Reddit reviews Big Business: A Love Letter to an American Anti-Hero

Perhaps I am naive to enjoy and regular a blog where the authors receive, via multiple channels, funding from the Koch brothers. But I do frequent the blog, and I (maybe naively) think I can enjoy what I believe are genuine arguments and discard the content that justifies Koch funding. But no one should be so naive as to take this post at face value.

There is currently a high-stakes PR battle being waged on who should bear the burden of indirectly reversing US life expectancy in some cohorts and indirectly causing the deaths of hundreds of thousands of Americans. Physicians? Big Business? The addicted? Regulatory bodies (FDA)? Chinese manufacturers? Dealers? The current state of the US that drives drug use and quasi-suicide (neoliberalism, atomization, destruction of metis, waning of religion)?

Where blame lands will have enormous monetary and credibility consequences. From Massachusetts General Hospital in February 2019:

> Illicit opioids now cause the majority of overdose deaths, and such deaths are predicted to increase by 260 percent -- from 19,000 to 68,000 -- between 2015 and 2025.

Before blaming doctors, consider the fact that it is legal to turn money into changes in physician behavior. From OpenPaymentsData, a federally mandated data aggregator, see payments made by Purdue Pharma L.P. in 2013: 2.4MM, 2014: 6.3MM, 2015:11.8MM, 2016:5.1MM, 2017:5.5MM. The second tab shows how funds were spent. The drop-down selects by year, 2013 to 2017. If a firm is willing to behave in this way towards physicians, why would one not expect them to try to influence legislators? Regulators? The media?


There is also a strong critique of TFA's cited paper's belief that they can quantify "altruism" in the MR comments:

> steve

> This ignores what was going on in the medical world at the time. By 2010 people were worried about narcotic use. A lot of us had already become pretty skeptical about Purdue and their claims that THIS narcotic is better. Remember that when they released the original Oxycontin it was with the claim that it was much less likely to lead to addiction, and they had (made up) proof it was better. However, it was around 2009-2010 that people started doing their own research and finding that Oxycontin was addictive.

> So let's replace the word altruistic with naive or trusting. Let's replace the word less-altruistic with suspicious. The very fact that they brought out a new version that was supposedly less likely to have addiction issues after having promoted Oxy as the drug that did into have addiction issues set off alarms for a lot of people.

>> another Steve

>> This. Most doctors are surprisingly likely to believe drug company slogans. I don't think Purdue ever published made up studies on Oxy abuse rates. Everyone who looked into it in any detail knew from the 90s that Oxy abuse was common.

>> Also, if you put the two papers together, its not that clear what an altruistic doctor should have done in 2011 with a patient who was using old Oxy 80s but now wants Dilaudid as a substitute. You refuse and say take the new Oxy, its the same. They say "no," leave and ... buy Perc 30s and die? Did you help? Maybe you should offer Subs and some counseling but they refuse (or you can't prescribe subs) so it might be better (and easier) to let them have the Dilaudid. Who knows?

Any profession will have a fraction of people amenable to bribes. Any industry will have a fraction of firms that will try to sell harmful products and bribe/blackmail anyone who tries to stop them. The question is, what prevents these transactions from occurring? When the rules are broken at enormous human cost, what does a site like MR do? Do they fairly consider where to lay blame? Do they form or join a coalition to punish the firm giving all of business a bad name, even if it harms their ideological bent? Or do they try to deflect blame to individuals in an ideologically predictable way? And if they do deflect blame, should we, as readers and reddit voters, modify our model of the motivations of these authors and this site in a more cynical direction?

For those interested in podcasts, Michael Lewis (of Liar's Poker, Moneyball, Big Short) is currently authoring a very good podcast season themed around referees in America (sports, judiciary, editorial, grammar, finance).

https://www.amazon.com/Big-Business-Letter-American-Anti-Hero/dp/1250110548

A late addition to my summer reading list

I just remembered this one:

https://www.amazon.com/gp/product/1250110548/ref=dbs_a_def_rwt_bibl_vppi_i0

Book by respected economist Tyler Cowen about how big business makes your life better and is unfairly maligned.

Please check some of these things out. You talked about economists a lot, these are economists. See what they have to say