July 7, 2022 • 34 mins
A mystery that begins with the half-baked idea of an obscure California bureaucrat in the 1930’s and ends with one of the worst public crises in American history. Chicken Little said the sky was falling. And sometimes Chicken Little is right.
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Episode Transcript
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Speaker 1 (00:15):
Pushkin Hello, Hello, Revision's History listeners. I'm excited to announce
that this season I'm offering a bunch of perks from
my most loyal listeners, the ones who subscribe to Pushkin
Plus for those who just can't get enough. We're giving
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(00:37):
created many episodes released weekly, and I'm calling them tangents.
And of course you'll never hear any ads. Subscribe to
Pushkin Plus on the Revisionist History Show page in Apple
Podcasts or at pushkin FM. When I was in my
(00:58):
twenties many years ago, I was a reporter for the
Washington Post. A newsroom the size of a football field,
phones ringing, keyboards clattering, the glory days of print journalism.
I want you to describe what is the status in
position of a Washington Post reporter in Washington, DC in
(01:18):
nineteen eighty nine.
Speaker 2 (01:20):
Well, in general, godlike, because the whole city ran on
politics and news and there weren't many organizations that produced
it excellently, and the Post was sort of the place
that everyone cared about.
Speaker 1 (01:35):
That's my friend Michael Specter. He and I were both
on the Health and science speed for the Post. If
somebody cured something, discovered something, solved something, or screwed something up,
we were on it. In those days, it seemed like
everyone read everything we wrote.
Speaker 2 (01:52):
Well they did. I mean there is an exception, which
is we were in the science pod, and at least
at the Post that was considered like why would smart
people write about science when they could write about the
White House and wear yellow ties. But in general we
had big readerships, particularly in the when we wrote about
science policy.
Speaker 1 (02:17):
We sat at the center of a giant ecosystem of lobbyists, lawmakers, aids, bureaucrats,
policy wonks who tried to get us to see the
world their way. If you called someone and said you
were from the Washington Post, they called you back. I
used to listen to Michael every day on the phone
with a source on Capitol Hill.
Speaker 2 (02:36):
That individual had access to everything, but he didn't mind
ratting people out. It was like heaven. I had a
couple people like that.
Speaker 1 (02:45):
It was Heaven. I remember once where you get the
plain brown wrappers with stuff inside of it, because nothing,
of course was digital in those years, you would get
the mysterious phone call and you had to decide whether
to return it. So there's one member of this ecosystem
that I'm most interested in, ready, Sid Wolf.
Speaker 2 (03:11):
Sid Wolf. I love Sid. I loved him then, I
love him now. But you know, yeah, he is a
particular kind of guy.
Speaker 1 (03:18):
I think I was the most skeptical of Sid.
Speaker 2 (03:20):
Yeah, because you were like a right wing lunatic.
Speaker 1 (03:22):
I was a right wing wunatic, and it was a
right wing time Sidney M. Wolf MD versus me thirty
years ago, when I was a right wing lunatic. I
was different then, which I offer as at least a
small explanation from my behavior in the story. I'm about
to tell you. My name is Malcolm Gladwell. You're listening
(03:47):
to Revisionist History, my podcast about things Overlooked and Misunderstood.
This season is devoted entirely to experiments, and this episode
is about what happens when an experiment teaches us an
important lesson and we don't listen. Sidwulf came to Washington,
(04:11):
d C. In the nineteen sixties as a young doctor.
He went to work as a postgraduate fellow at the
National Institutes of Health, part of the same class as
Tony Fauci. One day in nineteen seventy one, someone told
him that half of the saline solution being supplied to
American hospitals was contaminated with bacteria. And Sid said, oh,
(04:33):
where are they going to take it off the market?
And the person said they aren't because if we do,
hospitals will run out of ivy fluid and will have
a disaster on our hands. And Sid said, that can't
be right. There have to be other sources of ivy fluid.
He did his research, found out there were other sources,
and went public, called the press, got his friend, the
(04:55):
political crusader Ralph Nader, to hold a press conference, and
the bad ivy fluid was pulled from the market. Sid
had found his calling as a consumer advocate.
Speaker 3 (05:07):
I am sick and tired of the paper attitude of
American Medical Association towards American patients patients.
Speaker 1 (05:13):
SID was unstoppable. He started something called the Public Citizens
Health Research Group and became one of the angriest voices
in Washington.
Speaker 3 (05:23):
As many of you know, our organization has now for
twenty five years, been the most outspoken critic of the FDA.
More than fifty times we've submitted petitions, sometimes resulting in
lawsuits against the agency to try and get them to
do what we think the law requires them.
Speaker 1 (05:38):
Example, in the c SPAN archives, there's practically a SID division.
Sit against the drug companies, sit against the doctors, sit
against the FDA.
Speaker 4 (05:48):
It is clear that of the seventeen years since we
have been running the Health Research Group and watching the FDA,
this is by far the worst period of time ever.
Speaker 1 (05:59):
SID didn't like anyone except those who are willing to
join him on the lonely ice flow of his sixties radicalism. Okay,
that's not fair. It's not that SID disliked people. It
was never personal for him. Sid's battle was with institutions.
SID believed that bureaucracies and companies and legislatures would behave
(06:20):
better only when constrained by the right laws, the right regulations,
and the right kind of relentless nudging from people like Sid.
He was the nudge of Washington DC.
Speaker 2 (06:33):
Sid's very smart and very colorful and a great quote.
But there's only one way in that's Sid's way. You
don't have like a deep, meaningful conversation on both sides
with SID. But some people, and he was one, were
just excellent at knowing what we needed and what we
(06:53):
wanted and how to package it. And that was Sid.
Speaker 1 (07:00):
I hadn't thought of Sidwolf in years, but then I
started reading about someone named Paul Madden, one of those
forgotten figures from the mid century. If you lived in
California in the nineteen forties, you would hear Madden from
time to time on the radio.
Speaker 5 (07:13):
Good Evening, ladies and gentlemen. There may be hotter jobs
than breaking up a narcotic brain.
Speaker 6 (07:20):
I don't know.
Speaker 5 (07:21):
I've never seen one. Especially difficult is a job of
rounding up a band of narcotic pedlars, including the brains
of the gang.
Speaker 1 (07:32):
Madden was a progressive that progressives believed that government could
fix things, that systems and regulations and rules properly written
could make the world a fair place. Progressives were activists
full of zeal. In nineteen thirty nine, Paul Madden was
(07:54):
appointed to run the California Bureau of Narcotic Enforcement. He
was the man responsible for stopping the use of illegal
drugs in the state of California, a job he tackled
with enthusiasm and his customary hyperbole. Let me quot directly
from his writing on the effects of marijuana, Madden wrote
that the user might quote believe himself so small that
(08:16):
he is afraid to step off the curbstone into the street,
or he may feel himself of enormous size and of
superhuman strength and passion, and in that condition commit crimes
altogether foreign to his nature. But because Paul Madden was
a progressive, he didn't just fulminate against a problem. He
had a whole, carefully thought out scheme for using the
(08:38):
enlightened power of government to fix it. Consider the great
fear of anti drug crusaders of that era, which was
that doctors might be driving drug addiction.
