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CNN Exclusive: The more opioids doctors prescribe, the more money they make (archive)
The data:
The CNN/Harvard analysis looked at 2014 and 2015, during which time more than 811,000 doctors wrote prescriptions to Medicare patients. Of those, nearly half wrote at least one prescription for opioids.
Fifty-four percent of those doctors -- more than 200,000 physicians -- received a payment from pharmaceutical companies that make opioids.
Among doctors in the top 25th percentile of opioid prescribers by volume, 72% received payments. Among those in the top fifth percentile, 84% received payments. Among the very biggest prescribers -- those in the top 10th of 1% -- 95% received payments.
On average, doctors whose opioid prescription volume ranked among the top 5% nationally received twice as much money from the opioid manufacturers, compared with doctors whose prescription volume was in the median. Doctors in the top 1% of opioid prescribers received on average four times as much money as the typical doctor. Doctors in the top 10th of 1%, on average, received nine times more money than the typical doctor. [...]
Some studies have looked at whether the amount of money a doctor receives makes a difference. Studies by researchers at Yale University, the George Washington University Milken Institute of Public Health and Harvard Medical School have all found that the more money physicians are paid by pharmaceutical companies, the more likely they are to prescribe certain drugs.
The story:
Angela Cantone says she wishes she had known that opioid manufacturers were paying her doctor hundreds of thousands of dollars; it might have prompted her to question his judgment.
She says Dr. Aathirayen Thiyagarajah, a pain specialist in Greenville, South Carolina, prescribed her an opioid called Subsys for abdominal pain from Crohn's disease for nearly 2½ years, from March 2013 through July 2015.
Subsys is an ultrapowerful form of fentanyl, which is 50 to 100 times more potent than morphine, according to the US Centers for Disease Control and Prevention.
"He said it would do wonders for me, and it was really simple and easy. You just spray it in your mouth," Cantone said.
She says Subsys helped her pain, but it left her in "a zombie-like" state. She couldn't be left alone with her three young children, two of whom have autism and other special needs.
"I blacked out all the time. I'd find myself on the kitchen floor or the front lawn," she said.
She says that if she missed even one day of the drug, she had uncontrollable diarrhea and vomiting.
She said she brought her concerns to Thiyagarajah, but he assured her it couldn't be the Subsys that was causing her health problems.
"I trusted him. I trusted my doctor as you trust the police officer that's directing traffic when the light is out," she said.
She says that when she eventually asked Thiyagarajah to switch her to a non-opioid medication, he became belligerent.
"He said it was Subsys or nothing," she said.
Cantone would later learn that from August 2013 through December 2016, the company that makes Subsys paid Thiyagarajah more than $200,000, according to Open Payments, the federal government database that tracks payments from pharmaceutical companies to doctors.
CNN compared the $190,000 he received from 2014 to 2015 with other prescribers nationwide in the same medical specialty and found that he received magnitudes [50 times] more than the average for his peers.Nearly all of the payments were for fees for speaking, training, education and consulting.
Dr. Aathirayen Thiyagarajah wrote nearly twice as many opioid prescriptions per patient annually compared to his colleagues
The rebuttal:
Dr. Patrice Harris, a spokeswoman for the American Medical Association, said that the CNN and Harvard data raised "fair questions" but that such analyses show only an association between payments and prescribing habits and don't prove that one causes the other.
It's "not a cause and effect relationship," said Harris, chairwoman of the association's opioid task force, adding that more research should be done on the relationship between payments and prescriptions.
"[We] strongly oppose inappropriate, unethical interactions between physicians and industry," she added. "But we know that not all interactions are unethical or inappropriate." Harris added that relationships between doctors and industry are ethical and appropriate if they "can help drive innovation in patient care and provide significant resources for professional medical education that ultimately benefits patients."
(Score: 2, Touché) by Anonymous Coward on Tuesday March 20 2018, @01:02PM (6 children)
Corruption is a very serious crime you understand, this might qualify them for capital punishment, soon.
(Score: 3, Interesting) by KiloByte on Tuesday March 20 2018, @01:30PM
For pharma companies paying doctors I'd agree, but let's start with politicians first.
And such laws existed in the past: interwar Poland: Dz.U. 1921 nr.30 poz.177 (also Dz.U. 1920 nr.11 poz.61): Art.2: An official, guilty of accepting a gift or another material benefit, or a promise thereof, [in matters relevant to duties], shall be punished by death by shooting.
Apply this to any "campaign donations", and only then proceed to doctors.
Ceterum censeo systemd esse delendam.
(Score: 1, Troll) by The Mighty Buzzard on Tuesday March 20 2018, @01:58PM (3 children)
Since when? It's been the status quo in every form of government ever.
My rights don't end where your fear begins.
