1 00:00:15,356 --> 00:00:21,996 Speaker 1: Pushkin Hello, Hello, Revision's History listeners. I'm excited to announce 2 00:00:21,996 --> 00:00:24,916 Speaker 1: that this season I'm offering a bunch of perks from 3 00:00:24,956 --> 00:00:29,316 Speaker 1: my most loyal listeners, the ones who subscribe to Pushkin 4 00:00:29,356 --> 00:00:32,876 Speaker 1: Plus for those who just can't get enough. We're giving 5 00:00:32,916 --> 00:00:37,476 Speaker 1: every episode to our subscribers one week early. Plus We've 6 00:00:37,516 --> 00:00:42,676 Speaker 1: created many episodes released weekly, and I'm calling them tangents. 7 00:00:43,156 --> 00:00:48,316 Speaker 1: And of course you'll never hear any ads. Subscribe to 8 00:00:48,356 --> 00:00:52,036 Speaker 1: Pushkin Plus on the Revisionist History Show page in Apple 9 00:00:52,076 --> 00:00:57,956 Speaker 1: Podcasts or at pushkin FM. When I was in my 10 00:00:58,036 --> 00:01:01,276 Speaker 1: twenties many years ago, I was a reporter for the 11 00:01:01,356 --> 00:01:05,196 Speaker 1: Washington Post. A newsroom the size of a football field, 12 00:01:05,716 --> 00:01:10,076 Speaker 1: phones ringing, keyboards clattering, the glory days of print journalism. 13 00:01:10,636 --> 00:01:13,716 Speaker 1: I want you to describe what is the status in 14 00:01:13,836 --> 00:01:18,196 Speaker 1: position of a Washington Post reporter in Washington, DC in 15 00:01:18,316 --> 00:01:20,036 Speaker 1: nineteen eighty nine. 16 00:01:20,516 --> 00:01:25,196 Speaker 2: Well, in general, godlike, because the whole city ran on 17 00:01:25,356 --> 00:01:30,956 Speaker 2: politics and news and there weren't many organizations that produced 18 00:01:30,996 --> 00:01:33,956 Speaker 2: it excellently, and the Post was sort of the place 19 00:01:33,996 --> 00:01:35,116 Speaker 2: that everyone cared about. 20 00:01:35,996 --> 00:01:38,476 Speaker 1: That's my friend Michael Specter. He and I were both 21 00:01:38,476 --> 00:01:41,236 Speaker 1: on the Health and science speed for the Post. If 22 00:01:41,236 --> 00:01:46,756 Speaker 1: somebody cured something, discovered something, solved something, or screwed something up, 23 00:01:47,316 --> 00:01:50,196 Speaker 1: we were on it. In those days, it seemed like 24 00:01:50,356 --> 00:01:52,476 Speaker 1: everyone read everything we wrote. 25 00:01:52,996 --> 00:01:55,796 Speaker 2: Well they did. I mean there is an exception, which 26 00:01:55,876 --> 00:01:59,876 Speaker 2: is we were in the science pod, and at least 27 00:01:59,956 --> 00:02:02,716 Speaker 2: at the Post that was considered like why would smart 28 00:02:02,756 --> 00:02:04,996 Speaker 2: people write about science when they could write about the 29 00:02:05,036 --> 00:02:08,556 Speaker 2: White House and wear yellow ties. But in general we 30 00:02:08,636 --> 00:02:11,636 Speaker 2: had big readerships, particularly in the when we wrote about 31 00:02:11,636 --> 00:02:12,876 Speaker 2: science policy. 32 00:02:17,276 --> 00:02:22,996 Speaker 1: We sat at the center of a giant ecosystem of lobbyists, lawmakers, aids, bureaucrats, 33 00:02:23,116 --> 00:02:25,516 Speaker 1: policy wonks who tried to get us to see the 34 00:02:25,516 --> 00:02:28,556 Speaker 1: world their way. If you called someone and said you 35 00:02:28,596 --> 00:02:31,796 Speaker 1: were from the Washington Post, they called you back. I 36 00:02:31,876 --> 00:02:34,156 Speaker 1: used to listen to Michael every day on the phone 37 00:02:34,156 --> 00:02:35,556 Speaker 1: with a source on Capitol Hill. 38 00:02:36,676 --> 00:02:41,836 Speaker 2: That individual had access to everything, but he didn't mind 39 00:02:41,916 --> 00:02:44,596 Speaker 2: ratting people out. It was like heaven. I had a 40 00:02:44,596 --> 00:02:45,596 Speaker 2: couple people like that. 41 00:02:45,676 --> 00:02:50,156 Speaker 1: It was Heaven. I remember once where you get the 42 00:02:50,156 --> 00:02:53,396 Speaker 1: plain brown wrappers with stuff inside of it, because nothing, 43 00:02:53,436 --> 00:02:56,236 Speaker 1: of course was digital in those years, you would get 44 00:02:56,236 --> 00:02:58,676 Speaker 1: the mysterious phone call and you had to decide whether 45 00:02:58,716 --> 00:03:02,236 Speaker 1: to return it. So there's one member of this ecosystem 46 00:03:02,236 --> 00:03:10,076 Speaker 1: that I'm most interested in, ready, Sid Wolf. 47 00:03:11,076 --> 00:03:15,076 Speaker 2: Sid Wolf. I love Sid. I loved him then, I 48 00:03:15,116 --> 00:03:17,316 Speaker 2: love him now. But you know, yeah, he is a 49 00:03:17,356 --> 00:03:18,316 Speaker 2: particular kind of guy. 50 00:03:18,516 --> 00:03:20,836 Speaker 1: I think I was the most skeptical of Sid. 51 00:03:20,956 --> 00:03:22,876 Speaker 2: Yeah, because you were like a right wing lunatic. 52 00:03:22,996 --> 00:03:25,636 Speaker 1: I was a right wing wunatic, and it was a 53 00:03:25,716 --> 00:03:31,916 Speaker 1: right wing time Sidney M. Wolf MD versus me thirty 54 00:03:31,996 --> 00:03:35,356 Speaker 1: years ago, when I was a right wing lunatic. I 55 00:03:35,476 --> 00:03:38,036 Speaker 1: was different then, which I offer as at least a 56 00:03:38,076 --> 00:03:41,876 Speaker 1: small explanation from my behavior in the story. I'm about 57 00:03:41,916 --> 00:03:47,836 Speaker 1: to tell you. My name is Malcolm Gladwell. You're listening 58 00:03:47,836 --> 00:03:52,476 Speaker 1: to Revisionist History, my podcast about things Overlooked and Misunderstood. 59 00:03:53,116 --> 00:03:57,996 Speaker 1: This season is devoted entirely to experiments, and this episode 60 00:03:58,356 --> 00:04:01,036 Speaker 1: is about what happens when an experiment teaches us an 61 00:04:01,036 --> 00:04:11,316 Speaker 1: important lesson and we don't listen. Sidwulf came to Washington, 62 00:04:11,356 --> 00:04:14,356 Speaker 1: d C. In the nineteen sixties as a young doctor. 63 00:04:14,836 --> 00:04:17,116 Speaker 1: He went to work as a postgraduate fellow at the 64 00:04:17,196 --> 00:04:20,356 Speaker 1: National Institutes of Health, part of the same class as 65 00:04:20,356 --> 00:04:24,756 Speaker 1: Tony Fauci. One day in nineteen seventy one, someone told 66 00:04:24,796 --> 00:04:27,716 Speaker 1: him that half of the saline solution being supplied to 67 00:04:27,756 --> 00:04:32,836 Speaker 1: American hospitals was contaminated with bacteria. And Sid said, oh, 68 00:04:33,436 --> 00:04:34,956 Speaker 1: where are they going to take it off the market? 