Speaker 7 (08:48):
What if the person gets the script from the doctor
and goes down and keeps some of the drugs for
himself and then sell some of the drugs on the street,
then you're going to have the problem of the initiation
of new addicts potentially if that happens.
Speaker 1 (09:04):
David Courtwright, who is America's leading historiander the drug trade,
says that people who were worried that patients could walk
into the doctor's office asking for an addictive drug like
morphine and the doctor would just give it to them.
So stading, we're a small number of doctors who are
relatively unscrupulous, who are simply writing prescriptions for maintenance, and
(09:25):
much of that drug may end up being diverted. How
would I identify the doctor who's doing that.
Speaker 7 (09:32):
So one of the things you might do is send
an informer to the doctor and he would try to
persuade Typically it was a he. He would try to
persuade the doctor to write a prescription.
Speaker 1 (09:46):
In California, Paul Madden looks at that practice of running
sting operations against shady doctors and says, that's a crude
and inefficient way of dealing with the problem. Remember, he's
a good progressive, a man who believes in systems and procedures.
So Madden decides to create a bureaucratic solution. First, Madden
(10:10):
makes a list of all the prescription painkillers that he
considers dangerously addictive morphine, opium coding, chloral hydrate, and then
he convinces the state legislature to create a new regulation
for doctors Chapter three, ARTCA one, Section one one one
six six six of the California Narcotics Act, the Madden
(10:33):
Amendment of nineteen thirty nine.
Speaker 8 (10:36):
The prescription blanks shall be printed on distinctive paper, serial
number of the book being shown on each form, and
also each form being serially numbered. Each prescription blank shall
be printed in triplicate, with one blank attached to the
book in such a manner that it will be readily removed,
while two of the blanks shall be perforated for removal.
Speaker 1 (11:00):
Meaning every time a physician prescribes one of the listed
pain killers, they have to use a special state issued
prescription pad where every prescription page comes equipped with two
additional carbon copies. To use a contemporary turn of phrase,
he wants to create a back up of every narcotic
prescription in the state. The first copy was to be
(11:23):
kept at the office of the prescribing physician for a
minimum of two years, available for scrutiny at any time
by one of Madden's team of inspectors. Copy number two
had to be kept by the pharmacist for two years.
At number three had to be mailed by the pharmacist
to the Bureau of Narcotic's head office in San Francisco.
(11:43):
A record of physician and pharmacist behavior in triplicate a
textbook example a progressive big brother in action. Now, why
did I think of Sid Wolf when I heard about
Paul Madden? Because Madden seemed to me like Sid one
point zero the nineteen thirties edition. Different context and emphasis,
(12:07):
of course, but the same place book, the same urgency,
the same relentlessness. The government needs to fix things. And
here is my twenty nine point plan to accomplish that,
which I'm forwarding over to you right now. Call me
when you get it right away. This is too big
to way.
Speaker 2 (12:24):
So you know, Sid was his hair was always on
fire about something.
Speaker 1 (12:29):
My memories of Sid is you would never know when
you would get off the phone.
Speaker 2 (12:33):
That's true, that's true. I mean I've even talked to
him recently about some stuff I've done, and he'll not
just talk to you. Then the information starts flowing. In
those days, the facts started to churn because that's how
we got stuff. But Sid was like I would go
out to lunch and if there was a pile of
fax paper on my desk, it'd be like Sid struck.
Speaker 1 (12:57):
How many forests were sacrificed to feed Sid's fax machine?
God only knows. In any case, I moved on. I
left the Washington Post and forgot all about and his fixations,
and then I heard about an experiment and it all
came flooding back.
Speaker 9 (13:31):
Once you've found the right doctor and have told him
or her about your pain. Don't be afraid to take
what they give you. Often it will be an opioid medication.
Speaker 1 (13:42):
Beginning in the late nineteen nineties, a catastrophe unfolded in
cities and towns around the United States. Opioid overdoses people
suffering a cascade of terrifying effects, pinpoint pupils, labored breathing,
respiratory arrest, choking, purple lips, loss of consciousness, and, in
(14:02):
what has now been over eight hundred thousand cases, death.
Speaker 10 (14:07):
There's no question that our best, strongest pain medicines are
the opioids. They don't wear out, they go on working,
they do not have serious medical side effects. And so
these drugs, which I repeat are our best, strongest pain medications,
should be used much more than they are for patients
in pain.
Speaker 1 (14:26):
At the heart of the crisis was a class of
new powerful painkillers that came on the market in the
nineteen nineties, especially OxyContin, launched in nineteen ninety six by
the Purdue Pharmaceutical Company. OxyContin is highly addictive, and Purdue
promoted it to doctors more heavily than any other pain
(14:46):
color in history. By two thousand and two, Purdue had
thousands of salespeople around the country pushing OxyContin. This went
on for more than a decade, until doctors were prescribing
three billion dollars worth of OxyContin a year. But even after,
(15:09):
for twenty years of the opioid epidemic, there were all
kinds of questions like was OxyContin the cause of the
overdose epidemic or just a symptom of something deeper? And
even more puzzling, why didn't opioids cause the same level
of devastation everywhere? Take Massachusetts and New York, two states
(15:30):
side by side. If you run every significant fact about
Massachusetts and New York through an algorithm, you'll find there
are almost no two states more alike, same population profile,
same basic economy, same levels of poverty, very similar rural
urban mix. You'd think they would have had similar experiences
with overdoses. They didn't. Massachusetts has had a bloodbath, New
(15:55):
York not so much. Same thing with New York and
New Jersey super similar states by any measure, So why
did New Jersey suffer so much more than its neighbor
Perdue would end up in bankruptcy courts result of multiple
lawsuits launched against them, for misleading marketing practices, and not
long ago, four economists Abbey Albert, William Evans, Ethan Lieber,
(16:19):
and David Powell realized that the mountains of internal Purdue
documents unearthed in those lawsuits might hold some answers.
Speaker 11 (16:27):
I mean, so there were hundreds and hundreds of pages
of documents, some of which was not very interesting.
Speaker 1 (16:32):
That's Abby Albert, lead author of the paper The for
them ended up publishing origins of the opioid crisis and
its enduring impacts.
Speaker 11 (16:41):
But then when we happened upon the focus group research
especially and the launch plan, that really was the basis
for a lot of what we talk about in this paper.
Speaker 1 (16:53):
Buried in that mountain of documents was an internal Purdue
report on a series of focus groups that the company
held with physicians. This was in the spring of nineteen
ninety five, right before the launch of OxyContin. The focus
group report runs to almost sixty pages, and in that
long buried document, one phrase kept popping up again and again.
