The 3 big drug wholesalers who fostered the opioid crisis are now causing a shortage of a key medicine for children with behavioral disorders. Why? It's a problem called absentee ownership.
I read these posts the way I used to read newspapers. Distilling the vital parts, connecting with parts collected elsewhere to create my perspective of our current shared experience within our wider arc, a Joseph Campbell"ish" approach to understanding this moment.
You have pieced together so many disparate realities, over and over wonderfully with BIG, to offer a powerful illustration of WTF is going on in our economic & political landscapes. Reminds me of the explanatory power of Jaron Lanier - many compliments Matt.
Keep raising the voice that sings the song of contrast - maybe from there we can begin to communicate again within a few generations time.
While Adderall has valid uses it nevertheless remains one of the most dangerously over prescribed drugs in the nation. Parents demand it so that they can claim that their child’s normal but annoying youthful behavior ( mostly boys) is really a medical problem that requires medication and not the fault of parenting.
Mar 25, 2023·edited Mar 25, 2023Liked by Matt Stoller
Loved the Brandeis passage- Supreme Court justices used to have a more developed sense of morality than third graders.
Loved the Thorstein Veblen hot link too! Its not any one political party that is responsible for the rise or fall of corporate oligarchy in America, and what we need now is the correct application of a bi-partisan bureaucratic solution.
Bureaucracy is the only way a State can enforce the rule making intended to better our lives. And the most common ways that bureaucracies act are through more rule making , clearly a favorite of corporations, legislators and the very life of the Advocacy industry, or they can choose to act through
litigation, asking the courts to end the actions or practices that create such structural harm to our system for delivering needed goods and services.
The second form of action requires looking in the mirror, which as a country we seem to have stopped doing in the ‘70s. Currently there are enough members in both houses who long ago stopped doing this, or perhaps never had to! Big and this current antitrust movement has me looking forward to some changes my children and grandchildren may benefit from.
Hey Matt, how about doing a story on how chronic pain patients are in misery at the same time that the opioid crisis is an unabated conflagration and the FDC and CDC are treating pain as a mental health condition. There are far, far more chronic pain patients that those who need Adderall.
Thank you again, Matt! I continue to introduce your critically important work to others.
“He’s not allowed to read the contract that he’s a party to, as it’s secret…”
Question: Can you please point me to resources in law I can research that explain how such coercive behavior is allowed (because it is crazy!)? I ask merely for direction because it may involve more detail and time than reasonable to ask you to provide here. I keep noticing this theme of corporate opacity in so many of your articles…
Of course. This is just another face of ‘disaster capitalism’. Allow or create disasters to happen, while moving the Overton Window, and wait til the serfs start getting rambunctious, and then back off with a notch more systematic wealth transfer in their (the elites) favor. We’re long overdue for an explosion of antitrust actions. These huge monopolies are killing all western democratically-modeled nations.
Thanks Matt. As always you got right to the heart of the matter and what should have been done to the companies involved in the opioid crisis. Just shut them down. If I was in charge I would have used the Rico Act to take control of all the assets of these companies and put executives in prison. Running these companies is not rocket science. This would be the solution to our healthcare system by shutting down the pharmaceutical companies and insurance companies for the fraud they foster on Americans. Instead of large fines that change nothing. Greed needs to go to prison or nothing will change until citizens bring out the pitchforks.
Yet another disaster revealed (sigh!). This country is breaking down in so many ways, all at the same time, that addressing even a significant minority of the big problems seems impossible. This is particularly true in the context of America's elected 'absentee landlords' residing in Washington DC, the obvious societal divides, and the glaring lack of real leadership in this country. America reminds me of a ship foundering in a bad storm with nobody at the helm while pirates are looting the passenger's cabins.
"Absentee ownership" is exactly the phrase I was looking for earlier, Googling to see how many people are complaining about the cost of Revit (Autodesk BIM architecture/construction drawing program). $2,600 /year... but as an architect you also need to get AutoCAD, to read some drawings or even do some drawings, and then you'll also need the Adobe suite for presentations and you may also need Rhino for 3-D modeling, the Grasshopper... $5-6,000/ year out of an under $100K salary.
