The Addictive Profits of Pain

> US-pharma-opioid-crisis-health – updates here

“My teenage daughter recently had some blood work done, and the total cost was more than $1000. After insurance, we have the honor of paying $200 for a bloodtest …”, complains Annie Reneau in an article entitled “If Americans-understood how absurd our system is …”    She may have forgotten that all these costs must be right. As right as those efficiently pricing free markets make them.  And high prices all add up into GDP!  The more a nation spends on sickness the richer it is. Like $63,742 GDP per head in the US  compared to only  $40,447 in the UK.

Poor Old Europe…

On the other hand, the three high tech cancer ops I recently received from the NHS personally cost me £0,00 – well, I did pay for the taxi to the hospital.

Would that be capitalism with socialist characteristics?

As you breathe in the pleasurable profits of pain below you may ponder the idea of a once pleasure seeking capitalism having gone masochistic?

Just follow the money…

P R Keefe twitter

amazon blurb  5/2021   ‘Put simply, this book will make your blood boil . . . Keefe . . . paints a devastating portrait of a family consumed by greed and unwilling to take the slightest responsibility or show the least sympathy for what it wrought.’ John Carreyrou, author of Bad Blood, in the New York Times

The gripping and shocking story of three generations of the Sackler family and their roles in the stories of Valium and Oxycontin, by the prize-winning, bestselling author of Say Nothing.

The Sackler name adorns the walls of many storied institutions – Harvard; the Metropolitan Museum of Art; Oxford; the Louvre. They are one of the richest families in the world, known for their lavish donations in the arts and the sciences. The source of the family fortune was vague, however, until it emerged that the Sacklers were responsible for making and marketing Oxycontin, a blockbuster painkiller that was a catalyst for the opioid crisis-an international epidemic of drug addiction which has killed nearly half a million people.

In this masterpiece of narrative reporting and writing, Patrick Radden Keefe exhaustively documents the jaw-dropping and ferociously compelling reality. Empire of Pain is the story of a dynasty: a parable of 21st century greed.

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healthUS pharma – opioid crisis – reviews and articles/books updated 10/2023 14-10-2023 Who profits most from America’s baffling health-care system? Hint: it isn’t big pharma

>pharma 3-2023 Revealed: experts who praised new ‘skinny jab’ received payments from drug maker Observer investigation finds Novo Nordisk gave millions to obesity charities and healthcare professionals, including expert who advised Nice

>neuropharma, antidepressants, mental health 17-12-2022 US health agency accused of bowing to drug industry with new opioid guidance – Doctors say CDC’s softer guidelines ‘tossing aside’ safety limits put lives at risk as opioid epidemic continues to rage in the country 9-2019 ‘When we look back in 20 years’ time, this will be a turning point’ – Our journalist Ella Rhodes reports on a Public Health England review of withdrawal effects, and speaks to a British Psychological Society representative from the expert reference group – Professor John Read.

…Between 2017 and 2018 one in four adults in England were prescribed drugs which could lead to dependence or debilitating withdrawal effects, a Public Health England review has revealed – with prescription rates rising for some classes of drug. Antidepressants were included in the review, for the first time in a government-level report, despite many years of denial that the drugs could cause long-term, severe withdrawal effects. 

The review, written with input from the British Psychological Society, also considered benzodiazepines, z-drugs (prescribed for insomnia), opioid pain medications, and gabapentinoids – all of which are associated with dependence and withdrawal. Between 2015 and 2016 15.8 per cent of the adult population received prescriptions for antidepressants, rising to 16.6 per cent between 2017 and 2018. During the same two periods prescriptions for gabapentinoids rose from 2.9 per cent to 3.3 per cent. There were small decreases in prescriptions for the other three drug classes. 

The review also found that prescription rates for women were 1.5 times higher than men… 

>US health care 14-12-2022 The hospital wants $83,135 for saving my wife. She’s worth it – but where did that figure come from? – by Arwa Mahdawi – No one expects American doctors to remove an appendix for free. But it’s remarkable how quickly even the most shocking bills shrink once you start querying them –

…Regular readers may remember that I almost killed my wife a couple of months ago. She was complaining about stomach pains and thought she should go to the emergency room. It’s probably nothing, I told her. They’ll charge you a million dollars to tell you that you have indigestion. Luckily, she didn’t listen to me. She didn’t have indigestion, it turns out; she had a lousy appendix that caused a medical emergency. The bill to sort it out, which arrived last week, wasn’t a million dollars but it was heart-stoppingly high. According to our insurance company, the hospital had billed $83,135.08 (£67,000) for the procedure but – lucky us! – we would “only” have to pay about $2,000. How on earth could it cost so much money to remove an appendix?…”…

the guardian 12-11-2022 Digested week: Real cost of US health care – by Emma Brockes

…”…I receive a $2,000 bill from a New York hospital and call my insurers to politely enquire wtf. It takes years of living in the US to learn the exact phrasing required to challenge the endless stream of refused claims. In this case – calmly, in a tone more tender and endearing than any I have used on my children – I murmur a chain of words that will have the desired effect while quelling my rage.

