世纪犯罪（2021）

整个医疗系统里是存在的
and in the medical system to the point
到了19世纪中期
that in the mid-1800s, when anesthesia
那会麻醉剂刚问世
was first invented,
有些国内最厉害的外科医生
some of the most prominent surgeons in this country
并不接受这个发明
didn't want to adopt it because they wanted
因为他们想让病人在手术过程中感知痛苦
their patients to feel pain during procedures
好加快恢复的速度
in order to expedite the healing process.
但是我们看待痛苦的角度不一样了
Like, we don't think that way about pain anymore.
比如说“哎呀疼疼疼疼
You know, now we think,"Oh, my goodness, pain!
我得赶紧想办法止住疼痛”
Like, I've got to get rid of it immediately."
但是鸦♥片♥危机之所以特殊
But what makes the opioid crisis unique
就是因为药本身
is that the pills themselves
就具有高成瘾性
are so inherently addictive
再加上企业
that if you then add that
对这个产品的推广营销
to all of the business incentives
到过度开药
to overprescribe,
就造成了今天这种药物泛滥
you do end up with this kind of perfect storm
生灵涂炭的局面
that leads to the crisis that we have today.
听我说弟弟们
You know, guys,
在Purdue
you know, as far as the Purdue
看来
is concerned,
这是个热情高涨的
it's a high-energy sales
企业
organization.
是制药领域里
It's one of the best sales organizations
销♥售♥额最高的企业
in the pharmaceutical industry,
是最努力的企业
and they're hard-driven.
如果我们要为了他写歌♥儿
And if we're gonna write a song for these folks,
那必须整个大的
it's a song that's gotta smoke.
普渡准备好嗨起来了么？
Purdue, are you ready to rock?
看来大家伙是做好准备了啊
I think they're really ready to rock right now.
准备好了么?
I said, are you ready to rock right now?
让我看到你们的双手
Put your hands together if you're ready now.
在90年代末
In the late '90s,
普渡以他们的营销能力而出名
Purdue celebrated its marketing muscle.
有600名药代在全国
There were 600 sales reps pitching healthcare providers
进行推销
all over the country.
利用轰趴和旅游
Using parties and junkets
来诱惑医生多开药方
to lure doctors to write scripts,
普渡的推销员一年光奖金就能有4000万美元
Purdue's pitchmen banked $40 million a year in bonuses.
到世纪末
At the turn of the century,
奥施康定每年的销♥售♥额超过10亿美元
OxyContin sales exceeded $1 billion a year,
超过伟哥成为美国最赚钱的药物
passing Viagra as America's most profitable drug.
我很高兴看到
I was very gladdened
奥施康定被
to see that OxyContin was meeting
如此多的医生病人
with such a strong, positive reception,
所接受和欢迎
by both physicians and patients.
先生们女士们
Ladies, and gentlemen...
我们针对的那些医生
The doctors that we targeted,
喜欢把我们叫钱袋子或者送财童子
they called me Moneybags and Easy Money,
因为在他们看来
I guess, because in their mind,
这要你用上奥施康定或者其他的阿片类药物
once you got them on OxyContin or a opioid
你就戒不掉了
and they got hooked,
你就会不停的去开药
you were going to get reoccurring prescriptions.
那每个月钱哗哗的
And the monthly bonus checks.
我应该是赚了
I believe I made in the neighborhood
17万美元
of about 170.170,000.
到了我最后一年大概是三十万
My final year, it was almost 300,000.
有的时候有医生会说
Sometimes doctors tell us they feel
我们的药代有些强势逼人
that our sales representatives have been pushy.
但是那是因为他们背负着
They are insistent because they're on a mission
解救有需要的人的使命
to bring this medication to people who need it
去帮助他们恢复有质量的生活
to restore their quality of life.
他们管我叫散财童子
Yeah, they called me Easy Money,
但是活儿一点儿都不好干
but there wasn't nothing easy about it
刚开始特别难
because we had such a wall to break away.
