Speaker 1: Pushkin. Hello, Hello Revisionist History listeners. I'm excited to announce
Speaker 1: that this season I'm offering a bunch of perks from
Speaker 1: my most loyal listeners, the ones who subscribe to pushkim
Speaker 1: plus for those who just can't get enough. We're giving
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Speaker 1: pushkim plus on the Revisionist History Show page in Apple
Speaker 1: Podcasts or at pushkin dot FM. When I was in
Speaker 1: my twenties many years ago, I was a reporter for
Speaker 1: the Washington Post. A newsroom the size of a football field,
Speaker 1: phones ringing, keyboards clattering, the glory days print journalism. I
Speaker 1: want you to describe what is the status in position
Speaker 1: of a Washington Post reporter in Washington, d C. In
Speaker 1: nineteen eighty nine. Well, in general, godlike, because the whole
Speaker 1: city ran on politics in news, and there weren't many
Speaker 1: organizations that produced it excellently. In the Post was sort
Speaker 1: of the place that everyone cared about. That's my friend
Speaker 1: Michael Specter. He and I were both on the health
Speaker 1: and science beat for the Post. If somebody cured something,
Speaker 1: discovered something, solve something, or screwed something up, we were
Speaker 1: on it. In those days, it seemed like everyone read
Speaker 1: everything we wrote. Well they did. I mean there is
Speaker 1: an exception, which is we were in the science pod,
Speaker 1: and at least at the Post that was considered like
Speaker 1: why would smart people write about science when they could
Speaker 1: write about the White House and wear yellow ties. But
Speaker 1: in general we had big readerships, particularly in the when
Speaker 1: we wrote about science policy, we sat at the center
Speaker 1: of a giant ecosystem of lobbyists, lawmakers, aids, bureaucrats, policy
Speaker 1: wonks who tried to get us to see the world
Speaker 1: their way. If you called someone and said you were
Speaker 1: from the Washington Post, they called you back. I used
Speaker 1: to listen to Michael every day on the phone with
Speaker 1: a source on Capitol Hill. That individual had access to everything,
Speaker 1: but he didn't mind ratting people out. It was like heaven.
Speaker 1: I had a couple of people like that. It was heaven.
Speaker 1: I remember once where you get the plain brown wrappers
Speaker 1: with stuff inside of it, because nothing, of course was
Speaker 1: digital in those years. You would get the mysterious phone
Speaker 1: call and you had to decide whether to return it.
Speaker 1: So there's one member of this ecosystem that I'm most
Speaker 1: interested in, ready, Sid Wolf. Sid Wolf. I love Sid.
Speaker 1: I loved him then, I love him now. But you know, yeah,
Speaker 1: he is a particular kind of guy. I think I
Speaker 1: was the most skeptical of Sid. Yeah, because you were
Speaker 1: like a right wing lunatic. I was a right wing
Speaker 1: lunatic and it was a right wing time Sidney M.
Speaker 1: Wolf m d versus me thirty years ago, when I
Speaker 1: was a right wing lunatic. I was different then, which
Speaker 1: I offer as at least a small explanation from my
Speaker 1: behavior in the story. I'm about to tell you my
Speaker 1: name is Malcolm Gladwell. You're listening to Revisionist History, my
Speaker 1: podcast about things overlooked and misunderstood. This season is devoted
Speaker 1: entirely to experiments, and this episode is about what happens
Speaker 1: when an experiment teaches us an important lesson and we
Speaker 1: don't listen. Sid Wulf came to Washington, d C. In
Speaker 1: the nineteen sixties as a young doctor. He went to
Speaker 1: work as a post graduate fellow at the National Institutes
Speaker 1: of Health, part of the same class as Tony Fauci.
Speaker 1: One day in nineteen seventy one, someone told him that
Speaker 1: half of the saline solution being supplied to American hospitals
Speaker 1: was contaminated with bacteria. And Sid said, oh, where are
Speaker 1: they going to take it off the market? And the
Speaker 1: person said they aren't because if we do, hospitals will
Speaker 1: run out of ivy fluid and will have a disaster
Speaker 1: on our hands. And Sid said that can't be right.
