Saturday, February 23, 2019
Big Pharma is taking advantage of patent law to keep OxyContin from ever dying
November 18, 2017
The US opioid epidemic seems
to many to have come out of nowhere, and there’s been much finger-pointing in
recent years about how this state of affairs came to be. Some have argued
that inadequate
mental healthcare is to blame. Others have
postulated that doctors were naively over prescribing them as a way to
quickly treat pain and please their patients. But, according to a recently
published draft report, at least some of the blame should be attributed to
the way pharmaceutical companies have manipulated patent extensions over the
past decade.
In the 1970s and 80s, doctors
were looking for better ways to control pain, and many believed
opioids a good, non-addictive option. In the 1990s, drug manufacturers
began aggressively marketing the
painkillers to doctors and patients. Soon, patients (or their
loved oneswho stole their pills) were developing tolerances for low doses,
and graduated to abusing the drugs by crushing them and either snorting or
liquefying and injecting the powders, or turning to heroin, often fatally. By
the time the science caught up in the early 2000s, it was too late: Thousands of
people were addicted to opioids. Opioids have killed over 560,000 people in the
US since 2000. Last month, president Donald Trump declared the crisis a public
health emergency.
Pharmaceutical companies
profited from this demand, and the exclusive rights they had to make these
compounds. This allowed them to pump even more money into marketing, which
inevitably led to doctors prescribing more of them.
From the moment a drug company
patents a compound, it has 20 years of exclusive manufacturing and selling
rights on it. In theory, a company’s monopoly on a drug dissolves after its
patents expire and generics flood the market. But drug companies usually file
for patents in the discovery stages as a way of staking their territory in the
field. The approval process for drugs from the US Food and Drug Administration
involves lengthy clinical trials, which usually take around 12 years—meaning
that manufacturers typically only get to actually sell their drugs exclusively
for about
eight years before generics come onto the market. So they often seek
ways to extend this exclusive period.
Perhaps the most common way is
to change a drug ever so slightly. For example, a company can file a new patent
if it makes a version of a drug with a slightly different dosage, or with a
different way it’s released in the body over time.
“Our patent system doesn’t
require something to be better, just different,” says Robin Feldman, the
director of the Institute for Innovation Law at the University of California
Hastings College of Law. “Rather than creating new medicines, pharmaceutical
companies are largely recycling and repurposing [drugs].” The manufacturer can
then hold off generic competition for a few more years. Competitors (or anyone
else) could theoretically make the case in court that these compounds aren’t
actually different, but the legal battle would likely be too costly and time
consuming to be worth it.
Feldman, together with Connie
Wang, a law student at Stanford University, meticulously went through a
decade’s worth of versions of the US Food and Drug Administration’s “Orange
Book” and US Patent and Trademark Office website listings to investigate
the relationship between patent filings, exclusivity extensions, and drug
approvals.
They found that of the 100
best-selling drugs from 2005 to 2015,about
80% (paywall) had a patent extension filed on them at least once.
About 50% of these drugs had multiple extensions.
That, Feldman argues, can
create a dangerous cycle. “The immense monopoly profits allow drug companies
like Purdue to aggressively market their drugs to doctors,” explains Feldman.
“Physicians preferentially prescribe these particular drugs. Where drugs are
addictive and problematic, that’s dangerous.”
Purdue Pharma is the company
behind one of the most popular prescription opioids. OxyContin first came on
the market in 1996 and has since brought in billions of
dollars of revenue. Purdue’s patent for OxyContin was originally
supposed to expire in 2013. But by making minor tweaks to the drug’s chemical
structure to create a slow-release pill the company markets as “abuse-proof,”
Purdue has been able to file new patents for OxyContin 13 times with the US
Patent and Trademark Office over the past decade, thereby extending its
exclusive selling rights on the drug through 2030.
Purdue did not respond
directly to Feldman’s analysis when forwarded a copy by Quartz, instead
providing a statement noting, “One potentially important step towards the goal
of creating safer opioid analgesics has been the development of opioids that
are formulated to deter abuse. FDA considers the development of these products
a high
public health priority. Purdue reformulated OxyContin with abuse-deterrent
properties recognized by FDA, and the Patent and Trademark Office granted
Purdue patents for inventions that went into the development of those
properties.”
The most prominent example is
a patent Purdue filed
in 2003 for “abuse-proof” OxyContin. It was made of materials that are
harder to crush, and forms a gel that is more viscous and harder to inject. In
theory, it would make for a safer alternative to regular OxyContin. However,
the same patent claims that “intravenous administration of such a gel would
most probably result in obstruction of blood vessels, associated with serious
embolism or even death of the abuser.” In all likelihood, people crushing these
pills to get high would still seriously harm, if not kill, themselves.
