A snap decision by Google has begun to reshape the drug treatment industry, tilting the playing field toward large conglomerates — the precise opposite outcome Google had hoped to achieve.
The fateful decision was made September 14. Google faced pressure from an exposé in The Verge released a week earlier, documenting how shady lead generators game its AdWords system. High-cost ads based on rehab keywords referred users to phone hotlines that gave the impression of being independent information services, but were actually owned by treatment center conglomerates. Representatives, who reap large fees based on how many patients they sign up, employ high-pressure sales tactics to push people into their favored facilities, whether or not that facility is the right one for the patient.
This deceptive marketing can lead to substandard treatment and massive overbilling. It also made lots of money for Google, which was shown in the story actively courting addiction treatment advertisers.
And so Google made a quick call: It effectively stopped running ads from treatment facilities. At first blush, that may look like a happy alignment of the public good and a company’s need for good public relations, with Google taking a hit to make the world a better place in the midst of an epidemic.
But the problem of economic concentration is so deep in the United States today that peeling back one layer merely reveals another. Without ads, addicts or their parents are left only with the organic search results.
Guess who wins those?
It’s not Ben Camp. He’s the CEO of RehabPath, which bills itself as a resource for addiction recovery, connecting patients with quality treatment information. Camp has been a longtime critic of the fraud rampant in the treatment industry and felt that Google was operating from the right impulse, but got it wrong — to the detriment of smaller facilities.
“I think Google made a mistake,” Camp told The Intercept. “They’re putting rehab centers out of business that are doing good work. And if they come back in a month and say, ‘We figured this out,’ the centers will say, ‘Thanks, but we’re out of business now.’”
Addiction recovery during the worst drug epidemic in American history is expected to generate $42 billion in business by 2020. Insurers are required to cover substance abuse treatment under the Affordable Care Act, and some stays can cost up to $60,000 a month, making every patient extremely lucrative. And the majority of addicts or their parents — 61 percent, according to Google’s internal statistics — use the internet to find help.
The first click on that path is usually to Google, giving the search engine tremendous influence over how America responds to a public health emergency. Google ads gave preferential treatment to whomever paid the most, regardless of the standard of care. Kenneth Miller, who worked at community treatment centers in Florida for a decade (and, full disclosure, is my cousin), said his facility “spent an insane amount of money on advertising, specifically through Google. They used to give us flash drives with the Google logo on them.” Some facilities were spending $1 million a month on this type of advertising.
Many of those ads steered addicts to woefully substandard facilities that were little more than vehicles for insurance and Medicaid fraud. That’s been widely known and was even the subject of the industry’s 2016 conference.
But The Verge article touched a nerve, and Google responded by stopping all AdWords marketing for addiction treatment, a blanket policy that froze out every treatment center — good and bad. “We found a number of misleading experiences among rehabilitation treatment centers that led to our decision, in consultation with experts, to restrict ads in this category,” said Google spokesperson Elisa Greene in a public statement at the time of the announcement.
Screenshot of google search for “rehab treatment” with ads as results on Sept. 22, 2017.
Today, that restriction mostly remains in place. You can definitely find paid ads if you use certain obscure combinations of words in searches; Google has described the change as a gradual process. But a Google search for “drug rehab near me” yields no links with that ubiquitous green “Ad” box in front. It just shows organic search results, listing treatment centers in your area, as well as third-party referrers and locators.
The problem is that organic search is often dominated by the same sketchy treatment chains that were buying up the ads, because when it comes to search results, scale almost always trumps quality — and now the conglomerates no longer face competition from decent centers that were losing on search but at least could buy ads.
“Almost any result you find with a neutral query has some sort of tie-in,” Camp said. He gave the example of Rehabs.com, the top listing under Google Maps in the generic search The Intercept tested. (Test it yourself: Type in any combination of addiction-related keywords you can think of into Google, and Rehabs.com won’t be far from the top.) The website runs what appears to the consumer to be an unbiased, comprehensive directory of treatment facilities, with ratings, reviews, and helpful articles. Because the site has been featured on The Huffington Post, Business Insider, and other top sites, it maintains a high Google rank.
But Rehabs.com was purchased in 2015 by American Addiction Centers, a 1,200-bed conglomerate that owns 20 facilities, in a $60 million deal. In fact, AAC owns several websites with neutral-sounding names, like Recovery.org, MentalHelp.net, and Dependency.net, all through a subsidiary, making it hard to figure out what’s going on. This drives more users to its dedicated call centers, especially with AdWords out of the way and organic search as the only option for inquiring addicts.
