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.
If you’d like to keep up with the most recent news from this and other Pushkin podcasts, be sure to sign up for our email list at Pushkin.fm.
See omnystudio.com/listener for privacy information.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:15):
Pushkin. Hello, Hello Revisionist 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 pushkim
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 adds. Subscribe to
pushkim plus on the Revisionist History Show page in Apple
Podcasts or at pushkin dot FM. When I was in
(00:57):
my 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 print journalism. I
want you to describe what is the status in position
of a Washington Post reporter in Washington, d C. In
(01:18):
nineteen eighty nine. Well, in general, godlike, because the whole
city ran on politics in news, and there weren't many
organizations that produced it excellently. In the Post was sort
of the place that everyone cared about. That's my friend
Michael Specter. He and I were both on the health
(01:38):
and science beat for the Post. If somebody cured something,
discovered something, solve something, or screwed something up, we were
on it. In those days, it seemed like everyone read
everything we wrote. 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
(02:01):
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, we sat at the center
of a giant ecosystem of lobbyists, lawmakers, aids, bureaucrats, policy
(02:23):
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. That individual had access to everything,
but he didn't mind ratting people out. It was like heaven.
(02:44):
I had a couple of people like that. 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. Sid Wolf. I love Sid.
(03:14):
I loved him then, I love him now. But you know, yeah,
he is a particular kind of guy. I think I
was the most skeptical of Sid. Yeah, because you were
like a right wing lunatic. I was a right wing
lunatic and it was a right wing time Sidney M.
Wolf m d versus me thirty years ago, when I
was a right wing lunatic. I was different then, which
(03:36):
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 to Revisionist History, my
podcast about things overlooked and misunderstood. This season is devoted
entirely to experiments, and this episode is about what happens
(03:59):
when an experiment teaches us an important lesson and we
don't listen. Sid Wulf came to Washington, d C. In
the nineteen sixties as a young doctor. He went to
work as a post graduate fellow at the National Institutes
of Health, part of the same class as Tony Fauci.
(04:21):
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, 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
(04:42):
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 political
crusader Ralph Nader, to hold a press conference, and the
bad ivy fluid was pulled from the market. Sid had
(05:03):
found his calling as a consumer advocate. I am sick
and part of the paper ternizing attitude of the American
Medical Association towards American patients. Patient was unstoppable. Doctor. He
started something called the Public Citizens Health Research Group and
became one of the angriest voices in Washington. As many
(05:23):
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. Example, in the c
SPAN archives's practically a SID division. Sit against the drug companies,
(05:44):
sit against the doctors, sit against the FDA. 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. SID
didn't like anyone except those who were willing to join
him on the lonely ice flow of his sixties radicalism. Okay,
(06:07):
that's not fair. It's not that Sid disliked people. It
was never personal for him. Sid's battle was with institutions.
Said believed that bureaucracies and companies and legislatures would behave
better only when constrained by the right laws, the right regulations,
and the right kind of relentless nudging from people like Sid.
(06:29):
He was the nudge of Washington DC. Sid's very smart
and very colorful and a great quote. But there's only
one way in that Sid's way. You don't have like
a deep, meaningful conversation on both sides. Was Sid, but
some people, and he was one, were just excellent at
(06:51):
knowing what we needed and what we wanted and how
to package it, and that was sid I hadn't thought
of Sidwolf in years, but then I started reading about
someone named Paul Madden, one of those forgotten figures in
the mid century. If you lived in Californa in the
nineteen forties, you would hear Madden from time to time
(07:12):
on the radio. Good Evening, ladies and gentlemen. There may
be harder jobs than breaking up a narcotic rain. I
don't know. I've never seen one. Especially difficult is the
job of rounding up a band of narcotic pedlers, including
the brains of the day. Madden was a progressive that
(07:35):
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 appointed to run the California
(07:56):
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 directly from his writing on the effects of marijuana,
Madden wrote that the user might quote, believe himself so
small that he is afraid to step off the kerbstone
(08:18):
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 enlightened power of government to fix it.