“This claim has been miscoded on your end,” I say sweetly, as if into a lover’s ear. “It was diagnostic, not routine and as such falls under the auspices of the benefit schedule for follow-up referrals.” I sigh, as if contemplating life’s endless wonder, which, in all of humanity, only me and this helpful man in the call centre understand. “If you could send it up to the escalation team I’d be incredibly grateful.” It’s as close to begging as I can decently get.

There are other phrases; the “loyalty discount” you must know to ask for to lower your renewal quote; the phrase “put me on the do not call list”, which, by law in the US – but only if you use that exact wording – ensures that the scores of insurance brokers calling during open enrolment are compelled to stop the harassment.

Most importantly, you must learn to recognise the terrible danger lurking in the innocuous-sounding phrase “limited benefit plan”. This plan, which will cost half the amount you’re currently paying – with the promise of vision and dental! – is in reality a “wellness policy” that covers you for jack shit in the event of a medical emergency. Get out your magnifying glass, because there it is at the bottom of the page: should you and your family wind up in the hospital, you will be responsible for “the first $17,000 in expenses”. “ 27-4-2022 McKinsey denies illegally hiding work for opioid-maker Purdue Pharma while advising FDA – Consulting firm was protecting client confidentiality, chief says, and wasn’t obliged to disclose work advising drug manufacturer 10-4- 2022 ellen-isaacs-purdue-pharma-opioid-settlement 2-2022 empire-of-pain-patrick-radden-keefe-sackler-opioid-crisis-oxycontin 1-2022 dreamlands-sam-quinones-on-opioids-drug-cartels-new-book.html 12-2021 Federal-Judge-tosses-4-5-billion-settlement-shielding-Purdue-Pharmas-Sackler-family-opioid 2021 Reflections on Drug Crises – by Tammy L . Anderson

Conclusion – The US opioid epidemic shows no sign of abating after two+decades and billions of dollars in aid. In fact, researchers and public officials now warn about a possible fourthwave of the problem featuring opioid use (i.e., mostly illegal fentanyl) combined with stimulants such as cocaine and methamphetamines. This new wave comes at a time when Covid-19 is threatening to worsen substance abuse and its most dangerous consequences: drug overdose deaths. While many are claiming a spike in overdose deaths may follow from Covid-19 mitigation tactics and social fears that stymie naloxone distribution and MOUD compliance, the pandemic is also worsening joblessness, poverty, educational access and quality, housing security, racial inequality and healthcare disparities. While naloxone and MOUDs are necessary for people suffering opioid use disorders, they are insufficient alone and must complimented by a more comprehensive response anchored in the social determinants of health.The call for an approach to addiction, anchored in the social determinants of health, iswidely endorsed and has been argued eloquently over time by experts like sociologist Harry Levine and by leading opioid researchers. Recently, Dasgupta, Beletsky and Ciccarone maintained: By ignoring the underlying drivers of drug consumption, current interventions are aggravating its trajectory. Thes tructural and social determinants of health frame-work is widelyunderstood to be critical in responding to public health challenges.Until we adopt this framework, we will continue to fail in our eorts to turn thetide of the opioid crisis.So, let us renew our attention to and support of the social determinants of health that drive ourproblem with opioids and other substances. Forging ahead with an interdisciplinary approachthat utilizes ecacious biomedical interventions along with increased social and financial investment in community and individual empowerment programs will help us realize improvedbehavioral health for all. 2015 Dreamland: The True Tale of America’s Opiate Epidemic by Sam Quinones

In fascinating detail, Sam Quinones chronicles how, over the past 15 years, enterprising sugar cane farmers in a small county on the west coast of Mexico created a unique distribution system that brought black tar heroin—the cheapest, most addictive form of the opiate, 2 to 3 times purer than its white powder cousin—to the veins of people across the United States. Communities where heroin had never been seen before—from Charlotte, NC and Huntington, WVA, to Salt Lake City and Portland, OR—were overrun with it. Local police and residents were stunned. How could heroin, long considered a drug found only in the dense, urban environments along the East Coast, and trafficked into the United States by enormous Colombian drug cartels, be so incredibly ubiquitous in the American heartland? Who was bringing it here, and perhaps more importantly, why were so many townspeople suddenly eager for the comparatively cheap high it offered?