Speaker 1: There have to be other sources of ivy fluid. He
Speaker 1: did his research, found out there were other sources, and
Speaker 1: went public, called the press, got his friend, the political
Speaker 1: crusader Ralph Nader, to hold a press conference, and the
Speaker 1: bad ivy fluid was pulled from the market. Sid had
Speaker 1: found his calling as a consumer advocate. I am sick
Speaker 1: and part of the paper ternizing attitude of the American
Speaker 1: Medical Association towards American patients. Patient was unstoppable. Doctor. He
Speaker 1: started something called the Public Citizens Health Research Group and
Speaker 1: became one of the angriest voices in Washington. As many
Speaker 1: of you know, our organization has now for twenty five years,
Speaker 1: been the most outspoken critic of the FDA. More than
Speaker 1: fifty times we've submitted petitions, sometimes resulting in lawsuits against
Speaker 1: the agency to try and get them to do what
Speaker 1: we think the law requires them. Example, in the c
Speaker 1: SPAN archives's practically a SID division. Sit against the drug companies,
Speaker 1: sit against the doctors, sit against the FDA. It is
Speaker 1: clear that of the seventeen years since we have been
Speaker 1: running the Health Research Group and watching the FDA, this
Speaker 1: is by far the worst period of time ever. SID
Speaker 1: didn't like anyone except those who were willing to join
Speaker 1: him on the lonely ice flow of his sixties radicalism. Okay,
Speaker 1: that's not fair. It's not that Sid disliked people. It
Speaker 1: was never personal for him. Sid's battle was with institutions.
Speaker 1: Said believed that bureaucracies and companies and legislatures would behave
Speaker 1: better only when constrained by the right laws, the right regulations,
Speaker 1: and the right kind of relentless nudging from people like Sid.
Speaker 1: He was the nudge of Washington DC. Sid's very smart
Speaker 1: and very colorful and a great quote. But there's only
Speaker 1: one way in that Sid's way. You don't have like
Speaker 1: a deep, meaningful conversation on both sides. Was Sid, but
Speaker 1: some people, and he was one, were just excellent at
Speaker 1: knowing what we needed and what we wanted and how
Speaker 1: to package it, and that was sid I hadn't thought
Speaker 1: of Sidwolf in years, but then I started reading about
Speaker 1: someone named Paul Madden, one of those forgotten figures in
Speaker 1: the mid century. If you lived in Californa in the
Speaker 1: nineteen forties, you would hear Madden from time to time
Speaker 1: on the radio. Good Evening, ladies and gentlemen. There may
Speaker 1: be harder jobs than breaking up a narcotic rain. I
Speaker 1: don't know. I've never seen one. Especially difficult is the
Speaker 1: job of rounding up a band of narcotic pedlers, including
Speaker 1: the brains of the day. Madden was a progressive that
Speaker 1: progressives believed that government could fix things, that systems and
Speaker 1: regulations and rules properly written could make the world a
Speaker 1: fair place. Progressives were activists full of zeal. In nineteen
Speaker 1: thirty nine, Paul Madden was appointed to run the California
Speaker 1: Bureau of Narcotic Enforcement. He was the man responsible for
Speaker 1: stopping the use of illegal drugs in the state of California,
Speaker 1: a job he tackled with enthusiasm and his customary hyperbole.
Speaker 1: Let me directly from his writing on the effects of marijuana,
Speaker 1: Madden wrote that the user might quote, believe himself so
Speaker 1: small that he is afraid to step off the kerbstone
Speaker 1: into the street, or he may feel himself of enormous
Speaker 1: size and of superhuman strength and passion, and in that
Speaker 1: condition commit crimes altogether foreign to his nature. But because
Speaker 1: Paul Madden was a progressive, he didn't just fulminate against
Speaker 1: a problem. He had a whole, carefully thought out scheme
Speaker 1: for using the enlightened power of government to fix it.