So I was thinking that the people who run these companies are so out of touch, we should go picket around their houses, the way that people did for Kevin de Leon in LA :).
If I might add another angle as to how monopolization makes drug shortages worse. As you know, market power imbalance permits PBMs to dictate reimbursements to independent pharmacies - which is to say, pharmacies that are more likely to use the "other" 5-15% of the wholesaler market. Such dictated payment schemes frequently reimburse the pharmacy the same amount for different generics of a medication - the pharmacy "should" just be dispensing the cheaper generic. But what happens when a medication is in a shortage, and the next generic manufacturer to have some stock available knows that wholesalers and pharmacies do not have other options? The price increases - but the reimbursement doesn't.
So to pull some numbers out of thin air, let's pretend that the pre-shortage wholesaler price of a prescription is $20, and the reimbursement is $22. Now let's say the post-shortage wholesaler price of the only generic available is $40, but the reimbursement is still $22 because the pharmacy "should" have dispensed the generic that used to be on the market and costs $20. So the pharmacy doesn't want to lose $18, the pharmacy doesn't order the medication, the medication sits in a warehouse somewhere, and the patient still doesn't get their medication.
"These institutions tended to “convert independent tradesmen into clerks” and “sapping the resources, the vigor, and the hope of the smaller cities and towns.” It wasn’t just that far away financiers sucked up profits, but that the decision-makers didn’t live near the people whose lives were affected by their choices."
90 years on and it isn't just store pricing it is online retail that eliminates travel, provides searchablility, and argueably provides better customer service. I say this having lived most of my 70 years in urban/suburban centers on both coasts with exception of living in small town Maine from late 70s through much of 80s and the last 13 years in small town rural county Oregon.
I read these posts the way I used to read newspapers. Distilling the vital parts, connecting with parts collected elsewhere to create my perspective of our current shared experience within our wider arc, a Joseph Campbell"ish" approach to understanding this moment.
You have pieced together so many disparate realities, over and over wonderfully with BIG, to offer a powerful illustration of WTF is going on in our economic & political landscapes. Reminds me of the explanatory power of Jaron Lanier - many compliments Matt.
Keep raising the voice that sings the song of contrast - maybe from there we can begin to communicate again within a few generations time.
While Adderall has valid uses it nevertheless remains one of the most dangerously over prescribed drugs in the nation. Parents demand it so that they can claim that their child’s normal but annoying youthful behavior ( mostly boys) is really a medical problem that requires medication and not the fault of parenting.
That map of the counties in WA state with more opioid prescriptions than people would look even worse if it was applied to Missouri or Iowa.
Rotten to the core. Surely this is at the interface with corruption?
Matt - your work should have millions of followers who should be pressing for change. Brilliant writing and analysis- thank you.
Loved the Brandeis passage- Supreme Court justices used to have a more developed sense of morality than third graders.
Loved the Thorstein Veblen hot link too! Its not any one political party that is responsible for the rise or fall of corporate oligarchy in America, and what we need now is the correct application of a bi-partisan bureaucratic solution.
Bureaucracy is the only way a State can enforce the rule making intended to better our lives. And the most common ways that bureaucracies act are through more rule making , clearly a favorite of corporations, legislators and the very life of the Advocacy industry, or they can choose to act through
litigation, asking the courts to end the actions or practices that create such structural harm to our system for delivering needed goods and services.
The second form of action requires looking in the mirror, which as a country we seem to have stopped doing in the ‘70s. Currently there are enough members in both houses who long ago stopped doing this, or perhaps never had to! Big and this current antitrust movement has me looking forward to some changes my children and grandchildren may benefit from.
Thanks Matt- another great edition!
Hey Matt, how about doing a story on how chronic pain patients are in misery at the same time that the opioid crisis is an unabated conflagration and the FDC and CDC are treating pain as a mental health condition. There are far, far more chronic pain patients that those who need Adderall.
Thank you again, Matt! I continue to introduce your critically important work to others.