Technically, the abuse-proof
pills worked: When researchers from Washington University in St. Louis informally surveyed more
than 2,500 people taking opioids to see if this pill really was more
abuse-proof than before, they found that the number of people who admitted to using
it to get high dropped from about 35% to about 13% two years later. However,
two thirds of respondents said they had switched to other opioids instead—often
heroin, which is less expensive and easy to use.
It’s not Purdue’s fault
doctors kept prescribing (and overprescribing) these pills in an attempt to
alleviate pain, nor that the loved
ones of patients often took instead to get high. It’s also not the
company’s fault there weren’t better resources for those who found themselves
addicted—drugs like buprenorphine, methadone and naltrexone can help ease
addiction, but as recently as 2016, they
still weren’t being given to patients in two-thirds of US addiction
clinics.
That said, Purdue spent many
years and huge sums of money convincing doctors that OxyContin was non
addictive. In fact, the company has paid over $600
million (paywall) in fines to federal and state agencies, as well as
individual patients, to settle claims that it falsely marketed OxyContin as
safe from abuse. Three of the company’s executives pled guilty to
“misbranding,” which is a criminal violation.
The company is still profiting
off “abuse-deterrent” OxyContin. Though there are currently “authorized
generics” of OxyContin available, these are made by manufacturers with licenses
to use Purdue’s formula. In other words, Purdue makes money off them. And
there are currently no approved abuse-deterrent generics in the US. In
September of this year, FDA commissioner Scott Gottlieb said that
soon the agency plans to issue guidelines to assist companies who are trying to
file applications for these types of generics. No word on when that document
will be published, however.
Friday, February 22, 2019
Chicago Police Credit Their Extensive Experience Falsifying Evidence For Helping Solve Smollett Case
CHICAGO—Easily spotting what they described as a textbook
example of a fabricated crime, members of the Chicago Police Department on
Friday credited their own extensive experience falsifying evidence with helping
them solve the case of actor Jussie Smollett’s staged attack.
“We’ve been doing this sort of thing for decades, so we
were really able to bring a lot of expertise to bear on this matter,” said CPD
superintendent Eddie Johnson, adding that his officers—many of whom have built
their careers on falsifying evidence to further their personal interests—were
quick to notice similarities between Smollett’s letter containing crushed
aspirin and their own tried-and-true method of planting cocaine on drivers
during traffic stops.
“One look at that letter, and our detectives, who have
forged hundreds of documents themselves, knew it was a fake. And of course, the
supposed attack was immediately suspicious because nearly all violent crimes in
this city end with a dead black man at the scene. So this was very much an
open-and-shut case.”
Johnson went on to state that it was a shame Smollett had
taken on too much too soon and wasted his potential talent for covering up
unlawful, self-serving behavior, as the young man could have had a bright
future with the force.
Putin rattles sabre as nuclear pact collapses
Russian President warns West
that deploying missile launchers in Europe could ignite ‘tit for tat’ response
By PEPE ESCOBAR, MOSCOW
President Putin’s state
of the nation address to the Federal Assembly in Moscow this week was
an extraordinary affair. While heavily focused on domestic social and
economic development, Putin noted, predictably, the US decision to pull out of
the Intermediate-Range Nuclear Forces (INF) treaty and clearly outlined
the red lines in regard to possible consequences of the move.
It would be naïve to believe
that there would not be a serious counterpunch to the possibility of the US
deploying launchers “suitable for using Tomahawk missiles” in Poland and Romania,
only a 12-minute flight away from Russian territory.
Putin cut to the chase: “This
is a very serious threat to us. In this case, we will be forced – I want
to emphasize this – forced to take tit-for-tat steps.”
Later that night, many hours
after his address, Putin detailed what was construed in the US, once again, as
a threat.
“Is there some hard
ideological confrontation now similar to what was [going on] during the Cold
War? There is none. We surely have mutual complaints, conflicting approaches to
some issues, but that is no reason to escalate things to a stand-off on the
level of the Caribbean crisis of the early 1960s”.
This was a direct reference to
the Cuban missile crisis in 1962 when President Kennedy confronted USSR’s
Nikita Khrushchev over missiles deployed off the US mainland.
The Russian Defense Ministry,
meanwhile, has discreetly assured that conference calls with the Pentagon are
proceeding as scheduled, every week, and that this bilateral dialogue is
“working”.
In parallel, tests of
state-of-the-art Russian weaponry such as the Sarmat intercontinental ballistic
missile and the hypersonic Khinzal also proceed, alongside mass production of
the hypersonic Avangard. The first regiment of the Russian Strategic
Missile Forces will get the Avangard before the end of this year.
And then there’s the Tsircon, a hypersonic missile
capable of reaching US command centers in a mere five minutes – leaving the
whole range of NATO military assets exposed.
What Putin meant in his
address about Russia targeting “centers for decision-making” was
fundamentally related to NATO, not the American mainland.
And once again, it’s crucial
to underline that none of these disturbing developments mean that Russia would
engage in a pre-emptive strike against the deployment of US missiles in Eastern
Europe. Putin was adamant that there’s no need for it. Moreover, Russian
nuclear doctrine forbids any sort of pre-emptive strikes, not to mention a nuclear
first strike.
