【经济学人】阿片类止痛药是否真的“止痛“丨2017.04.06丨总第868期

BETWEEN 1999 and 2014 sales of prescription opioid drugs almost quadrupled in America, an increase that came not simply in response to patient suffering but because more of the population are addicted to these powerful drugs. Such is the demand for them, Americans now consume four-fifths of the global supply.

在美国，处方阿片类药物从1999年到2014年的销量翻了两番。这一数量的增加不只是为了解决患者的痛苦，也是因为更多的人们深深的迷上了这种强效药物。美国人现在所消耗的处方阿片类药物占全球总量的五分之四。

• Quadrupled:使成四倍

Growth on this scale has been profitable for some: OxyContin,a popular opioid made by Purue Pharmda, a drug company in Stamford, Connecticut, has made its manufacturer tens of billions of dollars (see chart). But more broadly it has spelled tragedy. Deaths from opioid use in America quadrupled over the same period. About 90 people die every day, according to the Centres for Disease Control and Prevention.

这一规模的增长对一些药物来说是有利可图的，即奥施康定，由位于斯坦福的康涅狄格的普度制药公司研发的常见阿片类药物，这种药物使得制造商收益数百亿美元（见表格）。但是，更广泛的来讲，它也带来了悲剧。使用阿片类药物致死率与同期相比增加了四倍。据疾病控制与预防中心的数据，每天大约有90人死亡。

• OxyContin:奥施康定

• Spell:招致

• Purdue Pharma:普度制药公司

• Centres for Disease Control and Prevention  疾病控制与预防中心

That dissonance between corporate success and private pain has become a  matter of public interest. On March 28th Senator Claire McCaskill, a Democrat from Missouri, said that she would investigate the role that pharma firms played in creating the opioid crisis. Through a committee that oversees issues of homeland security and government affairs, she has written to five makers of prescription painkillers—Purdue Pharma, Depomed, Janssen/Johnson & Johnson, Insys Therapeutics and Mylan. She is demanding internal corporate documents stretching back over five years.

公司的成功和个人的痛苦之间的失衡已经成为公共利益事项。3月28号来自密苏里州民主党的参议员 Claire McCaskill说，她将会调查制药公司在阿片类药物危机中扮演什么样的角色。Claire McCaskill通过监督国土安全与政府事件的委员会，给Purdue  Pharma, Depomed, Janssen/Johnson & Johnson, Insys Therapeutics and Mylan这5个制造商处方止痛药物公司写了信，.她要求公司内部递交五年里的内部文件。

• Dissonance:失调

• A matter of public interest:公共利益事项

• Prescription painkillers:处方止痛药

Ms McCaskill wants to know exactly how firms marketed their drugs and what they knew about the risks of addiction and abuse. In particular, she wants to find out if companies used calculated sales-and-marketing strategies that involved encouraging doctors to prescribe opioids for a wider category of causes of pain than they would otherwise have done and downplaying the risk of addiction.

Ms McCaskill特别想知道企业如何销售药品以及关于成瘾和滥用药品的风险，企业知道多少，特别的是，她想知道公司是否使用销售与营销的策略，包括鼓励医生对更加广泛地疼痛原因开具处方药-阿片类药物，而不像以前做的的那样，会降低上瘾的风险。

• Prescribe:开处方

• Downplaying:淡化

• Sales-and-marketing strategies  

  销售与营销策略

This is not the first time such questions have been raised. In a case in 2007, the parent company of Purdue Pharma and three current and former executives there pleaded guilty to criminal charges that they misled regulators, doctors and patients about OxyContin’s risk of addiction and potential for abuse. Purdue promoted the drug, which is long-acting, as posing a lower risk of abuse and addiction than shorter-acting painkillers—such as Percocet and Vicodin. (读者试译)

这已经不是第一次提出这些问题。在2007年中的一个案例中，普度制药公司的总公司和3个现任和前任的高管对于刑事指控已经认罪，关于奥施康定的成瘾和滥用可能的风险，他们误导监督机构、医生、患者。“期待您的翻译，将您的理解留言在文章下方留言处，第二天将会有长难句解析的呦。”

• Parent company:总公司

The firm admitted it had made statements about its drug that were “inconsistent” with approved prescribing information. In other words, the firm had incorrectly told doctors that OxyContin was less prone to abuse than other opioid medicines. The firm agreed to pay $600m and the three executives paid $34.5m in fines.