69 00:04:35,316 --> 00:04:38,436 Speaker 1: And the person said they aren't because if we do, 70 00:04:38,756 --> 00:04:41,396 Speaker 1: hospitals will run out of ivy fluid and will have 71 00:04:41,436 --> 00:04:44,916 Speaker 1: a disaster on our hands. And Sid said, that can't 72 00:04:44,956 --> 00:04:47,996 Speaker 1: be right. There have to be other sources of ivy fluid. 73 00:04:48,596 --> 00:04:51,876 Speaker 1: He did his research, found out there were other sources, 74 00:04:52,276 --> 00:04:55,556 Speaker 1: and went public, called the press, got his friend, the 75 00:04:55,596 --> 00:04:58,756 Speaker 1: political crusader Ralph Nader, to hold a press conference, and 76 00:04:58,836 --> 00:05:02,596 Speaker 1: the bad ivy fluid was pulled from the market. Sid 77 00:05:03,036 --> 00:05:06,116 Speaker 1: had found his calling as a consumer advocate. 78 00:05:07,516 --> 00:05:10,276 Speaker 3: I am sick and tired of the paper attitude of 79 00:05:10,276 --> 00:05:13,156 Speaker 3: American Medical Association towards American patients patients. 80 00:05:13,156 --> 00:05:17,996 Speaker 1: SID was unstoppable. He started something called the Public Citizens 81 00:05:17,996 --> 00:05:21,676 Speaker 1: Health Research Group and became one of the angriest voices 82 00:05:21,716 --> 00:05:22,316 Speaker 1: in Washington. 83 00:05:23,596 --> 00:05:26,516 Speaker 3: As many of you know, our organization has now for 84 00:05:26,556 --> 00:05:29,756 Speaker 3: twenty five years, been the most outspoken critic of the FDA. 85 00:05:30,516 --> 00:05:33,796 Speaker 3: More than fifty times we've submitted petitions, sometimes resulting in 86 00:05:33,876 --> 00:05:36,036 Speaker 3: lawsuits against the agency to try and get them to 87 00:05:36,076 --> 00:05:38,196 Speaker 3: do what we think the law requires them. 88 00:05:38,196 --> 00:05:41,996 Speaker 1: Example, in the c SPAN archives, there's practically a SID division. 89 00:05:42,556 --> 00:05:46,116 Speaker 1: Sit against the drug companies, sit against the doctors, sit 90 00:05:46,156 --> 00:05:47,036 Speaker 1: against the FDA. 91 00:05:48,036 --> 00:05:51,876 Speaker 4: It is clear that of the seventeen years since we 92 00:05:51,956 --> 00:05:55,196 Speaker 4: have been running the Health Research Group and watching the FDA, 93 00:05:55,316 --> 00:05:58,276 Speaker 4: this is by far the worst period of time ever. 94 00:05:59,916 --> 00:06:02,676 Speaker 1: SID didn't like anyone except those who are willing to 95 00:06:02,756 --> 00:06:07,436 Speaker 1: join him on the lonely ice flow of his sixties radicalism. Okay, 96 00:06:07,556 --> 00:06:11,396 Speaker 1: that's not fair. It's not that SID disliked people. It 97 00:06:11,476 --> 00:06:15,316 Speaker 1: was never personal for him. Sid's battle was with institutions. 98 00:06:15,956 --> 00:06:20,396 Speaker 1: SID believed that bureaucracies and companies and legislatures would behave 99 00:06:20,476 --> 00:06:25,156 Speaker 1: better only when constrained by the right laws, the right regulations, 100 00:06:25,356 --> 00:06:28,996 Speaker 1: and the right kind of relentless nudging from people like Sid. 101 00:06:29,676 --> 00:06:32,076 Speaker 1: He was the nudge of Washington DC. 102 00:06:33,036 --> 00:06:37,636 Speaker 2: Sid's very smart and very colorful and a great quote. 103 00:06:38,116 --> 00:06:41,036 Speaker 2: But there's only one way in that's Sid's way. You 104 00:06:41,116 --> 00:06:45,076 Speaker 2: don't have like a deep, meaningful conversation on both sides 105 00:06:45,156 --> 00:06:50,156 Speaker 2: with SID. But some people, and he was one, were 106 00:06:50,236 --> 00:06:53,036 Speaker 2: just excellent at knowing what we needed and what we 107 00:06:53,276 --> 00:06:56,516 Speaker 2: wanted and how to package it. And that was Sid. 108 00:07:00,076 --> 00:07:02,956 Speaker 1: I hadn't thought of Sidwolf in years, but then I 109 00:07:02,956 --> 00:07:05,836 Speaker 1: started reading about someone named Paul Madden, one of those 110 00:07:05,876 --> 00:07:08,636 Speaker 1: forgotten figures from the mid century. If you lived in 111 00:07:08,676 --> 00:07:11,996 Speaker 1: California in the nineteen forties, you would hear Madden from 112 00:07:12,036 --> 00:07:13,476 Speaker 1: time to time on the radio. 113 00:07:13,836 --> 00:07:18,196 Speaker 5: Good Evening, ladies and gentlemen. There may be hotter jobs 114 00:07:18,196 --> 00:07:19,916 Speaker 5: than breaking up a narcotic brain. 115 00:07:20,436 --> 00:07:21,036 Speaker 6: I don't know. 116 00:07:21,876 --> 00:07:26,356 Speaker 5: I've never seen one. Especially difficult is a job of 117 00:07:26,476 --> 00:07:30,476 Speaker 5: rounding up a band of narcotic pedlars, including the brains 118 00:07:30,716 --> 00:07:31,276 Speaker 5: of the gang. 119 00:07:32,956 --> 00:07:37,476 Speaker 1: Madden was a progressive that progressives believed that government could 120 00:07:37,476 --> 00:07:42,356 Speaker 1: fix things, that systems and regulations and rules properly written 121 00:07:42,556 --> 00:07:46,636 Speaker 1: could make the world a fair place. Progressives were activists 122 00:07:46,996 --> 00:07:54,836 Speaker 1: full of zeal. In nineteen thirty nine, Paul Madden was 123 00:07:54,836 --> 00:07:58,476 Speaker 1: appointed to run the California Bureau of Narcotic Enforcement. He 124 00:07:58,636 --> 00:08:01,436 Speaker 1: was the man responsible for stopping the use of illegal 125 00:08:01,516 --> 00:08:04,476 Speaker 1: drugs in the state of California, a job he tackled 126 00:08:04,636 --> 00:08:09,676 Speaker 1: with enthusiasm and his customary hyperbole. Let me quot directly 127 00:08:09,796 --> 00:08:12,876 Speaker 1: from his writing on the effects of marijuana, Madden wrote 128 00:08:12,996 --> 00:08:16,836 Speaker 1: that the user might quote believe himself so small that 129 00:08:16,916 --> 00:08:19,636 Speaker 1: he is afraid to step off the curbstone into the street, 130 00:08:20,036 --> 00:08:22,876 Speaker 1: or he may feel himself of enormous size and of 131 00:08:22,956 --> 00:08:26,796 Speaker 1: superhuman strength and passion, and in that condition commit crimes 132 00:08:26,956 --> 00:08:32,356 Speaker 1: altogether foreign to his nature. But because Paul Madden was 133 00:08:32,396 --> 00:08:35,796 Speaker 1: a progressive, he didn't just fulminate against a problem. He 134 00:08:35,836 --> 00:08:38,556 Speaker 1: had a whole, carefully thought out scheme for using the 135 00:08:38,676 --> 00:08:42,516 Speaker 1: enlightened power of government to fix it. Consider the great 136 00:08:42,556 --> 00:08:45,676 Speaker 1: fear of anti drug crusaders of that era, which was 137 00:08:45,676 --> 00:08:48,076 Speaker 1: that doctors might be driving drug addiction. 