"They desperately tried to prevent the truth about the Famine from reaching the ears of the higher ups."
Raleigh, Helen. Confucius Never Said (p. 25).
Raleigh and others have described the problems in Mao's China and Stalin's USSR with communication up the political hierarchy. But of course for Americans that history is hardly relevant. In the USA, truth reaches the higher ups because we have democracy, a free press, and modern technology. And we don't have famines.
But we do have an opioid epidemic. Below we see how it took almost 20 years for the U.S. government to pay attention, as measured by word frequencies ("opioid" or "opioids") in the Federal Register.
Only in 2017 did the opioid epidemic get as much attention as climate change.
Alternatively, we could look at the Congressional record, where the words "opioid" or "opioids" appeared exactly zero times as recently as 2014 (a year in which "climate change" appeared over 300 times).
As pointed out in the book, "Dreamland", the government had a large part in the problem. They declared that a patient had a right to be pain-free, not just with minimal pain. Hospital's lawyers said that if we didn't medicate them we could be sued. Further, the government relied on Press-Ganey evaluations of patient's assessment of their care. A big component wasn't "did you get better" but how nice were the providers. Eliminating pain, of course, counted as being nice. As such, the incentive structure for hospitals and doctors was to prescribe painkillers, lots of them. Unfortunately, the role that regulation played in this tragedy will be ignored.
ReplyDelete