Too Clever By Half: Why Public Nuisance is Again at the Heart of a Public Health Debate

Below is my column in the Wall Street Journal on the ongoing opioid litigation and an important ruling out of the Oklahoma Supreme Court. The product has become the latest battleground over the use of public nuisance to curtail products from paint to pills to guns.

Here is the column:

Opioid medications and guns are not ordinarily products linked in the minds of consumers, but their abuse has been at the heart of litigation across the country over whether they constitute forms of  “public nuisances.” The Oklahoma Supreme Court last week struck down a $465 million opioid award against Johnson & Johnson based on a legal theory that has previously been tried and failed against guns. Commentators described the Oklahoma decision as “shocking,” but it was predictable. Yet it leaves the matter far from resolved.

Opioid litigation has proceeded like a locomotive in part because of Judge Dan Aaron Polster, a federal jurist in Ohio who has been given control of some 2,000 federal cases from across the country under the multidistrict litigation system. The plaintiffs generally allege that the industry flooded states with prescription opioids and caused an epidemic of addiction. Forty-eight states, including Oklahoma, have brought lawsuits based on the same theory. Judge Polster pushed drug makers to settle before clearly establishing legal liability. He now presides in a trial that could hold pharmacies liable for opioid abuse.

There is no disagreement that the opioid crisis is real. As many as 500,000 people in the U.S. have died from abuse of opioids—both prescription medications and illegal street drugs—since the late 1990s. Johnson & Johnson earned Judge Polster’s ire for defending itself in court rather than accepting liability. The company and the Oklahoma justices are right on the law.

Public nuisance was originally addressed in England by criminal laws against such offenses as obstructing “the King’s highways.” It evolved into a common-law tort to address a broader range of “interests of the community at large—interests that were recognized as rights of the general public entitled to protection,” in the words of the American Law Institute’s Second Restatement of Torts (1965-79).

It has limits, however—most notably the standard statute of limitations, which commonly range from one to four years. By alleging a nuisance that creates a continuing injury, litigants can dispense with the statute of limitations. By proceeding under nuisance, moreover, litigants free themselves from having to prove an actual product defect.

In the opioid litigation, the companies were producing a lawful, nondefective product. The complaint was that they encouraged overprescription and failed to address the addictive danger adequately. That also highlighted the disconnection with product-liability law. Under common law, courts recognize the defense of the “learned intermediary,” namely physicians. Companies gave doctors the underlying medical data on drugs, and doctors decided whether prescribing the drug (or renewing a prescription) was medically warranted. There is no question that doctors have engaged in malpractice in many of these cases of the over-prescription of opioids.

The Oklahoma opioid ruling is consistent with the results of earlier efforts to supplant product liability with nuisance law. Some such cases were raw efforts to use the courts to achieve failed legislative agendas. Take guns. Not only are they lawful; their ownership is protected by the Second Amendment. Faced with resistance in state and federal legislatures, some states sought to declare them a public nuisance.

Those cases collapsed, and rightly so. In Chicago v. Beretta U.S.A. (2004), the Illinois Supreme Court rejected the claim while acknowledging that “the tragic personal consequences of gun violence are inestimable.” The court found that there was no interference with a legal public right. It held that such theories “would permit nuisance liability to be imposed on an endless list of manufacturers, distributors, and retailers of manufactured products.” The opioid claims are similar. Neither product was defective; both worked—all too well in some cases. The claims were based on third parties’ illegal or harmful use of them.

The same result was seen in nuisance claims on lead paint. In State v. Lead Industries Association (2008), the Rhode Island Supreme Court rejected an effort to use nuisance as a substitute for product liability. The court recognized the huge toll from the product while insisting that if it is defective, that should be addressed by product liability: “Our hearts go out to those children whose lives forever have been changed by the poisonous presence of lead. But, however grave the problem of lead poisoning is in Rhode Island, public nuisance law simply does not provide a remedy for this harm.”