“It’s like Consumer Reports being owned by Toyota,” Camp said.
Other companies have parroted this technique. Addiction Campuses, which owns four large facilities, also owns DrugRehab.org, another online aggregator. “Some of the people who were most aggressive with AdWords are the most scaled-out as an organization,” said Marcello La Rocca, director of Sandstone Care, which runs two substance use facilities in Colorado. “They put money into organic ratings.”
Facilities could buy their way onto the aggregator sites, but that’s a far more costly option, and one without quality controls.
Meanwhile, taking out an ad and hoping for a click is a relatively simple process for the tiny IT and marketing staffs of smaller facilities, compared to battling large players for the top of the Google rankings. “It’s hard to get patients in South Florida regardless, we have a reputation as a sewer. This will make it worse,” said Miller, who now works with a small 10-bed facility, referring to South Florida’s well-earned reputation for being a haven of fraudulent rehabs.
Google’s approach to the business of drug treatment is being crafted in consultation with the nonprofit group Facing Addiction, Google spokesperson Elisa Greene said, referring The Intercept to the heads of the organization.
Jim Hood, the co-founder and CEO of Facing Addiction, confirmed to The Intercept he’s been in regular contact with Google and applauded its interest in solving the problem. The ban on ads, he said, was a good first step, though he thinks there is more work to be done. “They’re trying to work with people who have no axe to grind,” said Hood, referring to his organization’s nonprofit status. “It’s problematical if Google turns to any player within the treatment industry. It’s a cesspool.”
Facing Addiction launched in the fall of 2015 with a celebrity concert on the National Mall and has drawn criticism for aligning itself with what’s known as an abstinence-only approach to drug treatment and recovery. The American treatment industry in general has been deeply resistant to opening itself up to an evidence-based approach, even as the medical establishment and federal regulators insist on the efficacy of medication-assisted treatment.
The medication buprenorphine has been shown in repeated studies to be a far more effective approach when it comes to length of recovery and reduction of overdose deaths, but many treatment centers remain committed to in-patient, 30-day abstinence programs developed around Alcoholics Anonymous, despite challenges in adapting the program for opioid use disorders.
Hood said his organization is still developing a consumer guide to treatment centers and that if future evidence shows the medication to be effective, he may include a section on it. But as of now, his group treats all approaches equally.
Camp decided to put Addiction Campuses to the test. He performed an organic Google search for “alcohol rehab center in Wisconsin,” purportedly looking for help for his father. The first link went to a list on DrugRehab.org of the 10 top rehab centers in the state. All of them directed users to the same phone number. So Camp dialed the number and recorded the call.
Ben Camp’s call with a helpline operator at DrugRehab.org.
For 20 minutes, the helpline operator “Jamie” persistently tried to steer him away from the Wisconsin facility he chose, claiming she could find him something better out of state. “Most of the time when you go to rehab, close to home is not the best idea,” Jamie said. “It’s more of a commitment when you get on an airplane.”
Jamie instead recommended an Addiction Campuses site in Massachusetts called Swift River — “It’s basically a resort” with a five-star chef, fitness center, and rock wall, she said. Stays at Swift River can cost $25,000 for 30 days. The facility recently went from 48 to 112 beds. The Intercept called the facility intake and asked if Suboxone, the leading medication for addiction that contains buprenorphine and naloxone, was allowed. “We prefer you get off that stuff,” the operator said, medical advice offered without knowing the situation.
When Camp pushed back on Swift River’s treatment plan, Jamie suggested another high-end Addiction Campuses site in Dallas, the Treehouse.
Even when Camp said that his father didn’t want to travel and asked if there were any good facilities in Wisconsin, Jamie said no, they catered to heroin abuse, not alcohol. Camp asked about Illinois, a neighboring state, and Jamie said she couldn’t find any open beds. “This is going to save his life,” she said, pivoting again to Addiction Campuses sites. “He needs the best possible place for him. The best might not necessarily be the closest.”
Photo: John Moore/Getty Images
The lack of AdWords means that search engine-optimized aggregators leap to the top of the page, funneling vulnerable addicts and their families to their services. That’s not only true of the organic search, but in what might be expected to be a more neutral source: Google Maps.
Google searches for restaurants or retail businesses typically show a map in the vicinity of a particular ZIP code. However, Marcello La Rocca of Sandstone Care explained that business listings can be effectively hijacked by interlopers who can request changes to phone numbers, re-routing traffic to their call centers. “We’ve had our phone number changed, all our calls were getting diverted,” La Rocca said.
