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The Four Ordinary People Who Took On Big Pharma

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Beth Macy writes in the NY Times:

In the beginning, there were just four: the Godfather from Philly, the Army sergeant from Georgia, the professor from California and the feisty mom from Florida.

It was the early 2000s, and they usually talked over old-school computer message boards. Occasionally they gathered in person, carrying posters of their children and middle-aged spouses — all dead from OxyContin overdoses.

Today we know just how dangerous this drug is. Purdue Pharma, the company that made OxyContin, the first extended-release opioid to be widely prescribed, may finally be held to account. Some 200,000 people have died from overdosing on prescription opioids, and around 2,000 lawsuits attempting to make opioid makers and distributors pay for the damage unleashed by careless overprescribing are wending their way through the courts. But experts predict it will take more than $100 billion to turn the crisis around, and it’s hard to feel optimistic when you know the story of how long and hard these four labored in obscurity before anyone listened to them.

The four called themselves RAPP, short for Relatives Against Purdue Pharma, and they testified at hearings, lent support at whistle-blower trials and marched outside pharmaceutical-funded physician meetings at fancy resorts. They were outgunned at every pass — by a pharma-funded phalanx of lawyers and by doctors who had become paid spokesmen for the company. One resort even turned a sprinkler on them. But they picked up new members by the week.

Their leader was Ed Bisch, an I.T. worker from Philadelphia who’d lost his 18-year-old son, Eddie, in 2001. They called him the Godfather because he’d brought them together in the first place, via his website, OxyKills, shortly after Eddie’s death.

Mr. Bisch had wanted to believe Purdue’s excuses at first. He was persuaded, even, to change the name of his message board to OxyAbuseKills, after the company approached him about softening his tone, then gave him a $10,000 grant to put toward his education efforts. “They kept blaming it on the ‘abusers,’ but finally I said, ‘Look, at least 50 percent of my emails are from relatives of peoplewho are patients who are either dead or addicted,’” Mr. Bisch recalled. “It took me a while to realize how evil this company was.”

Barbara Van Rooyan, a professor of counseling at Folsom Lake College in California until she retired in 2012, told Mr. Bisch recently that finding his website “saved my life and gave me hope that the grief could be used for some good.” Her 24-year-old son, Patrick, died after taking OxyContin at a Fourth of July party in 2004. “It’s kind of like a muscle relaxant, and it’s F.D.A.-approved, so it’s safe,” the friend told Patrick.

The following year, with support from RAPP, Ms. Van Rooyan petitioned the Food and Drug Administration to recall OxyContin until it could be reformulated to make it harder for abusers to crush or dissolve the pills for a more intense high; she also wanted the drug restricted to end-of-life care and to treatment of cancer and other severe pain. It took eight years before the F.D.A. responded by noting that Purdue had voluntarily reformulated the drug in 2010 (so that point was moot), and her restriction petition was denied.

By 2007, RAPP numbered in the hundreds. That August scores of them converged in the rain outside a tiny federal courthouse in Abingdon, Va., because they wanted “to look evil in the face,” as the Florida mother, Lee Nuss, put it. Three of Purdue’s top executives had flown in to be sentenced on misdemeanor misbranding charges. Purdue’s parent company pleaded guilty to a felony misbranding charge, admitting that for six years it had fraudulently marketed OxyContin as being less prone to abuse and having fewer narcotic side effects than competing drugs.

All four of the original members of RAPP spoke at the hearing. They knew one another so well by then that they car-pooled to Abingdon and doubled up in hotel rooms to save money. One of them, Ed Vanicky, had fed evidence to the Virginia prosecutors — including a now-infamous cassette tape of a public-relations conference in which a Purdue spokesman brushed off the problems of OxyContin in Appalachia by saying, “The fact is, these rural areas have had problems with prescription drug abuse since the Civil War.” (In other words, the hillbillies, not Purdue’s drug, were defective.)

Mr. Vanicky was an Army sergeant in 2000 when he found his 44-year-old wife, Mary Jo, in bed dead after taking OxyContin for a herniated disc. He had just returned home from a yearlong posting in Korea and had never even heard the word OxyContin until the coroner who performed his wife’s autopsy inquired about it.

