The Great American Drug Deal

Do we really have to choose between affordability of drugs and lifesaving innovation? No. In The Great American Drug Deal, Peter Kolchinsky offers clear-eyed analysis, compelling stories, and vital ideas for closing loopholes, dealing with bad actors, supporting patients, and fueling discoveries that ease suffering now and for generations to come.

In the warped world of prescription drug pricing, generic drugs can cost more than branded ones, old drugs can be relaunched at astronomical prices, and low-cost options are shut out of the market. In Drugs, Money and Secret Handshakes, Robin Feldman shines a light into the dark corners of the pharmaceutical industry to expose a web of shadowy deals in which higher-priced drugs receive favorable treatment and patients are channeled toward the most expensive medicines. At the center of this web are the highly secretive middle players who establish coverage levels for patients and negotiate with drug companies. By offering lucrative payments to these middle players (as well as to doctors and hospitals), drug companies ensure that inexpensive drugs never gain traction. This system of perverse incentives has delivered the kind of exorbitant drug prices - and profits - that everyone loves except for those who pay the bills.

The prescription drug market -- Proposed solutions for rising drug prices -- Measuring the value of prescription drugs -- Measuring drug value : whose job is it anyway? -- Institute for Clinical and Economic Review (ICER) -- Other US value assessment frameworks -- Do drugs for special populations warrant higher prices? -- Improving value measurement -- Aligning prices with value -- The path forward.

While there have always been norms and customs around the use of drugs, explicit public policies--regulations, taxes, and prohibitions--designed to control drug abuse are a more recent phenomenon. Those policies sometimes have terrible side-effects: most prominently the development of criminal enterprises dealing in forbidden (or untaxed) drugs and the use of the profits of drug-dealing to finance insurgency and terrorism. Neither a drug-free world nor a world of free drugs seems to be on offer, leaving citizens and officials to face the age-old problem: What are we going to do about drugs? In Drugs and Drug Policy, three noted authorities survey the subject with exceptional clarity, in this addition to the acclaimed series, What Everyone Needs to Know®. They begin, by defining "drugs," examining how they work in the brain, discussing the nature of addiction, and exploring the damage they do to users. The book moves on to policy, answering questions about legalization, the role of criminal prohibitions, and the relative legal tolerance for alcohol and tobacco. The authors then dissect the illicit trade, from street dealers to the flow of money to the effect of catching kingpins, and show the precise nature of the relationship between drugs and crime. They examine treatment, both its effectiveness and the role of public policy, and discuss the beneficial effects of some abusable substances. Finally they move outward to look at the role of drugs in our foreign policy, their relationship to terrorism, and the ugly politics that surround the issue. Crisp, clear, and comprehensive, this is a handy and up-to-date overview of one of the most pressing topics in today's world. What Everyone Needs to Know® is a registered trademark of Oxford University Press.

From the # 1 New York Times–bestselling author of Black Hawk Down: The “shocking” story of the country’s unlikeliest drug kingpin (The Baltimore Sun). By the early 1980s, Larry Lavin had everything going for him. He was a bright, charismatic young man who rose from working-class roots to become a dentist with an Ivy League education and a thriving practice, and a beloved father with a well-respected family in one of Philadelphia’s most exclusive suburbs. But behind the façade of his success was a dark secret: Lavin was also the mastermind behind a cocaine empire that spread from Miami to Boston to New Mexico, catering to lawyers, stockbrokers, and other professionals, and generating an annual income of $60 million for the good doctor. Now, Mark Bowden, a “master of narrative journalism” (The New York Times Book Review) tells the harrowing saga of Lavin’s rise and fall in “a shocking American tragedy . . . [that] shoots straight from the hip” (Pittsburgh Post-Gazette). “An engrossing crime story and a compelling morality tale.” —The Arizona Republic “Has all the elements of a chilling suspense thriller . . . A smoothly crafted, exciting, can’t-put-it-down book.” —The New Voice (Louisville)

The disturbing connection between well-meaning physicians and the prescription drug epidemic. Three out of four people addicted to heroin probably started on a prescription opioid, according to the director of the Centers for Disease Control and Prevention. In the United States alone, 16,000 people die each year as a result of prescription opioid overdose. But perhaps the most frightening aspect of the prescription drug epidemic is that it’s built on well-meaning doctors treating patients with real problems. In Drug Dealer, MD, Dr. Anna Lembke uncovers the unseen forces driving opioid addiction nationwide. Combining case studies from her own practice with vital statistics drawn from public policy, cultural anthropology, and neuroscience, she explores the complex relationship between doctors and patients, the science of addiction, and the barriers to successfully addressing drug dependence and addiction. Even when addiction is recognized by doctors and their patients, she argues, many doctors don’t know how to treat it, connections to treatment are lacking, and insurance companies won’t pay for rehab. Full of extensive interviews—with health care providers, pharmacists, social workers, hospital administrators, insurance company executives, journalists, economists, advocates, and patients and their families—Drug Dealer, MD, is for anyone whose life has been touched in some way by addiction to prescription drugs. Dr. Lembke gives voice to the millions of Americans struggling with prescription drugs while singling out the real culprits behind the rise in opioid addiction: cultural narratives that promote pills as quick fixes, pharmaceutical corporations in cahoots with organized medicine, and a new medical bureaucracy focused on the bottom line that favors pills, procedures, and patient satisfaction over wellness. Dr. Lembke concludes that the prescription drug epidemic is a symptom of a faltering health care system, the solution for which lies in rethinking how health care is delivered.