“He’s not allowed to read the contract that he’s a party to, as it’s secret…”
Question: Can you please point me to resources in law I can research that explain how such coercive behavior is allowed (because it is crazy!)? I ask merely for direction because it may involve more detail and time than reasonable to ask you to provide here. I keep noticing this theme of corporate opacity in so many of your articles…
Of course. This is just another face of ‘disaster capitalism’. Allow or create disasters to happen, while moving the Overton Window, and wait til the serfs start getting rambunctious, and then back off with a notch more systematic wealth transfer in their (the elites) favor. We’re long overdue for an explosion of antitrust actions. These huge monopolies are killing all western democratically-modeled nations.
Thanks Matt. As always you got right to the heart of the matter and what should have been done to the companies involved in the opioid crisis. Just shut them down. If I was in charge I would have used the Rico Act to take control of all the assets of these companies and put executives in prison. Running these companies is not rocket science. This would be the solution to our healthcare system by shutting down the pharmaceutical companies and insurance companies for the fraud they foster on Americans. Instead of large fines that change nothing. Greed needs to go to prison or nothing will change until citizens bring out the pitchforks.
Yet another disaster revealed (sigh!). This country is breaking down in so many ways, all at the same time, that addressing even a significant minority of the big problems seems impossible. This is particularly true in the context of America's elected 'absentee landlords' residing in Washington DC, the obvious societal divides, and the glaring lack of real leadership in this country. America reminds me of a ship foundering in a bad storm with nobody at the helm while pirates are looting the passenger's cabins.
"There are existing laws...." But let's add some new ones and more regulations. That'll solve things.
"Absentee ownership" is exactly the phrase I was looking for earlier, Googling to see how many people are complaining about the cost of Revit (Autodesk BIM architecture/construction drawing program). $2,600 /year... but as an architect you also need to get AutoCAD, to read some drawings or even do some drawings, and then you'll also need the Adobe suite for presentations and you may also need Rhino for 3-D modeling, the Grasshopper... $5-6,000/ year out of an under $100K salary.
So I was thinking that the people who run these companies are so out of touch, we should go picket around their houses, the way that people did for Kevin de Leon in LA :).
If I might add another angle as to how monopolization makes drug shortages worse. As you know, market power imbalance permits PBMs to dictate reimbursements to independent pharmacies - which is to say, pharmacies that are more likely to use the "other" 5-15% of the wholesaler market. Such dictated payment schemes frequently reimburse the pharmacy the same amount for different generics of a medication - the pharmacy "should" just be dispensing the cheaper generic. But what happens when a medication is in a shortage, and the next generic manufacturer to have some stock available knows that wholesalers and pharmacies do not have other options? The price increases - but the reimbursement doesn't.
So to pull some numbers out of thin air, let's pretend that the pre-shortage wholesaler price of a prescription is $20, and the reimbursement is $22. Now let's say the post-shortage wholesaler price of the only generic available is $40, but the reimbursement is still $22 because the pharmacy "should" have dispensed the generic that used to be on the market and costs $20. So the pharmacy doesn't want to lose $18, the pharmacy doesn't order the medication, the medication sits in a warehouse somewhere, and the patient still doesn't get their medication.
“ He’s not allowed to read the contract that he’s a party to, as it’s secret (which in and of itself is crazy). ”
This seems to violate a fundamental principle of contract law that there must be a meeting of the minds and such no valid contract exists..
Reason places a good bit of the blame for the adderall shortage on the DEA itself which apparently limits the supply. https://reason.com/2023/03/14/wheres-your-adderall/
"These institutions tended to “convert independent tradesmen into clerks” and “sapping the resources, the vigor, and the hope of the smaller cities and towns.” It wasn’t just that far away financiers sucked up profits, but that the decision-makers didn’t live near the people whose lives were affected by their choices."
90 years on and it isn't just store pricing it is online retail that eliminates travel, provides searchablility, and argueably provides better customer service. I say this having lived most of my 70 years in urban/suburban centers on both coasts with exception of living in small town Maine from late 70s through much of 80s and the last 13 years in small town rural county Oregon.