138 00:08:48,956 --> 00:08:52,676 Speaker 7: What if the person gets the script from the doctor 139 00:08:52,716 --> 00:08:54,796 Speaker 7: and goes down and keeps some of the drugs for 140 00:08:54,876 --> 00:08:57,236 Speaker 7: himself and then sell some of the drugs on the street, 141 00:08:58,316 --> 00:09:01,436 Speaker 7: then you're going to have the problem of the initiation 142 00:09:01,556 --> 00:09:04,156 Speaker 7: of new addicts potentially if that happens. 143 00:09:04,676 --> 00:09:08,116 Speaker 1: David Courtwright, who is America's leading historiander the drug trade, 144 00:09:08,316 --> 00:09:10,676 Speaker 1: says that people who were worried that patients could walk 145 00:09:10,676 --> 00:09:13,756 Speaker 1: into the doctor's office asking for an addictive drug like 146 00:09:13,836 --> 00:09:16,876 Speaker 1: morphine and the doctor would just give it to them. 147 00:09:17,236 --> 00:09:19,956 Speaker 1: So stading, we're a small number of doctors who are 148 00:09:19,996 --> 00:09:25,756 Speaker 1: relatively unscrupulous, who are simply writing prescriptions for maintenance, and 149 00:09:25,956 --> 00:09:28,636 Speaker 1: much of that drug may end up being diverted. How 150 00:09:28,676 --> 00:09:32,156 Speaker 1: would I identify the doctor who's doing that. 151 00:09:32,756 --> 00:09:35,716 Speaker 7: So one of the things you might do is send 152 00:09:35,996 --> 00:09:40,876 Speaker 7: an informer to the doctor and he would try to 153 00:09:40,916 --> 00:09:43,476 Speaker 7: persuade Typically it was a he. He would try to 154 00:09:43,516 --> 00:09:45,516 Speaker 7: persuade the doctor to write a prescription. 155 00:09:46,196 --> 00:09:49,356 Speaker 1: In California, Paul Madden looks at that practice of running 156 00:09:49,396 --> 00:09:53,636 Speaker 1: sting operations against shady doctors and says, that's a crude 157 00:09:53,996 --> 00:09:57,516 Speaker 1: and inefficient way of dealing with the problem. Remember, he's 158 00:09:57,516 --> 00:10:00,716 Speaker 1: a good progressive, a man who believes in systems and procedures. 159 00:10:01,436 --> 00:10:10,476 Speaker 1: So Madden decides to create a bureaucratic solution. First, Madden 160 00:10:10,516 --> 00:10:13,756 Speaker 1: makes a list of all the prescription painkillers that he 161 00:10:13,796 --> 00:10:19,836 Speaker 1: considers dangerously addictive morphine, opium coding, chloral hydrate, and then 162 00:10:19,876 --> 00:10:23,556 Speaker 1: he convinces the state legislature to create a new regulation 163 00:10:23,676 --> 00:10:28,156 Speaker 1: for doctors Chapter three, ARTCA one, Section one one one 164 00:10:28,476 --> 00:10:33,036 Speaker 1: six six six of the California Narcotics Act, the Madden 165 00:10:33,156 --> 00:10:35,396 Speaker 1: Amendment of nineteen thirty nine. 166 00:10:36,596 --> 00:10:40,996 Speaker 8: The prescription blanks shall be printed on distinctive paper, serial 167 00:10:41,076 --> 00:10:44,076 Speaker 8: number of the book being shown on each form, and 168 00:10:44,276 --> 00:10:48,596 Speaker 8: also each form being serially numbered. Each prescription blank shall 169 00:10:48,636 --> 00:10:51,876 Speaker 8: be printed in triplicate, with one blank attached to the 170 00:10:51,916 --> 00:10:55,036 Speaker 8: book in such a manner that it will be readily removed, 171 00:10:55,316 --> 00:10:58,436 Speaker 8: while two of the blanks shall be perforated for removal. 172 00:11:00,916 --> 00:11:04,356 Speaker 1: Meaning every time a physician prescribes one of the listed 173 00:11:04,396 --> 00:11:07,916 Speaker 1: pain killers, they have to use a special state issued 174 00:11:08,156 --> 00:11:12,076 Speaker 1: prescription pad where every prescription page comes equipped with two 175 00:11:12,156 --> 00:11:15,956 Speaker 1: additional carbon copies. To use a contemporary turn of phrase, 176 00:11:16,156 --> 00:11:18,956 Speaker 1: he wants to create a back up of every narcotic 177 00:11:18,996 --> 00:11:23,116 Speaker 1: prescription in the state. The first copy was to be 178 00:11:23,196 --> 00:11:25,876 Speaker 1: kept at the office of the prescribing physician for a 179 00:11:25,876 --> 00:11:29,796 Speaker 1: minimum of two years, available for scrutiny at any time 180 00:11:30,076 --> 00:11:33,476 Speaker 1: by one of Madden's team of inspectors. Copy number two 181 00:11:33,836 --> 00:11:36,476 Speaker 1: had to be kept by the pharmacist for two years. 182 00:11:37,196 --> 00:11:39,916 Speaker 1: At number three had to be mailed by the pharmacist 183 00:11:40,116 --> 00:11:43,076 Speaker 1: to the Bureau of Narcotic's head office in San Francisco. 184 00:11:43,876 --> 00:11:49,236 Speaker 1: A record of physician and pharmacist behavior in triplicate a 185 00:11:49,356 --> 00:11:56,556 Speaker 1: textbook example a progressive big brother in action. Now, why 186 00:11:56,596 --> 00:11:58,876 Speaker 1: did I think of Sid Wolf when I heard about 187 00:11:58,876 --> 00:12:02,716 Speaker 1: Paul Madden? Because Madden seemed to me like Sid one 188 00:12:02,756 --> 00:12:07,356 Speaker 1: point zero the nineteen thirties edition. Different context and emphasis, 189 00:12:07,356 --> 00:12:10,836 Speaker 1: of course, but the same place book, the same urgency, 190 00:12:11,196 --> 00:12:15,316 Speaker 1: the same relentlessness. The government needs to fix things. And 191 00:12:15,396 --> 00:12:17,996 Speaker 1: here is my twenty nine point plan to accomplish that, 192 00:12:18,236 --> 00:12:21,156 Speaker 1: which I'm forwarding over to you right now. Call me 193 00:12:21,196 --> 00:12:23,116 Speaker 1: when you get it right away. This is too big 194 00:12:23,156 --> 00:12:23,436 Speaker 1: to way. 195 00:12:24,636 --> 00:12:27,916 Speaker 2: So you know, Sid was his hair was always on 196 00:12:27,956 --> 00:12:28,916 Speaker 2: fire about something. 197 00:12:29,556 --> 00:12:32,076 Speaker 1: My memories of Sid is you would never know when 198 00:12:32,116 --> 00:12:33,116 Speaker 1: you would get off the phone. 199 00:12:33,796 --> 00:12:36,356 Speaker 2: That's true, that's true. I mean I've even talked to 200 00:12:36,436 --> 00:12:41,076 Speaker 2: him recently about some stuff I've done, and he'll not 201 00:12:41,396 --> 00:12:44,636 Speaker 2: just talk to you. Then the information starts flowing. In 202 00:12:44,676 --> 00:12:47,556 Speaker 2: those days, the facts started to churn because that's how 203 00:12:47,556 --> 00:12:50,276 Speaker 2: we got stuff. But Sid was like I would go 204 00:12:50,316 --> 00:12:52,036 Speaker 2: out to lunch and if there was a pile of 205 00:12:52,076 --> 00:12:54,836 Speaker 2: fax paper on my desk, it'd be like Sid struck. 