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In this edition of Scheer Intelligence, host Robert Scheer dives into a critical discussion with Dr. Charles LeBaron, a distinguished physician and CDC veteran, who has authored a compelling and essential book, Greed to Do Good: The Untold Story of CDC’s Disastrous War on Opioids. Dr. LeBaron offers a unique perspective on the opioid crisis, drawing from his extensive experience and personal encounters. Through his well-crafted narrative, he sheds light on the complexities of pain management, the challenges of public health policies, and the human stories behind addiction.
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This transcript was produced by an automated transcription service. Please refer to the audio interview to ensure accuracy.
Robert Scheer
Hi, this is Robert Scheer with another edition of Scheer Intelligence, where the intelligence comes from my guest and no question in this case, somebody here who went to Princeton and Harvard Medical School and published 50 scientific articles. And I’m building up his credibility because he’s written a really important, mercifully short book, I want to say, as somebody who reads books all the time.
And that is not getting the attention I think it deserves. And I read his book at my producer Josh Scheer’s suggestion. I’m happy for it. Because it’s about time I thought about not only the opioid crisis, but thinking about the CDC where Dr. Charles LeBaron, I hope I got it right, worked for 28 years.
And his view of the official medical agency and what it does and how it sets out guidelines is really powerful. But what adds force to it is at one point where I got really hooked on this book, one of the requirements at the CDC is you had to do some real life experience out there and he worked in a jail prison.
And that I found is a very moving part of the book. And then you worked on an Indian reservation where you actually functioned as a doctor there, not just as the epidemiologist studying these things as you had done, I shouldn’t say not just, but getting into the field. And what I found fascinating about this book is, first of all, it’s a page turner. Usually I think of doctors as people can hardly write a prescription, legibly.
And it’s very well written. But what really makes it so important is you really care about the outcome, know, not the statistics, but the pain, the health, does it work? Don’t kill the patient, don’t harm the patient, and so forth. And I don’t want to put words in your mouth. The title is Greed to Do Good. What is the subtitle again?
Well, I wrote it down before. The Untold Story of CDC’s Disastrous War on Opioids. Tell me about the greed to do good, this overview that you bring to it.
Charles LeBaron
Well, it’s a sort of tale of good intentions gone wrong twice, actually, the way the good intentions went wrong back in the late 90s and early 2000s, was everybody decided that nobody should be in pain. No one should have any pain whatsoever. And there were pain scales going around. And the idea is you walked into a doctor’s office and you experienced any pain, it would be basically criminal of the doctor not to prescribe something to relieve you of your pain.
Which is a little curious because in medicine you’re supposed to go after the cause of the pain rather than the effect. However, that was promoted very actively by a bunch of folks who make money off selling opioids. And that story is relatively well known that opioids were overprescribed and they were prescribed to the point where 80% of opioids were being consumed by the US in a global sense where we only have about 5% of the population.
You’re getting opioids at a rate of about 90% for operations where in Europe, for instance, only 5% people got opioids. And the result of this, you might call well-intentioned on some people’s part to reduce the number of people who are in pain, resulted in a large population of people who became, in essence, legally addicted to opioids, whereupon, as you might imagine, the number of overdoses also increased in parallel to the amount of prescriptions of opioids that are going on.
And people finally scratched their head at CDC and said, what are we going to do about this? So they slammed the door shut on people getting legal opioids. Well, you can imagine what happens if you’re opioid addicted to legal versions of opioids and they slam the door shut on that. There are a bunch of entrepreneurs south of the border who said maybe there’s a market share we can grab here.
And they said we can construct some really powerful opioids with some materials coming from China and they start importing fentanyl and other comparably lethal drugs, whereupon, as soon as CDC had decided to slam the door on legal opioids, there was an explosion of overdoses to the point where it quadrupled in about seven years, reaching to the point where there are 100,000 deaths per year.
And over the course of the first two decades of the 20th century, a million people had died of overdoses. And so again, these were two in a sense, well-meaning, but misguided interventions. One was to reduce the amount of pain in existence to zero. Well-intentioned, but misguided. And the second was, we’re going to eliminate addiction and overdoses by slamming the door on safe versions of opioids.
And in each case, matters went south. And here we are.
Robert Scheer
Well, as you point out in your book, there wasn’t only and maybe with the CDC, it was agreed to do good, but also there was a greed to make profit by pharmaceutical companies. And obviously, when you get into the illegal, even greater profit, perhaps. But I want to start with the pain, because actually I found that the book is divided into four sections. And I like that way of treating you because you put yourself in the position of the patient.