With the same dramatic drive of El Narco and Methland, Sam Quinones weaves together two classic tales of American capitalism: The stories of young men in Mexico, independent of the drug cartels, in search of their own American Dream via the fast and enormous profits of trafficking cheap black-tar heroin to America’s rural and suburban addicts; and that of Purdue Pharma in Stamford, Connecticut, determined to corner the market on pain with its new and expensive miracle drug, Oxycontin; extremely addictive in its own right. Quinones illuminates just how these two stories fit together as cause and effect: hooked on costly Oxycontin, American addicts were lured to much cheaper black tar heroin and its powerful and dangerous long-lasting high. Embroiled alongside the suppliers and buyers are DEA agents, local, small-town sheriffs, and the US attorney from eastern Virginia whose case against Purdue Pharma and Oxycontin made him an enemy of the Bush-era Justice Department, ultimately stalling and destroying his career in public service.

Dreamland is a scathing and incendiary account of drug culture and addiction spreading to every part of the American landscape 19/12/2021 After ‘startling rebuke’ of multibillion-dollar bankruptcy settlement, ‘these Sacklers don’t deserve a pass — again’  By Paul Pelletier and Beth Mac

…”…The evidence of callous greed was chilling. The company had fired employees who tried to blow the whistle on its crimes and maneuvered to have reporters who were onto the story fired or removed from their beats. Sales reps were encouraged to allow doctors to believe — falsely — that morphine was stronger than OxyContin when executives knew the opposite was true. The company’s medical director, Dr. Paul Goldenheim, lied to Congress when he testified that executives hadn’t known until 2000 that OxyContin was being widely abused: in fact, they’d become aware of addiction-related abuse shortly after the drug’s introduction in 1996.

A trial would have exposed the company’s OxyContin profits to forfeiture or prompted one of the executives to expose the magnitude of OxyContin scion Richard Sackler’s participation in the admitted crimes.

One of us (P.P.) had a front row seat to that miscarriage of justice, having overseen the federal Department of Justice’s Fraud Section’s review of the investigation. But political appointees at the department, apparently swayed by Purdue’s well-connected lawyers, including Mary Jo White and Rudy Giuliani, refused to approve felony charges for executives, letting Purdue off the hook with a $600 million fine.

Purdue had operated an ongoing criminal scheme, causing a massive pileup of deaths. The evidence against it was overwhelming, yet in the end political leaders at the Department of Justice chickened out, allowing only relatively minor charges.

After sentencing, we now know that the Sacklers and Purdue doubled down on their marketing. Years later, Richard Sackler admitted that he never even bothered to read the entire 2007 document that prosecutors outlined to guide Purdue’s future behavior. As Judge McMahon wrote in her ruling: “[I]f Purdue’s admissions in its 2020 Plea Agreement are believed, this purported acceptance of responsibility was a charade, and the oversight mechanisms built into the settlements were a conspicuous failure.”

Purdue hired consultants at McKinsey & Co., to advise them to “turbocharge” sales, concentrating on well-known pill mill operators, pushing the highest-dosage pills, and banning together with other opioid makers to pull end-runs around FDA regulators. McKinsey even suggested that Purdue offer to offset overdose deaths with client rebates. These death discounts never came to pass, but the damage was done.

Starting in 2015, American life expectancy began dropping for the first time since World War I, with opioid overdoses contributing the majority of deaths. Economists have since shown that overdose rates from heroin and fentanyl are significantly lower in the handful of states that were not privy to the company’s full OxyContin-as-cure-all marketing push. And a Gallup poll published last month reported that nearly one-third of Americans report struggling with drug addiction in their families…”… 2021 Reflections on Drug Crises (Delaware US)  by Tammy Anderson  27/11/2021 Empire of Pain by Patrick Radden Keefe review – all the moral power of a Victorian novel – This prizewinning account of a band of brothers who struck gold with the opioid OxyContin is a masterfully told story of corruption and greed  by

