'Mass shooting' reported at Sutherland Springs church in Texas

[JimandChristy 1,689]

9 hours ago, jayjayj said:

Anyone want to acknowledge the decreasing gun violence rate?

 

https://www.washingtonpost.com/news/wonk/wp/2015/12/03/weve-had-a-massive-decline-in-gun-violence-in-the-united-states-heres-why/?utm_term=.f23910fc743c

 

 

http://www.pewsocialtrends.org/2013/05/07/gun-homicide-rate-down-49-since-1993-peak-public-unaware/

 

 

Yes it has come down significantly in the past few decades and that's a good thing! BUT it is still WAY ABOVE other first world countries

[bcking 3,157]

5 minutes ago, jayjayj said:

https://www.nbcnews.com/storyline/americas-heroin-epidemic/many-doctors-get-goodies-opioid-makers-n791281

 

"Between 2013 and 2015, the team found 375,266 payments worth $46 million made to more than 68,000 doctors."

It was hard for me to respond on my phone so I waited to get to my computer.

 

I'll gladly have an honest conversation about this because I think we all agree it's a problem, and I think it goes beyond political opinions and bais (I think that way about as well gun violence, but unfortunately not everyone agrees).

 

I will start by adding a caveat I should have made before - I'm not in an area of medicine with opioid prescriptions are rampant. I work with infants and while we do give opioids it is in an inpatient setting, we don't prescribe them for outpatient use. So we aren't a target for pharmaceutical companies as it relates to opioid prescriptions.

 

That being said, neonatology is an incredibly expensive area of medicine and we have many high cost interventions that we DO have interactions with pharmaceutical companies regarding. One example (I could give you many) would be inhaled nitric oxide. It doesn't really matter what it does, but just to explain it is something that costs a lot (~150 dollars per hour of use, and patients can be on it for days). Our hospital's contract is in the millions. 

 

We do have pharmaceutical representatives from the company that supplies our iNO. What perks do we receive? They usually buy us lunch about once per week. What happens during that time? I go to the area, stand in line, say hello to the rep (he is quite friendly), get my food, and then go sit down. We will have a lecture/conference that day, but it will be UNRELATED to iNO, it won't be given by them, and it has nothing to do with the free food. They just supply the food. During the time of getting the food they say almost nothing. They will chat with you in a friendly way, sometimes give a 15 second "plug" about using iNO (or whatever else they are representing...formula makers supply us lunch a lot as well) and that's it. While in line for the food, I sign my name on a sheet of paper.

 

That happens about once per week. They then have to report what they are doing. I have no idea what they report the cost of the lunch is. Lets say 10 dollars? If I get lunch once a week for 40 weeks from them, they report that they've paid me "$400".

 

What have I actually received? Free lunch while I'm sitting at a lecture about something completely unrelated. In those 40 weeks I may have spoken to them 4 or 5 times about the product, but only in the time it takes me to get my lunch and leave. 

 

Are they bribing me to use iNO on more of my patients? I don't think so. If I had a patient where I think it would be of benefit, I would use it. I don't think to myself "Hmm, I did have an awfully good lunch the other day, so I should give this patient iNO".

 

The study that your links reference (I think at least 2 are referencing the same study) are looking at those "payments" that are "worth" 46 million dollars. The study themselves admit that most of it was very small amounts (I forget what they say, but you can read it since you quoted it) to individual doctors. The number sounds like a lot. Spread out across the doctors, it amounts to not that much and most of it is in the form of free food which has very minimal impact on prescribing practices.

 

This is getting long, but I will keep going just a bit more:

 

I do agree with you when it comes to the higher paid docs. The study does mention that. Some have been paid 2500+, or even more. The "high paid" situations come from speaking engagements. I agree that those are far more ethically dubious. Honestly though, even those speaking engagements are going to have many situations where they are completely reasonable and I bet you would have no problem with. Even in that study, they were looking at payouts from companies that make opioids. It isn't clear to me if they excluded payouts that were advertising other products. Another example in my line of work would be certain types of formulas. There is a "newer" type of elemental formula that has a different ratio of lipids that is better for a select group of patients. Would you have a problem with a physician presenting data on that? Formula isn't addictive, it doesn't kill, and the indications are specifically for a select group of patients. It can actually benefit them and you have to balance "getting the word out" on newer interventions that can actually be of benefit.

 

 

TL;DR -

 

While doctors accept "monetary" incentives from pharmaceutical companies, just looking at the raw numbers is misleading. Most of it is in the form of "free lunch" and I can tell you from experience that the "free lunch" rarely involves any sales pitch whatsoever. I honestly don't know why the pharmaceutical companies do it in many cases. Speaking engagements/Consulting is a little more dubious, but even then there is a lot that goes on that is perfectly ethical and I would say should actually be encouraged. Medicine has a problem where it takes a long time for newer interventions that have evidence backing them up to be accepted into practice. Those things need speakers and engagements to help spread the word in order to help enhance patient care.