Where does Oklahoma’s 5-1 ruling leave the opioid litigation and states that are counting on billions in damages? Some companies effectively conceded liability with massive settlements. They saw that as a way to stabilize their market positions, but they may now question that judgment. Purdue Pharma, makers of OxyContin, agreed to pay $4.5 billion and was dissolved. In a separate settlement, the distributors McKesson, Amerisource Bergen and Cardinal Health agreed to pay $20 billion to settle multidistrict litigation involving thousands of plaintiffs. Now pharmacies are in court, though the cases contain nonnuisance allegations, including violations under the federal Controlled Substances Act and state laws, as well as public-nuisance claims.

The latest decision follows a California trial judge’s Nov. 1 rejection of similar liability in November against four drug makers—Johnson & Johnson, Teva Pharmaceutical Industries Ltd. , Endo International PLC and AbbVie Inc. The Oklahoma ruling will likely be cited in other states whose governments are pursuing nuisance-abatement awards.

These courts are likely to be concerned, as Oklahoma’s justices were, that “stepping into the shoes of the Legislature by creating and funding government programs designed to address social and health issues goes too far.” The ruling also raises the possibility that companies will balk at more concessions in the federal litigation.

In Oscar Wilde’s “The Importance of Being Earnest” (1895), the character Jack complains: “I am sick to death of cleverness. . . . The thing has become an absolute public nuisance.” The use of public-nuisance law against lawful products is too clever by half, and the Oklahoma Supreme Court shares Jack’s lament.

Mr. Turley is a law professor at George Washington University.

45 thoughts on “Too Clever By Half: Why Public Nuisance is Again at the Heart of a Public Health Debate”

  1. If this case had succeeded, then opiods would cease to be manufactured. This might seem like a win to those not facing terminal cancer or massive injuries.

    Opiods are indeed addictive, and abuse can lead to harm. That’s why their use should be closely supervised, and why the medical community should come up with a withdrawal plan. In addition, it would be helpful if there was a database tied to each patient, which would prevent doctor shopping. As it stands, there doesn’t seem to be any way to know if a patient already has 5 prescriptions for the same drug, especially if they are paying out of pocket rather than through insurance.

    1. “Opiods are indeed addictive . . .”

      To *some* people, yet not to others. Just as chocolate, the internet, and seeking attention are addictive to *some* people, yet not to others.

      The important question is: Why are some people addicted to those things (and countless more), while others are not?

      Too many people play the determinism card to blame something or someone outside of them — the environment, “evil” corporations, biology. That gives them a handy excuse with which to play the “victim.”

      1. I think some people think if a doctor prescribes it, it’s safe. They take prescriptions too long.

        When I had surgery years ago, I had already known of people who got addicted, and the opiod crisis had been in the news for a while. I was scared to take pain meds at all, because I went in the other direction, obsessing that they might be even more addictive than they really are. I remember I would try to stretch out the time when I’d take pain meds, sweating with pain, refusing to take it on time, and stopping it altogether within a few days. By the time of my next doctor visit, I didn’t need them at all. He told me I was being an idiot, put myself through needless pain, because it takes longer than that to get addicted. Well, wish I’d asked him a bit more information before surgery. And I wish doctors would provide more information on how long it does take for addiction to set in each and every time they prescribe addictive pain relievers.

        I think that’s one of the problems, a lack of communication. Patients need to be proactive and ask up front about these kinds of risks and the timeframe involved. If someone is seriously injured, then rehab from pain killers might be a good idea as part of their long term overall care.

        I do agree with you that patients do bear some responsibility.

  2. If doctors weren’t in love with the kickbacks they receive, this would be far smaller problem – there is very little resembling actual medicine anymore in the American mainstream. Nine times out of ten at this point, if you go to a doctor, they will advise you to pop a pill, regardless of specialty, or whatever your issue is (‘Headache? Here, take this heroin level painkiller.’). Yet another area where America has fallen off of a cliff (and no, it isn’t capitalism. A person could charge for useful care, too. Let’s face it; that usually comes with a behavioral prescription and we are lazy mofos). Being healthy really ins’t all that mysterious for most who are in fact that. There is plenty of culpability to go around on this one, and it’s why I opposed the Affordable Care Act. It douen’t really matter how much insurance costs if people are caught in this spiral, though I’m sure it made the insurance companies etc. grin ear to ear.