As she stepped down from the Abingdon witness stand, the Florida mother, Ms. Nuss, brandished a small brass urn containing some of the ashes of her son, Randall, who was 18 when he overdosed on OxyContin. There was a metal detector in the courthouse, and her friends still can’t figure out how she managed to sneak in that urn.

In the end, the company was forced to pay some $634 million in fines. A pittance, compared to the billions it had earned on the drug.

That fine is still the largest paid by Purdue to date, and it would do nothing to slow the epidemic. Not a single executive went to jail, and none of the settlement money went to treatment. OxyContin sales surged in its aftermath, topping $2 billion in 2008.

When Purdue finally reformulated OxyContin to make it abuse-resistant, the pill-addicted switched to heroin and, later, fentanyl to keep their dopesickness at bay. Within another decade, nearly 400,000 people would be deadMore than 2.6 million Americans are now addicted.

Today, the group’s prescience is clear. But they are sad, and they are tired. They still believe the company’s owners, the Sackler family, and executives should go to jail. But more than anything, they want the judges overseeing the lawsuits to make sure Purdue and the family use their riches to guarantee Americans access to treatment.

Recent news of the company’s misdeeds — like the allegation from New York’s attorney general, Letitia James, that Sackler family members moved hundreds of millions of dollars into private or offshore accounts, paying themselves when they knew the company was already insolvent or close to it — only confirms what the four have long believed.

In March, Oklahoma settled its case against Purdue and the Sacklers for $270 million — in part because the company was contemplating filing bankruptcy, and the state feared bankruptcy claims would insulate it from paying restitution. That meant all the documents in the case would remain sealed — a fate RAPP laments because it allows the company to hide its tactics from public scrutiny, occluding the dangers of the drug. “I have been saying for years that sealing the lawsuits let them get away with murder,” Mr. Bisch said.

This summer Vanity Fair published a rare interview with David Sackler, grandson of one of the three brothers who founded Purdue Pharma, who said his family had suffered “endless castigation,” including the taunting of his 4-year-old at nursery school. With a tone-deafness reserved for people who can afford to surround themselves with sycophants, he told the writer Bethany McLean, “Look at all the good Purdue has done.”

Mr. Vanicky read the article and told me, “I bet it sucks to be a Sackler these days.” He has personally called the offices of many attorneys general to thank them for filing suit against the Sacklers and Purdue.

Now 72,  . . .

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Written by LeisureGuy

21 July 2019 at 3:27 pm

Health Insurers Make It Easy for Scammers to Steal Millions. Who Pays? You.

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Marshall Allen reports in ProPublica:

Ever since her 14-year marriage imploded in financial chaos and a protective order, Amy Lankford had kept a wary eye on her ex, David Williams.

Williams, then 51, with the beefy body of a former wrestler gone slightly to seed, was always working the angles, looking for shortcuts to success and mostly stumbling. During their marriage, Lankford had been forced to work overtime as a physical therapist when his personal training business couldn’t pay his share of the bills.

So, when Williams gave their three kids iPad Minis for Christmas in 2013, she was immediately suspicious. Where did he get that kind of money? Then one day on her son’s iPad, she noticed numbers next to the green iMessage icon indicating that new text messages were waiting. She clicked.

What she saw next made her heart pound. Somehow the iPad had become linked to her ex-husband’s personal Apple device and the messages were for him.

Most of the texts were from people setting up workouts through his personal training business, Get Fit With Dave, which he ran out of his home in Mansfield, Texas, a suburb of Fort Worth. But, oddly, they were also providing their birthdates and the group number of their health insurance plans. The people had health benefits administered by industry giants, including Aetna, Cigna and UnitedHealthcare. They were pleased to hear their health plans would now pay for their fitness workouts.

Lankford’s mind raced as she scrolled through the messages. It appeared her ex-husband was getting insurance companies to pay for his personal training services. But how could that be possible? Insurance companies pay for care that’s medically necessary, not sessions of dumbbell curls and lunges.