House of the Rising (Nuclear)
Sun
To allow this new paradigm to
sink in, I went on a long walk across Zamoskvorechye – “behind the Moskva
river” – stopping on the way back in front of the Biblioteka Lenina to pay my
respects to the Grandmaster Dostoevsky. And then it hit me; this was entirely
connected to what had happened the day before.
The day before Putin’s state
of the union address, I went to visit Alexander Dugin at his office in the
deliciously Soviet, art nouveau building of the former Central Post Office.
Dugin, a political analyst and strategist with a refined philosophical mind, is
vilified in Washington as Putin’s ideologue. He has also been targeted by US
sanctions.
I was greeted in the lobby by
his multi-talented daughter Daria – active in everything from philosophy and
music to geopolitics. Dugin was being interviewed by RAI correspondent Sergio
Paini. After the wrap-up, the three of us immediately engaged in a discussion
on populism, Salvini, the Italian politician, and the Gilets Jaunes (Yellow
Vests in France), in Italian. (Dugin is fluent in many languages).
Then we picked up on what we
had left behind, when I was in Moscow last December and talked extensively with
Daria. Dugin was in Shanghai teaching an international relations course at
Fudan University (see here and here), and gave lectures
at Tsinghua and Peking University. He returned quite impressed by Chinese
academia’s interest in populism, plus German philosopher Martin Heidegger and
the Gilets Jaunes, as well as the evolving paths of Russia and China’s
strategic partnership.
Eurasia debate
So inevitably we delved into
Eurasianism – and strategies towards Eurasian integration. Dugin sees China
applying a sort of remixed Spykman outlook to the “Road” component of the Belt
and Road Initiative (BRI), which is maritime, along the rimland. He privileges
the “Belt” component, which is overland, with one of the main corridors going
through Russia via the upgraded Trans-Siberian railway. I tend to view it as a
mix of Halford Mackinder, the famed English academic, and the influential
American political scientist Nicholas Spykman; China advancing on the West,
simultaneously in the heartland and the rimland.
Dugin’s office has the
atmosphere of a revolving think tank. I was trying to inform him on how Brazil
– under the ‘leadership’ of Steve Bannon, who walks and talks like he runs the
Bolsonaro presidential clan – has been dragged to the frontline in the US in
contrast to the Eurasian integration chessboard. Suddenly, none other
than Alastair
Crooke drops in. Serendipity or synchronicity?
Alastair, with his consummate
diplomatic flair, is, of course, one of the world’s foremost experts in
the Middle East and Europe – and much else. He’s in Moscow as a guest for one
of the Valdai Club’s famed discussions, on the Middle
East, along with key figures from Syria and Iran.
Soon the three of us are
engaged in an absorbing conversation on the soul of Islam, the purity of
Sufism, the Muslim Brotherhood (those fabled friends of the Clinton machine),
what President Erdogan and the Qataris are really up to, and the sterility –
intellectual and spiritual – of the Wahhabi House of Saud and the Emirates.
We tend to agree that
discussions like this, going on in Moscow – and in Tehran, Istanbul, Shanghai –
would greatly profit from the presence of a progressive Steve Bannon, capable
of organizing and promoting a running, non-ideological debate on multipolarity.
A day before Putin’s stark
reminder against any slip towards nuclear Armageddon, we were also discussing
the post-INF world, but with emphasis on post-Mackinder (and post-Brzezinski)
Eurasian integration. And that includes Russian and Chinese intellectual elites
acutely aware that they can’t afford to be isolated by American hyperpower.
I walked Alastair to his
hotel, past a gloriously illuminated Bolshoi. I kept going, and as Lubyanka
disappeared from view, a sidewalk busker was playing ‘House of the Rising Sun’,
the Animals version. In Russian.
Hopefully, it will not feature
a rising nuclear sun.
Message from Srećko Horvat
Next week all roads lead to…
Graz, Austria!
As part of the Elevate Festival opening on February 27 in Graz I’ll
be joined by actress and activist Pamela Anderson to promote our Green New Deal for Europe – the flagship policy
proposal in our Progressive Agenda for Europe we’re taking to ballot boxes
everywhere next May.
Our collaboration started last
year, when Pamela and I published a conversation for the American magazine Jacobin. In
it, we discussed various topics, from climate change to Gilets Jaunes, and
from activism to… Baywatch!
Among other things we both
agreed on what DiEM25 has been saying since its launch back in February 2016:
"Look at leaders such as
Trump, Bolsonaro, and Salvini and you will see exactly these properties (of
"ur-fascism"). They are destroying the Amazon, the Arctic, the whole
planet in “real time.” And there is no planet B," said Pamela.
"Retreating to
nationalistic tendencies is not an alternative”, she elaborated, adding that,
“The only road to freedom is via a joint fight of the unprivileged. This means
foreign workers included."
