Period as a semi-retired pensioner: 302 days
The opioid crisis is extremely topical now, and I have recently watched the two-part four-hour Netflix documentary, “Crime of the Century”. I do recommend it for those of you who have the stamina for this sort of thing. I wish to focus on one aspect of this relating to the role doctors, as medical professionals have played in the crisis. What motivates professionals and what are their values, ethical and moral boundaries? What happens when they lose their way? This is a topic worthy of rumination.
In the second episode, we are introduced to Alec Burlakoff former Insys Therapeutics vice-president of sales. He is described as a used car salesman on steroids and led an extremely successful sales team. Insys focussed on supplying fast-acting oral Fentanyl to doctors. Fentanyl is a highly addictive, very powerful fast-acting opioid that the FDA has approved for alleviating late-stage cancer pain in terminally ill patients. Unfortunately, Fentanyl is extremely dangerous and nearly 60 000 people died of opioid overdoses in the USA in 2020 with Fentanyl being the main culprit. https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates.
The FDA-approved market for Fentanyl is limited and rather small. Insys wished to expand the market beyond that and targeted doctors to prescribe their products at as high a dose as possible to as many patients as possible. For those who don’t have the stamina to watch the second episode of Crime of the Century, you can fast forward to minutes 29-33 where Alec Burlakoff explains his sales techniques. This Youtube video is also worth watching. https://www.youtube.com/watch?v=NqXZnAczbkM. His sales team called on doctors across the USA and classified the doctors according to his classification system as follows:
Blue: Analytical doctor: Needs to understand the science and looks at the results of properly published peer-reviewed double-blind studies and is not interested in a sales pitch before looking at the studies. Unbribable. Exclude
Yellow: Amiable doctors: They want to be nice to everyone and want to be fair to all suppliers. Will not entertain an exclusive relationship. Exclude
Green: Earthy tree-hugging doctors: Holistic medicine including natural remedies wellbeing, alignment of chakras, and mindfulness. Exclude
Red: Business-minded doctors: See as many patients as possible and run a very efficient factory-like practice. Maximise income. Extremely busy no time for detail and studying the science. Give the patients what they want if it makes money. Interested in the WIFM (what’s in it for me). Target aggressively including monetary incentives (a.k.a. bribes)
Although Insys was extremely successful it was ultimately criminally prosecuted, and Alec Burlakoff accepted a plea deal cooperated with the prosecution, and was sentenced to 26 months in prison. The billionaire founder of Insys, John Kapoor (77), was sentenced to 5 ½ years in prison. Insys is currently in chapter 11 bankruptcy proceedings.
Most doctors did not fall for the Insys hard-sell but those that did caused a tremendous amount of damage and killed several of their patients. Many of them are still practising medicine. The values, morals, and ethics of your doctor matter a great deal and it can literally be a matter of life or death.
One of the most encouraging aspects of the Crime of the Century documentary is the role that a small number of activist blue doctors play in policing the profession and ultimately curbing and limiting the damage red doctors do. They sometimes do this at a personal cost and face significant adversity. The errant red doctors are not a pushover. These activists are to be admired and act as an essential firewall against rampant abuse.
As one gets older it is inevitable that you will deal with doctors more and to the extent, I can choose I will obviously look for blue doctors, even if their bedside manner is deficient. I check out the relevant peer-reviewed science myself and ask the doctor about this. If the doctor is too busy, evasive, or appears uninformed it’s time to find another doctor. Sometimes there is no time to do this in a medical emergency. When I had a detached retina in November 2020 requiring emergency surgery, I did not have time to do extensive research but was lucky enough to find an extremely competent surgeon. If it had been a red surgeon rushing to complete the surgery perhaps, I would now be blind in one eye.
What has all this got to do with climate change? You may well ask! I now reveal some of the inner workings of a disturbed mind. How do you classify engineers working on the just energy transition to net-zero carbon emissions? The classifications for doctors are perhaps not directly transferable to engineers but there is some useful food for thought.
You do get blue engineers who are analytical and scientific. This is not sufficient. Engineers differ from pure scientists in that they are applied scientists. It is necessary for the projects they work on to be practical and economic. I would like to think of myself as a blue engineer.
You also get red engineers who are primarily interested in making money. They give the client what they want even if, privately, they think it is dumb. They see themselves as the hired help and that the owners are responsible for what they are doing. Sometimes they don’t concern themselves with the practicalities and economics of what they are doing because they don’t see that as their job.
Often engineers work in large organisations where their role is not to decide what is done but to implement what executive management has decided to do. For red engineers, this is no problem. Do what you are paid to do. Many career-minded red engineers in hierarchical organisations will complement executive management on their insight and strategic brilliance and rise in the organisation.
Things can get more difficult for blue engineers when they are asked to work on projects their analysis show to be impractical and uneconomic. In many cases, you then get a purple engineer. This is what you get when you mix red and blue and perhaps you get 50 shades of purple. The purple engineers may provide their analysis and if this gets ignored by management, they can take comfort in having raised their concerns. A common response from management is for you to stay in your lane. This is a somewhat polite micro-aggression reminding you that your opinion was not requested or wanted and is above your position in the dominance hierarchy.
In the case of doctors, the stakes can be incredibly high. It can be a matter of life or death. What is the harm in a business? Perhaps some shareholder value will be destroyed. If the projects are big enough the organisation could go bankrupt. Wasting money is not necessarily a crime particularly if the shareholders have agreed to it. Shareholders appoint executive management anyway and they are ultimately responsible if shareholder value is destroyed.
Now, what about climate change? The stakes are much higher than some businesses going bankrupt which is a natural part of the creative destruction inherent in the capitalist system. In this case, unwise capital allocation and groupthink have the potential to significantly delay the just energy transition. What will the consequences of this be?
Is there, perhaps, an important role for activist blue engineers in the just energy transition? What about grumpy semi-retired activists? I will leave it to my groupies and readers to answer this question.
Thank you very much for your comments and suggestions and please keep them coming.
Regards
Bruce
Ruminant Pink Friday 