Insurance companies also only pay for care provided by licensed medical providers, like doctors or nurses. Williams called himself “Dr. Dave” because he had a Ph.D. in kinesiology. But he didn’t have a medical license. He wasn’t qualified to bill insurance companies. But, Lankford could see, he was doing it anyway.

As Lankford would learn, “Dr. Dave” had wrongfully obtained, with breathtaking ease, federal identification numbers that allowed him to fraudulently bill insurers as a physician for services to about 1,000 people. Then he battered the system with the bluntest of ploys: submit a deluge of out-of-network claims, confident that insurers would blindly approve a healthy percentage of them. Then, if the insurers did object, he gambled that they had scant appetite for a fight.

By the time the authorities stopped Williams, three years had passed since Lankford had discovered the text messages. In total, records show, he ran the scheme for more than four years, fraudulently billing several of the nation’s top insurance companies — United, Aetna and Cigna — for $25 million and reaping about $4 million in cash.

In response to inquiries, Williams sent a brief handwritten letter. He didn’t deny billing the insurers and defended his work, calling it an “unprecedented and beneficial opportunity to help many people.”

“My objective was to create a system of preventative medicine,” he wrote. Because of his work, “hundreds of patients” got off their prescription medication and avoided surgery.

There are a host of reasons health care costs are out-of-control and routinely top American’s list of financial worries, from unnecessary treatment and high prices to waste and fraud. Most people assume their insurance companies are tightly controlling their health care dollars. Insurers themselves boast of this on their websites.

In 2017, private insurance spending hit $1.2 trillion, according to the federal government, yet no one tracks how much is lost to fraud. Some investigators and health care experts estimate that fraud eats up 10% of all health care spending, and they know schemes abound.

Williams’ case highlights an unsettling reality about the nation’s health insurance system: It is surprisingly easy for fraudsters to gain entry, and it is shockingly difficult to convince insurance companies to stop them.

Williams’ spree also lays bare the financial incentives that drive the system: Rising health care costs boost insurers’ profits. Policing criminals eats away at them. Ultimately, losses are passed on to their clients through higher premiums and out-of-pocket fees or reduced coverage.

Insurance companies “are more focused on their bottom line than ferreting out bad actors,” said Michael Elliott, former lead attorney for the Medicare Fraud Strike Force in North Texas.

As Lankford looked at the iPad that day, she knew something else that made Williams’ romp through the health care system all the more surprising. The personal trainer had already done jail time for a similar crime, and Lankford’s father had uncovered the scheme.


Scanning her ex-husband’s texts, Lankford, then 47, knew just who to call. During the rocky end of her marriage, her dad had become the family watchdog. Jim Pratte has an MBA in finance and retired after a career selling computer hardware, but even the mention of Williams flushed his face red and ratcheted up his Texas twang. His former-son-in law is the reason he underwent firearms training.

Lankford lived a few minutes away from her parents in Mansfield. She brought her dad the iPad and they pored over message after message in which Williams assured clients that their insurance would cover their workouts at no cost to them.

Lankford and Pratte, then 68, were stunned at Williams’ audacity. They were sure the companies would quickly crackdown on what appeared to be a fraudulent scheme.

Especially because Williams had a criminal record.

In early 2006, while Williams and Lankford were going through their divorce, the family computer started freezing up. Lankford asked her dad to help her recover a document. Scrolling through the hard drive, Pratte came upon a folder named “Invoices,” and he suspected it had something to do with Williams.

His soon to be ex-son-in-law had had a promising start. He’d wrestled and earned bachelor’s and master’s degrees at Boise State University, and a Ph.D. at Texas A&M University, before landing a well-paying job as a community college professor in Arlington. But the glow faded when the school suddenly fired him for reasons hidden by a confidential settlement and by Williams himself, who refused to reveal them even to his wife.

Out of a job, Williams had hustled investments from their friends to convert an old Winn-Dixie grocery store into a health club called “Doc’s Gym.” The deal fell apart and everyone lost their money. The failure was written up in the local newspaper under the headline: “What’s up with Doc’s?”