206 00:12:57,676 --> 00:13:01,196 Speaker 1: How many forests were sacrificed to feed Sid's fax machine? 207 00:13:01,516 --> 00:13:06,676 Speaker 1: God only knows. In any case, I moved on. I 208 00:13:06,756 --> 00:13:10,476 Speaker 1: left the Washington Post and forgot all about and his fixations, 209 00:13:11,156 --> 00:13:14,836 Speaker 1: and then I heard about an experiment and it all 210 00:13:14,876 --> 00:13:15,836 Speaker 1: came flooding back. 211 00:13:31,036 --> 00:13:33,836 Speaker 9: Once you've found the right doctor and have told him 212 00:13:33,956 --> 00:13:37,356 Speaker 9: or her about your pain. Don't be afraid to take 213 00:13:37,396 --> 00:13:40,996 Speaker 9: what they give you. Often it will be an opioid medication. 214 00:13:42,196 --> 00:13:46,076 Speaker 1: Beginning in the late nineteen nineties, a catastrophe unfolded in 215 00:13:46,196 --> 00:13:51,036 Speaker 1: cities and towns around the United States. Opioid overdoses people 216 00:13:51,116 --> 00:13:56,436 Speaker 1: suffering a cascade of terrifying effects, pinpoint pupils, labored breathing, 217 00:13:57,076 --> 00:14:02,596 Speaker 1: respiratory arrest, choking, purple lips, loss of consciousness, and, in 218 00:14:02,636 --> 00:14:06,556 Speaker 1: what has now been over eight hundred thousand cases, death. 219 00:14:07,556 --> 00:14:10,956 Speaker 10: There's no question that our best, strongest pain medicines are 220 00:14:10,956 --> 00:14:15,036 Speaker 10: the opioids. They don't wear out, they go on working, 221 00:14:15,316 --> 00:14:18,516 Speaker 10: they do not have serious medical side effects. And so 222 00:14:18,716 --> 00:14:22,516 Speaker 10: these drugs, which I repeat are our best, strongest pain medications, 223 00:14:22,676 --> 00:14:24,916 Speaker 10: should be used much more than they are for patients 224 00:14:24,916 --> 00:14:25,396 Speaker 10: in pain. 225 00:14:26,196 --> 00:14:28,516 Speaker 1: At the heart of the crisis was a class of 226 00:14:28,596 --> 00:14:31,556 Speaker 1: new powerful painkillers that came on the market in the 227 00:14:31,676 --> 00:14:37,556 Speaker 1: nineteen nineties, especially OxyContin, launched in nineteen ninety six by 228 00:14:37,596 --> 00:14:43,076 Speaker 1: the Purdue Pharmaceutical Company. OxyContin is highly addictive, and Purdue 229 00:14:43,116 --> 00:14:46,316 Speaker 1: promoted it to doctors more heavily than any other pain 230 00:14:46,396 --> 00:14:50,596 Speaker 1: color in history. By two thousand and two, Purdue had 231 00:14:50,756 --> 00:14:54,916 Speaker 1: thousands of salespeople around the country pushing OxyContin. This went 232 00:14:54,996 --> 00:14:58,556 Speaker 1: on for more than a decade, until doctors were prescribing 233 00:14:58,996 --> 00:15:09,116 Speaker 1: three billion dollars worth of OxyContin a year. But even after, 234 00:15:09,196 --> 00:15:12,156 Speaker 1: for twenty years of the opioid epidemic, there were all 235 00:15:12,236 --> 00:15:16,516 Speaker 1: kinds of questions like was OxyContin the cause of the 236 00:15:16,556 --> 00:15:21,156 Speaker 1: overdose epidemic or just a symptom of something deeper? And 237 00:15:21,636 --> 00:15:25,436 Speaker 1: even more puzzling, why didn't opioids cause the same level 238 00:15:25,476 --> 00:15:30,636 Speaker 1: of devastation everywhere? Take Massachusetts and New York, two states 239 00:15:30,756 --> 00:15:34,076 Speaker 1: side by side. If you run every significant fact about 240 00:15:34,156 --> 00:15:37,596 Speaker 1: Massachusetts and New York through an algorithm, you'll find there 241 00:15:37,636 --> 00:15:41,756 Speaker 1: are almost no two states more alike, same population profile, 242 00:15:42,036 --> 00:15:46,076 Speaker 1: same basic economy, same levels of poverty, very similar rural 243 00:15:46,236 --> 00:15:50,196 Speaker 1: urban mix. You'd think they would have had similar experiences 244 00:15:50,276 --> 00:15:55,436 Speaker 1: with overdoses. They didn't. Massachusetts has had a bloodbath, New 245 00:15:55,556 --> 00:15:58,516 Speaker 1: York not so much. Same thing with New York and 246 00:15:58,556 --> 00:16:02,156 Speaker 1: New Jersey super similar states by any measure, So why 247 00:16:02,156 --> 00:16:05,156 Speaker 1: did New Jersey suffer so much more than its neighbor 248 00:16:06,916 --> 00:16:10,196 Speaker 1: Perdue would end up in bankruptcy courts result of multiple 249 00:16:10,276 --> 00:16:14,076 Speaker 1: lawsuits launched against them, for misleading marketing practices, and not 250 00:16:14,196 --> 00:16:19,356 Speaker 1: long ago, four economists Abbey Albert, William Evans, Ethan Lieber, 251 00:16:19,476 --> 00:16:23,516 Speaker 1: and David Powell realized that the mountains of internal Purdue 252 00:16:23,516 --> 00:16:27,156 Speaker 1: documents unearthed in those lawsuits might hold some answers. 253 00:16:27,996 --> 00:16:29,836 Speaker 11: I mean, so there were hundreds and hundreds of pages 254 00:16:29,876 --> 00:16:32,556 Speaker 11: of documents, some of which was not very interesting. 255 00:16:32,876 --> 00:16:35,596 Speaker 1: That's Abby Albert, lead author of the paper The for 256 00:16:35,796 --> 00:16:39,916 Speaker 1: them ended up publishing origins of the opioid crisis and 257 00:16:39,996 --> 00:16:41,356 Speaker 1: its enduring impacts. 258 00:16:41,916 --> 00:16:45,036 Speaker 11: But then when we happened upon the focus group research 259 00:16:45,156 --> 00:16:49,076 Speaker 11: especially and the launch plan, that really was the basis 260 00:16:49,116 --> 00:16:51,156 Speaker 11: for a lot of what we talk about in this paper. 261 00:16:53,196 --> 00:16:57,036 Speaker 1: Buried in that mountain of documents was an internal Purdue 262 00:16:57,076 --> 00:16:59,956 Speaker 1: report on a series of focus groups that the company 263 00:16:59,996 --> 00:17:03,116 Speaker 1: held with physicians. This was in the spring of nineteen 264 00:17:03,156 --> 00:17:07,196 Speaker 1: ninety five, right before the launch of OxyContin. The focus 265 00:17:07,236 --> 00:17:10,516 Speaker 1: group report runs to almost sixty pages, and in that 266 00:17:10,636 --> 00:17:15,116 Speaker 1: long buried document, one phrase kept popping up again and again. 267 00:17:15,796 --> 00:17:19,316 Speaker 1: The phrase coined by Paul Madden half a century earlier, 268 00:17:19,956 --> 00:17:21,796 Speaker 1: triplicate prescriptions. 