(Score: 3, Interesting) by KiloByte on Tuesday March 20 2018, @02:08PM (2 children)
The only country with outright legalized corruption I can think of is the US. In the rest of the world, there are at least some laws against it. Such laws are notoriously disrespected, but at least civilized countries have above token-level enforcement, which at least puts some damper on it.
Like, say, outlawing pharma companies from bribing doctors.
Ceterum censeo systemd esse delendam.
(Score: 3, Insightful) by The Mighty Buzzard on Tuesday March 20 2018, @03:57PM (1 child)
The sheer amount of naivete in that statement is mind boggling.
My rights don't end where your fear begins.
(Score: 0) by Anonymous Coward on Tuesday March 20 2018, @08:55PM
well asymptotically above the token level
(Score: 2) by driverless on Tuesday March 20 2018, @09:52PM
"The more drugs dealers sell, the more money they make".
In other news:
Water is wet!
Asphalt is black!
The desert is dry!
Read all about it!
(Score: 4, Insightful) by Entropy on Tuesday March 20 2018, @01:07PM (26 children)
No one likes being in pain. Be it physical, emotional, or whatever. People are always going to use drugs, be it for curing the terrible pain of cancer or whatever emotional pain they may be enduring. This nonsense that opiates or whatever drugs are responsible for some doom and gloom is a fantasy: It's the very laws that make them illegal doing the harm. Otherwise people could enjoy whatever flavor of drug they prefer in relative safety for themselves and everyone else.
(Score: 0) by Anonymous Coward on Tuesday March 20 2018, @01:41PM (9 children)
Pain in is nature’s way of telling you to stop being stupid.
I live with pain daily. Just got of surgery, morphine drips I do not use. Opioids I have a prescription that script goes directly into the shrewder.
Do I like pain? No. Do I accept pain pain in my life? Yes
(Score: 0, Troll) by Anonymous Coward on Tuesday March 20 2018, @01:46PM (5 children)
If you understand the source of your pain, then it's stupid to continue feeling it.
What's the point of having a complex brain if you rely solely on base animal stimuli?
(Score: 3, Insightful) by The Mighty Buzzard on Tuesday March 20 2018, @02:01PM (4 children)
On the contrary, if you don't have to continue feeling it you have no motivation to change whatever is causing it. There's a reason religion is called the opiate of the masses and it is not because opiates are a good thing.
My rights don't end where your fear begins.
(Score: 3, Insightful) by Anonymous Coward on Tuesday March 20 2018, @02:08PM (3 children)
It's right in the subject line, you illiterate fool.
(Score: 0) by Anonymous Coward on Tuesday March 20 2018, @07:12PM (2 children)
You can use hypnosis to disassociate from most levels of pain. Of course higher levels of pain require more practice with hypnosis, but it's doable with no negative side effects. If the pain is still too much, you can kill the nerve if it isn't part of your brain.
(Score: 0) by Anonymous Coward on Tuesday March 20 2018, @11:49PM (1 child)
...you've never been in serious physical pain, have you?
(Score: 0) by Anonymous Coward on Thursday March 22 2018, @04:51AM
People get operated on under only hypnosis instead of being put to sleep. I've never had a cluster headache. These aren't absolutes. You can use hypnosis to lessen the pain then take a lighter pain killer. Of course you do need to be skilled at hypnosis, which may be difficult to do if you're already in pain when you start.
(Score: 2) by driverless on Tuesday March 20 2018, @09:56PM
So do I, unfortunately. Fortunately I can get away from Windows 10 outside working hours and on weekends, so there's some respite without having to resort to opioids.
(Score: 0) by Anonymous Coward on Tuesday March 20 2018, @10:46PM
Yes. All life is suffering. One must extinguish desire and embrace your buddha nature.
(Score: 2) by hendrikboom on Wednesday March 21 2018, @02:06AM
Some forms of pain interfere with healing. There's more to the morphine drip than just making you comfortable. When recovering from back surgery, I was given a morphine pump and told if it hurts, press the button. I did, and it stopped hurting soon and I did not become addicted, Precise dosage seems to be part of the solution.
(Score: 4, Touché) by Anonymous Coward on Tuesday March 20 2018, @01:43PM (1 child)
You act like the U.S. is a society founded on the protection of individual rights. Next you'll be telling me that chief among these are the rights to Life, Liberty, and the Pursuit of Happiness.
Crackpot.
(Score: 1, Funny) by Anonymous Coward on Tuesday March 20 2018, @08:38PM
The ability to pursue profits seems to be well enshrined here.
(Score: 5, Insightful) by Runaway1956 on Tuesday March 20 2018, @02:29PM (9 children)
Sorry, Entropy, but I don't think you *really* understand what has been happening.