From my part, I stressed that,
" unless the deep crisis of the European Union is solved, which is not
only internal but also concerns its foreign policy, I am afraid we will see the
situation deteriorating even more. So instead of the simple “Lexit” solution, I
think we need more trans-national politics, not just an inter-national politics
(between nations), but a trans-national one. We need to go beyond the nation
state."
Among the activities in Graz
next week, Pamela and I will discuss the role of activism today
and the current situation in Europe - and the world.
Also, Daniela Platsch (our MEP
candidate in Germany) will join us on February 27 at 3pm CET in a press
conference at Forum Stadtpark, where the three of us will speak about our
Green New Deal for Europe, and our transnational bid to enter the European
Parliament.
Supporting progressive
priorities such as our Green New Deal for Europe, having a true international
mentality and understanding about what's happening in the world today, from the
US to France, from Turkey to Brazil, is rare nowadays. The dominant discourse
is a retreat to toxic nationalisms and xenophobia. That an actress and
activist from the other side of the Atlantic like Pamela steps up to join and
support our struggle is outstanding – a courageous act we cherish and
appreciate.
The press conference will be
livestreamed, so stay tuned, keep an eye on our social media for links to the
stream and more info!
There is no culture without
popular culture! There is no resistance without imagination!
Carpe DiEM!
Srećko Horvat
DiEM25 co-founder
The U.S.-Venezuela Aid Convoy Story Is Clearly Bogus, but No One Wants to Say It
No one actually thinks the
same Donald Trump who kicked off his run for the White House by calling
Mexicans rapists, and subsequently, as president, left Puerto Rico for dead
after Hurricane Maria, cares at all about the Venezuelan poor. No one actually
thinks the murderers row of Cold Warriors—led by two of the most extreme
right-wingers in American politics, Venezuela envoy Elliott
Abrams and national security adviser John
Bolton—cares at all about the starving people in Venezuela or their plight.
No one reading this, be they right, left, center, libertarian or communist,
actually buys the prevailing narrative that the U.S. is sending “aid” to
Venezuela as a humanitarian gesture.
So why is everyone pretending
otherwise?
There are a number of
reasons why these superficial narratives take hold, but I’d like to speculate
on two of them.
First, the crisis in Venezuela
is very real and very daunting. Without litigating who’s responsible for what,
whether U.S.-led sanctions and economic sabotage are more to blame or the
economic policies of Nicolás Maduro, one simple fact is true: The status quo is
untenable. Perhaps, then, the instinct to “do something” is understandable. But
as with previous crises, both organic and contrived, what that “something”
is remains unclear. Liberals—as they did in the build-up to the invasions
of Iraq and Libya—are easily pressured into this “do something” posture.
The way these things work,
however, is that this vague moral directive often involves a combination of CIA
and U.S. military intervention. During the Syrian conflict, for example, it
meant U.S.- and NATO-led bombings of Syrian forces and a tacit declaration of
war under the guise of “no-fly zones.” What’s never considered is a reduction or
cessation of U.S. involvement, be it CIA
weapons running, wide-scale bombing campaigns, or the
imposition of sanctions—all of which prolong a given conflict or simply
make it more violent.
Because a core tenet of
American liberalism is to avoid assigning blame—at worst, its adherents
believe, the U.S. is run by a bunch of bumbling
do-gooders—what the American empire is actually doing to fuel a conflict
cannot be debated, much less censured. And so the notion that we could simply
cease our crippling sanctions, which even the pro-opposition Economist acknowledges are
designed to “starve” the Venezuelan people, is simply not an option.
The current “something” in
Venezuela we’re all compelled to “do” is ensure the arrival of a humanitarian
aid convoy. The fact that the bulk of the international aid community has
either distanced itself from this PR stunt or outright opposes it has been
widely ignored by the mainstream media. One exception is NPR, which
recently reported
this inconvenient truth:
The U.S. effort to distribute
tons of food and medicine to needy Venezuelans is more than just a humanitarian
mission. The operation is also designed to foment regime change in Venezuela —
which is why much of the international aid community wants nothing to do with
it. Humanitarian operations are supposed to be neutral.
That’s why the International
Committee of the Red Cross, United Nations agencies and other relief organizations
have refused to collaborate with the U.S. and its allies in the Venezuelan
opposition who are trying to force President Nicolás Maduro from power.
“Humanitarian action needs to
be independent of political, military or any other objectives,” Stéphane
Dujarric, the U.N. spokesman, told a press briefing last week in New York. “The
needs of the people should lead in terms of when and how humanitarian
assistance is used.”
In fact, no neutral observer
of international aid thinks Bolton and Abrams’ convoy is anything but a
mechanism to foment civil war and regime change. We know this because
high-level administration officials and their allies on the right keep telling
us that’s the case. As the New York Post recently proclaimed,
“U.S. delivers aid to town bordering Venezuela to undermine President
Nicolas Maduro.”