269 00:17:23,756 --> 00:17:26,356 Speaker 11: So I had never heard of a triplicate program, and 270 00:17:26,436 --> 00:17:29,916 Speaker 11: it's not something that was being discussed in the research 271 00:17:29,996 --> 00:17:30,796 Speaker 11: on opioids. 272 00:17:31,356 --> 00:17:35,116 Speaker 1: I mean, why would it be? Nobody really liked triplicates. 273 00:17:35,636 --> 00:17:39,076 Speaker 1: For decades, no one followed California's lead in imposing this 274 00:17:39,156 --> 00:17:44,716 Speaker 1: special requirement for prescribing painkillers. Drugmakers, of course, hated the idea, 275 00:17:44,876 --> 00:17:48,876 Speaker 1: so did doctors and state lawmakers. In the early nineteen eighties, 276 00:17:48,996 --> 00:17:51,916 Speaker 1: the state of Texas did start a Tripica program, and 277 00:17:51,996 --> 00:17:55,476 Speaker 1: the state Narcotics Division in Austin had to hire thirty 278 00:17:55,516 --> 00:17:58,636 Speaker 1: three data entry clerks who in the first year mailed 279 00:17:58,676 --> 00:18:02,716 Speaker 1: out twenty seven eight hundred Tripica prescription pads to doctors 280 00:18:02,716 --> 00:18:05,596 Speaker 1: around the state. The doctors then had to write a 281 00:18:05,676 --> 00:18:08,996 Speaker 1: check for seven dollars for every pad they used, mailed 282 00:18:09,236 --> 00:18:12,676 Speaker 1: check back to Austin. Use the special pad every time 283 00:18:12,716 --> 00:18:16,476 Speaker 1: they prescribe anything off the restricted list, keep the pink 284 00:18:16,516 --> 00:18:19,076 Speaker 1: copy in their office for two years, send the green 285 00:18:19,116 --> 00:18:21,396 Speaker 1: and the blue copy with the patient to the pharmacists, etc. 286 00:18:21,596 --> 00:18:21,796 Speaker 5: Etc. 287 00:18:22,316 --> 00:18:26,796 Speaker 1: I mean, triplicate was the kind of bureaucratic nitpickiness that 288 00:18:26,876 --> 00:18:30,676 Speaker 1: drives people in the medical world crazy. The few states 289 00:18:30,836 --> 00:18:39,316 Speaker 1: that did triotriplicate programs usually drop them. By the early 290 00:18:39,476 --> 00:18:43,156 Speaker 1: nineteen nineties, they were just five states with triplica programs 291 00:18:43,156 --> 00:18:48,076 Speaker 1: in place, California, the Pioneer Texas, which somehow managed to 292 00:18:48,076 --> 00:18:52,116 Speaker 1: stick it out, and then Illinois, Idaho, and New York, 293 00:18:52,556 --> 00:18:57,636 Speaker 1: five states with warehouses full of carbon copies of doctor's prescriptions. 294 00:18:58,076 --> 00:19:01,396 Speaker 12: Every time you pick up that prescription pad, it was like, boy, 295 00:19:02,436 --> 00:19:05,556 Speaker 12: I'm prescribing and someone's watching me. And that's what a 296 00:19:05,556 --> 00:19:07,116 Speaker 12: lot of folks call the chilling effect. 297 00:19:07,756 --> 00:19:10,116 Speaker 1: Linda Westilla, who teach which is at the University of 298 00:19:10,156 --> 00:19:14,676 Speaker 1: Maryland School of Pharmacy, she did her dissertation on triplicate programs. 299 00:19:14,956 --> 00:19:17,916 Speaker 1: The chilling effect she's talking about was the knowledge that 300 00:19:17,956 --> 00:19:21,876 Speaker 1: physicians in those states had that their behavior was being watched, 301 00:19:22,636 --> 00:19:25,916 Speaker 1: that there was a permanent record of every prescription they 302 00:19:25,956 --> 00:19:30,716 Speaker 1: wrote in three places on paper, not in some abstract, 303 00:19:30,836 --> 00:19:35,556 Speaker 1: invisible computer file up in the cloud. Presumably each physician 304 00:19:35,556 --> 00:19:39,036 Speaker 1: has got a filing cabinet in his or her office 305 00:19:39,556 --> 00:19:43,236 Speaker 1: just full of prescription forms which they're holding on to 306 00:19:43,356 --> 00:19:48,396 Speaker 1: for years. So it is a powerful psychological reminder of 307 00:19:48,636 --> 00:19:53,156 Speaker 1: the way you have handled this specific kind of medication exactly, 308 00:19:53,876 --> 00:19:56,996 Speaker 1: And the doctor knows that there's a corresponding filing cabinet 309 00:19:57,036 --> 00:20:00,316 Speaker 1: somewhere in the state Capitol with a team of investigators 310 00:20:00,356 --> 00:20:03,076 Speaker 1: attached who can look at every prescription and see the 311 00:20:03,116 --> 00:20:05,756 Speaker 1: name of the patient, the name of the pharmacist, and 312 00:20:05,836 --> 00:20:09,036 Speaker 1: the name of which doctor has the biggest bulging file, 313 00:20:09,636 --> 00:20:13,876 Speaker 1: a file that says, just by its size, something fishy 314 00:20:14,036 --> 00:20:18,756 Speaker 1: may be going on. This is exactly what Purdue Pharmaceutical 315 00:20:18,796 --> 00:20:21,476 Speaker 1: discovered when it did its focus group with doctors in 316 00:20:21,556 --> 00:20:24,756 Speaker 1: nineteen ninety five, just prior to the launch of OxyContin. 317 00:20:25,356 --> 00:20:28,836 Speaker 1: One of their sessions was in a tripicate state in Houston, Texas, 318 00:20:29,196 --> 00:20:31,556 Speaker 1: and Purdue's takeaway after meeting with a group of Houston 319 00:20:31,636 --> 00:20:36,676 Speaker 1: doctors was clear, quote the triplicate laws seemed to have 320 00:20:36,956 --> 00:20:41,276 Speaker 1: a dramatic effect on the product usage behavior of the physicians. 321 00:20:42,076 --> 00:20:45,156 Speaker 1: It went on. The mere thought of the government questioning 322 00:20:45,196 --> 00:20:48,956 Speaker 1: their judgment created a high level of anxiety in the 323 00:20:48,996 --> 00:20:54,436 Speaker 1: focus group room among the doctors. Prideue looked at that 324 00:20:54,916 --> 00:20:58,596 Speaker 1: high level of anxiety and asked, is it even worth 325 00:20:58,716 --> 00:21:03,316 Speaker 1: marketing OxyContin in tripicate states at all? Years later, Abbey 326 00:21:03,356 --> 00:21:07,636 Speaker 1: Albert's group of economists finds this long forgotten focus group report, 327 00:21:07,796 --> 00:21:11,196 Speaker 1: and they realized that stumbled on a beautiful example of 328 00:21:11,236 --> 00:21:15,996 Speaker 1: a natural experiment. Natural experiments are the economists dream. You 329 00:21:16,076 --> 00:21:18,676 Speaker 1: don't have to create a treatment group and a control 330 00:21:18,716 --> 00:21:22,436 Speaker 1: group then laboriously compare what happens to the two groups. 