You're right, of course, pain sucks. But there are many levels of pain. In fact, there are many different kinds of pain. Some stuff - you maybe need an aspirin. Other things, maybe prescription strength Ibuprofen. Something hurting a lot worse maybe requires a Tylenol 3. Opioids should be reserved for something a lot worse than a toothache, or a sprained ankle, or a hangnail.
Yet, doctors have been rescribing opioids frivolously.
No one is going to convince me that the profit motive played no part in all of this. "If I prescribe just 1000 more pills, I get a free pleasure cruise in the Caribbean!" Or, in the doctor's case in the story, a couple hundred thousand dollars.
That is out and out drug pushing, FFS. The patient's health and welfare take second place to making some easy money. The more drugs we push, the more money we make - and the cops WILL NOT bust you!
(Score: 2) by Entropy on Tuesday March 20 2018, @02:48PM (2 children)
I simply disagree. As long as someone is under a doctor's supervision they can use opiates for whatever medical reason it's deemed necessary. I don't think people should have to endure pain, and Tylenol is honestly kinda useless.
(Score: 0) by Anonymous Coward on Tuesday March 20 2018, @06:40PM
Absolutely! You should take paracetamol instead!
Geez! Some people. I tell ya!
(Score: 2) by Fluffeh on Tuesday March 20 2018, @11:01PM
Yes, as long as the doctor is doing the right thing. This story is pointing to a lot of people who might not quite be doing the right thing. Or maybe kinda right. Or rather, not terrible... And they are getting kickbacks from it.
It's like going to a dietitian because you are fat and want to lose weight, they sort you out with a diet, it looks delicious. You stick with it for a while, but you just get fatter. Then someone says that the dietitian is getting kickbacks from farmers if they make diets with extra burgers in them. It's food right? I mean, it's not BAD for you. You still need to eat... They could have suggested more salads, but you know they get extra cash for telling you to eat burgers.
Physical pain is the body's way of saying something is wrong. I don't get why people insist on masking this important information from the body. Fix what is wrong in the body rather than just making it quiet. If the issue can't be fixed, that's another story, but a tooth ache or post surgery or even post accident - that's not cause to jump for the pain killers - that should be cause to try to understand what your body is telling you.
Here's a great article about an American who went to Germany and needed a procedure [nytimes.com] performed.
(Score: 2) by Whoever on Tuesday March 20 2018, @03:30PM (5 children)
Some recent research shows that in many cases, Tylenol works as well as opioids.
(Score: 0) by Anonymous Coward on Tuesday March 20 2018, @04:13PM (4 children)
Sure it does!
So does thinking happy thoughts.
(Score: 3, Informative) by takyon on Tuesday March 20 2018, @04:17PM (3 children)
https://www.npr.org/sections/health-shots/2018/03/06/590837914/opioids-dont-beat-other-medications-for-chronic-pain [npr.org]
https://dx.doi.org/10.1001/jama.2018.0899 [doi.org]
[SIG] 10/28/2017: Soylent Upgrade v14 [soylentnews.org]
(Score: 0) by Anonymous Coward on Tuesday March 20 2018, @09:07PM (2 children)
different pain call for different pain killers.
some type of pain are better treated by THC+CBD
some by a mix of paracetamol and ibuprofen
some by opiates
some by topical capsaicin
...
the problem that opiates almost always works on the first try for almost any kind of pain , it is an easy solution for an overworked MD not specializing in pain managements
(Score: 2) by captain normal on Tuesday March 20 2018, @11:35PM (1 child)
"... topical capsaicin"
I prefer to take my capsaicin as nature intended, Jalapeno, Serrano, Habinaro...cooked up in some chili or mixed in a sauce.
When life isn't going right, go left.
(Score: 2) by The Mighty Buzzard on Wednesday March 21 2018, @01:05AM
Indeed. Let can't let our cornholes become complacent in their comfort. I just set up a delayed assault upon mine with twenty mango habanero hotwings not an hour ago.
My rights don't end where your fear begins.
(Score: 4, Insightful) by insanumingenium on Tuesday March 20 2018, @04:09PM (2 children)
Now perhaps there is some missing information, perhaps all these high paid pushers are all treating client bases which actually need more drugs. I would welcome data from both sides.
But if the situation is as is suggested, that people are being prescribed in excess of need primarily for the financial benefit of their doctors, then we have a serious problem.
I do things under doctors orders that I wouldn't do otherwise, most obviously take drugs, if the doctor had anything but my well being in mind when he made those recommendations that would be a terrible breach of trust.
Also, I hope you are never close to any addicts, that would make it very hard for you to deny the very real costs of addiction.
(Score: 2) by aiwarrior on Tuesday March 20 2018, @06:26PM
> I do things under doctors orders that I wouldn't do otherwise
This! Modern medicine requires a huge amount of training and knowledge so I assume that if this person says I should take this, then that is what is best. Maybe people don't realize, but most doctors can do what would be rape, if committed by any other person. I would never submit to a prostate examine by any other living being than a doctor. This is the amount of trust people put.