And the first part was about your back pain and your illness and so forth. And it’s really compelling because you’re getting it not from a doctor saying suck it up and live with it. You don’t want to make the cure worse than the illness. But you experience the pain. You write about it very movingly, trying to struggle with it, the temptation to take more and so forth. But you gained a lot of wisdom about it and having to manage pain.
So why don’t we begin with chapter one and then we’ll go through, I mean, section one and then go through the four themes of the book. Because I think there’s, I want to tell people, this is like 150, think 140 page book. Then there’s about another 60 pages of citation, good information. It’s very solid. But I just found it about the best way you could spend part of an afternoon reading it, you know. And on this show I reviewed books and things that take me up a week or two weeks to read. So I was grateful for that. But you, as I say, you have a real gift, I think, with the writing. And I haven’t read another book I saw by you on your first year at Harvard Medical School, but I’m going to get a hold of it after we’re done here. I’d like to know what that was like.
Charles LeBaron
Also short, also in that zone where an afternoon will do it for you.
Robert Scheer
Yeah, but let’s begin with the pain because when you have pain, you want to manage it, whether legally or illegally, you know, or including drinking too much or whatever. And so it’s really a good personal story there about how to deal with it and then what might be the role of opiates positively.
Charles LeBaron
Well, you’re absolutely right. I mean, it’s said in medical school, and it’s absolutely true, you learn a lot more from your patients than you do from your books. But they failed to put one additional thing in. You learn much more by being a patient than you do from either of those other factors. And pain is a particularly enlightening event. This has been well known throughout spiritual history as well. The distress educates.
And in my case, had what I think most people would consider to be majorly pain. I had a staphylococcal meningitis, collapsed a bunch of vertebrae. And on top of that, I got shingles, which is a ulcerative condition of the skin over about half my torso. And it’s all simultaneous. And it is remarkable when you’re in the level of pain which I experience, how fundamental that experience seems to be in many ways.
Fundamental to your understanding of yourself, your understanding of the world around you. You develop a very interesting view of how the universe operates when you’re in excruciating pains. It sounds metaphysical, and it is metaphysical, but believe me, it has a trivial aspect in that you realize that a pill can make it go away, but someone won’t give you that pill, even though it’s there.
And you develop a remarkable view of human nature when that happens. And in effect, what happened to me and happens to many people who are in really severe pain is the CDC had developed a bunch of rules associated with who was allowed and who was not allowed to get pain medications.
And it was remarkably instructive for me. And that was what motivated me to write the book about how pain is really a pretty extreme event when it’s as strong as what I had. And it’s pretty extreme view that you develop of other human beings if that the remedy is withheld from you.
Robert Scheer
So, but you also, there was a serious illness. I think you have a statistic in there that it was a 50% death rate of…
Charles LeBaron
Yeah, about that, right. I survived that. I ultimately ended up on a level of narcotics, which would, over time, create about 50% risk of ongoing need for narcotics. I managed to get off those. So I kind of had luck. I had luck. I survived physically. I had luck in that I survived the adverse events of the medication.
So one of the things I mentioned in there is it’s good to have good luck. Good luck in the sense that I got medical care. Other people don’t have access to medical care. I had good luck in that I come from a good sociologic in which I have the support of economic and personal and I had probably good accidental biologics in that I never got high off this stuff. I never felt euphoria. I never felt anything.
As far as I concerned, it was a medication to relieve pain. I never felt any of the other events, psychological events that are associated with ongoing news.
Robert Scheer
Let me go from that to the second part of your book, the capacity for fanaticism. How does that relate? So here you were from being the patient and now you’re describing your experience of being at the central health organization that revered most of the time, at least before the pandemic and now Donald Trump, but still it was revered. And what did you mean by that? The capacity for fanaticism?
Charles LeBaron
Well, I allowed myself to draw the analogy between what I had done at CDC and what CDC was trying to do with opioids. At CDC, things are very different right now. A different program would be required to examine what’s going on at CDC. But we’re serious folks at CDC. And we like to get rid of pathogens.
And in my case, we basically got rid of measles in the United States. You’ll note that measles is making a resurgence under the current regime. And we had previously gotten rid of smallpox. We’d worked on a bunch of other things. We’re serious folks about what we regard a pathogen as preying upon the public, and we want to get rid of it.