    1. Nine times out of ten at this point, if you go to a doctor, they will advise you to pop a pill…

      Most patients want an Rx to “fix” their malaise. Few want to do the real work involved. I’ve been telling patients to lose weight for decades precisely to avoid taking pills. Few comply. Then they take the Rxs to CVS or Walgreens drive-up window, and demand to have their pills dispensed in less than 5 minutes, and balk at having to pay a co-pay. We are a broken country on many levels.

  3. RIGHT TO AND FREEDOM OF INGESTION – 9TH AMENDMENT

    At some point, Americans will wake the —- up and grasp that they enjoy the absolute right to and freedom of ingestion, that they enjoy every last conceivable, natural and God-given right, freedom, privilege and immunity, while government and Congress are severely limited and restricted by the Constitution and Bill of Rights, and that, in the absence of the delegation or prohibition of power, power is reserved to the people, or to the state (i.e. people and state are differentiated not conflated).

    That America was created and exists to limit government.

    That Americans are the Sovereign and Congress and the government are the subject of the Sovereign.

    That the Constitution and Bill of Rights restrict government and Congress, as they provide maximal freedom to individuals.

    That the entire “administrative state” of several regulatory fiefdoms is unconstitutional per Article 1, Section 8, wherein regulation is limited and restricted to that of money, the “interchange” of commerce among states, and land and naval Forces (regulation of the “interchange” of commerce exists merely to preclude favor by one state over another).

    That Congress cannot tax for everything it pleases, merely “…general Welfare…,” omitting and, thereby, excluding individual welfare, specific welfare, charity and targeted redistribution of wealth, general being all.
    _

    Americans are obligated to obey laws against property damage and bodily injury. Americans enjoy the freedom to “pursue happiness” in the free markets of the private sector – they may establish a charity, advocate against substance ingestion, etc. Those who seek personal power reject and nullify the Constitution.
    _______________________________________________________________________________________

    9th Amendment

    The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.
    _____________________________________________________________________________________________________

    10th Amendment

    The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.
    ____________________________________________________________________________________________________________________________

    “…[Congress] are not to lay taxes ad libitum for any purpose they please;…”

    “[T]he laying of taxes is the power, and the general welfare the purpose for which the power is to be exercised. They [Congress] are not to lay taxes ad libitum for any purpose they please; but only to pay the debts or provide for the welfare of the Union. In like manner, they are not to do anything they please to provide for the general welfare, but only to lay taxes for that purpose.”

    – Thomas Jefferson

    1. This is an entirely moot discussion.

      Drug laws were and are unconstitutional violations of constitutional rights and freedoms. FDR was a power-hungry communist obsessed with wielding personal power. Everything Franklin Delano Roosevelt did was unconstitutional and must have been declared such by the entirely absent and derelict judicial branch (Roosevelt’s interference with financial markets turned a market crash in 1929 into a 13-year economic disaster, without which markets would have recovered in a relatively short period of time because mankind lives to endeavor not pout, caterwaul and beg for alms).

      Regulation must be done by industry in the private sector for the benefit of consumers and to protect industry itself against litigation with the potential to bankrupt.
      _______________________________________________________________________________________________________________________________

      1938 Food and Drug Act

      FDR signed the Food, Drug, and Cosmetic Act on 25 June 1938. The new law brought cosmetics and medical devices under control, and it required that drugs be labeled with adequate directions for safe use. The act also corrected abuses in food packaging and quality, and it mandated legally enforceable food standards.
      __________________________________________________________________________________________

      “Drug therapy in colonial and revolutionary America”

      Abstract

      Drug therapy during the Colonial and Revolutionary War period in America is discussed. Therapy in the 17th and 18th centuries remained largely symptomatic rather than curative. Treatment included such “depletion” measures as purging, sweating, bleeding, blistering and vomiting. Purgatives, emetics, opium, cinchona bark, camphor, potassium nitrate and mercury were among the most widely used drugs.

      – NIH
      ____

      Pure Food and Drug Act (1906)

      The Pure Food and Drug Act of 1906 was the first of a series of significant consumer protection laws which was enacted by Congress in the 20th century and led to the creation of the Food and Drug Administration.

      – Wiki
      _____

      “Many early Americans, including Benjamin Franklin, were regular users of Laudanum (Musto, 1991).”