Speaker 1: Consider the great fear of anti drug crusaders of that era,
Speaker 1: which was that doctors might be driving drug addiction. What
Speaker 1: if the person gets the script from the doctor and
Speaker 1: goes down and keeps some of the drugs for himself
Speaker 1: and then sell some of the drugs on the street,
Speaker 1: then you're going to have the problem of the initiation
Speaker 1: of new addicts potentially if that happens. David Courtwright, who
Speaker 1: is America's leading historian at the Drug Trade, says that
Speaker 1: people were worried that patients could walk into the doctor's
Speaker 1: office asking for an addictive drug like morphine and the
Speaker 1: doctor would just give it to them. So sendy were
Speaker 1: a small number of doctors who are relatively unscrupulous, who
Speaker 1: are simply writing prescriptions for maintenance, and much of that
Speaker 1: drug may end up being diverted. How would I identify
Speaker 1: the doctor who's doing that. So one of the things
Speaker 1: you might do is send an informer to the doctor
Speaker 1: and he would try to persuade Typically it was a he,
Speaker 1: he would try to persuade the doctor to write a prescription.
Speaker 1: In California, Paul Madden looks at that practice of running
Speaker 1: sting operations against shady doctors and says, that's a crude
Speaker 1: and inefficient way of dealing with the problem. Remember, he's
Speaker 1: a good progressive, a man who believes in systems and procedures.
Speaker 1: So Madden decides to create a bureaucratic solution. First, Madden
Speaker 1: makes a list of all the prescription painkillers that he
Speaker 1: considers dangerously addictive morphine, opium coding, chloral hydrate, and then
Speaker 1: he convinces the state legislature to create a new regulation
Speaker 1: for doctors Chapter three, Article one, Section one one one
Speaker 1: six six dot O six of the California Narcotics Act,
Speaker 1: the Madden Amendment of nineteen thirty nine. The prescription blanks
Speaker 1: shall be printed on distinctive paper, serial number of the
Speaker 1: book being shown on each form, and also each form
Speaker 1: being serially numbered. Each prescription blank shall be printed in triplicate,
Speaker 1: with one blank attached to the book in such a
Speaker 1: manner that it will be readily removed, while two of
Speaker 1: the blanks shall be perforated for removal. Meaning every time
Speaker 1: a physician prescribes one of the listed pain killers, they
Speaker 1: have to use a special state issued prescription pad where
Speaker 1: every prescription page comes equipped with two additional carbon copies.
Speaker 1: To use a contemporary turn of phrase, he wants to
Speaker 1: create a back up of every narcotic prescription in the state.
Speaker 1: The first copy was to be kept at the office
Speaker 1: of the prescribing physician for a minimum of two years,
Speaker 1: available for scrutiny at any time by one of Madden's
Speaker 1: team of inspectors. Copy number two had to be kept
Speaker 1: by the pharmacist for two years. A number three had
Speaker 1: to be mailed by the pharmacist to the Bureau of
Speaker 1: Narcotic's head office in San Francisco. A record of physician
Speaker 1: and pharmacist behavior in triplicate a textbook example a progressive
Speaker 1: big brother in action. Now, why did I think of
Speaker 1: sid Wulf when I heard about Paul Madden? Because Madden
Speaker 1: seemed to me like Sid one point o the nineteen
Speaker 1: thirties edition. Different context and emphasis, of course, but the
Speaker 1: same play book, the same urgency, the same relentlessness. The
Speaker 1: government needs to fix things, and here is my twenty
Speaker 1: nine point plan to accomplish that, which I'm forwarding over
Speaker 1: to you right now. Call me when you get it
Speaker 1: right away. This is too big to wait. So you
Speaker 1: know Sid, his hair was always on fire about something.
Speaker 1: My memories of Sid is you would never know when
Speaker 1: you would get off the phone. That's true, that's true.
Speaker 1: I mean I've even talked to him recently about some
Speaker 1: stuff I've done, and he'll not just talk to you.