(17:15):
The phrase coined by Paul Madden half a century earlier,
triplicate prescriptions.
Speaker 11 (17:23):
So I had never heard of a triplicate program, and
it's not something that was being discussed in the research
on opioids.
Speaker 1 (17:31):
I mean, why would it be? Nobody really liked triplicates.
For decades, no one followed California's lead in imposing this
special requirement for prescribing painkillers. Drugmakers, of course, hated the idea,
so did doctors and state lawmakers. In the early nineteen eighties,
the state of Texas did start a Tripica program, and
(17:51):
the state Narcotics Division in Austin had to hire thirty
three data entry clerks who in the first year mailed
out twenty seven eight hundred Tripica prescription pads to doctors
around the state. The doctors then had to write a
check for seven dollars for every pad they used, mailed
check back to Austin. Use the special pad every time
(18:12):
they prescribe anything off the restricted list, keep the pink
copy in their office for two years, send the green
and the blue copy with the patient to the pharmacists, etc.
Speaker 5 (18:21):
Etc.
Speaker 1 (18:22):
I mean, triplicate was the kind of bureaucratic nitpickiness that
drives people in the medical world crazy. The few states
that did triotriplicate programs usually drop them. By the early
nineteen nineties, they were just five states with triplica programs
(18:43):
in place, California, the Pioneer Texas, which somehow managed to
stick it out, and then Illinois, Idaho, and New York,
five states with warehouses full of carbon copies of doctor's prescriptions.
Speaker 12 (18:58):
Every time you pick up that prescription pad, it was like, boy,
I'm prescribing and someone's watching me. And that's what a
lot of folks call the chilling effect.
Speaker 1 (19:07):
Linda Westilla, who teach which is at the University of
Maryland School of Pharmacy, she did her dissertation on triplicate programs.
The chilling effect she's talking about was the knowledge that
physicians in those states had that their behavior was being watched,
that there was a permanent record of every prescription they
wrote in three places on paper, not in some abstract,
(19:30):
invisible computer file up in the cloud. Presumably each physician
has got a filing cabinet in his or her office
just full of prescription forms which they're holding on to
for years. So it is a powerful psychological reminder of
the way you have handled this specific kind of medication exactly,
(19:53):
And the doctor knows that there's a corresponding filing cabinet
somewhere in the state Capitol with a team of investigators
attached who can look at every prescription and see the
name of the patient, the name of the pharmacist, and
the name of which doctor has the biggest bulging file,
a file that says, just by its size, something fishy
(20:14):
may be going on. This is exactly what Purdue Pharmaceutical
discovered when it did its focus group with doctors in
nineteen ninety five, just prior to the launch of OxyContin.
One of their sessions was in a tripicate state in Houston, Texas,
and Purdue's takeaway after meeting with a group of Houston
doctors was clear, quote the triplicate laws seemed to have
(20:36):
a dramatic effect on the product usage behavior of the physicians.
It went on. The mere thought of the government questioning
their judgment created a high level of anxiety in the
focus group room among the doctors. Prideue looked at that
high level of anxiety and asked, is it even worth
(20:58):
marketing OxyContin in tripicate states at all? Years later, Abbey
Albert's group of economists finds this long forgotten focus group report,
and they realized that stumbled on a beautiful example of
a natural experiment. Natural experiments are the economists dream. You
don't have to create a treatment group and a control
group then laboriously compare what happens to the two groups.
(21:22):
Someone else has created the experiment for you. In this case,
the someone else was Purdue. A third of the American
population lived in the triplicate states. Those states got passed
over by the Purdue marketing squads. The rest of the
(21:42):
American population lived in states without Big Brother looking over
their doctor's shoulders. They got the full Purdue treatment. If
you wanted to know how much of the opioid crisis
was caused by OxyContin, all you had to do was
compare what happened to the Tripicut states with everywhere else.
So that's what Albert did, and what she and her
(22:03):
colleagues found was that the triplicate rule was everything.
Speaker 11 (22:08):
What we found was that, in fact, the non triplicate
states had much more oxycon use per capita than the
Triplicut states, almost twice as much.
Speaker 1 (22:19):
In most years, more OxyContin means more OxyContin overdoses, and
not just that, because many of those who got addicted
to opioids with OxyContin went on to get addicted to
heroin and fentanyl.
Speaker 11 (22:34):
We see very quick increase in overdose deaths in the
non triplicate states and much slower growth in the triplicate states.
And these trends continue even twenty years after the launch.
Speaker 1 (22:48):
Let's go back to comparing outcomes in New York and Massachusetts.
New York was triplicate, Massachusetts was not. So how much
of a difference did death single requirement make the two
extra carbon copies on the New York prescription pad. Well,
if New York had Massachusetts opioid overdose rate between the
(23:09):
years two thousand and twenty nineteen, an additional twenty five
thousand New Yorkers would have died of overdoses twenty five thousand.
Not only that, it turns out that economic growth is
higher in triplicate states than nontripicate states, health outcomes of
babies are better, and violent crime is lower in triplicate states,
(23:31):
astonishingly lower as much as twenty five percent. Exactly eighty
years after Paul Madden wrote his amendment to the California
Narcotics Act, His bureaucratic nitpicking gets vindicated by social science,
and who else gets vindicated? Sidney M. Wolf, MD. In
(24:03):
the early nineteen nineties, someone in the White House wondered
what was known about the value of triplicate programs. The
requests got kicked over to the National Institute of Drug
Abuse NIDA, and NIDA rounded up everyone who might know
something about triplicates and invited them to a conference at
a hotel near its headquarters in Rockville, Maryland. So you
(24:26):
attended the symposium, yes, Linda Westilla, who had done her
dissertation on triplicates, was one of the attendees.
Speaker 12 (24:33):
I do remember the venue, and I do remember this
is really ridiculous. We couldn't have coffee.
Speaker 1 (24:38):
NIDA was very hardcore about these kinds of things.
Speaker 12 (24:42):
They wouldn't sponsor anything that had an addiction potential, including caffeine.
So at any rate, what I remember about that was
sort of the excitement of this is the first big
thing we've had about trying to control opioid use in
the United States.
Speaker 1 (25:01):
This is nineteen ninety one. OxyContin will be introduced in
nineteen ninety six, five years later, but opioid overdoses were
still high enough in those years that people were starting
to get worried about the problem.
Speaker 12 (25:13):
I was a pharmacist with a PhD. There weren't many
pharmacists with PhDs. So it was like, Wow, this is it,
and I believed in a lot of these policies.
Speaker 1 (25:23):
The pain specialist Russell Portnoy was at the Nightis symposium.
He would later do as much as anyone to promote
the aggressive use of OxyContin. He talked about the problem
of under prescribing opioids. Someone from the American Pharmaceutical Association
was there to say how strongly the industry's biggest trade
group was opposed to any kind of federally mandated triplicut requirement.