Poor America. Good luck
(Score: 2) by NotSanguine on Tuesday March 20 2018, @07:09PM
One of the things I noted from TFA which isn't included in TFS is that while the data on moneys paid to physicians is from the CMS database [cms.gov] which (or at least it's supposed to) covers all physicians in the US, the prescribing data comes only from *Medicare* recipients.
While there certainly are a lot of folks on Medicare (anyone over 65), there are many, many more who have private insurance or Medicaid.
Given that older people have chronic pain issues more often than younger people, it stands to reason that physicians would prescribe more painkillers to older folks.
One of the confusing things about TFA is why someone with young children (who was interviewed for the story) would be a part of the dataset used for the study. My guess is that she wasn't. Since her doctor was one of the most highly paid by big pharma, and that same physician (based on the Medicare data) prescribes opioids more than other physicians, it seems reasonable to expect that he would do so for non-Medicare patients as well.
But that's just inference, not data. We don't have any good studies on opioid prescribing nationally, in part, because while many states require reporting of such prescriptions, not all of them do, and the data that is reported isn't uniform or normalized between state programs.
What's more, that while correlation between volume of opioid prescriptions and "consulting/speaking fees" appears to be statistically significant, correlation does not explicitly mean causation.
This is complicated by the fact that many physicians play a dual role as educators (especially since physicians are *required* to have continuing education throughout their careers) and who better to educate others than those with significant experience in a particular specialty.
All that said, based on the strong correlations, the whole thing stinks of unsavory activities by big pharma and the physicians who receive hundreds of thousands of dollars.
Perhaps a solution might be to require the AMA to host and cover *all* costs for continuing education for its members and preclude big pharma (even if they contribute to the AMA's continuing education funds) from paying physicians directly.
There are several physicians in my family and I will ask their opinions (none of them specialize in "pain management" and none of them -- yes, I checked -- get large sums from big pharma) as to how they think these issues should be handled.
No, no, you're not thinking; you're just being logical. --Niels Bohr
(Score: 2) by cmdrklarg on Tuesday March 20 2018, @06:07PM
I can't stand pain... it hurts me!
The world is full of kings and queens who blind your eyes and steal your dreams.
(Score: 1, Interesting) by Anonymous Coward on Tuesday March 20 2018, @01:54PM (5 children)
That's a very weird and strange incentive, very much illegal here in my corner of Europe.
(Score: -1, Troll) by Anonymous Coward on Tuesday March 20 2018, @02:20PM (1 child)
Pharma companies put tons of resources into not only researching new medical innovations, but also spending exorbitant resources to get a stamp of approval from nosy governmental "regulators". It's not surprising that these companies would therefore try various means to push their products in order to recoup those resources.
Meanwhile, your corner of Europe happily sits around, twiddling its thumbs, hoping for Evil Uncle Pharma to invent better medicine for your stagnant socialized health care.
(Score: 0) by Anonymous Coward on Tuesday March 20 2018, @04:53PM
"Conservative" is another word for "stagnant".
Better stagnant than disappearing past the S-bend
*flush* :-)
(Score: -1, Troll) by Anonymous Coward on Tuesday March 20 2018, @06:17PM (2 children)
Pharma companies put tons of resources into not only researching new medical innovations, but also spending exorbitant resources to get a stamp of approval from nosy governmental "regulators". It's not surprising that these companies would therefore try various means to push their products in order to recoup those resources.
Meanwhile, your corner of Europe happily sits around, twiddling its thumbs, hoping for Evil Uncle Pharma to invent better medicine for your stagnant socialized health care.
(Score: 2) by hendrikboom on Wednesday March 21 2018, @12:22AM
Saying it twice won't make it any more true.
(Score: 0) by Anonymous Coward on Wednesday March 21 2018, @10:38AM
Original AC here,
I actually know a "sales rep" for a pharma company in my corner of Europe, that did invent a bunch of medicines (the pharma co). They can go around visit all doctors to inform them on new medicines, possible alterations to reduce side-effects, ... but they can not pay those doctors! Once in a while it happens that there is some commotion about drug companies organizing events for doctors to unveil new drugs, at very exclusive resorts, all costs paid for by the pharma company. That's already controversial enough and frowned upon. (But not outright illegal)
Also, because of socialized healthcare there is a big incentive to research a bunch of things that would be on the bottom on the list without socialized healthcare. E.g. a proper cure for diabetes instead of regular treatment, prevention of disease, ...
(Score: 5, Interesting) by idiot_king on Tuesday March 20 2018, @02:00PM (34 children)
...capitalist societies incentivize professionals to behave unscrupulously???!?!?