Speaker 1: Then the information starts flowing. In those days, the facts
Speaker 1: started to churn, because that's how we got stuff. But
Speaker 1: Sid was like I would go out to lunch and
Speaker 1: if there was a pile of fax paper in my desk,
Speaker 1: it would be like Sid struck. How many forests were
Speaker 1: sacrificed to feed Sid's fax machine? God only knows. In
Speaker 1: any case, I moved on. I left the Washington Post
Speaker 1: and forgot all about Sid and his fixations. And then
Speaker 1: I heard about an experiment and it all came flooding
Speaker 1: back Once you've found the right doctor and have told
Speaker 1: him or her about your pain, don't be afraid to
Speaker 1: take what they give you. Often it will be an
Speaker 1: opioid medication. Beginning in the late nineteen nineties, a catastrophe
Speaker 1: unfolded in cities and towns around the United States. Opioid
Speaker 1: overdoses people suffering a cascade of terrifying effects, pinpoint pupils,
Speaker 1: labored breathing, respiratory arrest, choking, purple lips, loss of consciousness, and,
Speaker 1: in what has now been over eight hundred thousand cases, death.
Speaker 1: There's no question that I best strongest pain medicines are
Speaker 1: the opioids. They don't wear out, they go on working,
Speaker 1: they do not have serious medical side effects. And so
Speaker 1: these drugs, which I repeat are our best, strongest pain medications,
Speaker 1: should be used much more than they are for patients
Speaker 1: and pain. At the heart of the crisis was a
Speaker 1: class of new, powerful pain killers that came on the
Speaker 1: market in the nineteen nineties, especially OxyContin, launched in nineteen
Speaker 1: ninety six by the Purdue Pharmaceutical Company. OxyContin is highly addictive,
Speaker 1: and Purdue promoted it to doctors more heavily than any
Speaker 1: other pain kilor in history. By two thousand and two,
Speaker 1: Purdue had thousands of salespeople around the country pushing OxyContin.
Speaker 1: This went on for more than a decade, until doctors
Speaker 1: were prescribing three billion dollars worth of OxyContin a year.
Speaker 1: But even for twenty years of the opioid epidemic, there
Speaker 1: were all kinds of questions like was OxyContin the cause
Speaker 1: of the overdose epidemic or just a symptom of something deeper?
Speaker 1: And even more puzzling, why didn't opioids cause the same
Speaker 1: level of devastation everywhere? Take Massachusetts and New York, two
Speaker 1: states side by side. If you run every significant fact
Speaker 1: about Massachusetts and New York through an algorithm, you'll find
Speaker 1: there are almost no two states more alike, same population profile,
Speaker 1: same basic economy, same levels of poverty, very similar rural
Speaker 1: urban mix. You'd think they would have had similar experiences
Speaker 1: with overdoses. They didn't. Massachusetts has had a blood bath,
Speaker 1: New York not so much. Same thing with New York
Speaker 1: and New Jersey super similar states by any measure, So
Speaker 1: why did New Jersey suffer so much more than its neighbor.
Speaker 1: Purdue would end up in bankruptcy court result of multiple
Speaker 1: lawsuits launched against them for misleading marketing practices, and not
Speaker 1: long ago for economists Abbie Albert, William Evans, Ethan Lieber,
Speaker 1: and David Powell realized that the mountains of internal Purdue
Speaker 1: documents unearthed in those lawsuits might hold some answers. I mean,
Speaker 1: so there are hundreds and hundreds of pages of documents,
Speaker 1: some of which was not very interesting. That's Abby Albert
Speaker 1: lead all through the paper. The four of them ended
Speaker 1: up publishing origins of the opioid crisis and its enduring impacts.
Speaker 1: But then when we happened upon the focus group researched
Speaker 1: especially and the launch plan, that really was the basis
Speaker 1: for a lot of what we talked about in this paper.
Speaker 1: Buried in that mountain of documents was an internal Purdue
Speaker 1: report on a series of focus groups that the company
Speaker 1: held with physicians. This was in a spring of nineteen
Speaker 1: ninety five, right before the launch of OxyContin The focus
Speaker 1: group report runs to almost sixty pages, And in that
Speaker 1: long buried document, one phrase kept popping up again and again.