(25:46):
After all, this was nineteen ninety one. Why will we
promoting some half baked idea from nineteen thirty nine. But
here and there there were other voices. An African American
doctor who worked in a tough neighborhood in Brooklyn, Gerald
d'es said this, I wish that anyone who opposes triplicate
prescription programs could walk with me into the real world
(26:09):
where these regulations are saving lives unquote. And then at
the end of the meeting, who gets up to speak,
SID will of course, because what is Sid's great cause
In the late eighties and early nineties, it's triplicans. SID
has decided that what America needs is a national version
(26:32):
of Chapter three, Article one, Section one one one six
six six of the California Narcotics Act. Sid, how are you.
Speaker 6 (26:42):
It's been a long time.
Speaker 1 (26:45):
So when I see Sid's name in the conference proceedings,
I realized I had to talk to Sid again after
all these years, so I called him up. Sid always
answers his phone, and right away he reminds me of
how we used to run into each other in the
Adams Morgan neighborhood of Washington, d C. We once played pool.
Speaker 6 (27:02):
Together Dan's pool room. The last I wanted to Dan's you,
I couldn't walk in there because there were about ten
people change smoking, so I've never been in there again.
I think it's no longer around.
Speaker 1 (27:16):
Just hearing that voice again, that low rumble, the eyebrow
raised at Dan's pool room, brought back all kinds of memories.
I think I was nervous. Thank you for joining me.
I would like to take a walk down memory lane
with you, and I want to talk about triplicate prescriptions.
(27:40):
I know this has been an issue that occupied you
with various points in your career, but I just wanted you.
I want to start at the beginning. When did the
subject of triplicate prescriptions first come to your attention.
Speaker 6 (27:51):
I became aware of it, I would say, in the
early eighties, late seventies, something like that.
Speaker 1 (27:59):
Even back in the nineteen eighties, you are concerned about
the problems being caused by opioids, thirty years before the
current epidemic. This is something that's very much a matter
of concern for you.
Speaker 6 (28:14):
What's a matter of concern for several reasons. I would
attend FDA Advisory Committee means, and not a small number
of them had to do with opioids. And there were
already some problems with opioids in those days.
Speaker 1 (28:29):
And SID, like Paul Madden two generations before him, had
become convinced that focusing on doctors was a big part
of the solution. Let them know they were being watched
with a few file cabinets of carbon copies.
Speaker 6 (28:43):
I mean, the data which you've seen showing what happens
in a very short period of time after some of
these states implement these tripical prescription programs is astounding.
Speaker 1 (28:54):
At the night of meeting in nineteen ninety one, SID
stood up and made the case for a national triplical program.
He said, in effect, California started an experiment. New York
and Illinois and others have joined, and the results of
the experiment are clear. It works. In a perfect world,
had everyone listened to whatnot it was saying in ninety one,
(29:17):
what all you guys were saying back in ninety one,
we would have had a very different and much less
damaging opioid epidemic of the last twenty years.
Speaker 6 (29:26):
Right, there's no question about that, because it's a clear
public health problem.
Speaker 1 (29:32):
He's right. A national triplicate program would clearly have slowed
the advance of OxyContin. Eight hundred and forty one thousand
people have died of drug overdoses since the nineteen nineties.
How many of those would now be alive. In nineteen
ninety three, SID published a monograph reiterating the need to
(29:52):
get serious about opioid prescriptions. It almost certainly made its
way to the Health and science desk at the Washington Post.
Did anyone take you up on it?
Speaker 7 (30:02):
No?
Speaker 1 (30:05):
I don't know why I bring us up on because
and one of the reasons this issue interested me so
much was that in the early nineties, when you were
thinking very seriously about the importance of triplicates, the person
covering the FDA, the Health bureaucracy, and science, all those
(30:26):
kinds of medical science, and for the Washington Post was me.
Speaker 6 (30:30):
That's how we met.
Speaker 1 (30:33):
We met, But back then my sympathies did not lie
with the Sid Wolves of the world. I didn't share
Sid's belief that government could fix everything. I thought medicine
was full of trustworthy, judicious professionals who did not need
Big Brother looking over their shoulder. In my time on
the Health and Science desk at the Washington Post, I
was in my twenties, a kid too young for nuances.
(30:55):
Sid was just the guy who called me up and
wouldn't let you off the phone, and sent you so
many papers and reports and polemics that you gave up
and just threw them in the trash. Sid Wolf was
so alert to the frailty of institutions that he seemed
to me like chicken little. I'll be candid. At the time,
(31:18):
I thought you were way off to the left. I
thought you were you know, my position was much more
sympathetic to big pharma that I thought you were just
a kind of crazy sixties radical who was always who
didn't believe in drugs. Now I realize no one was
more wrong than me on this issue. I mean, hundreds
(31:40):
of thousands of people have died in this country because
we didn't pay attention to what you were saying in
nineteen ninety one.
Speaker 6 (31:47):
Well, all I can say is I certainly have been
thought by a number of other people that I'm some
sort of a sixties radical. So I do not blame
you or anyone else that thought that I was some
wild eyed.
Speaker 1 (32:04):
But said I blame myself. It is almost certainly the
case that that might ponograph you wrote about Triplica Prescriptions
was sent to me at the Washington Post. It is
almost certainly the case that I did not read it.
And it is almost certainly the case that had I
read it, and had I taken it seriously, and had
(32:24):
I called you up, and had I educated myself, and
had I written a story about it in the Washington Post,
that maybe it would have made some small difference, or.
Speaker 6 (32:32):
Even a book about it, or.
Speaker 1 (32:35):
Even a book about it. I didn't do any of
those things. In the nineteen thirties, the rest of America
dismissed what Paul Madden was saying because they thought Paul
Madden was overbearing and hysterical. In the nineteen nineties. I
dismissed what sid Wolf was saying because we thought sid
(32:58):
Wolf was overbearing and hysterical. We violated all of us
the first rule of learning from experiments, which is to
judge the message, not the messenger.
Speaker 9 (33:10):
Once you've found the right doctor and have told him
or her about your pain, don't be afraid to take
what they give you.
Speaker 1 (33:19):
Sidwolf said the sky was falling back in nineteen ninety one,
and guess what the sky fell. Revisionist History is produced
by Elvis Linton, Leeman Gesteu, and Jacob Smith, with Taly
Emlin and Harrison VJ. Choi. Our editor is Julia Barton.
(33:41):
Our executive producer is mie La Belle. Original scoring by
Luis Kira, mastering by Flon Williams, and engineering by Nina Lawrence.
Fact checking by Keishaw Williams. Our voice actor was David Glover.
I'm Malcolm Glava. Well, thank you so much. This has
(34:03):
been so much fun and interesting. I think I can
find that memory serves. I think I read at least
part of your monograph from the art I can say.