Where the problem becomes is when you apply the pathogen notion to a medication like opioids. And to some extent, if you take that lens and view opioids as if they were an infectious agent, there’s some seductiveness to it because they basically are imported. There’s, in effect, it becomes a communicable disease. If other people are taking opioids, you tend to do so.
But if you regard them as an infectious disease that you need to eradicate, no one ever needed a little bit of smallpox to get along in life. No one ever needed a little bit of measles to survive. But opioids are an essential medication for survival in many ways.
And the extent to which we applied the same degree of seriousness of purpose, in the sense the capacity for fanaticism to opioids, created the problem of illegalization being normalized, and then overdoses being the consequence.
Robert Scheer
Well, but when you say fanaticism, I mean, they yeah, they really messed up a lot of people’s lives. And you experienced some of that eyewitness when you worked in the prison. Right. One example of a young man, went in there 20 something for a pocketful of what they said was a lot of drugs and he’s going to be there till he’s in his early 50s. And, know, that I mean, just to sort of carelessness of the way we mix up that which we should ban and if we do better how to ban it Whose choice it is.
I mean, it’s a very powerful eyewitness in your book and sort of a madness to it. I don’t know I don’t want to again put ideas or words in your mouth, but that’s what has struck me as a reader You know, it’s kind of what’s going on. And it was racially based too. I think the one prison you were in, was like 80% people were African Americans.
Charles LeBaron
Exactly right. Yeah, the one claim I’ll make for my book, you know, is said in medicine that you’re either an inch deep and a mile wide, or you’re a mile deep and an inch wide. You’re either a hyper specialist or a hyper generalist. In my case for this book, I will make the claim for uniqueness in that I had a variety of experiences, which at least to my knowledge, no one else has published.
I have had extreme pain that required opioids for long periods of time. I’ve treated populations in Appalachia where the highest rates of addiction and overdose are present. I’ve worked in the prison system where so many people have been incarcerated. We have the highest rate of incarceration in the world. And so I, in a sense, know the situation from a great deal of breath.
I don’t claim to know the situation from the same degree of depth that an opioid treatment specialist would. But I have the sense that I know the situation from a breath. And what you’re bringing out is the other aspect of what’s happened with opioids, which is basically the notion that if you make a war on supply, if you go after the supply, the demand will go away.
Well, the difficulty is there’s no evidence that that’s been the case. And our war on supply is basically a war on poor people, because we’re not arresting the people in Purdue, the Sacklers. The Sacklers have a wing of the Metropolitan Museum. They’re not in a wing of the federal pen. But the people who are trying to sell a couple grams of something, they end up with a mandatory minimum. And one of the things that that was an experience working in the federal penitentiary that was remarkable to see how many lives were being ruined by the supply side aspect of the thing.
Yeah, we get El Chapo once in a while or we get the Sacklers to give up a billion dollars or something, but the real casualties are the people at the bottom who end up going in in their 20s, not coming out until their 50s because they had a pocket full of some stuff they were trying to sell.
Robert Scheer
You know, it’s interesting because that’s an issue right now with the Trump administration between the United States and China, fentanyl and so forth. It’s a big issue with Mexico and it’s dominating the whole discussion. I mean, maybe we should talk a little bit about that.
Charles LeBaron
Well, it is interesting because that’s one aspect that I haven’t had too much to deal with. So I can’t speak to it. I haven’t been a law enforcement officer. I may have had all these other hats, but I haven’t arrested people at the border. But it’s an enormous fuel to run around and say that we’re going to impose what, you know, 80% tariffs on Mexico, bringing in cars, and that’s somehow going to reduce the fentanyl that’s coming in.
There’s no evidence that would be the case. And so far, all our efforts at preventing fentanyl from coming in across the border have been largely futile because the demand is very, very strong here. And all you need to get across the border is something equivalent of a 12-pack of beer of an even more potent opioid than fentanyl, it’s carfentanil.
If you bring in basically the equivalent of 12 pack of beer in a false bottom of an 18 wheeler, that’s enough to overdose every man, woman and child in the United States. So it is basically impossible to prevent drugs coming in. Where you can prevent the drugs coming in is cease to have the demand, the level that we have. And we’re willing to spend billions, particularly in tariffs, on creating obstacles to the supply, which cannot be done.
You’re basically a paperclip to a rising tide. And we don’t spend a cent on the treatments and other things are necessary to reduce the demand.