Speaker 1: The phrase coined by Paul Madden half a century earlier
Speaker 1: triplicate prescriptions. So I had never heard of a triplicate program,
Speaker 1: and it's not something that was being discussed in the
Speaker 1: research on opioids. I mean, why would it be. Nobody
Speaker 1: really liked triplicates. For decades, no one followed California's lead
Speaker 1: in imposing this special requirement for prescribing painkillers. Drug makers,
Speaker 1: of course, hated the idea, so did doctors and state lawmakers.
Speaker 1: In the early nineteen eighties, the state of Texas did
Speaker 1: start a Tripica program, and the State Narcotics Division in
Speaker 1: Austin had to hire thirty three data entry clerks who
Speaker 1: in the first year mailed out twenty seven thousand, eight
Speaker 1: hundred Tica prescription pads to doctors around the state. The
Speaker 1: doctors then had to write a check for seven dollars
Speaker 1: for every pad they used, mail check back to Austin.
Speaker 1: Use the special pad every time they prescribe anything off
Speaker 1: the restricted list, keep the pink copy in their office
Speaker 1: for two years, send the green and the blue copy
Speaker 1: with the patient to the pharmacist, etc. I mean, triplicate
Speaker 1: was the kind of bureaucratic nit pickiness that drives people
Speaker 1: in the medical world crazy. The few states that did
Speaker 1: trio triplicate programs usually drop them by the early nineteen nineties,
Speaker 1: they were just five states with triplica programs in place, California,
Speaker 1: the Pioneer Texas, which somehow managed to stick it out,
Speaker 1: and then Illinois, Idaho, and New York. Five states with
Speaker 1: warehouses full of carbon copies of doctors prescriptions. Every time
Speaker 1: you pick up that prescription pad, it was like, boy,
Speaker 1: I'm prescribing and someone's watching me. And that's what a
Speaker 1: lot of folks call the chilling effect. Linda was Stilla
Speaker 1: who at the University of Maryland School of Pharmacy. She
Speaker 1: did her dissertation on triplicate programs. The chilling effect she's
Speaker 1: talking about was the knowledge that physicians in those states
Speaker 1: had that their behavior was being watched, that there was
Speaker 1: a permanent record of every prescription they wrote in three
Speaker 1: places on paper, not in some abstract, invisible computer file
Speaker 1: up in the cloud. Presumably each physician has got a
Speaker 1: filing cabinet in his or her office just full of
Speaker 1: prescription forms which they're holding onto for years. So it
Speaker 1: is a powerful psychological reminder of the way you have
Speaker 1: handled this specific kind of medication exactly. And the doctor
Speaker 1: knows that there's a corresponding filing cabinet somewhere in the
Speaker 1: state capital with a team of investigators attached who can
Speaker 1: look at every prescription and see the name of the patient,
Speaker 1: the name of the pharmacist, and the name of which
Speaker 1: doctor has the biggest bulging file, a file that says,
Speaker 1: just by its size, something fishy may be going on.
Speaker 1: This is exactly what Purdue Pharmaceutical discovered when it did
Speaker 1: its focus group with doctors in nineteen ninety five, just
Speaker 1: prior to the launch of OxyContin. One of their sessions
Speaker 1: was in a tripicate state in Houston, Texas, and Perdue's
Speaker 1: takeaway after meeting with a group of Houston doctors was clear,
Speaker 1: quote the triplicate laws seemed to have a dramatic effect
Speaker 1: on the product usage behavior of the physicians. It went on.