“The worthy winner of the Baillie Gifford prize earlier this month, Patrick Radden Keefe’s Empire of Pain is a work of nonfiction that has the dramatic scope and moral power of a Victorian novel. It’s about corruption that is so profitable no one wants to see it and denial so embedded it’s almost hereditary….”…

science/  21/8/2021  Sackler Dynasty: A Searing Portrait of Greed From the Pharmaceutical Industry   by Mohammad Anas

…”Part-biography, part-investigation, the book chronicles the lives of Arthur Sackler – a pioneer of medical advertising – and his two brothers, Raymond and Mortimer, all of them doctors. Arthur, the family patriarch and son of Jewish immigrants, popularised drugs such as Terramycin and Betadine in the 1950s through an ad agency called William Douglas McAdams. He helped Pfizer transform itself from a supplier of chemicals to a major player in the pharmaceutical business.  His biggest success came through marketing Valium. It would become the first $100 million drug. And its makers, the Swiss healthcare company Roche, reaped billions of dollars in revenue.  All of this was achieved through a blitzkrieg of revolutionary marketing techniques, creative advertisements and an army of salespersons. The Medical Advertising Hall of Fame would eulogise Arthur’s legacy thus: “no single individual did more to shape the character of medical advertising than the multi-talented Dr Arthur Sackler. His seminal contribution was bringing the full power of advertising and promotion to pharmaceutical marketing”. …”…  16/5/2021  Empire of Pain by Patrick Radden Keefe, review — the Sacklers and the opioid crisis – An exposé of the family that allegedly fuelled painkiller addiction in America is jaw-dropping   by John Arlidge
“Some books make you so angry you want to chuck rocks at the bad guys they expose. This book is one of those. …”…  15/5/2021 Patrick Radden Keefe traces the roots of America’s opioid epidemic
Introduced in 1996, OxyContin generated vast sales—and led to enormous suffering

…”…“The prescription blizzard will be so deep, dense and white,” Richard Sackler, son of Raymond, promised at the launch party for OxyContin. His words proved all too prophetic. The plan for mass-market opioids was abetted by misleading advertising, which claimed that less than 1% of patients would become addicted, and a vast salesforce incentivised by lucrative commissions.

The company peddled theories of “pseudo-addiction” (for which the cure was said to be more opioids) and of “opiophobia” among sceptical doctors. The guardrails against harm buckled in the face of Purdue’s wealth and the lawyers and lobbyists it could buy. Regulators endorsed ludicrous claims about the drug’s safety. A serious case brought by federal prosecutors in Virginia in the early 2000s was watered down by the Department of Justice. Thousands of doctors were given all-expenses-paid trips. Altogether, OxyContin took in $35bn in sales. The results were brutal.” …  15/5/2021  Last year, more people in San Francisco died of overdoses than of covid-19 – This is part of a worrying national trend, following changes in drug markets  13/5/2021 Empire of Pain review by Patrick Radden Keefe – the dynasty behind an opioid crisis –  This examination of the Sackler family, purveyors of OxyContin, lays bear its responsibility for the US’s opioid epidemic  by Samanth Subramanian

… “The things they knew! They knew that OxyContin was more potent than morphine, and they exploited the fact that doctors thought the reverse to be true. (“It is important that we be careful not to change the perception of physicians,” a Purdue official advised.) They claimed OxyContin posed little risk of addiction, even though Purdue had carried out no tests to that effect at all. They knew they were using flimsy literature to reassure physicians about OxyContin’s safety: “not a peer-reviewed study,” Keefe writes, “but a five-sentence letter to the editor by two doctors at Boston University”. They knew the drug could be injected, but they didn’t let on. They argued that OxyContin’s slow-release mechanism was a barrier to abuse, but they knew they also owned another company that made immediate-release oxycodone. Studying their sales data, they maintained a secret list of doctors who overprescribed OxyContin – and did little to alert the authorities to these pill mills, preferring to grow rich off the proceeds instead. …

Keefe’s narrative is so lush with details that only in the chinks do we spot the story behind the story: the rotting structure of American healthcare that almost wills disasters into being.” …”   12/5/2021 Empire of Pain by Patrick Radden Keefe review — the family who profited from America’s opioid crisis   The story of the ruthless promotion of OxyContin by Purdue, the pharma company owned by the Sackler dynasty, is a shocking page –  by Melanie Reid  2021 What Did the Sacklers Know? – Patrick Radden Keefe’s new book provides the fullest accounting so far of Purdue Pharma’s role in the opioid crisis.  2021 Empire of Pain review: the Sacklers, opioids and the sickening of America – Patrick Radden Keefe delivers a damning account of Purdue Pharma, OxyContin and a family that grew rich   by Lloyd Green  2021 Protect the Family at All Costs – A damning portrait of the Sacklers, the billionaire clan behind the OxyContin epidemic. BY Laura Miller