The hijacking scheme is nothing new: The New York Times recently ran an exposé about shady call centers for locksmiths. Indeed, the original Verge article and other news outlets have highlighted scam rehab marketers changing phone numbers in Google Maps, or renting a P.O. Box in a certain city (or even listing a street corner as an address) and using that to pop up in local search. The dumping of AdWords makes local search and Maps that much more critical, magnifying these forms of abuse. “Google needs to make sure the listings are authentic,” La Rocca said.
A Google spokesperson told The Intercept that the company has “significantly reduced fraud with treatment center listings on Google and are committed to continuing to eradicate this type of fraud on our platforms.”
While Google has been accused of waiting too long to shut down the AdWords scheme, savoring the healthy profits it provided, it claims its intentions for the crackdown after the fact were noble — which may indeed be true. But that’s beside the point: Google’s dominance in search gives it quasi-governmental power to shape how the addiction treatment industry operates. And the technology giant doesn’t have the same incentives as a government would. “They’re not trying to do evil, they’re just not aware,” said Matt Stoller of Open Markets Institute. “It’s not clear that whatever would come up in Google’s natural search is in the public interest.”
That puts a heavy burden on vulnerable individuals seeking help to make sure they’re not being scammed, forced to fact-check themselves. “How are they going to be able to do that when they’re on heroin in Ohio?” wondered Miller.
The Substance Abuse and Mental Health Services Administration maintains a treatment services directory, a neat tool that lists all facilities in an area, with detailed information and direct phone numbers. But the SAMHSA directory doesn’t rise to the top in generic searches for rehab; instead, the conglomerates have the lead. And SAMHSA does not regularly inspect the thousands of facilities on the list, so while it is neutral, it is merely a list.
Google wouldn’t comment on how it plans to handle rehab searches and advertising in the long term, referring questions to Facing Addiction. For small treatment centers that have a handful of beds and little cash flow, even a month of waiting to optimize a new system could be too late.
La Rocca, whose Sandstone Care centers are integrated with local social workers in Colorado, thinks the change won’t affect his business as much. But he worries about how patients might be affected. “There’s so much stigma and shame around folks struggling with mental health or substance use,” he said. “Google can be an important resource for families, but unfortunately unethical organizations take advantage.”
Unethical organizations are forever on the lookout for ways to exploit cracks in the system. The discovery of Russian agents purchasing presidential election ads at Facebook and now Google has created the impression that the problem with tech monopolies is inadequate self-policing leading to an exploitable Wild West online. But that’s not quite right. The size and influence of these platforms means that any decision they make carries large ripple effects and unintended consequences. Facebook and Google’s sheer size gives them the ability to influence a presidential election whether they choose to act or not — far too much power for a company to have.
And in the case of treatment centers, America has outsourced public policy on the opioid epidemic to a private, for-profit search monopoly — which may have good intentions but has no idea what it’s doing.
And underneath that, it has allowed Wall Street-funded conglomerates to hoover up small treatments centers and corner the market on a service that is needed to save lives and funded by either government or private insurance. It would be hard to design a system more ripe for a ripoff.
So if Google wants all that power — and whether it does or not, it has it for now — then with it comes public responsibility. Hood said he sympathizes with Google’s dilemma. “It’s hard to play God when there are 15 or 16,000 data points,” he said.
It might be hard but, when it comes to the lives of people seeking help for a potentially fatal disorder, Google is now God. So they better figure it out fast.
That the company took any action at all could be seen as an encouraging sign. But when asked to comment on the fact that their search results send people to the same types of call centers they hoped to shut down with their ad ban, the enthusiasm for action diminishes. First, the Google spokesperson asked for evidence that, in fact, search results were sending folks to call centers. Then, she provided this statement.
We are deeply committed to delivering useful and relevant search results to our users. A site’s ranking on Google Search is determined using hundreds of factors to calculate a page’s relevance to a given query, including things like PageRank, the specific words that appear on websites, the freshness of content, and your region.
In other words, you’re on your own.
Ryan Grim contributed reporting.
Top photo: An attendee uses a computer to sign in for the Google I/O developers conference on May 15, 2013 in San Francisco.
I listened to about the 1st 6 or 7 minutes of Ben’s phone call with the twit that took his call at DrugRehab.org … until I literally wanted to scream. I have enough of a medical background to know when malpractice is being practiced. The performance delivered by that Saleswoman on the other end of the phone should have resulted in the site being immediately taken down, and charges filed against the principals.
And yes, we have a Yooge drug problem here in this country that has evolved from over prescription of painkillers … into a serious epidemic – thank you Sackler’s for Oxycontin. By the way – your donations to art museums hardly make up for the pain and suffering you have caused.