Speaker 1: The mere thought of the government questioning their judgment created
Speaker 1: a high level of anxiety in the focus group room
Speaker 1: among the doctors. Purdue looked at that high level of
Speaker 1: anxiety and asked, is it even worth marketing OxyContin in
Speaker 1: tripicate states at all? Years later, Abby Albert's group of
Speaker 1: economists finds this long forgotten focus group report, and they
Speaker 1: realize that stumbled on a beautiful example of a natural
Speaker 1: experiment natural experiments are the economists dream. You don't have
Speaker 1: to create a treatment group and a control group, then
Speaker 1: laboriously compare what happens to the two groups. Someone else
Speaker 1: has created the experiment for you. In this case, the
Speaker 1: someone else was Purdue. A third of the American population
Speaker 1: lived in the triplicate states. Those states got passed over
Speaker 1: by the Purdue marketing squads. The rest of the American
Speaker 1: population lived in states without Big Brother looking over their
Speaker 1: doctor's shoulders. They got the full Purdue treatment. If you
Speaker 1: wanted to know how much of the opioid crisis was
Speaker 1: caused by OxyContin, all you had to do was compare
Speaker 1: what happened to the tripicate states with everywhere else. So
Speaker 1: that's what Albert did, and what she and her colleagues
Speaker 1: found was that the triplicate rule was everything. What we
Speaker 1: found was that, in fact, the non triplicate states had
Speaker 1: much more oxycon use per capita than the triplicate states,
Speaker 1: almost twice as much. In most years, more OxyContin means
Speaker 1: more OxyContin overdoses, and not just that, because many of
Speaker 1: those who got addicted to opioids with OxyContin went on
Speaker 1: to get addicted to heroin and fentanyl. We see very
Speaker 1: quick increase in overdose deaths in the non triplicate states
Speaker 1: and much slower growth in the triplicate states, and these
Speaker 1: trends continue even twenty years after the launch. Let's go
Speaker 1: back to comparing outcomes in New York and Massachusetts. New
Speaker 1: York was triplicate, Massachusetts was not. So how much of
Speaker 1: a difference to death single requirement make the two extra
Speaker 1: carbon copies on the New York prescription pad. Well, if
Speaker 1: New York had Massachusetts opioid overdose rate between the years
Speaker 1: two thousand and twenty nineteen, an additional twenty five thousand
Speaker 1: New Yorkers would have died of overdoses twenty five thousand.
Speaker 1: Not only that, it turns out that economic growth is
Speaker 1: higher in triplicate states than non triplicate states, health outcomes
Speaker 1: of babies are better, and violent crime is lower in
Speaker 1: triplicate states, astonishingly lower as much as twenty five percent.
Speaker 1: Exactly eighty years after Paul Madden wrote his amendment to
Speaker 1: the Californian Narcotics Act, his bureaucratic nitpicking gets vindicated by
Speaker 1: social science, and who else gets vindicated Sidney M. Wolf
Speaker 1: m d. In the early nineteen nineties, someone in the
Speaker 1: White House wondered what was known about the value triplicate programs.
Speaker 1: The request got kicked over to the National Institute of
Speaker 1: Drug Abuse NIDA, and NAIDA rounded up everyone who might
Speaker 1: know something about triplicates and invited them to a conference
Speaker 1: at a hotel near its headquarters in Rockville, Maryland. So
Speaker 1: you attended the symposium, Yes, Linda was Stilla, who had
Speaker 1: done her dissertation on triplicates, was one of the attendees.
Speaker 1: I do remember the venue, and I do remember this
Speaker 1: is really ridiculous. We couldn't have coffee. NAIDA was very
Speaker 1: hardcore about these kinds of things. They wouldn't sponsor anything
Speaker 1: that had an addiction potential, including caffeine. So diddy right.
Speaker 1: What I remember about that was sort of the excitement
Speaker 1: of this is the first big thing we've had about
Speaker 1: trying to control opioid use in the United States. This
Speaker 1: is nineteen ninety one. OxyContin will be introduced in nineteen
Speaker 1: ninety six, five years later, but opioid overdoses were still
Speaker 1: high enough in those years that people were starting to
Speaker 1: get worried about the problem. I was a pharmacist with
Speaker 1: a pH d. There weren't many pharmacists with pH DS,
Speaker 1: So it was like, Wow, this is it, and I
Speaker 1: believed in a lot of these policies. The pain specialist
Speaker 1: Russell Portnoy was at the night, a symposium he would
Speaker 1: later do as much as anyone to promote the aggressive
Speaker 1: use of OxyContin. He talked about the problem of under
Speaker 1: prescribing opioids. Someone from the American Pharmaceutical Association was there
Speaker 1: to say how strongly the industry's biggest trade group was
Speaker 1: opposed to any kind of federally mandated triplicate requirement. After all,
Speaker 1: this was nineteen ninety one. Why were we promoting some
Speaker 1: half baked idea from nineteen thirty nine. But here and
Speaker 1: there there were other voices. An African American doctor who
Speaker 1: worked in a tough neighborhood in Brooklyn gerald Ds said this,
Speaker 1: I wished that anyone who opposes triplicate prescription programs could
Speaker 1: walk with me into the real world where these regulations
Speaker 1: are saving lives. And then at the end of the meeting,
Speaker 1: who gets up to speak? Sid Wolf? Of course, because
Speaker 1: what is Sid's great cause in the late eighties and
Speaker 1: early nineties, it's triplicates. SID has decided that what American
Speaker 1: needs is a national version of Chapter three, Article one,
Speaker 1: Section one one one six six dot six of the
Speaker 1: California Narcotics Act. Sid, how are you. It's been a
Speaker 1: long time, So when I see Sid's name in the
Speaker 1: conference proceedings, I realized I had to talk to Sid
Speaker 1: again after all these years, so I called him up.