Donald Trump delivered a long
and rambling speech in Miami last week and didn’t once mention human rights,
instead railing against the evils of socialism. Former acting FBI director
Andrew McCabe reflects in his new book that Trump has openly
fantasized about overthrowing Maduro, something he has discussed in
White House meetings. “That’s the country we should be going to war with,”
Trump said, according to McCabe. “They have all that oil, and they’re right on
our back door.”
Determined to maintain U.S. hegemony
and control over the world’s largest-known oil reserves, the Trump officials
plotting this latest coup aren’t even bothering to take its humanitarian
pretext seriously. Why, then, are purportedly centrist and liberal media
outlets?
A second matter to consider is
how our government has weaponized the public’s sense of morality. Since
the Spanish-American
War, the U.S. has used humanitarian concerns as a shield against criticism
or skepticism, and it has more or less worked every time. It’s why “aid”
organizations like Air America used food transports to ship guns to
anti-Communists in Indochina in the 1960s and ’70s. (Weapons were code-named
“hard rice.”) And it’s why Elliott Abrams—the current quarterback of this
latest affair in Venezuela—used
humanitarian aid shipments to smuggle weapons to the Nicaragua’s
Contras in the ’80s. Ultimately, these shipments allow for massive military
buildups, without anyone in the media or Congress asking too many questions.
After all, what kind of monster is opposed to helping starving people?
It’s impossible to know if the
current shipments to Venezuela are being used to transport weapons, although
Venezuelan authorities say
they have intercepted American arms shipments. But given the history of the
U.S. (to say nothing of Abrams’), and the fact that the Trump administration is
openly calling for Maduro’s ouster while amassing forces along the Colombian
border, it’s not exactly a long shot. Still, our political press dismisses the
possibility as tin-foil hat stuff, at least in part because mocking wacky Latin
American “conspiracy theories” is a mark of one’s seriousness in foreign policy
circles.
Unlike a lot of U.S. regime
change activities, reports indicate that this latest stunt was exceptionally
rushed and slapdash. The Wall Street Journal paints
a picture of a U.S. operation its architects believed would work in a
day or two:
“The people who devised it in
Caracas and sold it here [in Washington], sold it with the promise that if
Guaidó made a move and [South American countries] and the U.S. came in behind,
the military would flip and Maduro would go,” said a former senior U.S.
official. “They thought it was a 24-hour operation.”
Because the large-scale
military defections expected never took place (as they almost never do), the
U.S. has had to resort to its Plan B for promoting conflict and galvanizing the
Venezuelan opposition: On Sat., Feb. 23, President of the National Assembly
Juan Guaidó will carry out a “humanitarian
avalanche” at the Venezuelan border with Colombia and Brazil that, when one
reads the fine print, sounds
a lot like a U.S.-led invasion. Billionaire Richard Branson is reportedly
organizing a “humanitarian aid” concert the night before. But we know this is a
fig leaf, and we know this because those running this operation say so again
and again. Bolton himself has speculated that Maduro could end up in a “beach
area like Guantanamo.”
Despite all the evidence
before them, MSNBC, CNN and countless other networks and publications across
the ideological spectrum refuse to frame this humanitarian gambit as an act of
hostility. Instead, knowing what they know and who they are covering, they have
largely portrayed Trump, Bolton and Abrams as champions of the Venezuelan
people.
It goes without saying that
hundreds of thousands are suffering in Venezuela, and the instinct to alleviate
that suffering is a healthy one. But a craven marketing stunt by far-right Cold
Warriors—without any buy-in from actual aid organizations—cannot be taken at
face value.
Just as the U.S. military has
made calls to high-ranking Venezuelan officials, I am writing directly to the
editors, television producers and reporters of our most prominent news outlets.
I’m asking you to defect and come to the side of the patently obvious. Unlike
the Pentagon, I can’t bribe you or promise you amnesty, but I can appeal to
your basic sense of integrity and intellectual honesty: At best, you are
helping provide cover for a campaign designed to starve the Venezuelan people;
at worst, you are enabling a military conflict that will drag on for years.
One does not need to hold any
normative opinions about the fate of Venezuela to be able to identify a naked
PR campaign when they see one. Journalists with blue checkmarks on Twitter must
say so before this gets any further out of hand.
How Stupid Do They Think We Are? - Plutocrats Using Logical Fallacies to Defend the Health Care Status Quo
In the early 21st century, the debate about health care
reform in the US ramped up. The result ultimately was the Patient Protection and
Affordable Care Act (PPACA, ACA, "Obamacare"), which arguably
improved access to health care, made some reforms in the regulation of health
care insurance, but did not affect the fundamental reliance of the US on
employer-paid, for-profit health care insurance to finance health care for many
patients. Nor did it really affect the issues we discuss on Health Care
Renewal (look here for
details).
