancer). Yet, doing something even symbolically is required.

It is therefore quite rational to be able honestly to say you will pray for someone -- even if you are atheist -- if the goal is to maximally signal support and goodwill (which you believe will benefit the "recipient" in some small but possibly positive nonzero way, as well as signaling virtue from the "sender".)

Frankly, that is one major reason I have instituted prayer in my decidedly atheist household.

"Respect the troops" is a combination of virtue signalling and a means of bullying people who aren't militaristic. It doesn't have anything to do with actually supporting the actual human beings who are veterans.

The idea is that veterans are more susceptible to these kinds of problems (as you write).

The veterans knew this, but accepted it in order to serve. So targeting them this way is disrespecting their service.

Kind of "we'll agree to serve, if you agree to protect us after".

This was a story last year.[1] At that time, the Insys CEO, John Kapoor, was prominently mentioned. But he's not in the group arrested.

[1] http://www.cnbc.com/2015/11/04/the-deadly-drug-appeal-of-ins...

Maybe he made a deal with the authorities to testify or provide evidence?

Not really related, but I noticed the name of the prosecuting attorney: Carmen M. Ortiz.

She's the one who prosecuted Aaron Swartz IIRC

You are right. Source: https://en.wikipedia.org/wiki/Carmen_Ortiz

Reading the Wikipedia article about this woman is a bit infuriating. I can see why she's considered to be overzealous.

She also prosecuted the Boston Marathon bombing suspect and moments after he was apprehended, held an impromptu press conference where she declared that he would not be read his Miranda rights because he was a "public safety threat" [0].

[0] http://www.thedailybeast.com/articles/2013/04/23/dzhokhar-ts...

She's being "tough on crime". It's a pubic prosecutors step to public office.

Oh boy here comes the congestive dissonance

I know HN is not the place for 1-line witty quips but congestive dissonance made me laugh out loud. Thanks for the laughter!

Back to the topic, real life is complex. The same person fighting against us on one issue can be working with us on another one. The "good guys/bad guys" narrative is deeply anchored in our storytelling arts but it's also a gross caricature of reality.

In the business realm, consider Apple and Samsung who both collaborate on projects and actively sue each other.

Ah, the perils of typing on a phone.

She's the US District Attorney for Massachusetts, so any federal case in Massachusetts is going to run through her office.

Some of these execs are being charged under RICO. That's going to be brutal.

I was under the impression Prosecutors generally avoid RICO due to higher burden of proof. I guess this sets an example for the Pharma industry to watch out.

It seems that laws around healthcare actually have teeth as they should. Criminals in this industry actually go to jail and are punished, unlike, say, the financial industry. Clearly the pharma lobby hasn't had as much success in detoothing law enforcement.

The medication, called “Subsys,” is a powerful narcotic intended to treat cancer patients suffering intense episodes of breakthrough pain. In exchange for bribes and kickbacks, the practitioners wrote large numbers of prescriptions for the patients, most of whom were not diagnosed with cancer.

Nowhere in that article did I read anything about arresting/charging the "practitioners" who actually wrote those prescriptions, or did I miss it?

Use of the word racketeering here is interesting. Wikipedia's definition is:

> A racket is a service that is fraudulently offered to solve a problem, such as for a problem that does not actually exist, that will not be put into effect, or that would not otherwise exist if the racket did not exist

But it sounds like they were engaging in illegal bribing, not racketeering. I don't know, am I misunderstanding?

Racketeering here refers to a specific law - specifically, RICO (Racketeering Influenced Criminal Organization). This was built to deal with mafia groups in the 70s, but explicitly written to include white-collar crime. RICO basically created a special class of crime to cover the commission of multiple less serious crimes in pursuit of an "enterprise", i.e. an organized criminal conspiracy.

So when the Justice Department says racketeering, and then mentions RICO farther down in the press release, it means that these are basically conspiracy charges that include a few different items on a list of thirty-something crimes that RICO includes.

Thanks for the info

i wish it were a prosecution for real crimes, yet so far reading it it looks like a typical way prescription drugs are pushed in the US, and the prosecution here may be just a scapegoating of those typical pharma-pushers just because of all the high attention the fentanyl abuse got recently, and thus government has to show action and Ortiz jumped at the chance to look good.