      Opium in America: The Early Story

      William L. White

      Opium in Colonial America

      Opium came to America early and in many forms. There was raw prepared opium (for
      smoking). There was granulated opium prepared in standard medical doses and taken by mouth,
      usually to treat diarrhea. There was powdered opium, whose fine granules could be sprinkled
      into an open wound to relieve pain. There was tincture of opium (opium suspended in alcohol).
      Representing these various forms of medicinal opium were three opium products that began the
      history of narcotic addiction in America: Laudanum, Dover’s Powder, and Paregoric (Maurer
      and Vogel, 1973).
      Laudanum, originally in the form of an opium pill and later in a liquid combination of
      opium and alcohol, was developed by Paracelsus, the Swiss chemist, in the sixteenth century.
      The name itself comes from the Latin, laudanum, which means “something to be praised.” In
      Colonial America, the term “laudanum” was used for a number of preparations that combined
      opium with ingredients such as wine, henbane, bone of the heart of a stag, cinnamon, frog’s
      sperm, and orange or lemon juice. The alcoholic preparation of opium that people drank was the
      most popular (Macht, 1915). It is likely that Laudanum entered America on the Mayflower and
      continued to arrive with each succeeding ship. Many early Americans, including Benjamin
      Franklin, were regular users of Laudanum (Musto, 1991).
      Paregoric–a mixture of opium, alcohol, camphor, benzoic acid, and anise oil–appeared
      in the early eighteenth century and was the most common product recommended for diarrhea. Its
      name comes from a Greek word meaning “soothing” or “consoling.” Paregoric was also the one
      of the most frequently used medicines for children in America, as noted in an early advertising
      jingle: “Paregoric by the bottle, emptied down the baby’s throttle.”
      Dover’s Powder was an opium-based preparation developed by Dr. Thomas Dover of
      England for the treatment of gout. It contained a concoction of opium, licorice, ipecac, and other
      assorted ingredients. Dover’s Powder was used as a pain killer, usually taken internally or
      applied to the skin. It became one of the most widely used elixirs on both sides of the Atlantic.1
      By the late eighteenth century opium was also available, primarily in the form of gum opium,
      from domestic growers in the colonies.

  4. They wouldn’t be able to push the pills if Americans would stop poppin them in their mouths.

    I walked away from commercialized medicine, especially the pharmaceutical aspect of it decades ago, opting to care for the body God gave me myself, and trust in my own judgment and not some for-profit doctor who’s been trained in the modern commercialized for-profit medicine dogma. Which is simple. And it goes like this; when someone comes to you because they are sick, don’t address the cause address the symptoms. Which means giving them pill after pill which in turn create a whole new list of problems.

    I mean, who doesn’t laugh when they hear a TV commercial for some new drug to do oh so important things like, …relieve itching, …clear up your skin. Or stop your legs from “twitching” at night. They show you healthy, happy couples laughing, holding hands, riding bikes, walking on the beach or shopping in an open-air market, …and of course laughing, always laughing with their hair blowing in the wind, …gotta have that hair blowing, in slow motion of course. And why are they showing you this? Because all these people are smarter than you, and are enjoying life because they took the pill being advertised? Didn’t you? Don’t you want to be smart and healthy and happy like these people? Sure you do. So tell your doctor you want some too. You want to be healthy and happy like the really smart healthy happy people in the video. Right? Then comes the “may cause(‘s)”. May cause, …drowsiness addiction, constipation, heart murmur, …blurred vision, …loss of vision, loss of coordination, sleeping problems, depression, suicidal thoughts, confusion, difficulty breathing, a reduced ability to fight infection, bleeding stomach, …bloody stools, diarrhea, explosive bowel syndrome (ok I made that one up) impotence, hearing loss or loss of motor function, ….death, …

    The lists go on and on. Yet the people tune it out, because you know, …they’re warning me about it so its ok, right? I mean it won’t likely happen to me, right? So, people keep taking them and of course we keep suing over our own inability to smell bulls#$ when it’s presented to us along with the inability to stop shoveling it in our own mouths.