We persist in treating patients who are addicted as though they were a drug enforcement problem – as opposed to a public health challenge. And that’s in the face of an excellent example in Portugal of what happens when you do this right.
We will never get ahead of the “drug problem” in this country until we begin to move away from treating addiction as a drug enforcement problem, and begin to treat it as a public health opportunity. And, furthermore, to do so within the paradigme of practice what Partners in Health describes as “Social Medicine,” and what I might call “treating the whole patient in the rich context within which s/he developed the problem, and now can heal.
The initial impetus to take a pain killer was usually the need to get some relief from physical pain. But not always. Many times that initial foray into opiods and other pain killers was to flee from and/or diminish psychic pain – despair, loneliness, alienation, self hatred, etc.
Unless and until we begin to treat not only the body that has become physically addicted to some member of the opiod family … but also the emotional pain that kept the owner of that body craving a more general release from a wider “pain cluster” … we will never solve this issue.
We have put medicine in a narrow box – one that only allows a physician to treat a single “presenting problem,” as opposed to the complex constellation of issues that surround that ICD code.
But until we get there … could we please put DrugRehab.org off the air and out of business? And maybe even press charges against some of their operators … the one to whom I listened on this piece was terrifying.
Please?
Being drunk may seem like a lot of enjoyment and may be an effective way to socialise and forget regarding the everyday problems. However at the same time it is also quite bad for you – leaving you dizzy and forgetful and meaning you are going to vomit. This means it’s not appropriate for every situation and that it can be dangerous too much. Having the ability to quickly sober back up then is a significant skill that we can look at here.
f you would imagine you have actually an obsession with liquor, confer with your doctor about whether you’ll want to withdraw from alcohol under medical supervision. Your physician can give you medicine that will help you properly withdraw from alcohol. Other medicines might be prescribed later that will help you remain sober. With a health care provider’s assistance, withdrawal from alcohol is safer.
I read this interesting book iwanttostopdrinkingfor.life that gave me a lot of useful tips about my disease and also a different perspective on the best therapeutical approach. I think you should read it too.
Re: “…GOOGLE IS SO BIG, IT IS NOW SHAPING POLICY TO COMBAT THE OPIOID EPIDEMIC. AND IT’S SCREWING IT UP…”
Between 1980-1994, I administered enough narcan, (‘Nalaxone’, an O.D. reversal agent), to replace, (by volume’), the entire Pacific ocean!
(Well…I am exaggerating, ever, so slightly!).
As long as there is a, (so, called…), drug war…let, alone, a ‘drug_war’ where the nickel bag-level ‘pharmacist’ gets busted, while the Big_Pharma – R.I.C.O. folks continue making 50 times the legitimate amount of the product…and retaining the profits, thereof…there is NO hope of ‘managing’ this mess!
googke isnt trying to save drug addict lives…they are simply shifting money from one pocket to another…
What remains puzzling is that it can be exceedingly difficult for those with legitimate need for opioid pain relief, to actually obtain prescriptions. Each prescription is recorded into a data bank, preventing people from obtaining more than one prescription at a time, using different doctors. These prescriptions are monitored, and time-limited. How there could be an epidemic of prescription opioid use remains a mystery. Yet, it is prescription drugs — not street drugs — that are targeted.
When people have a legitimate need for these medications, and aren’t able to get prescriptions, they tend to turn to street drugs. That’s when people die.
Why is it Google’s responsibility to vet the quality of the services rendered and parse out search results that are essentially the same business, obscured by complicated ownership schemes? Whether one is searching for addiction treatment, laser eye surgeons, plumbers, tutors, daycare, or lawyers, the consumer bears the responsibility to make an informed decision. Even with legal liability, regulations, and licensing laws, there is no way to prevent consumers from making bad decisions or guarantee that that a business will provide proper and adequate service without error or even malice. Regulations and licencing laws are influenced industry insiders, who do not always necessarily have the the public good at top priority when crafting legislation.
Instead of attacking Google, journalists should cover the high pressure sales tactics, the unqualified and dangerous “medical advice” coming from the sales people, the complicated ownership/conglomerate structure that these unscrupulous businesses use to offer a false neutral recommendation for their services, to expand upon Mr. Grim’s reporting. Or even create a an actual neutral service directory, something similar to Consumer Reports or Yelp, but geared towards mental health and substance abuse treatment. Google might even be interested in supporting such an effort.