Inside the “Invoices” folder, Pratte found about a dozen bills that appeared to be from a Fort Worth nonprofit organization where his daughter and Williams took their son Jake for autism treatment. As Pratte suspected, the invoices turned out to be fake. Williams had pretended to take Jake for therapy, then created the false bills so he could pocket a cash “reimbursement” from a county agency. . .

Continue reading. There’s more. And see also:

Health Insurance Hustle: The Confounding Way We Pay for Care

That’s a series of stories, of which the blogged report is one.

Written by LeisureGuy

19 July 2019 at 12:02 pm

Trump claims he tried to stop the “Send her back” chant by “speaking quickly” — check the video

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Written by LeisureGuy

18 July 2019 at 5:23 pm

Animal Protein Compared to Cigarette Smoking

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Written by LeisureGuy

12 July 2019 at 4:46 pm

Cancer prevention: Caloric Restriction vs. Plant-Based Diets

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This short (4-minute) video is quite interesting:

Written by LeisureGuy

11 July 2019 at 4:09 pm

Dialing Down the Grim Reaper Gene

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Dr. Michael Greger blogs:

Only about 1 in 10,000 people live to be a 100 years old. What’s their secret? I discuss this in my video Animal Protein Compared to Cigarette Smoking.

In 1993, a major breakthrough in longevity research was published about a single genetic mutation that doubled the lifespan of a tiny roundworm. Instead of all worms being dead by 30 days, the mutants lived 60 days or longer. This lifespan extension was “the largest yet reported in any organism.” This methuselah worm, a “medical marvel,” is “the equivalent of a healthy 200-year-old human.” All because of a single mutation? That shouldn’t happen. Presumably, aging is caused by multiple processes, affected by many genes. How could knocking out a single gene double lifespan?

What is this aging gene—a gene that so speeds up aging that if it’s knocked out, the animals live twice as long? It’s been called the Grim Reaper gene and is the worm equivalent of the human insulin-like growth factor 1 (IGF-1) receptor. Mutations of that same receptor in humans may help explain why some people live to be a hundred and other people don’t.

So, is it just the luck of the draw whether we got good genes or bad ones? No, we can turn on and off the expression of these genes, depending on what we eat. Years ago I profiled a remarkable series of experiments about IGF-1, a cancer-promoting growth hormone released in excess amounts by our liver when we eat animal protein. Men and women who don’t eat meat, egg white, or dairy proteins have significantly lower levels of IGF-1 circulating within their bodies, and switching people to a plant-based diet can significantly lower IGF-1 levels within just 11 days, markedly improving the ability of women’s bloodstreams to suppress breast cancer cell growth and then kill off breast cancer cells.

Similarly, the blood serum of men on a plant-based diet suppresses prostate cancer cell growth about eight times better than before they changed their diet. However, this dramatic improvement in cancer defenses is abolished if just the amount of IGF-1 banished from their systems as a result of eating and living healthier is added back. This is one way to explain the low rates of cancer among plant-based populations: The drop in animal protein intake leads to a drop in IGF-1, which in turn leads to a drop in cancer growth. The effect is so powerful that Dr. Dean Ornish and colleagues appeared to be able to reverse the progression of early-stage prostate cancer without chemotherapy, surgery, or radiation—just a plant-based diet and lifestyle program.

When we’re kids, we need growth hormones to grow. There’s a rare genetic defect that causes severe IGF-1 deficiency, leading to a type of dwarfism. It also apparently makes you effectively cancer-proof. A study reported not a single death from cancer in about 100 individuals with IGF-1 deficiency. What about 200 individuals? None developed cancer. Most malignant tumors are covered in IGF-1 receptors, but if there’s no IGF-1 around, they may not be able to grow and spread.

This may help explain why lives appear to be cut short by eating low-carb diets. It’s not just any low-carb diet, though. Specifically, low-carb diets based on animal sources appear to be the problem, whereas vegetable-based low-carb diets were associated with a lower risk of death. But low-carb diets are high in animal fat as well as animal protein, so how do we know the saturated animal fat wasn’t killing off people and it had nothing to do with the protein? What we need is a study that follows a few thousand people and their protein intakes for 20 years or so, and sees who lives longest, who gets cancer, and who doesn’t. But, there had never been a study like that…until now.