Speaker 1: Sid always answers his phone, and right away he reminds
Speaker 1: me of how we used to run into each other
Speaker 1: in the Adams Morgan neighborhood of Washington, d C. We
Speaker 1: once played pool together Dan's pool room. The last time
Speaker 1: in Dan's I couldn't walk in there because there were
Speaker 1: about ten people changed smoking, So I've never been in
Speaker 1: there again. I think it's no longer around at all.
Speaker 1: Just hearing that voice again, that low rumble, the eyebrow
Speaker 1: raised at Dan's pool room, brought back all kinds of memories.
Speaker 1: I think I was nervous. Thank you for joining me.
Speaker 1: I would like to take a walk down memory lane
Speaker 1: with you, and I want to talk about triplicate prescriptions.
Speaker 1: I know this has been an issue that occupied you
Speaker 1: with various points in your career, but I just wanted you.
Speaker 1: I want to start at the beginning. When did the
Speaker 1: subject of triplicate prescriptions first come to your attention. I
Speaker 1: became aware of it, I would say, in the early eighties,
Speaker 1: late seventies, something like that. Even back in the nineteen eighties,
Speaker 1: you are concerned about the problems being caused by opioids,
Speaker 1: thirty years before the current epidemic. This is something that's
Speaker 1: very much a matter of concern for you, which a
Speaker 1: matter of concern for several reasons. I would attend Fdadvisory
Speaker 1: Committee means, and not a small number of them had
Speaker 1: to do with opioids. And there were already some problems
Speaker 1: with opioids in those days. And SID, like Paul Madden
Speaker 1: two generations before him, had become convinced that focusing on
Speaker 1: doctors was a big part of the solution. Let them
Speaker 1: know they were being watched with a few file cabinets
Speaker 1: of carbon copies. I mean, the data which you've seen
Speaker 1: showing what happens in a very short period of time
Speaker 1: after some of these states implement these prescription programs is astounding.
Speaker 1: At the NINA meeting in nineteen ninety one, SID stood
Speaker 1: up and made the case for a national triplicate program.
Speaker 1: He said, in effect, California started an experiment New York
Speaker 1: and Illinois and others have joined, and the results of
Speaker 1: the experiment are clear. It works in a perfect world.
Speaker 1: Had everyone listened to what night it was saying in
Speaker 1: ninety one, when all you guys were saying back in,
Speaker 1: we would have had a very different and much less
Speaker 1: damaging opioid epidemic in the last twenty years. Right, there's
Speaker 1: no question about that, because it's a clear public health problem.
Speaker 1: He's right. A national triplicate program would clearly have slowed
Speaker 1: the advance of OxyContin. Eight hundred and forty one thousand
Speaker 1: people have died of drug overdoses since the nineteen nineties.
Speaker 1: How many of those would now be alive. In nineteen
Speaker 1: ninety three, SID published a monograph reiterating the need to
Speaker 1: get serious about opioid prescriptions. It almost certainly made its
Speaker 1: way to the Health and Science desk at the Washington Post.