[JimandChristy 1,689]

2 hours ago, jayjayj said:

Doctors in America kill more people every year with fraudulent or over-prescribed Opioid prescriptions.  Perhaps we need to administer monthly lie detector tests to doctors to ensure they aren't breaking the law.  

What does that have to do with gun violence, you seem to like the strawman.

[bcking 3,157]

Also, while I'm happy to continue to talk about the opioid epidemic:

 

1. It is a bit off topic on this thread, you can make a new one if you like.

 

2. We, as a country, can care about multiple things at once. We can want to fix the opioid epidemic AND want to reduce gun violence at the same time. That may seem novel and crazy, but it really can happen. The argument that we have other problems in our country, so lets ignore our gun homicide rate is just silly. We can do both. You aren't going to find people here who support gun legislation but say opioid overdoses aren't a problem. I'm pretty sure we'd all agree that they are BOTH problems.

 

EDIT:

Another "Evil pharma" conversation that is more applicable in my line of work is vaccines. I usually laugh a bit when I hear people say "PHarma companies are buying off doctors to make them vaccinate our kids". It's funny because I've never met a Pediatrician (Myself included, and I meet a lot) who gives vaccines because of pharma kick backs. Pharma doesn't need to pay us anything. We give them because we know they work.

Edited November 9, 2017 by bcking

[CaliCat 3,957]

21 minutes ago, JimandChristy said:

What does that have to do with gun violence, you seem to like the strawman.

 

It doesn't have anything to do with gun violence, but it makes for a good hole in the sand in which to bury one's head.

[The Nature Boy 7,659]

30 minutes ago, bcking said:

Also, while I'm happy to continue to talk about the opioid epidemic:

 

1. It is a bit off topic on this thread, you can make a new one if you like.

 

2. We, as a country, can care about multiple things at once. We can want to fix the opioid epidemic AND want to reduce gun violence at the same time. That may seem novel and crazy, but it really can happen. The argument that we have other problems in our country, so lets ignore our gun homicide rate is just silly. We can do both. You aren't going to find people here who support gun legislation but say opioid overdoses aren't a problem. I'm pretty sure we'd all agree that they are BOTH problems.

 

EDIT:

Another "Evil pharma" conversation that is more applicable in my line of work is vaccines. I usually laugh a bit when I hear people say "PHarma companies are buying off doctors to make them vaccinate our kids". It's funny because I've never met a Pediatrician (Myself included, and I meet a lot) who gives vaccines because of pharma kick backs. Pharma doesn't need to pay us anything. We give them because we know they work.

I am sorry but I would rather  get my vacation advice from a playboy bunny with an iq of 80 than someone who has spent 12 years doing book learning 

[The Nature Boy 7,659]

31 minutes ago, bcking said:

Also, while I'm happy to continue to talk about the opioid epidemic:

 

1. It is a bit off topic on this thread, you can make a new one if you like.

 

2. We, as a country, can care about multiple things at once. We can want to fix the opioid epidemic AND want to reduce gun violence at the same time. That may seem novel and crazy, but it really can happen. The argument that we have other problems in our country, so lets ignore our gun homicide rate is just silly. We can do both. You aren't going to find people here who support gun legislation but say opioid overdoses aren't a problem. I'm pretty sure we'd all agree that they are BOTH problems.

 

EDIT:

Another "Evil pharma" conversation that is more applicable in my line of work is vaccines. I usually laugh a bit when I hear people say "PHarma companies are buying off doctors to make them vaccinate our kids". It's funny because I've never met a Pediatrician (Myself included, and I meet a lot) who gives vaccines because of pharma kick backs. Pharma doesn't need to pay us anything. We give them because we know they work.

I had a coworker who took the yellow street percocet . It was straight Fentanyl. Guy was on a respirator 4 days. he is lucky to be living 

[bcking 3,157]

1 minute ago, Nature Boy Flair said:

I am sorry but I would rather  get my vacation advice from a playboy bunny with an iq of 80 than someone who has spent 12 years doing book learning 

Depends on the kind of vacation you are going for.

 

My wife and I have a trip planned for Botswana in February. I'd much rather get advice from someone who has done "book learning" on African cultures, flora and fauna for 12 years over a playboy bunny.

[bcking 3,157]

3 minutes ago, Nature Boy Flair said:

I had a coworker who took the yellow street percocet . It was straight Fentanyl. Guy was on a respirator 4 days. he is lucky to be living 

And that pertains to opioid prescribing practices among physicians how exactly?

 

Synethetic, illegaly proposed opioid are a problem and a part of the "opioid epidemic" but I got the impression from jayjay that he wanted to talk about physician prescribing practices and how they contribute to the problem. Physicians aren't prescribing illegal "street drugs".

[TBoneTX 43,525]

Several recent posts have been removed because they went past the point of good-natured bickering.

 

Reminder:  If the thread's OP suggests that this thread has run its course or is heading irrevocably in unrelated directions, it can be closed.