I run online marketing a mid-size rehab facility. My client has all the legal requirements, registrations, certified staff, etc… Everything was going great until Google decided to perform these changes last month.
Prior to the changes, there were keywords we couldn’t use because they were too expensive but at least there was a significant ROI. You would expect that with the changes it was going to benefit legit rehab centers and so on.
Nonetheless, the traffic has reduced by 1/5 and is not due to new rehab related keywords policies, instead, it has dropped because the bids have skyrocketed and we can no longer afford to pay for those kinds of keywords at all!
As a matter of fact, even the brand name keyword had dropped position and increased it’s CPC.
I have spoken to Google reps and all they can say is to wait it out and to report those company that are showing for rehab related terms. As if they can’t just block out and make the rollout even and fair for everybody.
Even and fair for everybody isn’t what capitalists do, and isn’t what capitalism is about. Capitalism is about those with the capital ruling over everyone else. Check google’s present valuation – there’s your answer.
If we want improvement in our lives, we must take the ultra-rich out of the picture.
I say tax them out of existence – the ultra-rich, that is – and restore “first duty is to the society” to the corporate charter.
To do anything even remotely like this, we need a progressive revolution; be damned sure to vote in EVERY primary and ONLY vote for Progressive candidates! No “lesser-evil, but hey he’s better than the other guy” – all that gets you is more evil and not necessarily “lesser.”
Why not just accept ads from facilities that show proper state licensing and credentials.
There are always cases that don’t resolve and some them are very dissatisfied and complain. It is a tough business.
Neoliberalism is to implement shareholder governance via monopoly privatization so taxpayers can socialize losses and impose wraparound protectionism that obviates failing and jailing. Universal comparative advantage for transnational capital.
As a wholesale investor in the global plutonomy, which relies on IMF rationalism, an opiate pandemic is an opportunity to commodify a problem into a trillion-dollar opportunity. Solve the problem and receive bupkis for letting a good crisis go to waste.
No person can posit a solution without having institutional cover, because our corporate-pimped government is where such meliorative threats go to die. Moreover the devolution into barbarity lends itself to reactionary simpletons who salivate over the notion of imposing Duterte remedies.
Initially the royalists were opium traffickers, e.g., the Astor, the Delano, and the Forbes family. Their profiteering from the China Opium Wars was at odds with industrial modernity, thereby foregrounding the 1913 Harrison Narcotics Tax with the Federal Reserve and the IRS.
At that time, the plutocrats needed an aspirational society to become an economic powerhouse for underwriting an imperial war machine. Such motivation was anathema to opiate dependency. but now surplus labor and professional redundancies can be pacified with opiate dreams replacing the American dream.
Whatever Google does will be small potatoes when compared with a hostile government enabling the corporate drug cartel to cultivate opiate cravings that seek heroin from America’s two-year inventory in Afghanistan. A treasonous complementarity from hell, yet perfectly rational when a parasitic empire needs to kill the host.
Stack them thirty to a holding cell until they are over their physical addiction and then kick them to the curb. The recidivism rates will be the same as they are with these sixty thousand dollar treatment centers.
Limit the production of pharmaceuticals to amounts justified by forecast legitimate needs. Do not go to war to increase poppy field production. Do not create a scourge on society for profits and then cash in on the “cure” too.
Stopping addiction in the first place is it’s only sure cure.
Geez, sorry somebody stepped on your dick.
If it wasn’t your own father, it was almost certainly a member of the ultra-rich, who have been putting a yoke on the non-ultra-rich since time immemorial. In other words, you’re putting your angst and vitriol (not to mention masochistic visions) at the wrong spot.
Drug addiction is a medical problem, not a criminal one, at least not on the part of the addicts. The so-called “War On Drugs” needs to be ended immediately. And drug manufacturers who harm those who take drugs should be taken to account – for example, their profits can pay for the treatment programs. And, we need to get the ultra-rich out of our government – in this case the FDA – so they can’t do things like use “regulatory capture” to foist hyper-addictive drugs on the public so they can get even more rich on the profits.
Misguided rants like yours gives the far right wing a bad name!
The solution is simple. If the Google search algorithm is producing bad results, invert the algorithm. Instead of returning search results for sites with high click rates and low quality, return results for the sites with low click rates and high quality. Congress should write the requisite search algorithm and pass it into law.
And within 24 hours, SEO folks would easily crack that too.
That’s a terrible idea and what you are asking for doesn’t exist in the real world. Google’s algorithm aims to prioritize high quality content on top that provides the best user experience. The results that are not ranking are not ranking for a reason…they are not quality and provide little value to readers. If you want to rank better, provide better quality content and resources (and obviously network and build relationships to get organic/non paid links).