Speaker 6 (34:14):
The only thing I downloaded it. It's in one PDF
which i'll send you. Do I have your email address
Pushkin Hello, Hello, Revision's History listeners. I'm excited to announce
that this season I'm offering a bunch of perks from
my most loyal listeners, the ones who subscribe to Pushkin
Plus for those who just can't get enough. We're giving
every episode to our subscribers one week early. Plus We've
(00:37):
created many episodes released weekly, and I'm calling them tangents.
And of course you'll never hear any ads. Subscribe to
Pushkin Plus on the Revisionist History Show page in Apple
Podcasts or at pushkin FM. When I was in my
(00:58):
twenties many years ago, I was a reporter for the
Washington Post. A newsroom the size of a football field,
phones ringing, keyboards clattering, the glory days of print journalism.
I want you to describe what is the status in
position of a Washington Post reporter in Washington, DC in
(01:18):
nineteen eighty nine.
Speaker 2 (01:20):
Well, in general, godlike, because the whole city ran on
politics and news and there weren't many organizations that produced
it excellently, and the Post was sort of the place
that everyone cared about.
Speaker 1 (01:35):
That's my friend Michael Specter. He and I were both
on the Health and science speed for the Post. If
somebody cured something, discovered something, solved something, or screwed something up,
we were on it. In those days, it seemed like
everyone read everything we wrote.
Speaker 2 (01:52):
Well they did. I mean there is an exception, which
is we were in the science pod, and at least
at the Post that was considered like why would smart
people write about science when they could write about the
White House and wear yellow ties. But in general we
had big readerships, particularly in the when we wrote about
science policy.
Speaker 1 (02:17):
We sat at the center of a giant ecosystem of lobbyists, lawmakers, aids, bureaucrats,
policy wonks who tried to get us to see the
world their way. If you called someone and said you
were from the Washington Post, they called you back. I
used to listen to Michael every day on the phone
with a source on Capitol Hill.
Speaker 2 (02:36):
That individual had access to everything, but he didn't mind
ratting people out. It was like heaven. I had a
couple people like that.
Speaker 1 (02:45):
It was Heaven. I remember once where you get the
plain brown wrappers with stuff inside of it, because nothing,
of course was digital in those years, you would get
the mysterious phone call and you had to decide whether
to return it. So there's one member of this ecosystem
that I'm most interested in, ready, Sid Wolf.
Speaker 2 (03:11):
Sid Wolf. I love Sid. I loved him then, I
love him now. But you know, yeah, he is a
particular kind of guy.
Speaker 1 (03:18):
I think I was the most skeptical of Sid.
Speaker 2 (03:20):
Yeah, because you were like a right wing lunatic.
Speaker 1 (03:22):
I was a right wing wunatic, and it was a
right wing time Sidney M. Wolf MD versus me thirty
years ago, when I was a right wing lunatic. I
was different then, which I offer as at least a
small explanation from my behavior in the story. I'm about
to tell you. My name is Malcolm Gladwell. You're listening
(03:47):
to Revisionist History, my podcast about things Overlooked and Misunderstood.
This season is devoted entirely to experiments, and this episode
is about what happens when an experiment teaches us an
important lesson and we don't listen. Sidwulf came to Washington,
(04:11):
d C. In the nineteen sixties as a young doctor.
He went to work as a postgraduate fellow at the
National Institutes of Health, part of the same class as
Tony Fauci. One day in nineteen seventy one, someone told
him that half of the saline solution being supplied to
American hospitals was contaminated with bacteria. And Sid said, oh,
(04:33):
where are they going to take it off the market?
And the person said they aren't because if we do,
hospitals will run out of ivy fluid and will have
a disaster on our hands. And Sid said, that can't
be right. There have to be other sources of ivy fluid.
He did his research, found out there were other sources,
and went public, called the press, got his friend, the
(04:55):
political crusader Ralph Nader, to hold a press conference, and
the bad ivy fluid was pulled from the market. Sid
had found his calling as a consumer advocate.
Speaker 3 (05:07):
I am sick and tired of the paper attitude of
American Medical Association towards American patients patients.
Speaker 1 (05:13):
SID was unstoppable. He started something called the Public Citizens
Health Research Group and became one of the angriest voices
in Washington.
Speaker 3 (05:23):
As many of you know, our organization has now for
twenty five years, been the most outspoken critic of the FDA.
More than fifty times we've submitted petitions, sometimes resulting in
lawsuits against the agency to try and get them to
do what we think the law requires them.
Speaker 1 (05:38):
Example, in the c SPAN archives, there's practically a SID division.
Sit against the drug companies, sit against the doctors, sit
against the FDA.
Speaker 4 (05:48):
It is clear that of the seventeen years since we
have been running the Health Research Group and watching the FDA,
this is by far the worst period of time ever.
Speaker 1 (05:59):
SID didn't like anyone except those who are willing to
join him on the lonely ice flow of his sixties radicalism. Okay,
that's not fair. It's not that SID disliked people. It
was never personal for him. Sid's battle was with institutions.
SID believed that bureaucracies and companies and legislatures would behave
(06:20):
better only when constrained by the right laws, the right regulations,
and the right kind of relentless nudging from people like Sid.
He was the nudge of Washington DC.
Speaker 2 (06:33):
Sid's very smart and very colorful and a great quote.
But there's only one way in that's Sid's way. You
don't have like a deep, meaningful conversation on both sides
with SID. But some people, and he was one, were
just excellent at knowing what we needed and what we
(06:53):
wanted and how to package it. And that was Sid.
Speaker 1 (07:00):
I hadn't thought of Sidwolf in years, but then I
started reading about someone named Paul Madden, one of those
forgotten figures from the mid century. If you lived in
California in the nineteen forties, you would hear Madden from
time to time on the radio.
Speaker 5 (07:13):
Good Evening, ladies and gentlemen. There may be hotter jobs
than breaking up a narcotic brain.
Speaker 6 (07:20):
I don't know.
Speaker 5 (07:21):
I've never seen one. Especially difficult is a job of
rounding up a band of narcotic pedlars, including the brains
of the gang.
Speaker 1 (07:32):
Madden was a progressive that progressives believed that government could
fix things, that systems and regulations and rules properly written
could make the world a fair place. Progressives were activists
full of zeal. In nineteen thirty nine, Paul Madden was
(07:54):
appointed to run the California Bureau of Narcotic Enforcement. He
was the man responsible for stopping the use of illegal
drugs in the state of California, a job he tackled
with enthusiasm and his customary hyperbole. Let me quot directly
from his writing on the effects of marijuana, Madden wrote
that the user might quote believe himself so small that
(08:16):
he is afraid to step off the curbstone into the street,
or he may feel himself of enormous size and of
superhuman strength and passion, and in that condition commit crimes
altogether foreign to his nature. But because Paul Madden was
a progressive, he didn't just fulminate against a problem. He
had a whole, carefully thought out scheme for using the
(08:38):
enlightened power of government to fix it. Consider the great
fear of anti drug crusaders of that era, which was
that doctors might be driving drug addiction.