"In this country we find it pays to hang an admiral from time to time, to encourage the others".

If "In exchange for bribes and kickbacks..." is "a typical way prescription drugs are pushed" then I'm happy that "Ortiz jumped at the chance to look good" and hope others take her lead. Just because something is common doesn't mean it's legal.

(IANAL) it is my understanding that kickbacks from drug companies to doctors are pretty legal in US - or there is a very technical line between legal and illegal kickback in pharma/doctor relationship that regular people like us don't recognize it.

And don't get me wrong, i'm not against sending a bunch of pharma execs to a country club - i just think that so few of them are sent there that situation looks more like politically motivated selective enforcement of the law than full fledged justice.

It is OK for doctors to have financial relationships with companies, for example, to be a paid speaker or consultant. But I don't think those are "kickbacks", and there's a distinction between those relationships and what the Justice Dept. is prosecuting here

https://projects.propublica.org/docdollars/

It's a very subtle one, IMHO.

So subtle you might call it a "loophole".

The Truth About the Drug Companies by Marcia Angell (Random House, 2004)

http://www.nejm.org/doi/full/10.1056/NEJM200410073511522

You don't think they often give out speaker roles as kickbacks? Speaking fees are often just bribes. Malcolm Gladwell isn't a doctor, but here's how it works in some cases (pushing amphetamines and tobacco): http://shameproject.com/profile/malcolm-gladwell-2/

Wow. I realize this is about prescription Fentanyl, but my area (Vancouver BC) is getting hit really, really hard by this drug.

http://news.nationalpost.com/news/canada/b-c-declares-public...

It seems to have made it's way into a variety of drugs, not just heroin, so the demographic of those affected by the deaths has shifted from "junkie" to "recreational user".

I'm glad they put an end to this, but man, I can't help but think there's a serious problem with our government based on how many agencies were involved to do it.

It appears that most of these agencies were involved in a role closer to that of a witness than an investigator. These are government agencies that provide healthcare benefits, so they were paying for the prescriptions and therefore victims of this fraudulent scheme.

There were probably dozens of private employers and/or insurance companies involved in similar roles, but they're not listed in this press release.

Well, this has been going on for decades in the case of opioids, resulting in a national catastrophe, and no one has been arrested yet.

Actually there have been a lot of arrests, but so far they have been of the doctors and staff prescribing the pills, rather than the Mr Bigs. Google "pill mill arrests" for examples.

Yes, but at a macro level it has been just a slap on the wrist.

There was an article in the Observer about this the other day.

https://www.theguardian.com/global/2016/dec/11/pills-that-ki...

It will be interesting to see how the plea bargains come out. There won't be a trial of course.

When opiates are killing more people then guns in America as they did over the last 12 months, there is a very serious problem at hand. Good to see reason prevailing, assuming the charges stock and they do hard time

The way it generally seems to play out in the USA, especially for white collar defendents who can afford plenty of lawyers, is something like this. They are charged with crimes that carry a decade or two in prison, but are then offered a plea bargain. Going to trial is risky for both sides: conviction means a decade or two in prison, but acquittal is very public egg on the face of the lead prosecutor. In a case like this it mostly depends on who the jury feel sorrier for; the hard-working family men who overstepped an obscure rule, or the unfortunate addicts who were suckered into it by a bunch of unscrupulous bastards.

So a plea deal is very likely, which means a sentence of under a year, quite possibly suspended, and a stonking big fine to the company (which hits the shareholders rather than the managers who made the decisions).

Just to be contrarian:

  Innocent until proven guilty.

Right, that works for the justice system. Fortunately, we are humans with free will and cognitive ability to make our own judgements.

When the company's entire senior leadership team is caught bribing physicians, many of whom were themselves arrested[1] for over-prescribing the drug in question, and is caught defrauding insurance companies to push their drugs --- We can wholeheartedly believe they are guilty. I wouldn't want them to go to prison until they have a trial by jury, but I don't have to give them the benefit of the doubt.

[1] - https://www.nytimes.com/2014/11/28/business/drug-maker-gave-...

Wait - I thought all US healthcare was done on the basis of kickbacks, perks, benefits, and free lunches from drug salesmen to physicians?

How is this any different?

Somebody must of forgot to kick up the vig.

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