The Google algorithm has only gotten better over the years. If you recall just 5 to 7 years ago, the search results were filled with nothing but spam content pumped out by content mills. As an Internet user, those days were frustrating.
Do understand that none of what I said here is about the paid PPC ads that are listed at the very top (there are tweaks there that need to be done to level the playing field). Having the most money in your marketing budget does not correlate to having the top spots in these organic results. Sure It helps but if you don’t provide quality content, have a great user experience, or know how to do basic search engine optimization, don’t expect to rank well long-term….even if you are shady and buy links/publicity.
Proposing terrible ideas is my specialty. My experience indicates that the more terrible an idea, the greater the chance that it will be implemented. So I don’t waste my time with good ideas.
Excellent reporting, and very helpful to addicts and their families: be very wary searching for help with Google.
Every drug rehab facility in the United States should be under standardized medical supervision and should be licensed and visited every two years with no advance notice.
R.N.’s who have been trained in drug detox/rehab methodologies should be required on staff 24/7.
Make ALL these facilities meet the same high standards and then it wouldn’t matter “which” facility someone chose.
Put all the others out of business.
Sure, but to get that we’re going to have to have a change of administration AND Congress … and don’t hold your breaths that just any Democrats would support that! We need a Progressive Revolution!
I feel as though I have discovered the infection of corporatocracy in every organ of the America I believed in my whole life. This infection has caused resistant strains of corruption that are rotting the gov’t, news & media, all law enforcement agencies, and even agencies for public safety. Every ‘marketplace’ is diseased. It’s spread to the internet. Once you have this disease, all that matters is money. Public well-being and safety have been sold for monetary gains.
Now we can add life, death and medical treatment to this epidemic.
I feel you Bowiepoet
Benito Musolini – the dictator from WWII, not the one who posts here regularly – in discussing fascism said that perhaps corporatocracy was a better name for it. Yes, fascism / corporatocracy is the basic problem.
Question is; what the hell are we going to do about it?!
One part of the answer; quit wasting time on “wedge issues” that keep us apart and distract us and instead focus on this one problem. ALL our ills will be reduced once we throw the bastard’s yoke off our necks.
The medical marketplace. Single payer solves this problem.
the totality of the problem is “marketplace”.
Google, Facebook, and the security problems with the internet, show that the people behind these faceless corporations are not concerned with the well being of the people but are only gaming them for their money.
Google is steadily turning into a pile of shit. I’ve switched over to Duck Duck Go as a primary search engine and anyone with an ounce of sense should do the same. In addition, it’s high time that monopoly antitrust legislation targeting Google was launched.
Two points. First, this is proof that Google is just too big for its own good. All that matters is who are the power players? Second, if we had universal health care. EVERYONE would have equal access to the same care. This would save lives. This would stop ungrateful celebs going to “rehab” repeatedly and making a joke of the whole process. Many of these “exclusive” rehab centers don’t take most private insurance. Example. Eric Clapton started Crossroads, a rehab center in Antigua. I checked it out once and was told they don’t deal with private coverages. Why? Because it’s too much hassle. So how does this help poor Antiguans? It doesn’t. It only helps the ultra rich.
The incidence of corporate size and/or individual industry influence over presidential elections is not something that began with Google. Though you are correct to label it extremely problematic, I found the insertion of that paragraph into this particular story … dissonant. After all, if the NYT can do it, why should we be surprised to see the advertising industry – or Google and Farcebook – diving in as well?
http://www.slate.com/articles/news_and_politics/politics/2008/03/the_education_of_a_911_reporter.html
Fortunately, I don’t use G-search and I never select the first choice. What’s the matter with Americans today? Do people really click on the first thing that they see?
Why?
I use Adblock Plus, so in my Google search of my particular city, Rehabs.com appeared fifth – after three ADS. Using DDG, Rehabs.com popped up second, with no other distractions.
When I clicked onto the NYT article on locksmiths, something wonderful appeared on the NYT bottom-up (pop-up from the bottom): https://imgur.com/mGqAzRx
One can only hope a larger anti-monopoly outcry is heard (a)round the world.
Thank you for highlighting this paragon of virtue, David Dayen.
“That puts a heavy burden on vulnerable individuals seeking help to make sure they’re not being scammed, forced to fact-check themselves.”
Always good advice anyway, even if you are on heroin (…though I agree it’s unreasonable to expect someone in that circumstance to do their due-diligence). … I always look for product reviews or the places where people can complain.