Six thousand men and women over age 50 from across the United States were followed for 18 years, and those under age 65 with high protein intakes had a 75 percent increase in overall mortality and a fourfold increase in the risk of dying from cancer. Does it matter what type of protein? Yes. “These associations were either abolished or attenuated if the proteins were plant derived,” which makes sense given the higher IGF-1 levels in those eating excess protein.

The sponsoring university sent out a press release with a memorable opening line: “That chicken wing you’re eating could be as deadly as a cigarette.” It explained that “eating a diet rich in animal proteins during middle age makes you four times more likely to die of cancer than someone with a low-protein diet—a mortality risk factor comparable to smoking.” And when they say “low-protein diet,” what they actually mean is getting the recommended amount of protein.

“Almost everyone is going to have a cancer cell or pre-cancer cell in them at some point. The question is: Does it progress?” said one of the lead researchers. That may depend on what we eat. . .

Continue reading.

Written by LeisureGuy

11 July 2019 at 8:45 am

The Island Where People Forget to Die

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This is a golden oldie (from October 24, 2012) that is of new interest with my whole-food plant-based diet. Thanks to Joanne VR for pointing it out. Dan Buettner wrote in the NY Times Magazine:

In 1943, a Greek war veteran named Stamatis Moraitis came to the United States for treatment of a combat-mangled arm. He’d survived a gunshot wound, escaped to Turkey and eventually talked his way onto the Queen Elizabeth, then serving as a troopship, to cross the Atlantic. Moraitis settled in Port Jefferson, N.Y., an enclave of countrymen from his native island, Ikaria. He quickly landed a job doing manual labor. Later, he moved to Boynton Beach, Fla. Along the way, Moraitis married a Greek-American woman, had three children and bought a three-bedroom house and a 1951 Chevrolet.

One day in 1976, Moraitis felt short of breath. Climbing stairs was a chore; he had to quit working midday. After X-rays, his doctor concluded that Moraitis had lung cancer. As he recalls, nine other doctors confirmed the diagnosis. They gave him nine months to live. He was in his mid-60s.

Moraitis considered staying in America and seeking aggressive cancer treatment at a local hospital. That way, he could also be close to his adult children. But he decided instead to return to Ikaria, where he could be buried with his ancestors in a cemetery shaded by oak trees that overlooked the Aegean Sea. He figured a funeral in the United States would cost thousands, a traditional Ikarian one only $200, leaving more of his retirement savings for his wife, Elpiniki. Moraitis and Elpiniki moved in with his elderly parents, into a tiny, whitewashed house on two acres of stepped vineyards near Evdilos, on the north side of Ikaria. At first, he spent his days in bed, as his mother and wife tended to him. He reconnected with his faith. On Sunday mornings, he hobbled up the hill to a tiny Greek Orthodox chapel where his grandfather once served as a priest. When his childhood friends discovered that he had moved back, they started showing up every afternoon. They’d talk for hours, an activity that invariably involved a bottle or two of locally produced wine. I might as well die happy, he thought.

In the ensuing months, something strange happened. He says he started to feel stronger. One day, feeling ambitious, he planted some vegetables in the garden. He didn’t expect to live to harvest them, but he enjoyed being in the sunshine, breathing the ocean air. Elpiniki could enjoy the fresh vegetables after he was gone.

Six months came and went. Moraitis didn’t die. Instead, he reaped his garden and, feeling emboldened, cleaned up the family vineyard as well. Easing himself into the island routine, he woke up when he felt like it, worked in the vineyards until midafternoon, made himself lunch and then took a long nap. In the evenings, he often walked to the local tavern, where he played dominoes past midnight. The years passed. His health continued to improve. He added a couple of rooms to his parents’ home so his children could visit. He built up the vineyard until it produced 400 gallons of wine a year. Today, three and a half decades later, he’s 97 years old — according to an official document he disputes; he says he’s 102 — and cancer-free. He never went through chemotherapy, took drugs or sought therapy of any sort. All he did was move home to Ikaria.