Speaker 7 (08:48):
What if the person gets the script from the doctor
and goes down and keeps some of the drugs for
himself and then sell some of the drugs on the street,
then you're going to have the problem of the initiation
of new addicts potentially if that happens.
Speaker 1 (09:04):
David Courtwright, who is America's leading historiander the drug trade,
says that people who were worried that patients could walk
into the doctor's office asking for an addictive drug like
morphine and the doctor would just give it to them.
So stading, we're a small number of doctors who are
relatively unscrupulous, who are simply writing prescriptions for maintenance, and
(09:25):
much of that drug may end up being diverted. How
would I identify the doctor who's doing that.
Speaker 7 (09:32):
So one of the things you might do is send
an informer to the doctor and he would try to
persuade Typically it was a he. He would try to
persuade the doctor to write a prescription.
Speaker 1 (09:46):
In California, Paul Madden looks at that practice of running
sting operations against shady doctors and says, that's a crude
and inefficient way of dealing with the problem. Remember, he's
a good progressive, a man who believes in systems and procedures.
So Madden decides to create a bureaucratic solution. First, Madden
(10:10):
makes a list of all the prescription painkillers that he
considers dangerously addictive morphine, opium coding, chloral hydrate, and then
he convinces the state legislature to create a new regulation
for doctors Chapter three, ARTCA one, Section one one one
six six six of the California Narcotics Act, the Madden
(10:33):
Amendment of nineteen thirty nine.
Speaker 8 (10:36):
The prescription blanks shall be printed on distinctive paper, serial
number of the book being shown on each form, and
also each form being serially numbered. Each prescription blank shall
be printed in triplicate, with one blank attached to the
book in such a manner that it will be readily removed,
while two of the blanks shall be perforated for removal.
Speaker 1 (11:00):
Meaning every time a physician prescribes one of the listed
pain killers, they have to use a special state issued
prescription pad where every prescription page comes equipped with two
additional carbon copies. To use a contemporary turn of phrase,
he wants to create a back up of every narcotic
prescription in the state. The first copy was to be
(11:23):
kept at the office of the prescribing physician for a
minimum of two years, available for scrutiny at any time
by one of Madden's team of inspectors. Copy number two
had to be kept by the pharmacist for two years.
At number three had to be mailed by the pharmacist
to the Bureau of Narcotic's head office in San Francisco.
(11:43):
A record of physician and pharmacist behavior in triplicate a
textbook example a progressive big brother in action. Now, why
did I think of Sid Wolf when I heard about
Paul Madden? Because Madden seemed to me like Sid one
point zero the nineteen thirties edition. Different context and emphasis,
(12:07):
of course, but the same place book, the same urgency,
the same relentlessness. The government needs to fix things. And
here is my twenty nine point plan to accomplish that,
which I'm forwarding over to you right now. Call me
when you get it right away. This is too big
to way.
Speaker 2 (12:24):
So you know, Sid was his hair was always on
fire about something.
Speaker 1 (12:29):
My memories of Sid is you would never know when
you would get off the phone.
Speaker 2 (12:33):
That's true, that's true. I mean I've even talked to
him recently about some stuff I've done, and he'll not
just talk to you. Then the information starts flowing. In
those days, the facts started to churn because that's how
we got stuff. But Sid was like I would go
out to lunch and if there was a pile of
fax paper on my desk, it'd be like Sid struck.
Speaker 1 (12:57):
How many forests were sacrificed to feed Sid's fax machine?
God only knows. In any case, I moved on. I
left the Washington Post and forgot all about and his fixations,
and then I heard about an experiment and it all
came flooding back.
Speaker 9 (13:31):
Once you've found the right doctor and have told him
or her about your pain. Don't be afraid to take
what they give you. Often it will be an opioid medication.
Speaker 1 (13:42):
Beginning in the late nineteen nineties, a catastrophe unfolded in
cities and towns around the United States. Opioid overdoses people
suffering a cascade of terrifying effects, pinpoint pupils, labored breathing,
respiratory arrest, choking, purple lips, loss of consciousness, and, in
(14:02):
what has now been over eight hundred thousand cases, death.
Speaker 10 (14:07):
There's no question that our best, strongest pain medicines are
the opioids. They don't wear out, they go on working,
they do not have serious medical side effects. And so
these drugs, which I repeat are our best, strongest pain medications,
should be used much more than they are for patients
in pain.
Speaker 1 (14:26):
At the heart of the crisis was a class of
new powerful painkillers that came on the market in the
nineteen nineties, especially OxyContin, launched in nineteen ninety six by
the Purdue Pharmaceutical Company. OxyContin is highly addictive, and Purdue
promoted it to doctors more heavily than any other pain
(14:46):
color in history. By two thousand and two, Purdue had
thousands of salespeople around the country pushing OxyContin. This went
on for more than a decade, until doctors were prescribing
three billion dollars worth of OxyContin a year. But even after,
(15:09):
for twenty years of the opioid epidemic, there were all
kinds of questions like was OxyContin the cause of the
overdose epidemic or just a symptom of something deeper? And
even more puzzling, why didn't opioids cause the same level
of devastation everywhere? Take Massachusetts and New York, two states
(15:30):
side by side. If you run every significant fact about
Massachusetts and New York through an algorithm, you'll find there
are almost no two states more alike, same population profile,
same basic economy, same levels of poverty, very similar rural
urban mix. You'd think they would have had similar experiences
with overdoses. They didn't. Massachusetts has had a bloodbath, New
(15:55):
York not so much. Same thing with New York and
New Jersey super similar states by any measure, So why
did New Jersey suffer so much more than its neighbor
Perdue would end up in bankruptcy courts result of multiple
lawsuits launched against them, for misleading marketing practices, and not
long ago, four economists Abbey Albert, William Evans, Ethan Lieber,
(16:19):
and David Powell realized that the mountains of internal Purdue
documents unearthed in those lawsuits might hold some answers.
Speaker 11 (16:27):
I mean, so there were hundreds and hundreds of pages
of documents, some of which was not very interesting.
Speaker 1 (16:32):
That's Abby Albert, lead author of the paper The for
them ended up publishing origins of the opioid crisis and
its enduring impacts.
Speaker 11 (16:41):
But then when we happened upon the focus group research
especially and the launch plan, that really was the basis
for a lot of what we talk about in this paper.
Speaker 1 (16:53):
Buried in that mountain of documents was an internal Purdue
report on a series of focus groups that the company
held with physicians. This was in the spring of nineteen
ninety five, right before the launch of OxyContin. The focus
group report runs to almost sixty pages, and in that
long buried document, one phrase kept popping up again and again.
(17:15):
The phrase coined by Paul Madden half a century earlier,
triplicate prescriptions.