I recently was struck by a car as a pedestrian and thought maybe I’d recover on my own. When I ended up spending a couple of nights literally screaming in pain, went to a local clinic to get help. I was shocked to learn that they REFUSED to give me anything at all for the pain.
I was told I should use ibuprofen, which, unfortunately, doesn’t really work for me. When I mentioned that, I was told to take acetaminophen, which also doesn’t really work well. I was told to take massive doses.
When I asked WHY I wasn’t able to get anything else, they cited the modern epidemic of addiction. I said fine, don’t give me enough that I can get addicted – how about just a couple of pills so I can get through the night and get SOME sleep? Nope, refused to give me any at all.
I inquired WHY?! That I was in serious pain they had no doubt, but they were too afraid of this addiction problem. So, I rephraised the situation and asked the doctor to comment, “So, let me get this straight; you’re denying me medication you know I need, guaranteeing with 100% certainty that I’ll suffer needlessly, in order to prevent the chance of there being a modest risk I might get addicted, for which it’s not certain that that harm is worse than the one you’re now guaranteeing?!” “Yes, that’s correct.” I couldn’t believe my ears.
If anything, their denial of providing ANYTHING when it’s medically called for is going to push a lot of people into buying on the black market, having exactly the opposite effect of what they claim to want.
You really have to marvel at this “health system” we have. How anyone can think it’s the greatest in the world is beyond me.
And speaking of not great, my dentist friend then cautioned me that the amount of ibuprofen and acetaminophen they were recommending I take would be harming my liver within two weeks and I was best off not taking anything like their dosage, but rather alternate, take some of one, then some hours later some of the other, both in radically smaller doses than I had been told. . . I tried it and it worked at least as well as the huge doses but with greatly reduced risk of harming my internal organs.
For this, the bill is a little over $1000. Insane.
If there is a next time, I’m skipping the big doctor bill and going straight to the black market. I’m a mature adult, I know how to prevent addiction; only take exactly what’s needed to stop the pain and never any more, and cut back on the dosage now and then to confirm how much is actually required. Ween ones self off it as healing progresses. … It’s not rocket science, and not all of us are wired for addiction.
That´s what many do. They skip the doctor, go only to the hospital in case of emergency and treat themselves with the help of Doctor Google. And there it is – the big economic crisis.
The wonders of capitalism, isn’t it grand? Where the hospitals profits out weigh the patient’s needs.
My mom had a similar problem. She has had chronic pain for decades, and has managed it responsibly. A year or two ago, out of nowhere, her Doc told her she will have to submit to a drug test every year to get her pain meds. As if the Docs are cops now or something. They claimed, “An increased incidence in patients mixing drugs and getting into accidents” which made me think, “How does a drug test going to detect alcoholism if the patient doesn’t show up drunk?” It dawned on me later that the Medical Industry is worried about medical cannabis digging into their astronomical profits, and they want to cozy up with the cops to keep their dominance on people’s pain.
It’s sad too that pain med addiction is getting this level of policing, yet addictions to money, power, sex, porn, alcohol, television, attention, social media, salt, nostalgia, and sugar are seen as perfectly normal and acceptable addictions that fuel entire economies.
consider the thankless job Merck, Pfizer, Eli Lilly, etc. etc. have, leeching off of publicly funded medical research, to skim off the most promising/lucrative possibilities, receive all the accolades for “having developed” the medications, and then rolling in billions as they patent and re-patent taxpayer funded medical developments, preventing them from becoming generic for decades. its a hard hard thankless job…
This,
consider the thankless job Merck, Pfizer, Eli Lilly, etc. etc. have, leeching off of publicly funded medical research, to skim off the most promising/lucrative possibilities, receive all the accolades for “having developed” the medications, and then rolling in billions as they patent and re-patent taxpayer funded medical developments, preventing them from becoming generic for decades. its a hard hard thankless job…
was exactly what I saw working in HIV research for 15 years. And, with NIH-funded research on such tight spending limits for so many years, they also controlled follow-on research into drugs after production by controlling which projects received drugs for studies. I was personally part of at least two studies that didn’t happen because the companies reneged on commitments to supply drug after realizing that results may not be to their liking.
Addictions, per se, don’t bother me; its’ the negative outcomes that need to be mitigated, especially the negatives that are thrust upon people other than the addict.
