“Oligarchy…1 : government by the few. 2: a government in which a small group exercises control…” So, according to Webster’s Ninth New Collegiate Dictionary we are rapidly becoming an oligarchy in the USA. Some would reasonably say we are already there, an arrival greatly aided by the 2018 “Citizens United” Supreme Court decision.   https://www.theguardian.com/us-news/ng-interactive/2018/sep/26/america-oligarchy-dominated-billionaires-big-money-series

Regardless of where you stand on this issue, the fact the rich have become richer and the poor poorer over the last three or four decades in the USA, is undeniable. It is also undeniable corporations are responsible for many of the obstacles we all encounter.

I encountered one such obstacle last week.

In my last blog I spoke about my cancer. The good news is that the latest scans show no new cancer progression. The bad news is that two of the three vertebrae that were radiated for cancer, developed compression fractures. This was as painful as what I had suffered with the cancer in my ninth thoracic vertebra (T9).  To remedy this pain, kyphoplasty for all three vertebra that had cancer lesions was performed. Kyphoplasty is a process in which a surgeon, using tiny tubes removes the cancerous tissue from inside the vertebral body, and then fills it with a sort of cement, and expands the vertebral body to its size before the fractures. This worked very well (I think) on my T8 and T9 vertebrae. It did not work for the T12, and the pain was as bad as before. So, I went to palliative care, (which is not hospice) to cope with the pain. They adjusted my pain medication, adding Methadone to the Oxycodone I was taking. So, now I am relatively pain free, albeit a bit dopey, and unable to drive. The surgeon who performed the Kyphoplasty has ordered an MRI, which may show another way to remedy the situation.

It was the adjustment to my medication that became an obstacle. The opioid epidemic has made getting drugs like Oxycodone much harder. That is understandable considering the addiction costs to society. However, it also means that people who are in severe pain have to also jump through the new hoops to get their medication. The palliative care doctor had called in her prescription to my pharmacy while I was still in the clinic in Torrey Pines. Roger and I stopped for lunch in Rancho Bernardo, and I called the pharmacy to see if the prescription would be ready. The pharmacist I spoke with said no, because they needed a lot more information about my condition, which the palliative care doctor had not provided.  I was in a lot of pain at the time, and I’m afraid I might have raised my voice at this delay in getting better pain relief. So Roger drove me home, where I was able to get the weight off my back, and heat on it.

In a calmer frame of mind, I was able to analyze the situation, and realize, that because it was a different doctor than my oncologist who wrote the prescription, the pharmacy probably had to make sure I wasn’t shopping doctors. I called the pharmacy again, and explained my condition, noting that all the previous Rx’s had come from my Scripps oncologist, and the new one from the Scripps palliative care at the Scripps M. D. Anderson Cancer Center, and assured him I was not doctor shopping. He agreed to go ahead and release the medications, and poor Roger went back into town to pick them up for me.

So, if you’re still reading this, you’re probably asking “what the hell does this have to do with oligarchies?” Well, who is responsible for the opioid crisis? As the Los Angeles Times has so well pointed out, big pharma is the culprit. https://www.latimes.com/science/story/2019-09-17/opioid-lawsuit-who-is-to-blame  This has been widely demonstrated on news programs such as “60 Minutes” and in the press. https://www.washingtonpost.com/national/health-science/one-small-town-two-drug-companies-and-123-million-doses-of-opioids/2018/02/15/6436fe16-11a0-11e8-8ea1-c1d91fcec3fe_story.html When a large pharmaceutical sends 5.8 million pills to one pharmacy in a town of 1,779 people, without any hesitation or fear of being fined due to lack of governmental regulatory oversight, the power and influence of “the few” to have government act in their interest over the interests of regular citizens is as evident as the nose on my face. (Yes, I have a beautiful Roman nose, not exactly something to be ignored.)

Belatedly, long after the unlimited opioid availability, there has been some effort to regulate the distribution of opioids, and to punish the unconscionable actions of Big Pharma. A county district judge in Oklahoma ordered Johnson and Johnson to pay the state of Oklahoma $572 million in reparation for the damages done to the state. https://www.washingtonpost.com/health/johnson-and-johnson-is-responsible-for-fueling-oklahomas-opioid-crisis-judge-rules-in-landmark-case/2019/08/26/ed7bc6dc-c7fe-11e9-a4f3-c081a126de70_story.html Interestingly, Johnson and Johnson’s stock rose after the judgement. Oklahoma had asked for $17.5 billion in damages, to be paid over 30 years; that $17.5 billion being what the state calculated its costs would be to pay for the damages caused by opioids. Some might say this was just a slap on the wrist.

I’m not ready to say we have an absolute oligarchy, but we’re well on the way. Consider this.  If a doctor prescribes an opioid, she must also prescribe the drug for an overdose of an opioid, Narcan. Is this something the drug companies must do to pay for their crimes? No. This is something that opioid users must pay for unless, as did I, they understand that this is a drug only to use after overdose, because there is no law that the receiver of opioids must buy this drug. However, when my new palliative care doctor prescribed opioids, she also had to prescribe the overdose drug, Narcan. So, Roger, not aware of this, when told I had three prescriptions (not only the Oxycodone, but also the Methadone and the Narcan) he assumed that they were all drugs that would relieve my pain. Narcon without insurance can cost $140. It cost me, with Medicare, less than $5. I’m not sure how much it cost my insurer, and you the taxpayer.

It is clear to me that the interests and comfort of the majority of citizens take a back seat to the interests of corporations and the top .01 percent in wealth. I truly believe we can change this trend, but only if people vote against the servants of the ultra-wealthy.