331 00:21:22,476 --> 00:21:26,276 Speaker 1: Someone else has created the experiment for you. In this case, 332 00:21:26,756 --> 00:21:35,196 Speaker 1: the someone else was Purdue. A third of the American 333 00:21:35,236 --> 00:21:39,596 Speaker 1: population lived in the triplicate states. Those states got passed 334 00:21:39,596 --> 00:21:42,556 Speaker 1: over by the Purdue marketing squads. The rest of the 335 00:21:42,596 --> 00:21:45,916 Speaker 1: American population lived in states without Big Brother looking over 336 00:21:45,956 --> 00:21:50,316 Speaker 1: their doctor's shoulders. They got the full Purdue treatment. If 337 00:21:50,316 --> 00:21:53,156 Speaker 1: you wanted to know how much of the opioid crisis 338 00:21:53,196 --> 00:21:56,316 Speaker 1: was caused by OxyContin, all you had to do was 339 00:21:56,396 --> 00:21:59,556 Speaker 1: compare what happened to the Tripicut states with everywhere else. 340 00:22:00,676 --> 00:22:03,716 Speaker 1: So that's what Albert did, and what she and her 341 00:22:03,716 --> 00:22:07,556 Speaker 1: colleagues found was that the triplicate rule was everything. 342 00:22:08,676 --> 00:22:12,796 Speaker 11: What we found was that, in fact, the non triplicate 343 00:22:12,876 --> 00:22:16,956 Speaker 11: states had much more oxycon use per capita than the 344 00:22:16,956 --> 00:22:19,116 Speaker 11: Triplicut states, almost twice as much. 345 00:22:19,276 --> 00:22:25,636 Speaker 1: In most years, more OxyContin means more OxyContin overdoses, and 346 00:22:25,716 --> 00:22:28,236 Speaker 1: not just that, because many of those who got addicted 347 00:22:28,276 --> 00:22:31,756 Speaker 1: to opioids with OxyContin went on to get addicted to 348 00:22:31,836 --> 00:22:33,316 Speaker 1: heroin and fentanyl. 349 00:22:34,196 --> 00:22:39,556 Speaker 11: We see very quick increase in overdose deaths in the 350 00:22:39,596 --> 00:22:44,356 Speaker 11: non triplicate states and much slower growth in the triplicate states. 351 00:22:44,516 --> 00:22:47,716 Speaker 11: And these trends continue even twenty years after the launch. 352 00:22:48,596 --> 00:22:52,996 Speaker 1: Let's go back to comparing outcomes in New York and Massachusetts. 353 00:22:53,636 --> 00:22:58,476 Speaker 1: New York was triplicate, Massachusetts was not. So how much 354 00:22:58,476 --> 00:23:01,556 Speaker 1: of a difference did death single requirement make the two 355 00:23:01,596 --> 00:23:05,476 Speaker 1: extra carbon copies on the New York prescription pad. Well, 356 00:23:05,636 --> 00:23:09,596 Speaker 1: if New York had Massachusetts opioid overdose rate between the 357 00:23:09,676 --> 00:23:13,996 Speaker 1: years two thousand and twenty nineteen, an additional twenty five 358 00:23:14,196 --> 00:23:18,876 Speaker 1: thousand New Yorkers would have died of overdoses twenty five thousand. 359 00:23:19,556 --> 00:23:22,356 Speaker 1: Not only that, it turns out that economic growth is 360 00:23:22,436 --> 00:23:26,716 Speaker 1: higher in triplicate states than nontripicate states, health outcomes of 361 00:23:26,796 --> 00:23:30,636 Speaker 1: babies are better, and violent crime is lower in triplicate states, 362 00:23:31,116 --> 00:23:37,436 Speaker 1: astonishingly lower as much as twenty five percent. Exactly eighty 363 00:23:37,516 --> 00:23:40,476 Speaker 1: years after Paul Madden wrote his amendment to the California 364 00:23:40,596 --> 00:23:45,916 Speaker 1: Narcotics Act, His bureaucratic nitpicking gets vindicated by social science, 365 00:23:46,676 --> 00:24:03,756 Speaker 1: and who else gets vindicated? Sidney M. Wolf, MD. In 366 00:24:03,836 --> 00:24:06,916 Speaker 1: the early nineteen nineties, someone in the White House wondered 367 00:24:07,236 --> 00:24:10,916 Speaker 1: what was known about the value of triplicate programs. The 368 00:24:11,036 --> 00:24:14,356 Speaker 1: requests got kicked over to the National Institute of Drug 369 00:24:14,396 --> 00:24:18,276 Speaker 1: Abuse NIDA, and NIDA rounded up everyone who might know 370 00:24:18,356 --> 00:24:22,196 Speaker 1: something about triplicates and invited them to a conference at 371 00:24:22,196 --> 00:24:26,036 Speaker 1: a hotel near its headquarters in Rockville, Maryland. So you 372 00:24:26,076 --> 00:24:30,076 Speaker 1: attended the symposium, yes, Linda Westilla, who had done her 373 00:24:30,116 --> 00:24:32,956 Speaker 1: dissertation on triplicates, was one of the attendees. 374 00:24:33,676 --> 00:24:36,316 Speaker 12: I do remember the venue, and I do remember this 375 00:24:36,356 --> 00:24:38,596 Speaker 12: is really ridiculous. We couldn't have coffee. 376 00:24:38,956 --> 00:24:41,996 Speaker 1: NIDA was very hardcore about these kinds of things. 377 00:24:42,316 --> 00:24:47,236 Speaker 12: They wouldn't sponsor anything that had an addiction potential, including caffeine. 378 00:24:47,276 --> 00:24:51,516 Speaker 12: So at any rate, what I remember about that was 379 00:24:51,556 --> 00:24:55,276 Speaker 12: sort of the excitement of this is the first big 380 00:24:55,436 --> 00:24:59,476 Speaker 12: thing we've had about trying to control opioid use in 381 00:24:59,516 --> 00:25:00,356 Speaker 12: the United States. 382 00:25:01,316 --> 00:25:04,996 Speaker 1: This is nineteen ninety one. OxyContin will be introduced in 383 00:25:05,116 --> 00:25:09,396 Speaker 1: nineteen ninety six, five years later, but opioid overdoses were 384 00:25:09,436 --> 00:25:12,196 Speaker 1: still high enough in those years that people were starting 385 00:25:12,236 --> 00:25:13,876 Speaker 1: to get worried about the problem. 386 00:25:13,996 --> 00:25:16,916 Speaker 12: I was a pharmacist with a PhD. There weren't many 387 00:25:16,916 --> 00:25:20,316 Speaker 12: pharmacists with PhDs. So it was like, Wow, this is it, 388 00:25:20,356 --> 00:25:22,436 Speaker 12: and I believed in a lot of these policies. 389 00:25:23,076 --> 00:25:26,716 Speaker 1: The pain specialist Russell Portnoy was at the Nightis symposium. 390 00:25:27,116 --> 00:25:29,316 Speaker 1: He would later do as much as anyone to promote 391 00:25:29,316 --> 00:25:32,716 Speaker 1: the aggressive use of OxyContin. He talked about the problem 392 00:25:33,036 --> 00:25:38,356 Speaker 1: of under prescribing opioids. Someone from the American Pharmaceutical Association 393 00:25:38,516 --> 00:25:41,916 Speaker 1: was there to say how strongly the industry's biggest trade 394 00:25:41,916 --> 00:25:46,516 Speaker 1: group was opposed to any kind of federally mandated triplicut requirement. 