Cannabis wouldn’t help me in my circumstance. It’s not a panacea, but where it can be helpful, it should be freely used.
indeed massive doses of acetaminophen or ibuprofen can do damage to the liver or stomach respectively. We also see acetaminophen joined with an opioid e.g. tylenol with codeine. As far as I can tell, the acetaminophen does nothing whatsoever, and is put in just as a deterrent to taking large amounts of the opioid, for whatever reason. The thought being that people will be deterred by the high possibility of liver damage caused by the acetaminophen, incurred by taking high levels of the pills. The system would rather have you dead of liver failure than having some possibility of becoming addicted…
Agreed – thanks for your comment.
When my son recently had his wisdom teeth removed, I took a prescription for ibuprofen with a small amount of Oxycontin to CVS. My son was in severe pain. When I got home, I noticed the bag was unstapled. The Oxycontin had been stolen by the pharmacy technician. They put me through the ringer for three days, ignoring my demands until they checked the security video, and when that was cleared they then refused to do anything while my son took other medication and barely made it through. When I called CVS headquarters and complained, they were mildly interested. I live in a town of less than 1200 people. The bins of medicine to be picked up at CVS are stuffed, falling out, literally. We’ve been made mad by greed, and the coming-down from greed is our elixir.
Sorry to hear all that.
Good lesson, though: double check the medicine at time of pickup!
It would also be good to know what the correct pills look like, and check that, too! There’s something called a Physician’s Desk Reference – the PDR – which has such descriptions and a lot more. … I have a copy that’s almost 20 years old now. I seldom use it, but when I have I’ve been VERY grateful to have it on hand. … Time to get a new, updated copy! (YOu can buy the subscription service, but it’s not cheap. They also offer an online version, also not cheap!)
Art, I sincerely hope you do not face such severe pain and are truly influenced to seek pain management on the black market. Because unfortunately, the risk of becoming addicted is nothing compared to the risk of buying a substance adulterated with fentanyl. A dealer may not have any idea the fentanyl is even present, and there is no way to reliably test street drugs for safety. The potency of fentanyl can kill in a single dose, long before addiction is even remotely possible.
That said, it is unethical for a doctor to refuse adequate pain management, and you should have been re-evaluated for pain after trying the Tylenol/nsaid combo. There are other options, like an injection of anti-inflammatory, that may (or may not) have provided relief. But they could and should have worked with you instead of dismissing you as a drug-seeker. I understand where you are coming from, it’s insulting, upsetting and embarrassing to be treated like an out of control addict when suffering real pain. A few months ago I had an awful toothache, but I refused opiates and opted for prescription ibuprofin with the antibiotic. A month or so later, the toothache came back, and again, I refused the opiates and figured the ibuprofin and antibiotics would do. But I wasn’t okay, I was in agony all night. I didn’t have a choice, I had to go back to the urgent care clinic to get something stronger to get the pain under control. After twice refusing opiate pain killers that I had twice been offered, I was getting the run-around. My face was swollen and my gums clearly inflamed, so it wasn’t like they couldn’t see a painful condition. They gave me BS excuses, saying that my insurance rejected it, then that other medications I take flagged me and the system would not allow them to enter a script for an opiate. The pain was excruciating, I hadn’t had any sleep, I knew they thought I was drug-seeking and were lying about it, and I couldn’t hold back the tears. Oddly, the nurses were being really nice to me, very empathetic, and didn’t seem entirely sold on the idea that I wanted drugs for any reason other than relief. After some back and forth, one came back into room and offered me a shot of Tordal. I didn’t think it was going to help- it was useless for separate/ unrelated emergency I had experienced a while back- but I agreed to try it. Surprisingly, it worked great. Nonetheless, they could have simply offered the shot with out all the hassle, and just refer me to the hospital if it didn’t help. Now I feel like I’m labeled, and too embarrassed to go back there in the future.
Wow, Erin, sorry to hear all that. Hope you’re better and don’t ever face that again.
Our society is really sick with drugs and not ON the drugs but how the society treats them – and us. We MUST end this idiotic “War On Drugs” NOW. Of course, to do that, we need someone like Bernie in the white house…
NO MORE FAKE PROGRESSIVES LIKE HILLARY. We need the real thing.
People do silly, boring and unhealthy jobs for very little money. And hate it. Pain relievers help. Other people do creative, interesting and wholesome jobs for lots of money. And hate it. Because they feel the bottomless hatred. And they meet each other … in group therapy. Not true, of course not true.
Seems perhaps we are the ones who need treatment, in that we have created a culture that has left so many demoralized, which in my opinion has contributed significantly to this epidemic.
https://newint.org/columns/essays/2016/04/01/psycho-spiritual-crisis/
https://benthamopen.com/contents/pdf/TOADDJ/TOADDJ-1-7.pdf