    You couldn’t get me to take anything recently developed by the big pharmaceuticals over the last 30 years. _You couldn’t get me to get a “check-up” with a gun to my head. I don’t need a checkup to know how I am feeling, and what those check-ups are are just a way of getting you in the door. So they can sell you something. Just like the car dealers “warranty” service or “free tune-ups”. They’re designed to get you in the door so they can find something “wrong” so they can sell you something. And like the auto dealers and many mechanic shops, if they can’t find anything wrong, they’ll break something. Or set something so that it will break soon.

    Doctors hand out pills every day that they know darn good and well will likely deteriorate the patient’s liver or some other organ which will introduce a whole new set of problems for the patient within just a few short years or even in some cases less. But they do it, always “informing you of the risks” while writing out the prescription. In the last 30 years alone, there have been more than 30 judgments awarded against the big pharmaceuticals, (the same ones making this Covid vaccine they want us all to take) yet they keep pushin the pills and shooting down any natural remedies that anyone can use which work better than their pills often and without the ridiculously serious side effects.

    I’ll never forget my own father’s last 15 years. One day I was upstairs in his bedroom talking to him in our old house, and on the old wooden dresser he had as long as I can remember, were all these pill bottles. I started looking through them, reading the names and just being shocked at how much he took each day. I asked him “what’s this one for?” and he’d say, that ones to counter act the effects of the medicine they gave me for this or that. Then I’d say what’s this other one for? And he’d say “that ones to counter the side effects of the first one”. And so on and so on. He was literally taking pills to counter act the effects of the other pills. And of course, my father’s experience isn’t unique. Its routine.

    So I agree the premise is ridiculous to hold these pill pushers accountable for the mindless lemmings among us who pop em when they’re handed to us. We decide at the end of the day what we take into our own bodies or not. Or at least that’s still for the most part our right, then again if Joe Biden has his way then the govt will decide for us what we put into our own bodies. Fortunately, that’s being struck down everywhere, mostly in part to the battier than the belfry republicans who at least still claim to believe in individual freedom. At least when it serves their interest. The democrats seem to have abandoned the idea of individual freedom altogether, which is why they got their a$$es handed to them in this last election in my own state here in the beautiful state of God’s favorite place, … Virginia, and we have what seems like a fairly reasonable governor coming into office again. So I don’t see Mr Biden’s “we own your body” bulls$hit flying very far around these parts any time soon.

    But the bottom line with the lawsuit still comes back in my own opinion as erroneous simply because it’s not the pharmaceutical company’s fault that we take their crap. They tell us its crap. We passed laws that said if you make a fancy commercial that shows two people holding hands in a field of lillies because they took your pill and it cleared up their dry itchy skin, …that you also have to announce that your pill also gave them explosive diarrhea for a month and blew a hole in their colon.

    So we know. We know what we’re doing. We make the choices not them. If we’d stop taking them, they’d stop pushing them. So some of us stop. Like I did, about 30 years ago. The rest of us keep opening wide and poppin them down like Tic Tac’s so we have no one to blame but ourselves.

    1. And just a side note that I thought I should add, but I don’t consider people from my father’s era mindless lemmings for taking them. I wasn’t referring to him or people from his generation born back in the 20’s and 30’s. They came from a generation when medicine hadn’t been so commercialized and corrupted and therefore, they could trust it more. Even though they knew less still they did less and that in turn meant less problems and issues from the treatment. Less pills being pushed, less operations being sold, better medicine. But today we know, we see and read every day the issues with modern commercialized medicine yet most of us continue to trust it blindly popping whatever pills they’re pushed, until the insurance runs out. Then suddenly and mysteriously, so do the “cures”.

      1. “Horror Vacui.”

        – Aristotle
        ________

        Nature abhors a vacuum.

        The nature of some Americans is to ingest substances as self-medication after self-diagnosis, which they enjoy the right to and freedom of, while they have no right or freedom to cause property damage or bodily injury, or constitute a hazard and a threat to public safety.

        That nature abhors the vacuum created by dictatorial regimes which impose unconstitutional, arbitrary edicts effecting the elimination of substances and self-medication as a form of judgment and penalization, warranties that those substances and medications will be produced and distributed, if in substandard quality.

        What then is your penalty for suicide?

        Life in prison?

        Death by firing squad?