Robert Scheer
So, again, speaking from your experience, I mean, it’s a long time, 28 years to be at the CDC. you were honored there. You’re not some angry dissident or something. You’re a great success story. We grew up in the Bronx, not far from each other. You got into the special gifted high school. You got into Princeton. You got the Harvard you get the credentials you publish in the papers and what I loved about your book I got to keep pushing this book because I really just think it’s it’s a terrific book, Greed to Do Good: The Untold Story of CDC’s Disastrous War on Opioids and there’s one book you read about this.
This is the one and because there’s a humanity to it, you know, you’re not preaching, you’re not, know, like Robert Kennedy now, he’s got the answers and everything. He knows it should be this way. And then Donald Trump shows it should be another way. You just got open eyes there. You’re doing what any honest observers should do. And you say, hey, this is not working or these people are, you know, and the CDC, you talk about how they drew up their guidelines and that it wasn’t really good science.
I think that’s chapter three, isn’t it? The part three is about poor science. The work and it’s not fact driven. How does that happen?
Charles LeBaron
Well, it’s interesting how it would happen. What happens is there is an impatience in public health. When you see a rising tide of overdoses, you tend to say, I can’t just sit here. I have to do something. And there’s a danger to just doing something. Because in the case of public health, yes, sometimes you have to respond on plausibility alone.
And the plausibility here is, you know, the drug companies promoted these drugs and people are taking them like crazy. We got to cut off this promotion of drugs by drug companies. Sounds good. Basically, what you’d say the motivation is. The difficulty is that demand has been created. And addiction is a very, very powerful demand. It’s very hard to erase it merely by eating.
And the evidence that merely now just telling doctors they can’t prescribe opioids is going to correct the problem. All it did is displace it into the illegal system where it became much more, the demand became much more dangerous. And there’s no dishonor to operating quickly on plausibility without too much data because sometimes you have to react.
Where the difficulty is, is when things are ambiguous in the data, it is your obligation to constantly query the outcome. Am I doing good or am I doing harm? Now there is greed to do good in the sense that people want to do something right on a plausibility basis. Drug companies are really addicting everybody, we got to stop them.
However you need to examine the consequences of your own behavior. Did this have any effect that was beneficial? And when you get a doubling of overdoses after your intervention is applied, it behooves you to say, you know, are we doing more harm than good?
And what should we be doing? And that was not done. And this comes back, Robert, to what you’re talking about, the capacity for fanaticism, the characteristic of fanaticism in contrast to what you would call ethical medicine is, yeah, this was a good medication. I did it as best I could, but the patient got worse. I got to reconsider my strategy.
And unfortunately for basically six or seven years, while the overdose rate kept going up to the point where it is ultimately going to kill a million people in a decade, nothing was done to back off. And it just became, in essence, fanatical activity rather than a medical activity.
Robert Scheer
And as you predict in your book, another million will die in the next period. I mean, it’s not getting better.
Charles LeBaron
Well, it’s interesting how that thing recently, for reasons which aren’t clear, and I would love to think that it represents, CDC backed off slightly on its medication recommendations about a year and a half ago. And thereafter, the rate of overdoses has gone down somewhat, about 20% down.
And people, you can’t believe how much celebration there’s been over that. And of course I celebrate people not dying like anybody else. But what that means instead of a hundred thousand doses, a hundred thousand overdoses a year, we have 87,000. Okay, that’s good. I’m glad it went down.
That means in order to kill off another million people, we’ll do it in 12 years instead of in 10. That isn’t just the kind of success you’d usually break out the champagne for.
Robert Scheer
Well, you know, it’s interesting, this idea of the physician do no harm and and being, you know, having your book has great modesty to its essential style. You don’t claim you are a well-educated doctor, obviously of great experience, but you don’t claim you’re the expert on every aspect. You don’t claim you have the answer. And there’s a great sense of humility, which I really loved coming from a highly trained experience professional, no more so than in the fourth section when you talk about Native Americans.
And I was just thinking of the, and work on a reservation, I was just thinking when we were growing up in the Bronx, you know, and even though there had been strong Native cultures here before colonization in New York and so forth, people forget the Bronx of our time was also thought to be a place of farms and even some agriculture.
But nonetheless, there was absolutely no sense of self-criticism of the whole American expansionist adventure that we represented enlightenment, we represented white America, represented civilization and so forth. And that last section of your book, why don’t you talk about it, your work there because it really was quite enlightening to me as a reader.
Charles LeBaron
Well, it was enlightening to me as a physician. Basically, the call went out to members of the US Public Health Service, of which I was a member. Hey, we got a crisis going on up in this particular, they don’t like calling a reservation because it wasn’t technically a reservation. It was an area that had, and they had Indian Health Service, a hospital there. So I went up and the place was in total chaos.