FT 5/2021 Deadly Painkillers  review by John Gapper    5/9/2021  Opioids have killed 600,000 Americans. The Sacklers just got off basically scot-free – A bankruptcy court gave members of the pharma family immunity from further civil suits. They don’t have to admit wrongdoing – and they may end up richer than they started    by Chris McGreal  (author of American Overdose: The Opioid Tragedy in Three Acts)

…”The US has 375 bankruptcy judges but, as Levitin told Congress, just three oversaw the majority of cases filed by large companies last year. Purdue Pharma chose to file with one of those three, Judge Robert Drain, to decide the conditions of its bankruptcy. Although Purdue is based in Connecticut, it filed for bankruptcy in White Plains, New York, where Drain is the only bankruptcy judge. It’s unlikely to have gone unnoticed by the Sacklers’ lawyers that Drain had an unusual record of staying lawsuits against third parties who have not filed for bankruptcy.  One of Drain’s first steps was to block efforts to sue individual members of the Sackler family, even though they were separate from the Purdue bankruptcy case. Then he permitted the Sacklers to effectively hold the plaintiffs hostage by offering a stark choice between settling for a cut of the profits of misery in return for wiping the legal slate clean or facing years of court battles. States, municipalities and families desperate for money to cope with the huge social consequences of the epidemic were left with little choice but to agree, although many expressed their distaste.  …

Judge Drain said he was unhappy with the outcome of the case but that his hands were tied. “This is a bitter result,” he said, arguing that he had little choice but to agree to the Sacklers’ demands or risk no financial settlement at all. The judge’s critics say the outcome was preordained from the moment Purdue filed its case in his court.  But it is an outcome that fits with the history of a uniquely American epidemic. No other country has experienced the same scale of opioid addiction and death, in part because corporations in other countries do not wield the same influence over the practice and regulation of medicine. Neither did Purdue act alone in this crisis. Drug distributors and pharmacies jumped on the bandwagon. Other opioid manufacturers, such as Johnson & Johnson, raked in the profits of narcotic painkiller addiction.

Even as evidence of a crisis grew and doctors witnessing the devastation sounded warnings, the din of corporate money drowned them out. The quarter of a billion dollars a year the drug industry spends on lobbying bought the complicity of politicians, influenced regulators, weakened investigations by the justice department and stalled action by the Drug Enforcement Administration. Purdue used its political muscle to head off even more serious criminal charges and to keep its executives out of prison.

Above all, the drug industry kept the doors to mass prescribing of opioids open for years not because they were an effective way to treat pain but because they were hugely profitable. Those same firms are now increasingly agreeing to payouts to head off a torrent of lawsuits – but it’s hard to conclude that they regard it as anything more than the cost of doing business. Not least because, like the members of the Sackler family behind Purdue, none of them admit to having done anything wrong.” …  4/9/2021 US drug companies say $26bn opioid settlement will proceed – Companies say ‘enough’ US states joined a settlement resolving claims they fuelled the opioid epidemic, allowing it to move ahead. 3/9/2021 What is the bankruptcy “loophole” used in the Purdue Pharma settlement?
A controversial legal arrangement shields the owners of companies from personal liability

ON SEPTEMBER 1ST a long legal wrangle in America’s opioid epidemic, which continues to kill thousands of people a year, at last came to an end. A federal judge in New York approved the bankruptcy plan of Purdue Pharma, which developed and manufactured OxyContin, a highly addictive painkiller. The deal settles thousands of lawsuits against the firm filed by states, localities, tribes and individuals. Purdue will be re-organised as a public-benefit company called Knoa Pharma, and its future profits will go towards alleviating the damage done by opioid addiction. Members of the Sackler family, who own Purdue, will relinquish control of the firm and pay $4.5bn to plaintiffs. But nine states and Washington, DC opposed the final deal and some—Connecticut, Washington state and the District of Columbia —will appeal against it. Their objections stem from a legal arrangement shielding parties associated with bankrupt companies (which have not filed for bankruptcy themselves) from liability, which many people want to change.  18/8/2021  Purdue Pharma chair denies responsibility for US opioid crisis
…”Richard Sackler, 76, says in bankruptcy court he, his family and company are not responsible for epidemic … Richard Sackler’s denial of responsibility for the opioid crisis comes a day after another Sackler family member said the group wouldn’t accept a settlement without guarantees of immunity from further legal action….”…  24/7/2021  What Those in Power Are Missing About the Opioid Epidemic “This is what happens when public health fails.” By Jack Shuler