NEW YORK TIMES BESTSELLER • A NEW YORK TIMES NOTABLE BOOK • “A tour de force . . . a comprehensive and suitably furious guide to the political landscape of American healthcare . . . persuasive, shocking.”—The New York Times America’s Bitter Pill is Steven Brill’s acclaimed book on how the Affordable Care Act, or Obamacare, was written, how it is being implemented, and, most important, how it is changing—and failing to change—the rampant abuses in the healthcare industry. It’s a fly-on-the-wall account of the titanic fight to pass a 961-page law aimed at fixing America’s largest, most dysfunctional industry. It’s a penetrating chronicle of how the profiteering that Brill first identified in his trailblazing Time magazine cover story continues, despite Obamacare. And it is the first complete, inside account of how President Obama persevered to push through the law, but then failed to deal with the staff incompetence and turf wars that crippled its implementation. But by chance America’s Bitter Pill ends up being much more—because as Brill was completing this book, he had to undergo urgent open-heart surgery. Thus, this also becomes the story of how one patient who thinks he knows everything about healthcare “policy” rethinks it from a hospital gurney—and combines that insight with his brilliant reporting. The result: a surprising new vision of how we can fix American healthcare so that it stops draining the bank accounts of our families and our businesses, and the federal treasury. Praise for America’s Bitter Pill “An energetic, picaresque, narrative explanation of much of what has happened in the last seven years of health policy . . . [Brill] has pulled off something extraordinary.”—The New York Times Book Review “A thunderous indictment of what Brill refers to as the ‘toxicity of our profiteer-dominated healthcare system.’ ”—Los Angeles Times “A sweeping and spirited new book [that] chronicles the surprisingly juicy tale of reform.”—The Daily Beast “One of the most important books of our time.”—Walter Isaacson “Superb . . . Brill has achieved the seemingly impossible—written an exciting book about the American health system.”—The New York Review of Books

Now a major TV series on Disney+ 'A shocking investigation... Dopesick is essential' The Times 'Unfolds with all the pace of a thriller' Observer 'A deep – and deeply needed – look into the troubled soul of America' Tom Hanks 'Essential reading' New York Times Beth Macy reveals the disturbing truth behind America's opioid crisis and explains how a nation has become enslaved to prescription drugs. This powerful and moving story explains how a large corporation, Purdue, encouraged small town doctors to prescribe OxyContin to a country already awash in painkillers. The drug's dangerously addictive nature was hidden, whilst many used it as an escape, to numb the pain of of joblessness and the need to pay the bills. Macy tries to answer a grieving mother's question – why her only son died – and comes away with a harrowing tale of greed and need.

NEW YORK TIMES BESTSELLER. The unbelievable true story of the man who built a billion-dollar online drug empire from his bedroom—and almost got away with it In 2011, a twenty-six-year-old libertarian programmer named Ross Ulbricht launched the ultimate free market: the Silk Road, a clandestine Web site hosted on the Dark Web where anyone could trade anything—drugs, hacking software, forged passports, counterfeit cash, poisons—free of the government’s watchful eye. It wasn’t long before the media got wind of the new Web site where anyone—not just teenagers and weed dealers but terrorists and black hat hackers—could buy and sell contraband detection-free. Spurred by a public outcry, the federal government launched an epic two-year manhunt for the site’s elusive proprietor, with no leads, no witnesses, and no clear jurisdiction. All the investigators knew was that whoever was running the site called himself the Dread Pirate Roberts. The Silk Road quickly ballooned into $1.2 billion enterprise, and Ross embraced his new role as kingpin. He enlisted a loyal crew of allies in high and low places, all as addicted to the danger and thrill of running an illegal marketplace as their customers were to the heroin they sold. Through his network he got wind of the target on his back and took drastic steps to protect himself—including ordering a hit on a former employee. As Ross made plans to disappear forever, the Feds raced against the clock to catch a man they weren’t sure even existed, searching for a needle in the haystack of the global Internet. Drawing on exclusive access to key players and two billion digital words and images Ross left behind, Vanity Fair correspondent and New York Times bestselling author Nick Bilton offers a tale filled with twists and turns, lucky breaks and unbelievable close calls. It’s a story of the boy next door’s ambition gone criminal, spurred on by the clash between the new world of libertarian-leaning, anonymous, decentralized Web advocates and the old world of government control, order, and the rule of law. Filled with unforgettable characters and capped by an astonishing climax, American Kingpin might be dismissed as too outrageous for fiction. But it’s all too real.

The League of Nations Advisory Committee on the Traffic in Opium and Other Dangerous Drugs, created in 1920, culminated almost eight decades of political turmoil over opium trafficking, which was by far the largest state-backed drug trade in the age of empire. Opponents of opium had long struggled to rein in the profitable drug. Opium’s Long Shadow shows how diverse local protests crossed imperial, national, and colonial boundaries to gain traction globally and harness public opinion as a moral deterrent in international politics after World War I. Steffen Rimner traces the far-flung itineraries and trenchant arguments of reformers—significantly, feminists and journalists—who viewed opium addiction as a root cause of poverty, famine, “white slavery,” and moral degradation. These activists targeted the international reputation of drug-trading governments, first and foremost Great Britain, British India, and Japan, becoming pioneers of the global political tactic we today call naming and shaming. But rather than taking sole responsibility for their own behavior, states in turn appropriated anti-drug criticism to shame fellow sovereigns around the globe. Consequently, participation in drug control became a prerequisite for membership in the twentieth-century international community. Rimner relates how an aggressive embrace of anti-drug politics earned China and other Asian states new influence on the world stage. The link between drug control and international legitimacy has endured. Amid fierce contemporary debate over the wisdom of narcotics policies, the 100-year-old moral consensus Rimner describes remains a backbone of the international order.