SAY IT AIN'T SO!
Seriously though. Capitalism kills.
(Score: 2) by The Mighty Buzzard on Tuesday March 20 2018, @02:03PM (15 children)
Try anything else sometime. The corruption will be a thousand times worse, I promise you.
My rights don't end where your fear begins.
(Score: 3, Insightful) by JoeMerchant on Tuesday March 20 2018, @03:24PM (8 children)
Try transparent representative government, and similar transparency in regulated corporate activity.
No secrets. That would be novel.
🌻🌻 [google.com]
(Score: 2) by The Mighty Buzzard on Tuesday March 20 2018, @03:59PM (7 children)
Good luck with that. It's not in the best interests of the ones in charge, so it's never going to exist.
My rights don't end where your fear begins.
(Score: 2) by JoeMerchant on Tuesday March 20 2018, @04:15PM (6 children)
That's why we have to reframe the concept of who's in charge. With democratically elected government, the change is theoretically possible.
🌻🌻 [google.com]
(Score: 2) by The Mighty Buzzard on Tuesday March 20 2018, @04:50PM (5 children)
The key words there are "in theory". In practice it's always a choice between a giant douche and a turd sandwich.
My rights don't end where your fear begins.
(Score: 2) by JoeMerchant on Tuesday March 20 2018, @06:45PM (4 children)
Hey, in 2016 we had a nutso commie option to the giant douche - and we almost got him.
🌻🌻 [google.com]
(Score: 2) by The Mighty Buzzard on Tuesday March 20 2018, @09:56PM (3 children)
Politician who owns three fairly expensive houses telling the poor that he'll take all those evil rich people's money and give it to them? He's well within tolerance for giant douchehood.
My rights don't end where your fear begins.
(Score: 2) by JoeMerchant on Wednesday March 21 2018, @12:12AM (2 children)
O.K. - you have to look at relative merit within the system we've got. None of the other douches are even talking about shrinking the gap. Just because a man has three houses doesn't mean he believes he should get 5 more in exchange for 10 poor families being evicted.
🌻🌻 [google.com]
(Score: 2) by The Mighty Buzzard on Wednesday March 21 2018, @01:08AM (1 child)
True but it does mean he believes it is right that he have a second and third home while others go without one at all. If he believes any of the things he said in his campaign, he is a hypocrite of homeric stature.
My rights don't end where your fear begins.
(Score: 2) by JoeMerchant on Wednesday March 21 2018, @03:12AM
Homer's times were too humble to have hypocrites even approaching the magnitude we do today.
To move in the circles of power, you have to be one of them. We are not going to be saved by Ghandi here. It doesn't make him a good man through and through, but it doesn't mean he can't or won't help to improve things for a lot of people.
Personally, I'd like to see Warren Buffet get off his ass, stop throwing around vaguely concerned remarks and start actually doing something to improve the unfairness he continues to exploit. Maybe he could back the next Bernie in 2020.
🌻🌻 [google.com]
(Score: 0) by Anonymous Coward on Tuesday March 20 2018, @06:34PM (5 children)
You have no idea what you are talking about. You haven't lived in any other society but the United States of North America. I'll bet that between maintaining this site and fishing you spend most of your time listening to Lush Rimjob and watching Faux News.
(Score: 1, Redundant) by The Mighty Buzzard on Tuesday March 20 2018, @10:10PM (4 children)
Yes, it's utterly impossible to know what you're talking about without actually going to every country in the world. Dipshit.
Oh, and you'd lose that bet. For starters, I'm not remotely what any sane person could consider right-wing; I'm a whole lot closer to an anarchist than I am to either wing. Continuing, the only talking heads I listen to are these [youtube.com]. Finally, I rarely even think about politics unless I'm trying to educate fools on SN.
My rights don't end where your fear begins.
(Score: 3, Informative) by NotSanguine on Tuesday March 20 2018, @11:00PM (3 children)
That's a good one Buzzard, although I'd think you'd be more partial to this one [youtube.com] or this one [youtube.com] Those are good too, although I've always been partial to this one [youtube.com] and this one [youtube.com].
All in all, they're much better than other types of talking heads. :)
No, no, you're not thinking; you're just being logical. --Niels Bohr
(Score: 2) by The Mighty Buzzard on Wednesday March 21 2018, @01:10AM (2 children)
All worthy as well. I just like watching John Goodman in the video is why I picked the one I did. He's a funny guy.
My rights don't end where your fear begins.
(Score: 2) by NotSanguine on Wednesday March 21 2018, @03:23AM (1 child)
Works for me.
It may not be your cup of tea, but in the same vein, I also enjoy Paul Simon's You Can Call Me Al [youtube.com] as Chevy Chase is *quite* amusing. :)
No, no, you're not thinking; you're just being logical. --Niels Bohr
(Score: 2) by The Mighty Buzzard on Wednesday March 21 2018, @10:55AM
Ditto and a good tune to start the morning.