After the tumultuous election of President Donald Trump,
the debate started up again with his and his party's attempt to "repeal
and replace" Obamacare. Arguably, Obamacare ended up damaged but not
repealed. Once again, the issues we discuss on Health Care Renewal were
ignored, including threats ot the integrity of the clinical evidence base,
deceptive marketing, distortion of health care regulation and policy making,
bad leadership and governance, concentration of power, abandonment of health
care as a calling, perverse incentives, the cult of leadership, managerialism,
impunity enabling corrupt leadership, and taboos, or the anechoic effect.
(Look here for
a detailed discussion. )
It is time once again to discuss health care reform in the
US. Now the push is from the Democrats and the left, with the stated
goals of making care more universal, and perhaps decreasing or even ending the
role of for-profit commercial health care insurance companies.
It is no surprise that those who benefit the most from the
current system (even as modified by Obamacare) are rushing to its
defense.
Dark Money to Defend Commercial Health Insurance
We already discussed
how large health care corporations, including pharmaceutical and biotechnology
companies, have been using dark money to funnel money for distinctly partisan
purposes, to defeat whom they perceive as too left-leaning politicians, almost
all Democrats. They seem to fear such politicians might promote health
care reform efforts that would be based on "anti-free-market,
anti-business ideology," that is efforts to decrease the role of
commercial, for-profit health insurance in financing health care.
More recently, the focus has shifted to Democratic
proposals for government run single-payer, or "Medicare for all"
health insurance. In early January, 2019, the
Hill reported
Thomas Donohue, the president and CEO of the Chamber of
Commerce, on Thursday vowed to use all of the Chamber's resources to fight
single-payer health care proposals.
'We also have to respond to calls for government-run, single-payer health care, because it just doesn't work,' Donohue said during his annual 'State of American Business' address.
'We also have to respond to calls for government-run, single-payer health care, because it just doesn't work,' Donohue said during his annual 'State of American Business' address.
The US Chamber of Commerce historically has had many executives of big health care corporations on its board. We listed 10 such members in 2015. It also historically has received financial support from some corporations. We listed 17 in 2018.
Then later in January, The Hill reported that a group called Partnership for America's Health Future started digital ads attacking "Medicare for All." The Hill stated its members include major industry players such as America’s Health Insurance Plans and the Pharmaceutical Research and Manufacturers of America.
So here we have the leaders of big health care corporations
funneling corporate money into propaganda campaigns to defeat government run
single payer health insurance, an old policy idea that suddenly is looking
politically credible. Current US regulation and practice allows them to
hide the exact amounts spent on such campaigns by processing them through dark
money organizations.
Such stealth health policy advocacy is now not new.
What is surprising now is how some top leaders are willing to jump into the
debate themselves, rather than just trying to manipulate public opinion through
public relations/ propaganda proxies. Here are some telling examples. in
chronological order.
Quest Diagnostics CEO Attacks "Medicare-for-All"
Using an Appeal to Authority, an Argument by Gibberish, the Non Sequitur
Fallacy, (and an Incomplete Comparison)
On January 24, 2019, Yahoo
Finance reported
A top health care CEO is sounding the alarm on 'Medicare
for All,' an idea gaining steam in political circles, including from
newly-elected Rep. Alexandria Ocasio-Cortez (D-NY).
'Most people don’t understand the basics of health-care economics in the United States,' said Steve Rusckowski, chairman & CEO Quest Diagnostics (DGX), in an interview with Yahoo Finance editor-in-chief Andy Serwer at the World Economic Forum in Davos, Switzerland....
'Most people don’t understand the basics of health-care economics in the United States,' said Steve Rusckowski, chairman & CEO Quest Diagnostics (DGX), in an interview with Yahoo Finance editor-in-chief Andy Serwer at the World Economic Forum in Davos, Switzerland....
Mr Rusckowski implied that he knows a lot more about health
care economics than most people, so most people should listen to him.
Thus, he began with an implied logical fallacy, the appeal
to authority.
He then presented the justification for his argument.
'The majority of people get their health care from their
employers, and the majority of healthcare costs are paid by employers and
employees,' he said. 'If you look at the $3.5 trillion spent on healthcare
costs, that portion is actually funding the Medicare and Medicaid programs
throughout this country.'
The syntax was fractured, and so this was incoherent and
confusing. In particular, it was not clear to what "this portion"
referred. $3.5 trillion? Health care costs paid by employers and
employees?
The context of his use of that phrase did not
help. Note that US total health spending was reported to be approximately
$3.5 trillion in 2017 by
the US Center for Medicare and Medicaid Services (CMS). However, that
was total health spending, not just the amount spent by Medicare and
Medicaid. Furthermore, Medicare and Medicaid are funded by sources other
than employers and their employees. While employers and employees pay tax
on employee income to fund Medicare, general funds from the federal government,
and from state governments funds Medicaid. Furthermore, many employers pay
parts of their employees' private health insurance premiums, while the
employees make up the difference in premiums. Self-employed people may may for
their own insurance, etc, etc.