  5. The vast majority of opioid drug deaths are due to synthetic, non-prescription, illegal substances.
    The vast majority are in single, never married individuals.
    The vast majority are in the age bracket of 25-34

    Connect the dots.

    “Overdose Deaths Accelerating During COVID-19”
    “Synthetic opioids (primarily illicitly manufactured fentanyl) appear to be the primary driver of the increases in overdose deaths, increasing 38.4 percent from the 12-month period leading up to June 2019 compared with the 12-month period leading up to May 2020”

    https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html

    “In 2015, of the population age 25 and older, 61 percent of Americans were married, and together with widowed Americans made up 68 percent of the population, but accounted for only 28 percent of opioid overdose deaths. In contrast, never-married and divorced Americans made up about 32 percent of the population, but accounted for 71 percent of all opioid overdose deaths“

    https://www.jec.senate.gov/public/index.cfm/republicans/analysis?ID=B96FA0F7-CDE0-46C8-A005-EF2AA1611B1C

  6. “[T]he industry flooded states with” food, beds, water, cars, gambling, sports, donuts, social media, chocolate, etc., etc.

    Every product ever made or service offered *can be* a source of addiction — to an addictive personality. There is no such thing as an inherently addictive product or service. There are only individuals with an addictive psychology, who then search for an object with which to satisfy that neurotic behavior.

    It is bizarre to claim that a company is somehow responsible, but that the individuals who misuse a product are not responsible.

    1. Perhaps, but what if the company hired PhD Applied Psychologists who are experts in behavioral control, and who were tasked with making a product more addictive? What is food scientists were put to the same task for designing addictive food products? We know the Big Tech companies have gone this route to get people to “spend more time on their platform”.

      It’s a crazy, complex world with all kinds of business incentives to hook people on products they don’t necessarily need. You seem to be saying a person of ordinary self-control deserves no protection against the imperatives of a professional addiction engineer. Many of us believe that industries reaching for behavioral control of private individuals are sociopathic and need to be reigned in. Altho, I’m not expert enough in lawmaking to know how you do that without stifling continuous product improvement and innovation.

  7. TBH, I put most of the blame on the docs who prescribed this stuff in various pill mills. Pharma may deserve condemnation for marketing, but no one put a gun to those quacks heads and told them to keep pushing the stuff on people who no loner needed it or who never needed it in the first place.

  8. “Under common law, courts recognize the defense of the “learned intermediary,” namely physicians. Companies gave doctors the underlying medical data on drugs, and doctors decided whether prescribing the drug (or renewing a prescription) was medically warranted. There is no question that doctors have engaged in malpractice in many of these cases of the over-prescription of opioids”
    ****************
    We’ll that’s the companies’ sanitized version. In reality they gave them a lot more than data. Big Pharma paid doctors kickbacks in the form of cash and benefits to overprescribe these addicting drugs. They do it all the time with all manner of drugs. This time is killed hundreds of thousands.

      1. skip:

        “Prescribers who received opioid-specific payments prescribed 8784 opioid daily doses per year more than their peers who did not receive any such payments (P < 0.001). Recipient of hydrocodone-related payments was associated with 5161 additional daily doses of hydrocodone (P < 0.001). Recipient of oxycodone-related payments was associated with 3624 additional daily doses of oxycodone (P < 0.001). Prescribers receiving any fentanyl-specific payments prescribed 1124 daily doses per year more than their peers (P < 0.001). Among recipients of opioid-specific payments (63 062 physicians), a 1% increase in amount of payments was associated with 50 daily doses of opioid"

        Read it yourself:

        https://onlinelibrary.wiley.com/doi/abs/10.1111/add.14509

        1. mespo – looks like drug reps found loopholes in the rules about paying doctors, such as paying for them to attend conferences, research grants, and consulting fees.

          There are a few laws that restrict payments, like the Medicaid/Medicare Anti-Kickback law, but that only affects federal healthcare programs. Some states have anti-kickback laws, as well.

          I think it’s unethical for doctors to receive kickbacks. Sometimes, the line gets blurred, such as when a drug company sponsors doctors to attend medical conferences, it might not seem like a kickback, but rather a welcome opportunity to get up to date medical information. But it is a gift of value, and these kinds of gifts are associated with more prescriptions, as you’ve pointed out.