My rights don't end where your fear begins.
(Score: 1, Insightful) by Anonymous Coward on Tuesday March 20 2018, @02:06PM (7 children)
What kills is authoritarianism.
If you want your society to work (including a socialist society), then you must build that society atop capitalism; authoritarianism cannot create a free society, only harm it.
(Score: 2) by fritsd on Tuesday March 20 2018, @05:04PM (6 children)
Please take a look at the "political compass": https://www.politicalcompass.org/ [politicalcompass.org]
A 2-D representation, with 2 axes "economic left to economic right" and "social libertarian to authoritarian", makes political descriptions a lot better understandable.
I think that you meant: stay away from rigid dogmatic authoritarianism ("Marijuana is verboten, because then we have a lever that we can push you around with if someone says that you ever smoked it in the last 25 years").
And then you can still choose on the left-right economic dimension, between libertarian left and capitalist libertarian right, the difference being who pays for your Marijuana.
Correct me if I'm wrong.
(Score: 3, Informative) by NotSanguine on Tuesday March 20 2018, @05:22PM
Yes. Please do. I found it to be quite interesting.
It allows you to compare various well known figures as well as your own views.
For example, here's my result:
https://www.politicalcompass.org/yourpoliticalcompass?ec=-5.75&soc=-6.62 [politicalcompass.org]
I think that some of you might be surprised at how you are rated, but many of you won't be. I certainly wasn't surprised at my result.
Alternatively (and way off-topic, not to mention very NSFW) you might be surprised at your ratings here [bdsmtest.org].
Oh, and you're welcome!
No, no, you're not thinking; you're just being logical. --Niels Bohr
(Score: 0) by Anonymous Coward on Tuesday March 20 2018, @06:28PM (4 children)
You're making a distinction where you can't make one, because everything is economics.
What you call "rigid dogmatic authoritarianism" is only possible if one ignores the principles of capitalism; it requires the would-be authoritarian to deny the property rights of other people, and thus would require the would-be authoritarian to reject capitalism.
Put another way, this is not capitalism: "We've decided you have to help pay for Karl's marijuana; if you refuse, we're going to throw you into a cage."
If you want socialism to work, you have to build it within a framework of voluntary contracts; the fundamental philosophy is capitalism.
(Score: 3, Insightful) by pipedwho on Tuesday March 20 2018, @09:51PM (3 children)
The problem is that capitalism can't exist in the absence of authoritarianism. Capitalism tends towards monopolies and rent seeking behaviour. Eventually, you end up having to enforce all that property you own (and want to control) so the renting class must pay you to use your otherwise unusable property. For things that are necessities, such as food and shelter, people will pay whatever it takes, up to a point where they will give up and just pay nothing. At that point, you need to come in with your authoritarian jack boots and rough them up until they pay 'that last drop of blood from the stone' again. This goes on and on, and as the class gap increases, those with the capital must maintain even more authority and control over those at the bottom, without the jack boots they have no control over their 'assets'.
If you completely remove authoritarian government enforcement of 'property' rights, then you either end up with private armies, and people just taking whatever they want. Think warlords and feudalism.
Capitalism needs to be a constrained subset of governance, along with some amount of authority, and some amount of liberty. With democracy people can theoretically decide how this balance is set. At present the marketing arms of the D and R parties in the US seem to be heavily biased towards increased authority - and that is almost definitely a direct result of capitalist behaviour influencing the decision making process. If everything is for sale, they why not a few unjust laws or regulations?
(Score: 0) by Anonymous Coward on Tuesday March 20 2018, @10:52PM (2 children)
Your response reduces to this sentence:
Voluntary interaction depends on involuntary interaction.
Clearly, that is a contradiction.
(Score: 2) by MostCynical on Wednesday March 21 2018, @12:29AM (1 child)
How about
"Voluntary interaction requires enforcement", so, when one party decides to gyp the other, there is some third party available to both rule on any infringement, arbitrate, and possibly sanction. Such sanctions require force. Oh look, you've created government, judges, and police.
"I guess once you start doubting, there's no end to it." -Batou, Ghost in the Shell: Stand Alone Complex
(Score: 0) by Anonymous Coward on Wednesday March 21 2018, @02:59AM
The mechanism of a contract's enforcement is necessarily part of the contract; there has already been agreement to such enforcement and thus such enforcement is by definition voluntary.
Your "government, judges, and police" are not implied; certainly, it is not implied that those kinds of services need be rendered by a violently imposed monopoly.
Get it yet?