[CaliCat 3,957]

41 minutes ago, TBoneTX said:

Several recent posts have been removed because they went past the point of good-natured bickering.

 

Reminder:  If the thread's OP suggests that this thread has run its course or is heading irrevocably in unrelated directions, it can be closed.

 

You get an A+ for subtlety! Shut her down, I'd say.

Edited November 9, 2017 by CaliCat

[Voice of Reason 10,298]

20 hours ago, Steeleballz said:

 

    Actually if I suddenly develop murderous intent, I don't have a black market supplier on my speed dial and I don't have a readily available source lined up who I would plan to steal a gun from. The best I could think of  is there is this one guy who sometimes leaves a loaded gun in his driveway but that would take some logistical work.

 

   It doesn't have to be easy for potential criminals to get a gun. We could make it so it's not.

I can PM you his address if it makes things easier for you.  (Last I heard, the gun was in his vehicle, not the driveway).

[CaliCat 3,957]

1 minute ago, IDWAF said:

I can PM you his address if it makes things easier for you.  (Last I heard, the gun was in his vehicle, not the driveway).

 

Oh, that story about the gun in the driveway, that wasn't the driveway, and then it was something else? 

 

It had a kaleidoscopic quality to it, that story had...

 

 

[Voice of Reason 10,298]

20 hours ago, bcking said:

I see one point you are sort of getting at - These mass shootings are a "drop in the bucket" to our overall number of gun homicides.

 

Yes I agree with you on that. If we worked to solve just these mass shootings, we wouldn't make much of a dent in our gun homicide rate overall.

 

That being said - We are still an huge outlier for these mass shooting events and while they may be a "drop in the bucket", they are still innocent lives being lost. Other countries have mentally ill people and don't see mass shootings like we do. If it isn't stricter gun laws, we should be figuring out what else is different so we can emulate it.

 

EDIT: Also, though others have already said that, your little story isn't a "source" for anything being "proven over and over again".

 

You have not yet provided actually evidence to suggest that these people who commit mass shootings in the US would just "get guns anyway" if we had strict gun control laws.

I am not picking your post for any particular reason other than to address what some of you are saying isn’t any proof, so please don’t take my shock as only being towards you.  It’s towards several of you.

 

Are you KIDDING me?  Talk about having your head in the sand as regards criminals and guns.  Do you think that all those thugs in Chicago that have used handguns this year to murder so many (Is it over 500 now?  Over 600?  IDK, but it’s A LOT) went down to their local Wal Mart and just filled out the forms and got a pistol???  The lot of you sit here and argue that there are SO MANY guns in the US, and THAT is the problem, then when I tell you there exists a criminal element that will steal guns or get them on the black market, I am told there is no proof of that.  *SMH*

 

How then, do you suppose the majority of criminals, many of which are repeat offenders with rap sheets longer than both your legs, obtain said weapons?  

 

We have always on the books now that keep guns out of bad guys’ hands.  Buying a gun legally is not easy, unless you have a clean record.  True, the “system” failed in the case of the Texas domestic violence dude turned mass murderer, but I present to you that it is a one-off situation.  Most actual felons CANNOT obtain a gun legally. 

 

I know most of you arguing for “more gun control” have probably never purchased a gun nor gotten a CC license.  But I encourage you to  go thru the process, even if you don’t intend to actually buy one.  Go to a gun show and try to buy a handgun without following the law (many here seem to think that gun “fairs” are an easy place to pick up an illegal purchase).

 

As for your last paragraph, BCKing, we DO have strict gun control laws already, and mass shooters have been getting them for years.  So while I didn’t provide you a link where you can READ what I said is true, I assure you, based on my knowledge of guns and some of the crime I have seen over the years, there really isn’t any other way for them to get guns.  The “evidence” that you seek is in front of your face; in spite of gun control laws, criminals get guns and kill people.  Thousands per year.  If you (Steel, BC, Mango, etc.) think I am wrong (because of lack of evidence), then what would you counter with as to the reason they keep getting guns and killing people?

[Voice of Reason 10,298]

2 hours ago, JimandChristy said:

 

LOL classic pro gun deflection tactic. Why are you comparing the USA's murder rates with 2nd and 3rd world countries? The USA is a FIRST world country so only a fair measure of murder rates for the USA is to compare them to countries like them. Funny thing is when I discuss the topic of guns to very conservative Republicans they seem to throw out this same excuse I hear them say "Well at least we're not ..........(Throw in some random 2nd/3rd world country)"

If you are going to compare the US to other countries vis a vis gun homicides, then you should not discriminate as to which countries.  That’s like only comparing the US to Korea and Japan because they all three sell soju and saki.

 

Why the desire to only include countries who are aligned with the US?  Do the lives and practices of the other 3/4 of the world not matter to you?  That seems like quite the xenophobic attitude to me.  Or is it just because when you hand-pick your countries for comparison, it makes the gun problem in the US look worse, and gives you greater perceived need for more gun control?