          States should take note of these cases when legislating.

          https://journalofethics.ama-assn.org/article/it-legal-physician-receive-payment-prescribing-drug/2003-07

          I have known several people who became addicted to drugs after suffering gruesome or serious injuries. A few examples – A firefighter who fell through a roof. A couple of people had motorcycle accidents. With the length of time they took the medication, addiction was inevitable. Yet a withdrawal plan did not seem to be part of their treatment. Some of them were convinced that they could not stop taking their medicine because they would still be in pain from their injuries. Yet opioids make nerves more sensitive, and withdrawal symptoms include pain. These people had serious injuries that started this, so I have no idea if their pain really permanent from their injuries, or from addition itself. I’ve known of several people who got hooked really strongly, and would doctor shop, or they would contact friends when they had surgery to see if they had anything left. These were good people who got trapped. Seeing this, I have a lot of sympathy for addicts who got started from valid medical reasons. By the time they’re doctor shopping or stealing, they are well past the point of being in control.

          While there are indeed some doctors who are basically pushers, happily making money off of doctor shoppers, I also think that all the focus shouldn’t be on the physician. How can a doctor tell how much pain a new patient is in? Or if he or she has been doctor shopping? Doctors are so pressed for time that they spend minutes with each patient. How deep into their history can they actually get?

        1. Burnout in physicians is extremely high. Many Americans think a large percentage of physicians are greedy, detached, underperforming professionals. They don’t know the half of it. Physicians have the highest suicide rate of all professions, highest divorce rate, and the highest drug abuse rate as well.

          With all that said, physicians are easy targets. Most physicians do not know how to function in today’s medical business model. In as such, they are strung around like dogs on a chain, threatened by admins to perform to their metrics, in a profession for which they trained to be clinicians not revenue makers. Nothing in medical school or residency trains physicians for what medicine is today. Not surprisingly, these physicians redirect their anger or exasperation by using corrupt methods.

          Patients are a big part of the problem as well in medicine, like, for starters, not taking responsibility. This brings us back to opiate addiction.

          I refuse to view Americans like Alexandria Ocasio-Cortez, Ilhan Omar, Ayanna Pressley, Rashida Tlaib, Cori Bush, et al, do. Americans are not victims, helpless, pitiful, gullible rubes who need politicians to protect them from the treacheries of life. Americans have got it good, particularly when it comes to resources in our country. If they have chronic medical conditions, they only have themselves to blame including mental health issues. Generations before us did fine without opiates, benzos, SSRIs, anxiety agents, and many other modern day pharma drugs. Yet, depression, suicide, anxiety, et al, are far higher today than a few decades ago. There are plenty of physicians, mental health professionals, and far too many psychiatric meds to help anyone with anything. If they refuse, then that’s on them….and their families.

          Studies variably reported prevalence estimates of overall burnout or burnout subcomponents: 67.0% (122/182) on overall burnout, 72.0% (131/182) on emotional exhaustion, 68.1% (124/182) on depersonalization, and 63.2% (115/182) on low personal accomplishment

          Rotenstein LS, Torre M, Ramos MA, et al. Prevalence of Burnout Among Physicians: A Systematic Review. JAMA. 2018;320(11):1131–1150.

          1. Estovir,
            “Yet, depression, suicide, anxiety, et al, are far higher today than a few decades ago.”

            You could probably track their rise, like T2D, with the increase in eating high fructose corn syrup and/or processed food as percent of diet. Most Americans today eat a processed food-laden diet.

            1. Prairie Rose, I’ve lived with treatment-resistant major depression for decades. I don’t eat a diet high in corn syrup and/or processed foods (I mostly prepare my own food — whole grains, fresh or frozen fruit and veggies, limited amounts of low-fat dairy / chicken / seafood). For some mental health diagnoses, diagnosis has increased simply because we’re now treating mental health concerns more seriously. The brain is our most complex organ, and our understanding of effective mental health treatment still lags behind our understanding of how to effectively treat physical ailments/illnesses.

              1. Anonymous,
                I’m sorry you have had to deal with major depression for so long. My family, too, has struggles with mental health concerns.

                “For some mental health diagnoses, diagnosis has increased simply because we’re now treating mental health concerns more seriously.”