The CDC estimates that more than 93,000 Americans died from drug overdoses in 2020, up 29 percent from the year before. And since 1999, more than 840,000 Americans have died from overdoses. In recent years, the overwhelming majority died from using the synthetic opioid fentanyl, which is used on its own or found in other drugs, resulting in people taking it unintentionally.

Joe Biden’s platform for ending the opioid crisis supports important interventions, including expanded access to treatment, harm reduction, and health care. But he has spoken in favor of measures such as mandatory treatment for substance use, which takes away a person’s agency and is not proven to be effective, and drug courts, in which a judge essentially supervises treatment. The people most harmed by the structural violence of these policies, and by a lack of adequate health care, are poor, and many of them are people of color. Combatting the overdose crisis by punishing people who use drugs through the criminal-justice system will not work.

Read: The opioid epidemic might be much worse than we thought  15/7/2021  Pharmaceutical firms want to move on from the opioid crisis – but its victims cannot – how corporations funnelled hundreds of millions of prescription pain pills into West Virginia    by Richard Hall

There is a passage in John Steinbeck’s The Grapes of Wrath that details an exchange between a representative of a bank and a tenant they are in the process of evicting. It was published 80 years ago, but still feels relevant today.

“We’re sorry. It’s not us. It’s the monster. The bank isn’t like a man,” the banker tells the tenant.

“Yes, but the bank is only made of men,” comes the tenant’s reply, expecting some kind of reprieve.

“No, you’re wrong there – quite wrong there. The bank is something more than men, I tell you. It’s the monster. Men made it, but they can’t control it.”

I thought of those words recently as I sat in a courtroom in Charleston, West Virginia, listening to a drug company executive defend his employer’s role in fuelling the opioid epidemic.

The executive, a former compliance officer for one of the “Big Three” pharmaceutical companies that collectively funnelled hundreds of millions of prescription pain pills to the state, was asked why they had not stopped the shipments when it became clear there was a problem.

“We’re a company. We’re not an enforcement agency and we’re not a regulatory agency,” said Chris Zimmerman, senior vice president of regulatory affairs at AmerisourceBergen.   12/5/2021  US states oppose ‘unjust’ plan to shield Sackler wealth in opioid settlement – by Chris McGreal   –   Twenty-four states object to bankruptcy proposal for Sacklers to settle lawsuits by paying $4.3bn but family would keep about $7bn –  –  Nearly half of US states have joined growing opposition to a highly unusual bankruptcy plan that would protect the wealth of the Sackler family after it made billions of dollars from selling the drug that kickstarted the   US opioid epidemic.  5/2021  Big pharma doesn’t want us to expand Medicare. We have to fight them – By lifting the ban on Medicare negotiating prescription drugs prices we can expand benefits and lower the age of eligibility –  by Bernie Sanders

Americans spend $477 billion a year MORE on health care than other advanced countries, which amounts to $1,645 per person every year. So why do we pay so much compared to other wealthy nations? mu AMERICA VS. THE WORLD Where does all our money go? A breakdown of our ‘routine’ visits as compared to other wealthy nations.  2017  The Family That Built an Empire of Pain- The Sackler dynasty’s ruthless marketing of painkillers has generated billions of dollars—and millions of addicts.  By Patrick Radden Keefe   Since 1999, two hundred thousand Americans have died from overdoses related to OxyContin and other prescription opioids. The company funded research and paid doctors to make the case that concerns about opioid addiction were overblown, and that OxyContin could safely treat an ever-wider range of maladies. OxyContin is a controversial drug. Its sole active ingredient is oxycodone, a chemical cousin of heroin which is up to twice as powerful as morphine. Upon its release, in 1995, OxyContin was hailed as a medical breakthrough, a long-lasting narcotic that could help patients suffering from moderate to severe pain. The drug became a blockbuster, and has reportedly generated some thirty-five billion dollars in revenue for Purdue. health-care-facts-whats-wrong-american-insurance -us-health-care-is-an-ongoing-miserable-failure  2020  Deaths of Despair and the Future of Capitalism   by Anne Case, Angus Deaton