(08:41):
Consider the great fear of anti drug crusaders of that era,
which was that doctors might be driving drug addiction. 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
(09:01):
of new addicts potentially if that happens. David Courtwright, who
is America's leading historian at the Drug Trade, says that
people 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 sendy were
a small number of doctors who are relatively unscrupulous, who
(09:21):
are simply writing prescriptions for maintenance, and much of that
drug may end up being diverted. How would I identify
the doctor who's doing that. 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,
(09:42):
he would try to persuade the doctor to write a prescription.
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, Article one, Section one one one
six six dot O six of the California Narcotics Act,
(10:32):
the Madden Amendment of nineteen thirty nine. 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
(10:52):
manner that it will be readily removed, while two of
the blanks shall be perforated for removal. 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.
(11:14):
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 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
(11:34):
by the pharmacist for two years. A number three had
to be mailed by the pharmacist to the Bureau of
Narcotic's head office in San Francisco. A record of physician
and pharmacist behavior in triplicate a textbook example a progressive
big brother in action. Now, why did I think of
(11:57):
sid Wulf when I heard about Paul Madden? Because Madden
seemed to me like Sid one point o the nineteen
thirties edition. Different context and emphasis, of course, but the
same play 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
(12:19):
to you right now. Call me when you get it
right away. This is too big to wait. So you
know Sid, his hair was always on fire about something.
My memories of Sid is you would never know when
you would get off the phone. 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.
(12:42):
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 in my desk,
it would be like Sid struck. How many forests were
sacrificed to feed Sid's fax machine? God only knows. In
(13:04):
any case, I moved on. I left the Washington Post
and forgot all about Sid and his fixations. And then
I heard about an experiment and it all came flooding
back Once you've found the right doctor and have told
(13:33):
him or her about your pain, don't be afraid to
take what they give you. Often it will be an
opioid medication. 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,
(13:55):
labored breathing, respiratory arrest, choking, purple lips, loss of consciousness, and,
in what has now been over eight hundred thousand cases, death.
There's no question that I 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
(14:18):
these drugs, which I repeat are our best, strongest pain medications,
should be used much more than they are for patients
and pain. At the heart of the crisis was a
class of new, powerful pain killers 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,
(14:42):
and Purdue promoted it to doctors more heavily than any
other pain kilor 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.
(15:08):
But even 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
(15:30):
states 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
(15:50):
with overdoses. They didn't. Massachusetts has had a blood bath,
New 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.
Purdue would end up in bankruptcy court result of multiple
lawsuits launched against them for misleading marketing practices, and not
(16:14):
long ago for economists Abbie Albert, William Evans, Ethan Lieber,
and David Powell realized that the mountains of internal Purdue
documents unearthed in those lawsuits might hold some answers. I mean,
so there are hundreds and hundreds of pages of documents,
some of which was not very interesting. That's Abby Albert
(16:34):
lead all through the paper. The four of them ended
up publishing origins of the opioid crisis and its enduring impacts.
But then when we happened upon the focus group researched
especially and the launch plan, that really was the basis
for a lot of what we talked about in this paper.
Buried in that mountain of documents was an internal Purdue
(16:57):
report on a series of focus groups that the company
held with physicians. This was in a 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.
The phrase coined by Paul Madden half a century earlier
(17:19):
triplicate prescriptions. So I had never heard of a triplicate program,
and it's not something that was being discussed in the
research on opioids. 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. Drug makers,
(17:43):
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 the State Narcotics Division in
Austin had to hire thirty three data entry clerks who
in the first year mailed out twenty seven thousand, eight
hundred Tica prescription pads to doctors around the state. The
(18:04):
doctors then had to write a check for seven dollars
for every pad they used, mail check back to Austin.
Use the special pad every time 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 pharmacist, etc. I mean, triplicate
was the kind of bureaucratic nit pickiness that drives people
(18:27):
in the medical world crazy. The few states that did
trio triplicate programs usually drop them by the early nineteen nineties,
they were just five states with triplica programs in place, California,
the Pioneer Texas, which somehow managed to stick it out,
(18:48):
and then Illinois, Idaho, and New York. Five states with
warehouses full of carbon copies of doctors prescriptions. 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. Linda was Stilla
who at the University of Maryland School of Pharmacy. She
(19:11):
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, invisible computer file
(19:32):
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 onto for years. So it
is a powerful psychological reminder of the way you have
handled this specific kind of medication exactly. And the doctor
(19:54):
knows that there's a corresponding filing cabinet somewhere in the
state capital 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 may be going on.