Speaker 1: Did anyone take you up on it? No? Why? I
Speaker 1: don't know why I bringed us up on because I
Speaker 1: and one of the reasons this issue interested me so
Speaker 1: much was that in the early nineties, when you were
Speaker 1: thinking very seriously about the importance of replicates, the person
Speaker 1: covering the FDA, the Health bureaucracy and science, all those
Speaker 1: kinds of medical science for the Washington Post was me.
Speaker 1: That's how we met. We met, But back then my
Speaker 1: sympathies did not lie with the Sid Wolves of the world.
Speaker 1: I didn't share Sid's belief that government could fix everything.
Speaker 1: I thought medicine was full of trustworthy, judicious professionals who
Speaker 1: did not need Big Brother looking over their shoulder. In
Speaker 1: my time on the Health and science desk at the
Speaker 1: Washington Post, I was in my twenties, a kid too
Speaker 1: young for nuances. Sid was just the guy who called
Speaker 1: me up and wouldn't let you off the phone, and
Speaker 1: sent you so many papers and reports and polemics that
Speaker 1: you gave up and just threw them in the trash.
Speaker 1: Sid Wolfe was so alert to the frailty of institutions
Speaker 1: that he seemed to me like chicken little. I'll be candid.
Speaker 1: At the time, I thought you were way off to
Speaker 1: the left. I thought you were you know, my position
Speaker 1: was much more sympathetic to big pharma that I thought
Speaker 1: you were just a kind of crazy sixties radical who
Speaker 1: was always who didn't believe in drugs. Now I realized
Speaker 1: no one was more wrong than me on this issue.
Speaker 1: I mean, hundreds of thousands of people have died in
Speaker 1: this country because we didn't pay attention to what you
Speaker 1: were saying in nineteen ninety one. Well, all I can
Speaker 1: say is I certainly have been thought by a number
Speaker 1: of other people that I'm sort of a sixties radical.
Speaker 1: So I do not blame you or anyone else that
Speaker 1: thought that I was some wild eyed but said, I
Speaker 1: blame myself. It is almost certainly the case that that
Speaker 1: monograph you wrote about Triplica prescriptions was sent to me
Speaker 1: at the Washington Post. It is almost certainly the case
Speaker 1: that I did not read it. And it is almost
Speaker 1: certainly the case that had I read it, and had
Speaker 1: I taken it seriously, and had I called you up,
Speaker 1: and had I educated myself, and had I written a
Speaker 1: story about it in the Washington Post, that maybe it
Speaker 1: would have made some small difference, or even a book
Speaker 1: about it, or even a book about it. I didn't
Speaker 1: do any of those things. In the nineteen thirties, the
Speaker 1: rest of America dismissed what Paul Madden was saying because
Speaker 1: they thought Paul Madden was overbearing and hysterical. In the
Speaker 1: nineteen nineties, I dismissed what sid Wolf was saying. Because
Speaker 1: we thought sid Wolf was overbearing and hysterical, we violated
Speaker 1: all of us the first rule of learning from experiments,
Speaker 1: which is to judge the message, not the messenger. Once
Speaker 1: you've found the right doctor and have told him or
Speaker 1: her about your pain, don't be afraid to take what
Speaker 1: they give you. Sidwolf said the sky was falling back
Speaker 1: in nineteen ninety one, and guess what the sky fell.
Speaker 1: Revisionist History is produced by Eloise Linton Leaving Gustu and
Speaker 1: Jacob Smith, with Tali Emlyn and Harrison VJ. Choi. Our
Speaker 1: editor is Julia Barton. Our executive producer is Mia la Belle.
Speaker 1: Original scoring by Labiskara, mastering by Flawn Williams, and engineering
Speaker 1: by Nina Lawrence. Fact checking by Kesha Williams. Our voice
Speaker 1: actor was David Glover. I'm Malcolm glow. Well, thank you
Speaker 1: so much. This has been so much fun and interesting.
Speaker 1: I think I can find that memory serves. I think
Speaker 1: I read at least part of your monograph from the
Speaker 1: thing I downloaded. It's in one PDF which i'll send you.
Speaker 1: Do I have your email address