Speaker 11 (17:23):
So I had never heard of a triplicate program, and
it's not something that was being discussed in the research
on opioids.
Speaker 1 (17:31):
I mean, why would it be? Nobody really liked triplicates.
For decades, no one followed California's lead in imposing this
special requirement for prescribing painkillers. Drugmakers, of course, hated the idea,
so did doctors and state lawmakers. In the early nineteen eighties,
the state of Texas did start a Tripica program, and
(17:51):
the state Narcotics Division in Austin had to hire thirty
three data entry clerks who in the first year mailed
out twenty seven eight hundred Tripica prescription pads to doctors
around the state. The doctors then had to write a
check for seven dollars for every pad they used, mailed
check back to Austin. Use the special pad every time
(18:12):
they prescribe anything off the restricted list, keep the pink
copy in their office for two years, send the green
and the blue copy with the patient to the pharmacists, etc.
Speaker 5 (18:21):
Etc.
Speaker 1 (18:22):
I mean, triplicate was the kind of bureaucratic nitpickiness that
drives people in the medical world crazy. The few states
that did triotriplicate programs usually drop them. By the early
nineteen nineties, they were just five states with triplica programs
(18:43):
in place, California, the Pioneer Texas, which somehow managed to
stick it out, and then Illinois, Idaho, and New York,
five states with warehouses full of carbon copies of doctor's prescriptions.
Speaker 12 (18:58):
Every time you pick up that prescription pad, it was like, boy,
I'm prescribing and someone's watching me. And that's what a
lot of folks call the chilling effect.
Speaker 1 (19:07):
Linda Westilla, who teach which is at the University of
Maryland School of Pharmacy, she did her dissertation on triplicate programs.
The chilling effect she's talking about was the knowledge that
physicians in those states had that their behavior was being watched,
that there was a permanent record of every prescription they
wrote in three places on paper, not in some abstract,
(19:30):
invisible computer file up in the cloud. Presumably each physician
has got a filing cabinet in his or her office
just full of prescription forms which they're holding on to
for years. So it is a powerful psychological reminder of
the way you have handled this specific kind of medication exactly,
(19:53):
And the doctor knows that there's a corresponding filing cabinet
somewhere in the state Capitol with a team of investigators
attached who can look at every prescription and see the
name of the patient, the name of the pharmacist, and
the name of which doctor has the biggest bulging file,
a file that says, just by its size, something fishy
(20:14):
may be going on. This is exactly what Purdue Pharmaceutical
discovered when it did its focus group with doctors in
nineteen ninety five, just prior to the launch of OxyContin.
One of their sessions was in a tripicate state in Houston, Texas,
and Purdue's takeaway after meeting with a group of Houston
doctors was clear, quote the triplicate laws seemed to have
(20:36):
a dramatic effect on the product usage behavior of the physicians.
It went on. The mere thought of the government questioning
their judgment created a high level of anxiety in the
focus group room among the doctors. Prideue looked at that
high level of anxiety and asked, is it even worth
(20:58):
marketing OxyContin in tripicate states at all? Years later, Abbey
Albert's group of economists finds this long forgotten focus group report,
and they realized that stumbled on a beautiful example of
a natural experiment. Natural experiments are the economists dream. You
don't have to create a treatment group and a control
group then laboriously compare what happens to the two groups.
(21:22):
Someone else has created the experiment for you. In this case,
the someone else was Purdue. A third of the American
population lived in the triplicate states. Those states got passed
over by the Purdue marketing squads. The rest of the
(21:42):
American population lived in states without Big Brother looking over
their doctor's shoulders. They got the full Purdue treatment. If
you wanted to know how much of the opioid crisis
was caused by OxyContin, all you had to do was
compare what happened to the Tripicut states with everywhere else.
So that's what Albert did, and what she and her
(22:03):
colleagues found was that the triplicate rule was everything.
Speaker 11 (22:08):
What we found was that, in fact, the non triplicate
states had much more oxycon use per capita than the
Triplicut states, almost twice as much.
Speaker 1 (22:19):
In most years, more OxyContin means more OxyContin overdoses, and
not just that, because many of those who got addicted
to opioids with OxyContin went on to get addicted to
heroin and fentanyl.
Speaker 11 (22:34):
We see very quick increase in overdose deaths in the
non triplicate states and much slower growth in the triplicate states.
And these trends continue even twenty years after the launch.
Speaker 1 (22:48):
Let's go back to comparing outcomes in New York and Massachusetts.
New York was triplicate, Massachusetts was not. So how much
of a difference did death single requirement make the two
extra carbon copies on the New York prescription pad. Well,
if New York had Massachusetts opioid overdose rate between the
(23:09):
years two thousand and twenty nineteen, an additional twenty five
thousand New Yorkers would have died of overdoses twenty five thousand.
Not only that, it turns out that economic growth is
higher in triplicate states than nontripicate states, health outcomes of
babies are better, and violent crime is lower in triplicate states,
(23:31):
astonishingly lower as much as twenty five percent. Exactly eighty
years after Paul Madden wrote his amendment to the California
Narcotics Act, His bureaucratic nitpicking gets vindicated by social science,
and who else gets vindicated? Sidney M. Wolf, MD. In
(24:03):
the early nineteen nineties, someone in the White House wondered
what was known about the value of triplicate programs. The
requests got kicked over to the National Institute of Drug
Abuse NIDA, and NIDA rounded up everyone who might know
something about triplicates and invited them to a conference at
a hotel near its headquarters in Rockville, Maryland. So you
(24:26):
attended the symposium, yes, Linda Westilla, who had done her
dissertation on triplicates, was one of the attendees.
Speaker 12 (24:33):
I do remember the venue, and I do remember this
is really ridiculous. We couldn't have coffee.
Speaker 1 (24:38):
NIDA was very hardcore about these kinds of things.
Speaker 12 (24:42):
They wouldn't sponsor anything that had an addiction potential, including caffeine.
So at any rate, what I remember about that was
sort of the excitement of this is the first big
thing we've had about trying to control opioid use in
the United States.
Speaker 1 (25:01):
This is nineteen ninety one. OxyContin will be introduced in
nineteen ninety six, five years later, but opioid overdoses were
still high enough in those years that people were starting
to get worried about the problem.
Speaker 12 (25:13):
I was a pharmacist with a PhD. There weren't many
pharmacists with PhDs. So it was like, Wow, this is it,
and I believed in a lot of these policies.
Speaker 1 (25:23):
The pain specialist Russell Portnoy was at the Nightis symposium.
He would later do as much as anyone to promote
the aggressive use of OxyContin. He talked about the problem
of under prescribing opioids. Someone from the American Pharmaceutical Association
was there to say how strongly the industry's biggest trade
group was opposed to any kind of federally mandated triplicut requirement.
