Many of us have wondered how the opioid epidemic could have happened — over the past two decades, nearly a half million people have died from opioid overdoses, which is hard to fathom for a tightly controlled prescription drug class like opioids. There have been numerous discussions and documentaries about this catastrophe, and even a fascinating streaming series (Goliath, Season four).

But when you delve into the drivers of the epidemic, and look under the hood, it becomes clear not only that this could have happened, but that variations on this will happen again and again: coercion, billions of dollars of profit, an infrastructural network, and needless deaths all characterize the opioid epidemic.

In the 1950s, the famous Asch conformity experiments were conducted, in which subjects were asked to gauge which of three lines of different length matched another line in length — a simple comparison that was made successfully in over 99% of trials. Surprisingly, however, when other subjects were included in the trials — subjects who, unbeknownst to the original subject, were actors who purposefully voiced the incorrect choice each time — the original subject caved to the majority, and frequently made the wrong choice. In fact, only 25% of the tested subjects consistently defied the majority, even though the majority, by design, was clearly incorrect!

The Asch conformity experiments demonstrated the remarkable power of peer pressure. But now imagine that, beyond the powerful effect of peer pressure, the subject was also offered millions of dollars to make the wrong choice — how many holdouts would be left? This was the situation in the opioid epidemic.

Sadly, the next opioid epidemic has already begun: once again, it is based on coercion, billions of dollars of profit, an infrastructural network of pharma, pharma-paid expert consultants, pharma-paid non-profit foundations, and even inappropriate meetings between corporate executives and an FDA leader; and once again, it is leading to needless morbidity and mortality. Anyone can see the obvious: the drugs being tested for Alzheimer’s disease are ineffective. But as Dr. Asch taught us decades ago, when you are surrounded by non-objective peers, nothing is obvious; and when the experts and the foundations have all been paid off, rational decisions are impossible.

We now have a remarkable opportunity — to avoid this next scandal, to avoid the unnecessary deaths, to prevent and reverse cognitive decline in its early stages, and to make Alzheimer’s disease the rare disease that it should be. To accomplish this, we will have to continue to work toward best patient outcomes, employing a targeted, precision medicine approach and continuing to optimize, rather than parroting the claims of the standard of care “experts.” Let’s all make a difference.  

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