(20:15):
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 Perdue's
takeaway after meeting with a group of Houston doctors was clear,
quote the triplicate laws seemed to have a dramatic effect
(20:38):
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. Purdue looked at that high level of
anxiety and asked, is it even worth marketing OxyContin in
(21:00):
tripicate states at all? Years later, Abby Albert's group of
economists finds this long forgotten focus group report, and they
realize 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. Someone else
(21:23):
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 American
population lived in states without Big Brother looking over their
(21:46):
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 tripicate states with everywhere else. So
that's what Albert did, and what she and her colleagues
found was that the triplicate rule was everything. What we
(22:09):
found was that, in fact, the non triplicate states had
much more oxycon use per capita than the triplicate states,
almost twice as much. 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
(22:30):
to get addicted to heroin and fentanyl. 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. Let's go
back to comparing outcomes in New York and Massachusetts. New
(22:53):
York was triplicate, Massachusetts was not. So how much of
a difference to 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 years
two thousand and twenty nineteen, an additional twenty five thousand
(23:14):
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 non triplicate states, health outcomes
of babies are better, and violent crime is lower in
triplicate states, astonishingly lower as much as twenty five percent.
(23:36):
Exactly eighty years after Paul Madden wrote his amendment to
the Californian Narcotics Act, his bureaucratic nitpicking gets vindicated by
social science, and who else gets vindicated Sidney M. Wolf
m d. In the early nineteen nineties, someone in the
(24:06):
White House wondered what was known about the value triplicate programs.
The request got kicked over to the National Institute of
Drug Abuse NIDA, and NAIDA 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 attended the symposium, Yes, Linda was Stilla, who had
(24:29):
done her dissertation on triplicates, was one of the attendees.
I do remember the venue, and I do remember this
is really ridiculous. We couldn't have coffee. NAIDA was very
hardcore about these kinds of things. They wouldn't sponsor anything
that had an addiction potential, including caffeine. So diddy right.
What I remember about that was sort of the excitement
(24:53):
of this is the first big thing we've had about
trying to control opioid use in the United States. 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. I was a pharmacist with
(25:14):
a pH d. There weren't many pharmacists with pH DS,
So it was like, Wow, this is it, and I
believed in a lot of these policies. The pain specialist
Russell Portnoy was at the night, a 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
(25:39):
to say how strongly the industry's biggest trade group was
opposed to any kind of federally mandated triplicate requirement. After all,
this was nineteen ninety one. Why were 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 Ds said this,
(26:02):
I wished that anyone who opposes triplicate prescription programs could
walk with me into the real world where these regulations
are saving lives. And then at the end of the meeting,
who gets up to speak? Sid Wolf? Of course, because
(26:22):
what is Sid's great cause in the late eighties and
early nineties, it's triplicates. SID has decided that what American
needs is a national version of Chapter three, Article one,
Section one one one six six dot six of the
California Narcotics Act. Sid, how are you. It's been a
(26:42):
long time, 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 together Dan's pool room. The last time
(27:07):
in Dan's I couldn't walk in there because there were
about ten people changed smoking, So I've never been in
there again. I think it's no longer around at all.
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.
(27:30):
I would like to take a walk down memory lane
with you, and I want to talk about triplicate prescriptions.
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. I
(27:51):
became aware of it, I would say, in the early eighties,
late seventies, something like that. 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
(28:12):
very much a matter of concern for you, which a
matter of concern for several reasons. I would attend Fdadvisory
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. And SID, like Paul Madden
two generations before him, had become convinced that focusing on
(28:35):
doctors was a big part of the solution. Let them
know they were being watched with a few file cabinets
of carbon copies. 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 prescription programs is astounding.
At the NINA meeting in nineteen ninety one, SID stood
(28:58):
up and made the case for a national triplicate 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 what night it was saying in
ninety one, when all you guys were saying back in,
(29:19):
we would have had a very different and much less
damaging opioid epidemic in the last twenty years. Right, there's
no question about that, because it's a clear public health problem.