Mr Ruskcowski, not to put to fine a point on it, seemed to
speaking gibberish, and would use this gibberish to justify his next
point. So in formal terms, he used the logical fallacy of an argument
by gibberish.
When incomprehensible jargon or plain incoherent gibberish
is used to give the appearance of a strong argument, in place of evidence or
valid reasons to accept the argument.
In any case, Mr Rusckowski went on to argue that he
remained skeptical of a Medicare-for-all plan funded by
corporations and employees. 'I don’t think [corporations and employees] can
afford to provide that access as described.'
However, not only were his earlier statement gibberish,
they were not clearly arguments in support of his contention that corporations
and employees cannot "afford to provide that access as
described." So this appeared to be an example of the logical
fallacy of the non-sequitur.
Mr Rusckowski's total compensation as CEO of Quest was over
$10 million in 2017, as estimated
by Bloomberg News. So it is perhaps not surprising that is
self-interest in preserving the status quo was strong enough to motivate him to
jump into the debate. One would think, however, that someone who managed
to become a rich CEO of a medical diagnostic company could manage to be a bit
more logical.
Anyway, he has some strange bed-fellows in this cause,
including two billionaires who are not directly involved in health care
corporations, but who have obviously benefited from the current economic status
quo.
Michael Bloomberg and Howard Schultz Used the Incomplete
Comparison Fallacy
Two billionaires provided striking examples of one logical
fallacy.
First, from the
New York Times, January 29, 2019:
Mr. Bloomberg, the former New York City mayor who is
considering a 2020 bid on a centrist Democratic platform, rejected the idea of
'Medicare for all,' which has been gaining traction among Democrats.
'I think you could never afford that. You’re talking about
trillions of dollars,' Mr. Bloomberg said during a political swing in New
Hampshire, which holds the nation’s first primary in 2020.
'I think you can have ‘Medicare for all’ for people that
are uncovered,' he added, 'but to replace the entire private system where
companies provide health care for their employees would bankrupt us for a
very long time.'
Second, from CNN
on January 30, 2019:
'Why do you think Medicare-for-all, in your words, is not
American?' CNN's Poppy Harlow asked Schultz on Tuesday.
'It's not that it's not American,' Schultz said. 'It's
unaffordable.'
'What I believe is that every American has the right to
affordable health care as a statement,' Schultz said, lauding the Affordable
Care Act, otherwise known as Obamacare, as 'the right thing to do.'
He added, 'But now that we look back on it, the premiums
have skyrocketed and we need to go back to the Affordable Care Act, refine it
and fix it.'
He argued that the Democratic progressive platform of
providing Medicare, free college education and jobs for everyone is costly and
as 'false as President Trump telling the American people when he was running
for president that the Mexicans were going to pay for the wall.'
So both billionaire Bloomberg and billionaire Schultz
stated that Medicare-for-all would cost too much. Yet neither addressed
how much our current health care system costs. However, as a subsequent
op-ed in the Washington Post by Paul Waldman pointed out, it only
makes sense to talk about affordability in the context of a comparison with a
reasonable alternative, say, the current health care system:
there is one thing you absolutely, positively must do
whenever you talk about the cost of a universal system — and that journalists
almost never do when they’re asking questions. You have to compare what a universal
system would cost to what we’re paying now.
There have been some recent attempts to estimate what it would cost to implement, for instance, the single-payer system that Sen. Bernie Sanders (I-Vt.) advocates; one widely cited study, from a source not favorably inclined toward government solutions to complex problems, came up with a figure of $32.6 trillion over 10 years.
There have been some recent attempts to estimate what it would cost to implement, for instance, the single-payer system that Sen. Bernie Sanders (I-Vt.) advocates; one widely cited study, from a source not favorably inclined toward government solutions to complex problems, came up with a figure of $32.6 trillion over 10 years.
That’s a lot of money. But you can’t understand what it
means until you realize that last year we spent about $3.5 trillion on health
care, and under current projections, if we keep the system as it is now, we’ll
spend $50 trillion over the next decade.
Again, you can criticize any particular universal plan on
any number of grounds. But if it costs less than $50 trillion over 10 years —
which every universal plan does — you can’t say it’s 'unaffordable' or it would
'bankrupt' us, because the truth is just the opposite.
These are text-book examples of the fallacy
of incomplete comparison.
By the way, buried amongst his use of gibberish and
non-sequiturs, Quest Diagnostics CEO Rusckowski also opined that
Medicare-for-all would be unaffordable without any reference to the costs of
the status quo, and hence also provided an example of an incomplete comparison.
The Waldman op-ed noted
The fact that these two highly successful businessmen — whose understanding of investments, costs and benefits helped them become billionaires — can say something so completely mistaken and even idiotic is a tribute to the human capacity to take our ideological biases and convince ourselves that they’re not biases at all but are instead inescapable rationality.