普度制药公司承认它对药物的声明与批准的处方信息不一致。总之，普度制药公司错误地告诉医生奥施康定相对于其他阿片类药物来说，较不容易滥用。

Ms McCaskill’s inquiry is not the only one drug firms face. The Department of Justice (DoJ) has alleged that kickbacks were offered to encourage drug prescriptions and also that, as a result, health insurers were defrauded. In December the DoJ arrested former senior staff at Insys Therapeutics on charges that they led a conspiracy to bribe doctors to unnecessarily prescribe patients a pain medication based on fentanyl (an opioid that is up to 50 times as powerful as heroin), defrauding the insurers who had to cover the drug’s cost. 

Ms McCaskill调查不只是制药公司。美国司法部声称提供的回扣用来鼓励开具药物处方，同时也欺骗了健康保险公司。在12月，美国司法部逮捕了在INSYS治疗中心的前任高级职员，指控他们制造阴谋来贿赂医生为病人开具不必要的芬太尼镇痛药（一种阿片类药物，是海洛因药效的50倍），并且欺骗那些要承担病人药物消费的保险公司。

• Kickbacks:回扣

• health insurers:健康保险公司

• Defrauded:欺骗

• The Department of Justice (DoJ) :美国司法部

• Conspiracy:阴谋

• Bribe:贿赂

• Fentanyl:芬太尼

The Drug Enforcement Administration has also taken action against firms for failing to control the “diversion” of prescription drugs to illicit uses. Earlier this year McKesson, a San Francisco-based pharma distributor, agreed to pay $150m for failing to report suspiciously large orders of drugs.

药品监督管理局也采取行动来打击未能控制处方药的转移以非法使用的现象。今年早些时候，一家San Francisco-based制药经销商McKesson对于未能报告大量药品这件事同意支付1.5亿美元。

• The Drug Enforcement Administration  

  药品监督管理局

• Illicit:非法

Increasingly, too, counties and cities are filing lawsuits against manufacturers for their role in the opioid epidemic. There may be further legal action against the firms that distribute opioid medicines, acting as intermediaries between pharma firms and pharmacies. Some have been named in lawsuits.

越来越多的县市也开始针对制造商在阿片类药物流行中扮演的角色提起诉讼。可能会有进一步的法律行动来打击分发阿片类药物的作为制药公司和药店之间的中介机构的公司。一些公司的名字已经出现在诉讼案件中。

• Pharmacy:药店

Nora Volkow, director of the National Institute on Drug Abuse, says that pharma companies are not the only ones to blame for the opioid crisis. She points to well-meaning efforts to implement procedures to make sure that pain was not under-treated in hospitals. Direct-to-consumer advertising of opioids may also have encouraged overuse. Only America and New Zealand allow pharma firms to advertise drugs directly to patients.

国家药物滥用研究所所长Nora Volkow说对于阿片类药物危机来说，不仅仅制药公司对其负责。她善意的指出了努力的方向，在医院治疗过程中，确保疼痛没有得到不当的治疗。直接向消费者宣传阿片类药物也可能导致药物过度使用。只有美国和新西兰允许制药公司直接向病人宣传药品。

• Director of the National Institute on Drug Abuse:国家药物滥用研究所所长
  

• well-meaning:好心的

The scrutiny on the industry is nonetheless intensifying. The number of opioid prescriptions being given is no longer rising, and may be falling. The same cannot be said for drugs firms’ legal woes.

然而，对该行业的审查仍在加强。开具阿片类药物处方数量不会再增加，也许将会下降。对于制药公司的法律困境，情况就不一样了。

• woes    困境，灾难

翻译 ▍云图

审核 ▍Sopia.yao

编辑 ▍小精灵