(Score: 2) by KiloByte on Tuesday March 20 2018, @02:18PM (6 children)
I see you haven't lived in a socialist (with a big S) country, have you? Your comparison of the level of corruption between Socialist People's Republic of Anything vs capitalist societies is wrong by so many orders of magnitude it's mind-boggling. The country I live in was one of these until recently, and is transitioning to a form of theocratic national communism as we speak.
Currently, every single country I'd call civilized is capitalist. Not every capitalist country is civilized, though, and enforcement of corruption laws varies (in one case even including outright "campaign donations"), but compared to alternatives such as communism or feudalism, capitalism at least sometimes works.
Ceterum censeo systemd esse delendam.
(Score: 3, Interesting) by JoeMerchant on Tuesday March 20 2018, @03:26PM (5 children)
Socialism got a bad rap in the Eastern Bloc. Goons, guns, and gulag garbage in, what did you expect to come out of any revolution driven by that?
I kinda like how socialism is playing out in Scandinavia.
🌻🌻 [google.com]
(Score: 2) by KiloByte on Tuesday March 20 2018, @03:39PM (1 child)
FYI: we weren't allowed to own guns. Just like in Jews in Germany, and people in most if not all similar dictatorships.
Ceterum censeo systemd esse delendam.
(Score: 2) by JoeMerchant on Tuesday March 20 2018, @03:54PM
This is the one redeeming value of the US second amendment. The people in control of the socialist revolution did have guns, didn't they?
🌻🌻 [google.com]
(Score: 2) by maxwell demon on Tuesday March 20 2018, @05:16PM (2 children)
They did rap music in the Eastern Bloc?
The Tao of math: The numbers you can count are not the real numbers.
(Score: 1) by fritsd on Tuesday March 20 2018, @05:45PM
Yat-Kha [youtube.com]? Dunno if that counts as rap exactly...
(Score: 2) by JoeMerchant on Tuesday March 20 2018, @06:48PM
Bad rap [youtu.be].
🌻🌻 [google.com]
(Score: 0) by Anonymous Coward on Tuesday March 20 2018, @02:51PM (1 child)
Go back to Venezuela, you'll like it there, no capitalism at all.
(Score: 0) by Anonymous Coward on Tuesday March 20 2018, @07:11PM
But it certainly is not truly socialist.
(Score: 0) by Anonymous Coward on Tuesday March 20 2018, @03:28PM
So are you saying in Commie countries the incentive to behave unscrupulously is NOT financial? Than what is it...
I mean I know in places like Romania people stole from work whatever they could, and it wasn't because they could profit from it (like imagine stealing 10 paperclips every day), so maybe you are right, but why!?
(Score: 4, Informative) by NotSanguine on Tuesday March 20 2018, @02:01PM (15 children)
There's quite a bit quoted material and references to several studies and interviews.
However, there are zero links to the studies, the data associated with those studies or the interviews from which people are quoted.
Sure the information in TFS seems legit, but I'd like to dig a little deeper. Except I can't because there is NO TFA to back up the statements in TFS.
TFS has interesting information and makes significant claims. But there are no attributions whatsoever. From where was this sourced? USA Today? The Guardian? The Denver Post? Breitbart? RT? The Manila Bulletin?
I'd point out that the TFS is pretty much the same as the original submission [soylentnews.org]. Neither has any links to the quoted material.
Was this an oversight, or is SoylentNews moving to an attribution-free format?
No, no, you're not thinking; you're just being logical. --Niels Bohr
(Score: 2) by The Mighty Buzzard on Tuesday March 20 2018, @02:05PM (3 children)
If only we had an editor around to fix these things...
My rights don't end where your fear begins.
(Score: 2) by NotSanguine on Tuesday March 20 2018, @02:12PM (2 children)
Unfortunately, that wouldn't have made a difference in this case, as the original submission [soylentnews.org] had no such information.
No, no, you're not thinking; you're just being logical. --Niels Bohr
(Score: 3, Touché) by The Mighty Buzzard on Tuesday March 20 2018, @04:11PM (1 child)
Quit messing up my perfectly good zingers with your damned Vulcan logic.
My rights don't end where your fear begins.
(Score: 2) by NotSanguine on Tuesday March 20 2018, @05:08PM
There is a multi-legged creature crawling on your shoulder. May I kill it?
No, no, you're not thinking; you're just being logical. --Niels Bohr
(Score: 4, Informative) by NotSanguine on Tuesday March 20 2018, @02:11PM
One of the major reasons why I'm pushing on this is because AFAIK, there is no national controlled-substance prescription monitoring program [usdoj.gov]. And most, but not all states have such programs.
One can certainly get data about payments to physicians from pharmaceutical companies [cms.gov].
I'd love to see where the studies cited sourced their data. But I can't, because there are no TFAs, no links to the studies themselves or any corroborating information. At all.
Again I ask: WTF?