395 00:25:46,996 --> 00:25:49,876 Speaker 1: After all, this was nineteen ninety one. Why will we 396 00:25:49,956 --> 00:25:54,076 Speaker 1: promoting some half baked idea from nineteen thirty nine. But 397 00:25:54,236 --> 00:25:57,836 Speaker 1: here and there there were other voices. An African American 398 00:25:57,876 --> 00:26:00,916 Speaker 1: doctor who worked in a tough neighborhood in Brooklyn, Gerald 399 00:26:00,996 --> 00:26:05,356 Speaker 1: d'es said this, I wish that anyone who opposes triplicate 400 00:26:05,436 --> 00:26:09,036 Speaker 1: prescription programs could walk with me into the real world 401 00:26:09,396 --> 00:26:17,436 Speaker 1: where these regulations are saving lives unquote. And then at 402 00:26:17,436 --> 00:26:19,876 Speaker 1: the end of the meeting, who gets up to speak, 403 00:26:20,756 --> 00:26:24,356 Speaker 1: SID will of course, because what is Sid's great cause 404 00:26:24,476 --> 00:26:28,796 Speaker 1: In the late eighties and early nineties, it's triplicans. SID 405 00:26:28,796 --> 00:26:32,356 Speaker 1: has decided that what America needs is a national version 406 00:26:32,556 --> 00:26:36,076 Speaker 1: of Chapter three, Article one, Section one one one six 407 00:26:36,196 --> 00:26:41,836 Speaker 1: six six of the California Narcotics Act. Sid, how are you. 408 00:26:42,436 --> 00:26:43,836 Speaker 6: It's been a long time. 409 00:26:45,036 --> 00:26:47,956 Speaker 1: So when I see Sid's name in the conference proceedings, 410 00:26:48,036 --> 00:26:51,196 Speaker 1: I realized I had to talk to Sid again after 411 00:26:51,276 --> 00:26:54,276 Speaker 1: all these years, so I called him up. Sid always 412 00:26:54,316 --> 00:26:57,196 Speaker 1: answers his phone, and right away he reminds me of 413 00:26:57,236 --> 00:26:59,116 Speaker 1: how we used to run into each other in the 414 00:26:59,156 --> 00:27:03,036 Speaker 1: Adams Morgan neighborhood of Washington, d C. We once played pool. 415 00:27:02,796 --> 00:27:08,956 Speaker 6: Together Dan's pool room. The last I wanted to Dan's you, 416 00:27:09,116 --> 00:27:11,076 Speaker 6: I couldn't walk in there because there were about ten 417 00:27:11,116 --> 00:27:13,716 Speaker 6: people change smoking, so I've never been in there again. 418 00:27:13,836 --> 00:27:15,756 Speaker 6: I think it's no longer around. 419 00:27:16,876 --> 00:27:20,316 Speaker 1: Just hearing that voice again, that low rumble, the eyebrow 420 00:27:20,436 --> 00:27:23,996 Speaker 1: raised at Dan's pool room, brought back all kinds of memories. 421 00:27:24,596 --> 00:27:29,676 Speaker 1: I think I was nervous. Thank you for joining me. 422 00:27:30,836 --> 00:27:33,956 Speaker 1: I would like to take a walk down memory lane 423 00:27:33,996 --> 00:27:40,116 Speaker 1: with you, and I want to talk about triplicate prescriptions. 424 00:27:40,636 --> 00:27:42,756 Speaker 1: I know this has been an issue that occupied you 425 00:27:42,796 --> 00:27:45,556 Speaker 1: with various points in your career, but I just wanted you. 426 00:27:46,436 --> 00:27:48,516 Speaker 1: I want to start at the beginning. When did the 427 00:27:48,556 --> 00:27:51,156 Speaker 1: subject of triplicate prescriptions first come to your attention. 428 00:27:51,556 --> 00:27:55,596 Speaker 6: I became aware of it, I would say, in the 429 00:27:55,716 --> 00:27:58,716 Speaker 6: early eighties, late seventies, something like that. 430 00:27:59,516 --> 00:28:05,156 Speaker 1: Even back in the nineteen eighties, you are concerned about 431 00:28:05,156 --> 00:28:08,556 Speaker 1: the problems being caused by opioids, thirty years before the 432 00:28:08,636 --> 00:28:13,516 Speaker 1: current epidemic. This is something that's very much a matter 433 00:28:13,556 --> 00:28:14,316 Speaker 1: of concern for you. 434 00:28:14,796 --> 00:28:19,036 Speaker 6: What's a matter of concern for several reasons. I would 435 00:28:19,036 --> 00:28:22,756 Speaker 6: attend FDA Advisory Committee means, and not a small number 436 00:28:22,756 --> 00:28:24,916 Speaker 6: of them had to do with opioids. And there were 437 00:28:24,956 --> 00:28:29,356 Speaker 6: already some problems with opioids in those days. 438 00:28:29,156 --> 00:28:33,276 Speaker 1: And SID, like Paul Madden two generations before him, had 439 00:28:33,316 --> 00:28:36,836 Speaker 1: become convinced that focusing on doctors was a big part 440 00:28:36,876 --> 00:28:39,716 Speaker 1: of the solution. Let them know they were being watched 441 00:28:39,996 --> 00:28:42,596 Speaker 1: with a few file cabinets of carbon copies. 442 00:28:43,196 --> 00:28:47,356 Speaker 6: I mean, the data which you've seen showing what happens 443 00:28:47,396 --> 00:28:49,636 Speaker 6: in a very short period of time after some of 444 00:28:49,636 --> 00:28:54,236 Speaker 6: these states implement these tripical prescription programs is astounding. 445 00:28:54,996 --> 00:28:57,756 Speaker 1: At the night of meeting in nineteen ninety one, SID 446 00:28:57,836 --> 00:29:01,796 Speaker 1: stood up and made the case for a national triplical program. 447 00:29:02,036 --> 00:29:06,036 Speaker 1: He said, in effect, California started an experiment. New York 448 00:29:06,076 --> 00:29:09,356 Speaker 1: and Illinois and others have joined, and the results of 449 00:29:09,396 --> 00:29:13,996 Speaker 1: the experiment are clear. It works. In a perfect world, 450 00:29:14,036 --> 00:29:17,396 Speaker 1: had everyone listened to whatnot it was saying in ninety one, 451 00:29:17,436 --> 00:29:19,036 Speaker 1: what all you guys were saying back in ninety one, 452 00:29:19,476 --> 00:29:21,556 Speaker 1: we would have had a very different and much less 453 00:29:21,876 --> 00:29:26,636 Speaker 1: damaging opioid epidemic of the last twenty years. 454 00:29:26,716 --> 00:29:30,676 Speaker 6: Right, there's no question about that, because it's a clear 455 00:29:30,796 --> 00:29:31,836 Speaker 6: public health problem. 456 00:29:32,556 --> 00:29:37,156 Speaker 1: He's right. A national triplicate program would clearly have slowed 457 00:29:37,156 --> 00:29:41,436 Speaker 1: the advance of OxyContin. Eight hundred and forty one thousand 458 00:29:41,516 --> 00:29:44,796 Speaker 1: people have died of drug overdoses since the nineteen nineties. 