                This might be so, but, we have also had a massive change in how we eat and live and relate to one another.

                “The brain is our most complex organ, and our understanding of effective mental health treatment still lags behind our understanding of how to effectively treat physical ailments/illnesses.”

                You are right–while mental health concerns are being treated more seriously, effective treatment still lags behind. Our bodies need sufficient micronutrients to run cellular functions to operate optimally (this, too, is not sufficiently addressed in physical ailments/illnesses). So, too, with our brains. Our brains need sufficient vitamins, minerals, and macronutrients to not only build neurotransmitters, but to also build the myelin sheaths, cell walls, and to run the electrochemical cascades (etc).

              2. Part II:
                Have you sought guidance from a functional medicine doctor? I found mine at The Institute for Functional Medicine. https://www.ifm.org/

                While your diet sounds okay, it may still be inadequate for your needs. The low-fat element may mean you are not getting sufficient DHA–a beneficial fat for your brain, as well as all your cells. If you have an MTHFR single-nucleotide polymorphism (SNP), you may need more easily absorbed forms of B12 and folate in your diet (so, more red meat, for instance). If you are low in zinc or have gut dysbiosis, you may have increased intestinal permeability, which can increase inflammation due to responses to proteins/bacteria irritating immune cells along the intestinal tract. The gut dysbiosis (as well as poor nutrient absorption) can also mean poor formation of neurotransmitters.

                Do you get enough sunlight to make vitamin D? If you have inadequate magnesium, you will have difficulty converting the D. Or, do you think you might get too much blue light late in the day (from screens or some kinds of indoor light), which can upset your circadian rhythm?

                1. Hi Prairie Rose,

                  I didn’t give a complete list of my foods. I do eat healthy fats (fnuts, seeds, olive and canola oil, etc.), so it’s mostly that I’m trying to limit foods that are high in cholesterol and unhealthy fats. I do have a MTHFR single-nucleotide polymorphism (I only learned that a few months ago), and I take an L-methylfolate supplement to help make sure that I have enough bioactive folate. Thanks for your other suggestions.

              3. Part III:
                If you have a B6 SNP, that can mean you don’t convert B6 into its more usable form and thus struggle to make stomach acid. Or, maybe due to stress or a Heliobacter pylori infection your stomach acid production is decreased. This will make breaking down and absorbing things like proteins, zinc, magnesium, iron, B12, and selenium difficult. Then you will not have sufficient nutrients to effectively run your cells or build the things your body needs to function optimally, like neurotransmitters.

                Grains, even whole ones, can interfere with nutrient absorption due to the phytates, which can chelate zinc and magnesium, for instance. Ancient cultures soaked grains and legumes for a long time, often fermenting them, too, prior to eating to make them more digestible. We don’t do that much in this culture because it isn’t exactly a convenient process.

  9. Johnson & Johnson earned Judge Polster’s ire for defending itself in court rather than accepting liability.

    Who the hell is this Judge that thinks a Defendant cannot and should not defend itself in his Court?

    Is that the kind of Judge that should be passing judgement on anyone?

    He must think himself another Judge Adam Fenton from Eastwood’s movie “Hang’em High” or something.

    1. Like most judges, he was trying to avoid doing his job. He was probably angry because he knew the defendant would prevail and the judge’s ruling would make him unpopular. It would have been so much easier for the judge if the defendant had simply coughed up a few billion dollars.

    1. Amen to that. So could Bill DeBlasio. Seriously, any social media platform could be deemed to be a public nuisance

  10. What is not understood by most is the damage done by pharma and doctors really ceased almost 20 years ago. They got America hooked on opioids and were then regulated into curbing the rampant use. Then, they were regulated further more recently to even squeeze out legit pain patients.

    The vast majority of deaths the past decade or so are from street opiates, heroin and the lethal fentanyl. So, pharma and docs hooked Americans, they then were forced to cut off the addicts cold turkey, and turned them over to the drug cartels. Good enough for government work.

        1. Yes the COVID vaccine, thats another one, where people who are claiming to have been negatively affected, what is their recourse since the government has relieved the companies of liability. And of course people who have tried to raise these issues have been
          deplatformed by social media.

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