He's right. A national triplicate program would clearly have slowed
the advance of OxyContin. Eight hundred and forty one thousand
(29:41):
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
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? No? Why? I
(30:05):
don't know why I bringed us up on because I
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 replicates, the person
covering the FDA, the Health bureaucracy and science, all those
(30:26):
kinds of medical science for the Washington Post was me.
That's how we met. 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
(30:48):
my time on the Health and science desk at the
Washington Post, I was in my twenties, a kid too
young for nuances. 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.
(31:10):
Sid Wolfe was so alert to the frailty of institutions
that he seemed to me like chicken little. I'll be candid.
At the time, 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
(31:32):
was always who didn't believe in drugs. Now I realized
no one was more wrong than me on this issue.
I mean, hundreds of thousands of people have died in
this country because we didn't pay attention to what you
were saying in nineteen ninety one. Well, all I can
say is I certainly have been thought by a number
(31:52):
of other people that I'm sort of a sixties radical.
So I do not blame you or anyone else that
thought that I was some wild eyed but said, I
blame myself. It is almost certainly the case that that
monograph you wrote about Triplica prescriptions was sent to me
(32:13):
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 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 even a book
(32:33):
about it, or 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
(32:53):
nineteen nineties, I dismissed what sid Wolf was saying. Because
we thought sid 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. Once
you've found the right doctor and have told him or
her about your pain, don't be afraid to take what
(33:17):
they give you. Sidwolf said the sky was falling back
in nineteen ninety one, and guess what the sky fell.
Revisionist History is produced by Eloise Linton Leaving Gustu and
Jacob Smith, with Tali Emlyn and Harrison VJ. Choi. Our
(33:39):
editor is Julia Barton. Our executive producer is Mia la Belle.
Original scoring by Labiskara, mastering by Flawn Williams, and engineering
by Nina Lawrence. Fact checking by Kesha Williams. Our voice
actor was David Glover. I'm Malcolm glow. Well, thank you
(34:03):
so much. This has 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
thing I downloaded. It's in one PDF which i'll send you.
Do I have your email address
Pushkin. Hello, Hello Revisionist 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 pushkim
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 adds. Subscribe to
pushkim plus on the Revisionist History Show page in Apple
Podcasts or at pushkin dot FM. When I was in
(00:57):
my 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 print journalism. I
want you to describe what is the status in position
of a Washington Post reporter in Washington, d C. In
(01:18):
nineteen eighty nine. Well, in general, godlike, because the whole
city ran on politics in news, and there weren't many
organizations that produced it excellently. In the Post was sort
of the place that everyone cared about. That's my friend
Michael Specter. He and I were both on the health
(01:38):
and science beat for the Post. If somebody cured something,
discovered something, solve something, or screwed something up, we were
on it. In those days, it seemed like everyone read
everything we wrote. 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
(02:01):
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, we sat at the center
of a giant ecosystem of lobbyists, lawmakers, aids, bureaucrats, policy
(02:23):
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. That individual had access to everything,
but he didn't mind ratting people out. It was like heaven.
(02:44):
I had a couple of people like that. 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. Sid Wolf. I love Sid.
(03:14):
I loved him then, I love him now. But you know, yeah,
he is a particular kind of guy. I think I
was the most skeptical of Sid. Yeah, because you were
like a right wing lunatic. I was a right wing
lunatic and it was a right wing time Sidney M.
Wolf m d versus me thirty years ago, when I
was a right wing lunatic. I was different then, which
(03:36):
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 to Revisionist History, my
podcast about things overlooked and misunderstood. This season is devoted
entirely to experiments, and this episode is about what happens
(03:59):
when an experiment teaches us an important lesson and we
don't listen. Sid Wulf came to Washington, d C. In
the nineteen sixties as a young doctor. He went to
work as a post graduate fellow at the National Institutes
of Health, part of the same class as Tony Fauci.