No, no, you're not thinking; you're just being logical. --Niels Bohr
(Score: 3, Informative) by cocaine overdose on Tuesday March 20 2018, @02:11PM (4 children)
(Score: 2) by NotSanguine on Tuesday March 20 2018, @02:17PM (3 children)
Thank you. I look forward to reading the article. I appreciate you submitting this.
This
https://www.cnn.com/2018/03/11/health/prescription-opioid-payments-eprise/index.html [cnn.com]
was exactly what I was looking for.
Please note that the above link has autoplay video (assholes!).
No, no, you're not thinking; you're just being logical. --Niels Bohr
(Score: 2) by bzipitidoo on Tuesday March 20 2018, @02:35PM (1 child)
Firefox is better than Chrome at stopping autoplay, though the control is buried in about:config, instead of being easily accessible in the settings/options/preferences dialogs. Set media.autoplay.enabled to false. That takes care of HTML5 video. As for Flash, starting in Firefox 57, they stopped autoplay of that by making no play the default, and now the user has click on this little brick icon they added to the URL bar whenever Flash is detected, to pop up a menu that asks if you want to play Flash videos from that site.
Chrome's options to disable autoplay don't work on an awful lot of web sites.
(Score: 2) by NotSanguine on Tuesday March 20 2018, @05:14PM
I am aware of this.
Thanks for posting the instructions anyway.
Truth be told, I just wanted to vent about assholes who think autoplay video is a good idea.
No, no, you're not thinking; you're just being logical. --Niels Bohr
(Score: 3, Insightful) by Runaway1956 on Tuesday March 20 2018, @02:42PM
I have found myself in that position. Someone quotes something from out of the blue, and I wonder "Where the hell did that come from?" So, I just copy part of the relevant text, and stuff it into a search query. For, example, "Angela Cantone says she wishes she had known that opioid manufacturers were paying her doctor hundreds of thousands of dollars; it might have prompted her to question his judgment.
She says Dr. Aathirayen Thiyagarajah, a pain specialist in Greenville, South Carolina, prescribed her an opioid called Subsys for abdominal pain from Crohn's disease for nearly 2½ years, from March 2013 through July 2015." goes into DuckDuckgo.
duckduckgo.com/?q=++++Angela+Cantone+says+she+wishes+she+had+known+that+opioid+manufacturers+were+paying+her+doctor+hundreds+of+thousands+of+dollars%3B+it+might+have+prompted+her+to+question+his+judgment.++++++She+says+Dr.+Aathirayen+Thiyagarajah%2C+a+pain+specialist+in+Greenville%2C+South+Carolina%2C+prescribed+her+an+opioid+called+Subsys+for+abdominal+pain+from+Crohn's+disease+for+nearly+2½+years%2C+from+March+2013+through+July+2015.&t=ffsb&ia=web
I get a boatload of hits, 9 of which appear to contain that quote, exactly. I can't know WHICH of those 9 hits the submitter copied from - but it's reasonable to assume that he used one of them. I can now read any or all of those sources.
Yeah, I understand, and agree, that submitter *should have* included a link. However, if he doesn't make regular submissions, he probably wasn't aware that block quotes don't copy his link into the submission.
Sometimes, you just gotta go the extra mile, because the submitter thought he had already run that mile, and finished the race.
(Score: 2) by takyon on Tuesday March 20 2018, @04:24PM (4 children)
Way too much text is quoted too. I blame bytram.
Added link finally, and archive link (adblocker).
[SIG] 10/28/2017: Soylent Upgrade v14 [soylentnews.org]
(Score: 1) by cocaine overdose on Tuesday March 20 2018, @05:08PM (2 children)
(Score: 0) by Anonymous Coward on Wednesday March 21 2018, @12:47AM (1 child)
Maybe you should just cut a couple of lines every every hour or for the Eds, so they could stay awake all night doing ed stuff.
(Score: 1) by cocaine overdose on Wednesday March 21 2018, @01:02AM
(Score: 2) by NotSanguine on Tuesday March 20 2018, @05:10PM
Thanks Takyon.
It's much appreciated!
No, no, you're not thinking; you're just being logical. --Niels Bohr
(Score: 2) by All Your Lawn Are Belong To Us on Tuesday March 20 2018, @04:11PM (3 children)
Please?
This sig for rent.
(Score: 2) by All Your Lawn Are Belong To Us on Tuesday March 20 2018, @04:15PM (2 children)
My bad, sorry Cocaine Overdose - didn't see you already posted it in comments. Apologies. Saw it as soon as I looked at comments but timeout stopped me.
This sig for rent.
(Score: 1) by cocaine overdose on Tuesday March 20 2018, @05:03PM (1 child)
(Score: 2) by All Your Lawn Are Belong To Us on Tuesday March 20 2018, @07:32PM
Damn. *starts clock*
This sig for rent.