Escaping Paternalism Book Club: Jubal Harshaw’s Reaction

Blogger Jubal Harshaw sent me this response to last week’s installment of the Escaping Paternalism Book Club last week.  Reprinted with his permission.

Hey Bryan,

Today you wrote:

“4. Once again, I wish the book contained a detailed section on opioids.  The usual view, of course, is that Big Pharma’s lobbying prevented wise regulation from paternalistically saving hundreds of thousands of American lives.  This is clearly a public choice story, but not one in the spirit of Escaping Paternalism.  So is the conventional story flat wrong – or what?”

Yes, the conventional story is flat wrong. It contains some elements of truth, but is pretty implausible for several reasons. I don’t know how this threads into your posts on paternalism, but there are some important fact that get omitted from the standard narrative on the opioid epidemic. Rates of opioid abuse and addiction were flat over the relevant period (early 00s to present) when opioid prescriptions did something like quadruple. Purdue Pharma was a small share of the market, so somehow the benefits of their marketing accrued mostly to other manufacturers. Most drug poisoning deaths involve multiple substances (they aren’t simply “opioid overdoses” but drug interactions, suggesting a more complex causal story), and a substantial fraction of drug poisoning deaths have various ailments and chronic illnesses listed on the death certificate (suggesting that many of these deaths might have had multiple causes, or might not have been opioid poisonings at all).

I have written quite a lot about this on my (pseudonymous) blog. I hope you find some of it interesting.

This one is a pretty comprehensive takedown of the standard story:

https://grokinfullness.blogspot.com/2017/09/debunking-standard-narrative-on-opioid.html

This one has some data on historic rates of abuse/addiction:

https://grokinfullness.blogspot.com/2019/07/prescription-opioid-abuse-trends-in.html

This one is an attempted take-down of a study that tells the standard narrative, blaming Purdue:

https://grokinfullness.blogspot.com/2019/12/interesting-study-on-origins-of-opioid.html

And this one is aimed at the book Dreamland:

https://grokinfullness.blogspot.com/2020/03/dreamlands-narrative-is-wrong.html

There’s a lot there, but you asked a big question.