(25:46):
After all, this was nineteen ninety one. Why will we
promoting some half baked idea from nineteen thirty nine. But
here and there there were other voices. An African American
doctor who worked in a tough neighborhood in Brooklyn, Gerald
d'es said this, I wish that anyone who opposes triplicate
prescription programs could walk with me into the real world
(26:09):
where these regulations are saving lives unquote. And then at
the end of the meeting, who gets up to speak,
SID will of course, because what is Sid's great cause
In the late eighties and early nineties, it's triplicans. SID
has decided that what America needs is a national version
(26:32):
of Chapter three, Article one, Section one one one six
six six of the California Narcotics Act. Sid, how are you.
Speaker 6 (26:42):
It's been a long time.
Speaker 1 (26:45):
So when I see Sid's name in the conference proceedings,
I realized I had to talk to Sid again after
all these years, so I called him up. Sid always
answers his phone, and right away he reminds me of
how we used to run into each other in the
Adams Morgan neighborhood of Washington, d C. We once played pool.
Speaker 6 (27:02):
Together Dan's pool room. The last I wanted to Dan's you,
I couldn't walk in there because there were about ten
people change smoking, so I've never been in there again.
I think it's no longer around.
Speaker 1 (27:16):
Just hearing that voice again, that low rumble, the eyebrow
raised at Dan's pool room, brought back all kinds of memories.
I think I was nervous. Thank you for joining me.
I would like to take a walk down memory lane
with you, and I want to talk about triplicate prescriptions.
(27:40):
I know this has been an issue that occupied you
with various points in your career, but I just wanted you.
I want to start at the beginning. When did the
subject of triplicate prescriptions first come to your attention.
Speaker 6 (27:51):
I became aware of it, I would say, in the
early eighties, late seventies, something like that.
Speaker 1 (27:59):
Even back in the nineteen eighties, you are concerned about
the problems being caused by opioids, thirty years before the
current epidemic. This is something that's very much a matter
of concern for you.
Speaker 6 (28:14):
What's a matter of concern for several reasons. I would
attend FDA Advisory Committee means, and not a small number
of them had to do with opioids. And there were
already some problems with opioids in those days.
Speaker 1 (28:29):
And SID, like Paul Madden two generations before him, had
become convinced that focusing on doctors was a big part
of the solution. Let them know they were being watched
with a few file cabinets of carbon copies.
Speaker 6 (28:43):
I mean, the data which you've seen showing what happens
in a very short period of time after some of
these states implement these tripical prescription programs is astounding.
Speaker 1 (28:54):
At the night of meeting in nineteen ninety one, SID
stood up and made the case for a national triplical program.
He said, in effect, California started an experiment. New York
and Illinois and others have joined, and the results of
the experiment are clear. It works. In a perfect world,
had everyone listened to whatnot it was saying in ninety one,
(29:17):
what all you guys were saying back in ninety one,
we would have had a very different and much less
damaging opioid epidemic of the last twenty years.
Speaker 6 (29:26):
Right, there's no question about that, because it's a clear
public health problem.
Speaker 1 (29:32):
He's right. A national triplicate program would clearly have slowed
the advance of OxyContin. Eight hundred and forty one thousand
people have died of drug overdoses since the nineteen nineties.
How many of those would now be alive. In nineteen
ninety three, SID published a monograph reiterating the need to
(29:52):
get serious about opioid prescriptions. It almost certainly made its
way to the Health and science desk at the Washington Post.
Did anyone take you up on it?
Speaker 7 (30:02):
No?
Speaker 1 (30:05):
I don't know why I bring us up on because
and one of the reasons this issue interested me so
much was that in the early nineties, when you were
thinking very seriously about the importance of triplicates, the person
covering the FDA, the Health bureaucracy, and science, all those
(30:26):
kinds of medical science, and for the Washington Post was me.
Speaker 6 (30:30):
That's how we met.
Speaker 1 (30:33):
We met, But back then my sympathies did not lie
with the Sid Wolves of the world. I didn't share
Sid's belief that government could fix everything. I thought medicine
was full of trustworthy, judicious professionals who did not need
Big Brother looking over their shoulder. In my time on
the Health and Science desk at the Washington Post, I
was in my twenties, a kid too young for nuances.
(30:55):
Sid was just the guy who called me up and
wouldn't let you off the phone, and sent you so
many papers and reports and polemics that you gave up
and just threw them in the trash. Sid Wolf was
so alert to the frailty of institutions that he seemed
to me like chicken little. I'll be candid. At the time,
(31:18):
I thought you were way off to the left. I
thought you were you know, my position was much more
sympathetic to big pharma that I thought you were just
a kind of crazy sixties radical who was always who
didn't believe in drugs. Now I realize no one was
more wrong than me on this issue. I mean, hundreds
(31:40):
of thousands of people have died in this country because
we didn't pay attention to what you were saying in
nineteen ninety one.
Speaker 6 (31:47):
Well, all I can say is I certainly have been
thought by a number of other people that I'm some
sort of a sixties radical. So I do not blame
you or anyone else that thought that I was some
wild eyed.
Speaker 1 (32:04):
But said I blame myself. It is almost certainly the
case that that might ponograph you wrote about Triplica Prescriptions
was sent to me at the Washington Post. It is
almost certainly the case that I did not read it.
And it is almost certainly the case that had I
read it, and had I taken it seriously, and had
(32:24):
I called you up, and had I educated myself, and
had I written a story about it in the Washington Post,
that maybe it would have made some small difference, or.
Speaker 6 (32:32):
Even a book about it, or.
Speaker 1 (32:35):
Even a book about it. I didn't do any of
those things. In the nineteen thirties, the rest of America
dismissed what Paul Madden was saying because they thought Paul
Madden was overbearing and hysterical. In the nineteen nineties. I
dismissed what sid Wolf was saying because we thought sid
(32:58):
Wolf was overbearing and hysterical. We violated all of us
the first rule of learning from experiments, which is to
judge the message, not the messenger.
Speaker 9 (33:10):
Once you've found the right doctor and have told him
or her about your pain, don't be afraid to take
what they give you.
Speaker 1 (33:19):
Sidwolf said the sky was falling back in nineteen ninety one,
and guess what the sky fell. Revisionist History is produced
by Elvis Linton, Leeman Gesteu, and Jacob Smith, with Taly
Emlin and Harrison VJ. Choi. Our editor is Julia Barton.
(33:41):
Our executive producer is mie La Belle. Original scoring by
Luis Kira, mastering by Flon Williams, and engineering by Nina Lawrence.
Fact checking by Keishaw Williams. Our voice actor was David Glover.
I'm Malcolm Glava. Well, thank you so much. This has
(34:03):
been so much fun and interesting. I think I can
find that memory serves. I think I read at least
part of your monograph from the art I can say.
Speaker 6 (34:14):
The only thing I downloaded it. It's in one PDF
which i'll send you. Do I have your email address
Host
Malcolm Gladwell
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