(04:21):
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, 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
(04:42):
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 political
crusader Ralph Nader, to hold a press conference, and the
bad ivy fluid was pulled from the market. Sid had
(05:03):
found his calling as a consumer advocate. I am sick
and part of the paper ternizing attitude of the American
Medical Association towards American patients. Patient was unstoppable. Doctor. He
started something called the Public Citizens Health Research Group and
became one of the angriest voices in Washington. As many
(05:23):
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. Example, in the c
SPAN archives's practically a SID division. Sit against the drug companies,
(05:44):
sit against the doctors, sit against the FDA. 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. SID
didn't like anyone except those who were willing to join
him on the lonely ice flow of his sixties radicalism. Okay,
(06:07):
that's not fair. It's not that Sid disliked people. It
was never personal for him. Sid's battle was with institutions.
Said believed that bureaucracies and companies and legislatures would behave
better only when constrained by the right laws, the right regulations,
and the right kind of relentless nudging from people like Sid.
(06:29):
He was the nudge of Washington DC. Sid's very smart
and very colorful and a great quote. But there's only
one way in that Sid's way. You don't have like
a deep, meaningful conversation on both sides. Was Sid, but
some people, and he was one, were just excellent at
(06:51):
knowing what we needed and what we wanted and how
to package it, and that was sid I hadn't thought
of Sidwolf in years, but then I started reading about
someone named Paul Madden, one of those forgotten figures in
the mid century. If you lived in Californa in the
nineteen forties, you would hear Madden from time to time
(07:12):
on the radio. Good Evening, ladies and gentlemen. There may
be harder jobs than breaking up a narcotic rain. I
don't know. I've never seen one. Especially difficult is the
job of rounding up a band of narcotic pedlers, including
the brains of the day. Madden was a progressive that
(07:35):
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 appointed to run the California
(07:56):
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 directly from his writing on the effects of marijuana,
Madden wrote that the user might quote, believe himself so
small that he is afraid to step off the kerbstone
(08:18):
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 enlightened power of government to fix it.
(08:41):
Consider the great fear of anti drug crusaders of that era,
which was that doctors might be driving drug addiction. 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
(09:01):
of new addicts potentially if that happens. David Courtwright, who
is America's leading historian at the Drug Trade, says that
people 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 sendy were
a small number of doctors who are relatively unscrupulous, who
(09:21):
are simply writing prescriptions for maintenance, and much of that
drug may end up being diverted. How would I identify
the doctor who's doing that. 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,
(09:42):
he would try to persuade the doctor to write a prescription.
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, Article one, Section one one one
six six dot O six of the California Narcotics Act,
(10:32):
the Madden Amendment of nineteen thirty nine. 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
(10:52):
manner that it will be readily removed, while two of
the blanks shall be perforated for removal. 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.
(11:14):
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 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
(11:34):
by the pharmacist for two years. A number three had
to be mailed by the pharmacist to the Bureau of
Narcotic's head office in San Francisco. A record of physician
and pharmacist behavior in triplicate a textbook example a progressive
big brother in action. Now, why did I think of
(11:57):
sid Wulf when I heard about Paul Madden? Because Madden
seemed to me like Sid one point o the nineteen
thirties edition. Different context and emphasis, of course, but the
same play 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
(12:19):
to you right now. Call me when you get it
right away. This is too big to wait. So you
know Sid, his hair was always on fire about something.
My memories of Sid is you would never know when
you would get off the phone. 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.
(12:42):
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 in my desk,
it would be like Sid struck. How many forests were
sacrificed to feed Sid's fax machine? God only knows. In
(13:04):
any case, I moved on. I left the Washington Post
and forgot all about Sid and his fixations. And then
I heard about an experiment and it all came flooding
back Once you've found the right doctor and have told
(13:33):
him or her about your pain, don't be afraid to
take what they give you. Often it will be an
opioid medication. 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,
(13:55):
labored breathing, respiratory arrest, choking, purple lips, loss of consciousness, and,
in what has now been over eight hundred thousand cases, death.
There's no question that I 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
(14:18):
these drugs, which I repeat are our best, strongest pain medications,
should be used much more than they are for patients
and pain. At the heart of the crisis was a
class of new, powerful pain killers 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,
(14:42):
and Purdue promoted it to doctors more heavily than any
other pain kilor 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.
(15:08):
But even 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
(15:30):
states 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
(15:50):
with overdoses. They didn't. Massachusetts has had a blood bath,
New 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.