有好多的大夫一开始不敢用这个
At least early on, doctors were afraid of the opiates,
也不相信高剂量这个说法
and they didn't believe in using high doses.
他们不愿意在非癌症患者身上使用阿片类
They didn't believe in using it in non-cancer pain,
我们就得想办法克服这些
so we had to overcome all that.
在本项目里，这些病人
In this program,these and other patients,
都遭受着经年累月的
all of whom have suffered through years
慢性疼痛的折磨
of varying degrees of chronic pain,
有他们来讲述那漫长
tell the story of their long, often frustrating,
挫折以及痛苦的救赎之旅
always painful search for adequate treatment.
他们做了个视频叫“夺回我的生活”
They had a video called "I Got My Life Back"
我在医生办公室里不知道放了多少遍
I played many a-times in physicians' offices,
就是为了把这个问题人格化
sort of humanize the idea of treating pain patients.
自从我开始服用这些新产品
Since I've been on this new pain medication...
我和我丈夫的关系越来越好
I'm more of a partner to my husband again.
我能去看电影了-我还活着
Now I can go to a movie.- I'm still alive.
当他们说到他们
When they mentioned the dosages
服用的剂量时
that they were on...
目前是1200毫克
I'm currently at 1,200 milligrams
奥施康定
of OxyContin.
有些大夫会
You know, some physicians,
大惊失色，你懂吧
their mouth would drop open and, you know,
我们就会解释说
we would explain to them that
这个药的剂量是没上限的
there was no maximum on the dosage,
成分纯粹
that you could go with a pure opioid
梅没有掺别的成分
that had no secondary product in it
不像泰诺，布洛芬，阿司匹林这些
like Tylenol, or ibuprofen, or aspirin.
这种药不会让你变成行尸走肉
This medication does not turn you into a zombie.
是阿片药让我焕发了生机
The opioids have given my life back to me.
赚钱的点儿就是
The gold nugget was
非癌症的慢性痛患者
non-cancer, chronic pain.
奥施康定吃了
OxyContin, it's the one to start with
就别想戒掉
and the one to stay with.
什么是疼痛
What is pain?
疼痛就是折磨，就是痛苦
Pain is suffering. Pain is soreness.
没有尽头的疼痛
Throbbing. Aching.
疼痛就是那些遭受痛苦的人
Pain is whatever the person experiencing the pain
真实感受
says it is.
强啊
Amazing!
普渡大方的啊
Purdue was so generous.
有录像带
They had video tapes.
有手册 有海报
They had manuals.They had posters.
直接发给了全国
They disseminated that
各大医院
to all the hospitals in the country
来引导医生
who had to educate their doctors.
像我一样，大夫们
It meant that I, a psychiatrist,
去听一整天的关于疼痛的讲座
had to go an all-day-long course on pain.
我都没去上一整天的心脏
I didn't have to go to an all-day-long course
或者放射科的讲座
on, you know, cardiology or radiology.
对疼痛的治疗就应该像
The fact is that pain should be treated
对或造成痛苦的潜在病症
as aggressively as the underlying condition
一样积极
that causes the pain.
我被教导治疗疼痛应当
I was taught that pain should be treated
遵循五大原则
like the fifth vital sign.
测血压的时候
When you take blood pressure,
测呼吸频率的时候
when you take respiratory rate,
测心率测体温
when you take heart rate, temperature,
你应该
you should show them
给她们按一到十打分
this scale from one to ten.
一等于啥事儿也没
One is like tiny, little bit of pain,
十就是马上要疼死了
and ten is the worst pain you could imagine.
将疼痛管理纳入
Incorporating pain management
各级护理教育将
into nursing education at all levels
培养出精通疼痛管理的
will produce staff members who are skilled
专业人才
in pain management.
我们一直被灌输着
We were constantly being told