459 00:29:45,316 --> 00:29:49,556 Speaker 1: How many of those would now be alive. In nineteen 460 00:29:49,596 --> 00:29:52,796 Speaker 1: ninety three, SID published a monograph reiterating the need to 461 00:29:52,836 --> 00:29:56,236 Speaker 1: get serious about opioid prescriptions. It almost certainly made its 462 00:29:56,236 --> 00:29:58,716 Speaker 1: way to the Health and science desk at the Washington Post. 463 00:30:00,596 --> 00:30:01,916 Speaker 1: Did anyone take you up on it? 464 00:30:02,636 --> 00:30:04,116 Speaker 7: No? 465 00:30:05,676 --> 00:30:09,676 Speaker 1: I don't know why I bring us up on because 466 00:30:11,996 --> 00:30:13,916 Speaker 1: and one of the reasons this issue interested me so 467 00:30:13,996 --> 00:30:17,796 Speaker 1: much was that in the early nineties, when you were 468 00:30:17,796 --> 00:30:22,196 Speaker 1: thinking very seriously about the importance of triplicates, the person 469 00:30:22,316 --> 00:30:26,756 Speaker 1: covering the FDA, the Health bureaucracy, and science, all those 470 00:30:26,836 --> 00:30:29,196 Speaker 1: kinds of medical science, and for the Washington Post was me. 471 00:30:30,956 --> 00:30:32,236 Speaker 6: That's how we met. 472 00:30:33,076 --> 00:30:36,276 Speaker 1: We met, But back then my sympathies did not lie 473 00:30:36,316 --> 00:30:39,036 Speaker 1: with the Sid Wolves of the world. I didn't share 474 00:30:39,116 --> 00:30:42,836 Speaker 1: Sid's belief that government could fix everything. I thought medicine 475 00:30:42,996 --> 00:30:46,356 Speaker 1: was full of trustworthy, judicious professionals who did not need 476 00:30:46,396 --> 00:30:49,396 Speaker 1: Big Brother looking over their shoulder. In my time on 477 00:30:49,436 --> 00:30:51,836 Speaker 1: the Health and Science desk at the Washington Post, I 478 00:30:51,916 --> 00:30:55,476 Speaker 1: was in my twenties, a kid too young for nuances. 479 00:30:55,836 --> 00:30:58,596 Speaker 1: Sid was just the guy who called me up and 480 00:30:58,596 --> 00:31:01,036 Speaker 1: wouldn't let you off the phone, and sent you so 481 00:31:01,156 --> 00:31:04,356 Speaker 1: many papers and reports and polemics that you gave up 482 00:31:04,516 --> 00:31:10,996 Speaker 1: and just threw them in the trash. Sid Wolf was 483 00:31:11,036 --> 00:31:13,796 Speaker 1: so alert to the frailty of institutions that he seemed 484 00:31:13,796 --> 00:31:18,356 Speaker 1: to me like chicken little. I'll be candid. At the time, 485 00:31:18,596 --> 00:31:21,636 Speaker 1: I thought you were way off to the left. I 486 00:31:21,676 --> 00:31:25,356 Speaker 1: thought you were you know, my position was much more 487 00:31:25,956 --> 00:31:29,836 Speaker 1: sympathetic to big pharma that I thought you were just 488 00:31:29,836 --> 00:31:33,356 Speaker 1: a kind of crazy sixties radical who was always who 489 00:31:33,356 --> 00:31:36,636 Speaker 1: didn't believe in drugs. Now I realize no one was 490 00:31:36,676 --> 00:31:40,356 Speaker 1: more wrong than me on this issue. I mean, hundreds 491 00:31:40,396 --> 00:31:42,996 Speaker 1: of thousands of people have died in this country because 492 00:31:43,516 --> 00:31:45,196 Speaker 1: we didn't pay attention to what you were saying in 493 00:31:45,276 --> 00:31:45,996 Speaker 1: nineteen ninety one. 494 00:31:47,156 --> 00:31:51,756 Speaker 6: Well, all I can say is I certainly have been 495 00:31:51,796 --> 00:31:54,236 Speaker 6: thought by a number of other people that I'm some 496 00:31:54,476 --> 00:31:59,396 Speaker 6: sort of a sixties radical. So I do not blame 497 00:31:59,436 --> 00:32:02,556 Speaker 6: you or anyone else that thought that I was some 498 00:32:02,836 --> 00:32:03,876 Speaker 6: wild eyed. 499 00:32:04,196 --> 00:32:07,876 Speaker 1: But said I blame myself. It is almost certainly the 500 00:32:07,876 --> 00:32:11,996 Speaker 1: case that that might ponograph you wrote about Triplica Prescriptions 501 00:32:12,476 --> 00:32:14,996 Speaker 1: was sent to me at the Washington Post. It is 502 00:32:15,036 --> 00:32:17,716 Speaker 1: almost certainly the case that I did not read it. 503 00:32:18,956 --> 00:32:21,396 Speaker 1: And it is almost certainly the case that had I 504 00:32:21,476 --> 00:32:24,556 Speaker 1: read it, and had I taken it seriously, and had 505 00:32:24,596 --> 00:32:26,556 Speaker 1: I called you up, and had I educated myself, and 506 00:32:26,556 --> 00:32:28,716 Speaker 1: had I written a story about it in the Washington Post, 507 00:32:29,196 --> 00:32:32,796 Speaker 1: that maybe it would have made some small difference, or. 508 00:32:32,796 --> 00:32:35,436 Speaker 6: Even a book about it, or. 509 00:32:35,396 --> 00:32:43,156 Speaker 1: Even a book about it. I didn't do any of 510 00:32:43,196 --> 00:32:46,676 Speaker 1: those things. In the nineteen thirties, the rest of America 511 00:32:46,756 --> 00:32:49,916 Speaker 1: dismissed what Paul Madden was saying because they thought Paul 512 00:32:49,956 --> 00:32:54,956 Speaker 1: Madden was overbearing and hysterical. In the nineteen nineties. I 513 00:32:55,036 --> 00:32:58,156 Speaker 1: dismissed what sid Wolf was saying because we thought sid 514 00:32:58,196 --> 00:33:02,516 Speaker 1: Wolf was overbearing and hysterical. We violated all of us 515 00:33:02,876 --> 00:33:06,236 Speaker 1: the first rule of learning from experiments, which is to 516 00:33:06,356 --> 00:33:09,076 Speaker 1: judge the message, not the messenger. 517 00:33:10,556 --> 00:33:13,356 Speaker 9: Once you've found the right doctor and have told him 518 00:33:13,436 --> 00:33:16,876 Speaker 9: or her about your pain, don't be afraid to take 519 00:33:16,916 --> 00:33:19,596 Speaker 9: what they give you. 520 00:33:19,676 --> 00:33:23,116 Speaker 1: Sidwolf said the sky was falling back in nineteen ninety one, 521 00:33:23,436 --> 00:33:32,796 Speaker 1: and guess what the sky fell. Revisionist History is produced 522 00:33:32,796 --> 00:33:36,596 Speaker 1: by Elvis Linton, Leeman Gesteu, and Jacob Smith, with Taly 523 00:33:36,676 --> 00:33:40,836 Speaker 1: Emlin and Harrison VJ. Choi. Our editor is Julia Barton. 524 00:33:41,276 --> 00:33:45,036 Speaker 1: Our executive producer is mie La Belle. Original scoring by 525 00:33:45,116 --> 00:33:49,396 Speaker 1: Luis Kira, mastering by Flon Williams, and engineering by Nina Lawrence. 526 00:33:49,836 --> 00:33:54,516 Speaker 1: Fact checking by Keishaw Williams. Our voice actor was David Glover. 527 00:33:55,836 --> 00:34:03,916 Speaker 1: I'm Malcolm Glava. Well, thank you so much. This has 528 00:34:03,956 --> 00:34:08,596 Speaker 1: been so much fun and interesting. I think I can 529 00:34:08,676 --> 00:34:12,036 Speaker 1: find that memory serves. I think I read at least 530 00:34:12,076 --> 00:34:14,596 Speaker 1: part of your monograph from the art I can say. 531 00:34:14,756 --> 00:34:18,716 Speaker 6: The only thing I downloaded it. It's in one PDF 532 00:34:18,756 --> 00:34:22,076 Speaker 6: which i'll send you. Do I have your email address