Purdue would end up in bankruptcy court result of multiple
lawsuits launched against them for misleading marketing practices, and not
(16:14):
long ago for economists Abbie Albert, William Evans, Ethan Lieber,
and David Powell realized that the mountains of internal Purdue
documents unearthed in those lawsuits might hold some answers. I mean,
so there are hundreds and hundreds of pages of documents,
some of which was not very interesting. That's Abby Albert
(16:34):
lead all through the paper. The four of them ended
up publishing origins of the opioid crisis and its enduring impacts.
But then when we happened upon the focus group researched
especially and the launch plan, that really was the basis
for a lot of what we talked about in this paper.
Buried in that mountain of documents was an internal Purdue
(16:57):
report on a series of focus groups that the company
held with physicians. This was in a 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.
The phrase coined by Paul Madden half a century earlier
(17:19):
triplicate prescriptions. So I had never heard of a triplicate program,
and it's not something that was being discussed in the
research on opioids. 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. Drug makers,
(17:43):
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 the State Narcotics Division in
Austin had to hire thirty three data entry clerks who
in the first year mailed out twenty seven thousand, eight
hundred Tica prescription pads to doctors around the state. The
(18:04):
doctors then had to write a check for seven dollars
for every pad they used, mail check back to Austin.
Use the special pad every time 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 pharmacist, etc. I mean, triplicate
was the kind of bureaucratic nit pickiness that drives people
(18:27):
in the medical world crazy. The few states that did
trio triplicate programs usually drop them by the early nineteen nineties,
they were just five states with triplica programs in place, California,
the Pioneer Texas, which somehow managed to stick it out,
(18:48):
and then Illinois, Idaho, and New York. Five states with
warehouses full of carbon copies of doctors prescriptions. 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. Linda was Stilla
who at the University of Maryland School of Pharmacy. She
(19:11):
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, invisible computer file
(19:32):
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 onto for years. So it
is a powerful psychological reminder of the way you have
handled this specific kind of medication exactly. And the doctor
(19:54):
knows that there's a corresponding filing cabinet somewhere in the
state capital 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 may be going on.
(20:15):
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 Perdue's
takeaway after meeting with a group of Houston doctors was clear,
quote the triplicate laws seemed to have a dramatic effect
(20:38):
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. Purdue looked at that high level of
anxiety and asked, is it even worth marketing OxyContin in
(21:00):
tripicate states at all? Years later, Abby Albert's group of
economists finds this long forgotten focus group report, and they
realize 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. Someone else
(21:23):
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 American
population lived in states without Big Brother looking over their
(21:46):
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 tripicate states with everywhere else. So
that's what Albert did, and what she and her colleagues
found was that the triplicate rule was everything. What we
(22:09):
found was that, in fact, the non triplicate states had
much more oxycon use per capita than the triplicate states,
almost twice as much. 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
(22:30):
to get addicted to heroin and fentanyl. 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. Let's go
back to comparing outcomes in New York and Massachusetts. New
(22:53):
York was triplicate, Massachusetts was not. So how much of
a difference to 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 years
two thousand and twenty nineteen, an additional twenty five thousand
(23:14):
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 non triplicate states, health outcomes
of babies are better, and violent crime is lower in
triplicate states, astonishingly lower as much as twenty five percent.
(23:36):
Exactly eighty years after Paul Madden wrote his amendment to
the Californian Narcotics Act, his bureaucratic nitpicking gets vindicated by
social science, and who else gets vindicated Sidney M. Wolf
m d. In the early nineteen nineties, someone in the
(24:06):
White House wondered what was known about the value triplicate programs.
The request got kicked over to the National Institute of
Drug Abuse NIDA, and NAIDA 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 attended the symposium, Yes, Linda was Stilla, who had
(24:29):
done her dissertation on triplicates, was one of the attendees.
I do remember the venue, and I do remember this
is really ridiculous. We couldn't have coffee. NAIDA was very
hardcore about these kinds of things. They wouldn't sponsor anything
that had an addiction potential, including caffeine. So diddy right.