Quite correctly, a crisis. But it was an ongoing crisis. And in that crisis, opioids were being distributed right, left, and center because there was no coordination whatsoever. And the interesting thing for me, having worked there for about 20 years periodically, is the tribe took over ultimately. Things improved so much when the tribe was running it than when we, the Indian health service, were running it.
And it was kind of remarkable. Now, some of that arose from, in a sense, an ambiguous situation. They opened a casino, which there had been a lot of debate as to whether they should have a casino there. But they got a casino, and a casino basically, as someone says, a casino is a tax on the mathematically challenged.
Basically what it is, is you’ve got a whole bunch of white people coming in, spending their money irrationally, and giving the tribe a whole bunch of cash. And then the question is, is the casino cash gonna do with it? And remarkably enough, the tribe, which is very different from the rest of us,
Yeah, they said, okay, should we just distribute it and everybody gets close to basically several thousand. They said, no, we’ll invest it. We’ll invest it in the schools, we’ll invest it in this case in the hospital. And they built a very, very nice hospital and they built up very good systems that reduced the amount of really bad opioid prescription to very little.
What was the difficulty? The difficulty was that they were able to do that, but they, like the rest of the United States, did not invest, which is very expensive, in decreasing the already existent demand, the addiction level that was in the population. And needless to say, there was a gigantic enterprise surrounding the reservation, this Appalachian, where there was plenty of illegal opioids coming in.
So they were able to clean up the act in the hospital, but they couldn’t clean up the United States act and what was going on outside of them. And in a sense, it represents the triumph and the tragedy of the whole situation, that they couldn’t cure us. They could cure themselves, but they couldn’t cure the rest of us.
Robert Scheer
You know that I’m going to conclude this, but the book, let me say it again. Greed to Do Good. Wow, that’s so much of US policy since we were kids in the Bronx. The Greed to Do Good: The Untold Story of CDC’s Disastrous War on Opioids. And what I think makes this book really a great model, and I hope we can do a little bit to improve sales.
It really should be read, is that you abandon the pretense of the arrogant professional, and you are actually looking there and say, wait a minute, I’m here as a doctor in this prison, or I’m here working on this reservation, or I’m here in this bureaucracy, and how is it affecting ordinary people? How is it really working out?
And, know, who’s my model in journalism is I always want to know who’s getting screwed and who’s doing the screwing, you know, and you’re very agnostic about it. I mean, the book just has a certain really wonderful honesty to it. You don’t claim you know everything. You don’t claim you have all the answers, but you sure have a good bull detector. You know this is not working. You know, why are these young people being locked up in this prison?
Who was it doing any good? Because he had the wrong stuff in his pocket that was somebody else was that they were selling, you know, what’s to be gained by keeping him here? I don’t know. That stuck with me as an image, you know, just always going to be there another 20 years. He hopes his girlfriend will still love him when he comes out. I mean, it was so poignant description. So anyway, I want to recommend the book. Get it.
Hopefully there’s some independent stores, you can get it on Amazon. Greed to Do Good, Dr. Charles LeBaron. That’s a very fancy name there, but he’s a guy from the Bronx like I am, so I wanna help him out here. And well, that’s it for this edition of Scheer Intelligence. See you next week, but wanna thanks to Joshua Scheer, our producer, who got me to read this book. I didn’t even know it was out. I think it’s terrific.
Diego Ramos who writes the introduction and is our managing editor at ScheerPost. Max Jones who does the video, which seems to get more people to watch these things than just the audio alone. And I wanna say thanks to Integrity Media, founded by a very good criminal lawyer in Chicago and Len Goodman for providing some funding for this. And the JKW Foundation in memory of Jean Stein, a very independent writer for helping out as well. See you next week with another edition of Scheer Intelligence.
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Robert Scheer
Robert Scheer, publisher of ScheerPost and award-winning journalist and author of a dozen books, has a reputation for strong social and political writing over his nearly 60 years as a journalist. His award-winning journalism has appeared in publications nationwide—he was Vietnam correspondent and editor of Ramparts magazine, national correspondent and columnist for the Los Angeles Times—and his in-depth interviews with Jimmy Carter, Richard Nixon, Ronald Reagan, Bill Clinton, Mikhail Gorbachev and others made headlines. He co-hosted KCRW’s political program Left, Right and Center and now hosts Scheer Intelligence, an independent ScheerPost podcast with people who discuss the day’s most important issues.
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