The fact that these two highly successful businessmen — whose understanding of investments, costs and benefits helped them become billionaires — can say something so completely mistaken and even idiotic is a tribute to the human capacity to take our ideological biases and convince ourselves that they’re not biases at all but are instead inescapable rationality.
Maybe. However, it may also be a tribute to their
arrogance bred by decades of public
relations (which Bernays
thought sounded better than "propaganda") and disinformation meant
to soften up the minds of the public so that they will follow the lead of the
rich and powerful.
Schultz Also Added an Appeal to Tradition (or to Common
Practice)
Schultz referred to a town hall hosted Monday night by CNN
in which Harris embraced a 'Medicare-for-all' single-payer health insurance
system and said she would be willing to end private insurance to make it
happen.
'That is the kind of extreme policy that is not a policy that I agree with,' Schultz said on 'The View,' adding that doing away with private insurers would lead to major job losses.
'That’s not correct. That’s not American,' Schultz said on CBS. 'What’s next? What industry are we going to abolish next? The coffee industry?'
'That is the kind of extreme policy that is not a policy that I agree with,' Schultz said on 'The View,' adding that doing away with private insurers would lead to major job losses.
'That’s not correct. That’s not American,' Schultz said on CBS. 'What’s next? What industry are we going to abolish next? The coffee industry?'
Presumably, by saying "that's not American,"
Schultz means that is not what we have always done, that is not what has been traditional
American practice, begging the question of whether that practice could be
ill-advised. Thus Schultz appeared to ladle on an appeal to common
practice, otherwise known as an appeal
to tradition.
As an aside, the quote also suggests that Schultz's real
concern is not with the affordability of Medicare-for-all, particularly in
comparison with that of the current system, but with the financial health of
the insurance industry. But that is for another day....
Summary
So, to protect against the dread "Medicare for
all," that is, proposals for a government single-payer health insurance
system to replace our current practice of financing health care through large,
mainly for-profit insurance companies, we see an acceleration of public
relations/ propaganda paid by undisclosed donors, that is, via dark
money. We also see prominent multi-millionaire and billionaire executives
laying down a barrage of logical fallacies to support the status quo.
It is hard to believe that the defenders of the current
system are not mostly self-interested. That status quo has made some
people very rich.
It is also hard to believe they are stupid. However,
a close reading of their arguments suggests they may think we are stupid, or at
least befuddled by repeated public relations/ propaganda/ disinformation
campaigns.
In 2011, we wrote,
Wendell Potter, author of Deadly Spin, has provided a
chilling picture of health care corporate disinformation campaigns and the
tactics used therein.
In particular,
Mr Potter recounted how deceptive PR campaigns subverted
the health care reform plans of US President Bill Clinton, reduced the impact
of Michael Moore's movie, 'Sicko,' and helped to remodel the recent health care
reform bill to reduce its threat to commercial health insurers. He further
noted how PR distracted public attention from the growing faults of a health
care system based on commercial health insurance, and how practical and legal
safeguards against abuses by insurance companies were eroded.
Furthermore, Mr Potter described 'charm offensives;' the
deliberate creation of distractions, including the planting of memes for
short-term goals that went on to have long-term adverse effects; fear
mongering; the use of front groups, including 'astroturf,' (faux disease
advocacy and/or grass roots organizations), public policy advocacy groups, and
tame (and conflicted) scientific/professional groups; and intelligence
gathering. He provided some practical advice for detecting such tactics.
For example, be very suspicious of policy advocacy by groups with no apparent
address or an address identical to that of a PR firm, or with
anonymous leaders and/or anonymous financial backing.
Now it is 2019, once again health care reform is in the air, and once again the defenders of the status quo are hard at work. Now, they are even wealthier than they were 10 years ago, and have even more sophisticated tools, like social media and its hacks, at their disposal. Still, however, their arguments are ultimately built on sand.
As I did
in 2011, it makes sense to quote Wendell Potter
onslaught drastically weakened health-care reform and how
it plays an insidious and often invisible role in our political process
anywhere that corporate profits are at stake, from climate change to defense
policy.
[Potter, Huffington Post]
[Potter, Huffington Post]
So,
The onslaughts of spin will not stop, the distortions will
not diminish, and the spin will not slow down. To the contrary, spin begets spin,
as the successes of corporate PR functionaries increase the revenues of their
employers, further funding their employers' efforts to create a more hospitable
climate for their business interests. Americans are thus being faced with
increasingly subtle but effective assaults on their beliefs and perceptions.
Their best defense right now is to understand and to recognize the
sophisticated tactics of the spinners trying to manipulate them.
Most important is a singular mandate: Be skeptical.
[Potter, Huffington Post]
Most important is a singular mandate: Be skeptical.
[Potter, Huffington Post]
I still hope that summarizing some of Mr Potter's amazing points will help us all to be much more skeptical.
You heard it here first.
Posted by Roy M. Poses MD
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