What I remember about that was sort of the excitement
(24:53):
of this is the first big thing we've had about
trying to control opioid use in the United States. 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. I was a pharmacist with
(25:14):
a pH d. There weren't many pharmacists with pH DS,
So it was like, Wow, this is it, and I
believed in a lot of these policies. The pain specialist
Russell Portnoy was at the night, a 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
(25:39):
to say how strongly the industry's biggest trade group was
opposed to any kind of federally mandated triplicate requirement. After all,
this was nineteen ninety one. Why were 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 Ds said this,
(26:02):
I wished that anyone who opposes triplicate prescription programs could
walk with me into the real world where these regulations
are saving lives. And then at the end of the meeting,
who gets up to speak? Sid Wolf? Of course, because
(26:22):
what is Sid's great cause in the late eighties and
early nineties, it's triplicates. SID has decided that what American
needs is a national version of Chapter three, Article one,
Section one one one six six dot six of the
California Narcotics Act. Sid, how are you. It's been a
(26:42):
long time, 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 together Dan's pool room. The last time
(27:07):
in Dan's I couldn't walk in there because there were
about ten people changed smoking, So I've never been in
there again. I think it's no longer around at all.
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.
(27:30):
I would like to take a walk down memory lane
with you, and I want to talk about triplicate prescriptions.
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. I
(27:51):
became aware of it, I would say, in the early eighties,
late seventies, something like that. 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
(28:12):
very much a matter of concern for you, which a
matter of concern for several reasons. I would attend Fdadvisory
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. And SID, like Paul Madden
two generations before him, had become convinced that focusing on
(28:35):
doctors was a big part of the solution. Let them
know they were being watched with a few file cabinets
of carbon copies. 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 prescription programs is astounding.
At the NINA meeting in nineteen ninety one, SID stood
(28:58):
up and made the case for a national triplicate 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 what night it was saying in
ninety one, when all you guys were saying back in,
(29:19):
we would have had a very different and much less
damaging opioid epidemic in the last twenty years. Right, there's
no question about that, because it's a clear public health problem.
He's right. A national triplicate program would clearly have slowed
the advance of OxyContin. Eight hundred and forty one thousand
(29:41):
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
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? No? Why? I
(30:05):
don't know why I bringed us up on because I
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 replicates, the person
covering the FDA, the Health bureaucracy and science, all those
(30:26):
kinds of medical science for the Washington Post was me.
That's how we met. 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
(30:48):
my time on the Health and science desk at the
Washington Post, I was in my twenties, a kid too
young for nuances. 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.
(31:10):
Sid Wolfe was so alert to the frailty of institutions
that he seemed to me like chicken little. I'll be candid.
At the time, 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
(31:32):
was always who didn't believe in drugs. Now I realized
no one was more wrong than me on this issue.
I mean, hundreds of thousands of people have died in
this country because we didn't pay attention to what you
were saying in nineteen ninety one. Well, all I can
say is I certainly have been thought by a number
(31:52):
of other people that I'm sort of a sixties radical.
So I do not blame you or anyone else that
thought that I was some wild eyed but said, I
blame myself. It is almost certainly the case that that
monograph you wrote about Triplica prescriptions was sent to me
(32:13):
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 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 even a book
(32:33):
about it, or 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
(32:53):
nineteen nineties, I dismissed what sid Wolf was saying. Because
we thought sid 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. Once
you've found the right doctor and have told him or
her about your pain, don't be afraid to take what
(33:17):
they give you. Sidwolf said the sky was falling back
in nineteen ninety one, and guess what the sky fell.
Revisionist History is produced by Eloise Linton Leaving Gustu and
Jacob Smith, with Tali Emlyn and Harrison VJ. Choi. Our
(33:39):
editor is Julia Barton. Our executive producer is Mia la Belle.
Original scoring by Labiskara, mastering by Flawn Williams, and engineering
by Nina Lawrence. Fact checking by Kesha Williams. Our voice
actor was David Glover. I'm Malcolm glow. Well, thank you
(34:03):
so much. This has 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
thing I downloaded. It's in one PDF which i'll send you.
Do I have your email address
Host
Malcolm Gladwell
Popular Podcasts
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Therapy Gecko
An unlicensed lizard psychologist travels the universe talking to strangers about absolutely nothing. TO CALL THE GECKO: follow me on https://www.twitch.tv/lyleforever to get a notification for when I am taking calls. I am usually live Mondays, Wednesdays, and Fridays but lately a lot of other times too. I am a gecko.