I met Moraitis on Ikaria this past July during one of my visits to explore the extraordinary longevity of the island’s residents. For a decade, with support from the National Geographic Society, I’ve been organizing a study of the places where people live longest. The project grew out of studies by my partners, Dr. Gianni Pes of the University of Sassari in Italy and Dr. Michel Poulain, a Belgian demographer. In 2000, they identified a region of Sardinia’s Nuoro province as the place with the highest concentration of male centenarians in the world. As they zeroed in on a cluster of villages high in Nuoro’s mountains, they drew a boundary in blue ink on a map and began referring to the area inside as the “blue zone.” Starting in 2002, we identified three other populations around the world where people live measurably longer lives than everyone else. The world’s longest-lived women are found on the island of Okinawa. On Costa Rica’s Nicoya Peninsula, we discovered a population of 100,000 mestizos with a lower-than-normal rate of middle-age mortality. And in Loma Linda, Calif., we identified a population of Seventh-day Adventists in which most of the adherents’ life expectancy exceeded the American average by about a decade.

In 2003, I started a consulting firm to see if it was possible to take what we were learning in the field and apply it to American communities. We also continued to do research and look for other pockets of longevity, and in 2008, following a lead from a Greek researcher, we began investigating Ikaria. Poulain’s plan there was to track down survivors born between 1900 and 1920 and determine when and where individuals died. The approach was complicated by the fact that people often moved around. That meant that not only were birth and death records required, but also information on immigration and emigration.

The data collection had to be rigorous. Earlier claims about long-lived people in places like Ecuador’s Vilcabamba Valley, Pakistan’s Hunza Valley or the Caucasus Mountains of Georgia had all been debunked after researchers discovered that many residents didn’t actually know their ages. For villagers born without birth certificates, it was easy to lose track. One year they were 80; a few months later they were 82. Pretty soon they claimed to be 100. And when a town discovers that a reputation for centenarians draws tourists, who’s going to question it? Even in Ikaria, the truth has been sometimes difficult to nail down. Stories like the one about Moraitis’s miraculous recovery become instant folklore, told and retold and changed and misattributed. (Stories about Moraitis have appeared on Greek TV.) In fact, when I was doing research there in 2009, I met a different man who told me virtually the exact same story about himself.

The study would try to cut through the stories and establish the facts about Ikaria’s longevity. Before including subjects, Poulain cross-referenced birth records against baptism or military documentation. After gathering all the data, he and his colleagues at the University of Athens concluded that people on Ikaria were, in fact, reaching the age of 90 at two and a half times the rate Americans do. (Ikarian men in particular are nearly four times as likely as their American counterparts to reach 90, often in better health.) But more than that, they were also living about 8 to 10 years longer before succumbing to cancers and cardiovascular disease, and they suffered less depression and about a quarter the rate of dementia. Almost half of Americans 85 and older show signs of Alzheimer’s. (The Alzheimer’s Association estimates that dementia cost Americans some $200 billion in 2012.) On Ikaria, however, people have been managing to stay sharp to the end.

Ikaria, an island of 99 square miles and home to almost 10,000 Greek nationals, lies about 30 miles off the western coast of Turkey. Its jagged ridge of scrub-covered mountains rises steeply out of the Aegean Sea. Before the Christian era, the island was home to thick oak forests and productive vineyards. Its reputation as a health destination dates back 25 centuries, when Greeks traveled to the island to soak in the hot springs near Therma. In the 17th century, Joseph Georgirenes, the bishop of Ikaria, described its residents as proud people who slept on the ground. “The most commendable thing on this island,” he wrote, “is their air and water, both so healthful that people are very long-lived, it being an ordinary thing to see persons in it of 100 years of age.”

Seeking to learn more about the island’s reputation for long-lived residents, I called on Dr. Ilias Leriadis, one of Ikaria’s few physicians, in 2009. On an outdoor patio at his weekend house, he set a table with Kalamata olives, hummus, heavy Ikarian bread and wine. “People stay up late here,” Leriadis said. . .

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Written by LeisureGuy

11 July 2019 at 8:13 am

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