“THE OPIOID epidemic is as bad as ever,” says Caleb Alexander at the Johns Hopkins Bloomberg School of Public Health. In a year when all eyes were on the death toll from covid-19, about 80,000 Americans died from drug overdoses from June 2019 to May 2020, more than during any other 12-month period ever recorded, according to preliminary figures from the Centres for Disease Control and Prevention. Both federal and state governments have been suing companies for their part in this. On December 22nd the Department of Justice (DOJ) added a high-profile suit against Walmart.
The DOJ accuses the world’s biggest retailer, which also manages some 5,000 in-store pharmacies, of fuelling the opioid epidemic by screening questionable prescriptions lackadaisically, despite repeated warnings from its own pharmacists. The suit was expected. Some counties have already sued other pharmacies. In October Walmart sued the DOJ pre-emptively, asking a federal court to clarify the responsibilities of pharmacists under the Controlled Substances Act (CSA), an unusual step that seemed to be primarily a public-relations exercise.
In its complaint, filed at a court in Delaware, the DOJ alleges that Walmart violated the CSA in various ways, as the operator both of pharmacies and of wholesale drug-distribution centres. Under pressure from their managers, Walmart pharmacists dispensed umpteen dodgy drug prescriptions, according to the suit. Managers denied pharmacists the authority to refuse prescriptions from suspect doctors, and told them to dispense prescriptions quickly because “shorter wait times keep patients in store”. Walmart pharmacists continued to dispense prescriptions from suspected “pill mills”, even when warned that other pharmacies were refusing them. And they ignored red flags, such as prescriptions for “trinities”—drug cocktails that often include an opioid and a muscle relaxant.
The complaint also alleges that, as operator of distribution centres (Walmart ceased distributing controlled substances from such centres in 2018), the company received hundreds of thousands of suspicious orders, which it failed to report to the DEA. Distributors are required to report orders unusual in size, pattern or frequency. Over an approximately four-year period, Walmart shipped an estimated 37.5m controlled-substance orders to its pharmacies, but reported only 204 suspicious orders to the DEA. During the same period, McKesson, Walmart’s back-up distributor, which shipped far fewer orders, reported more than 13,000 suspicious orders from Walmart pharmacies to the DEA.
Walmart rejects the charges. The company says the suit is “wrong on the law and riddled with factual inaccuracies, mischaracterisations and cherry-picked documents taken out of context”. Walmart points out that pharmacists are not doctors, so they should not second-guess prescriptions. Moreover, not dispensing a prescription also carries risks: they could harm a patient in need. State boards could investigate them or even take away their licence. And patients and doctors could sue.
The 160-page civil complaint from the DOJ reads like the so-called multidistrict litigation (MDL), says Andrew Pollis of the Case Western Reserve School of Law. More than 2,000 suits filed across the country by counties, cities and Native American tribes are co-ordinated by Dan Polster, a federal judge. The DOJ suit could be combined with the MDL, says Mr Pollis. Walmart has 60 days from the day the complaint was filed to respond. It could file a motion to dismiss the case, but the district court in Delaware is likely to reject such a motion. ■
This article appeared in the United States section of the print edition under the headline “Looking the other way”
It might just start with a filter, adding fake lashes to your selfie, or smoothing out the frown lines in some rosy, flattering light. But the life of a would-be influencer is not all that its airbrushed perfection would appear. As more and more young people turn to social media as a way of making money in an uncertain world, health experts have warned of a rise in body dysmorphia and cosmetic surgery, including some highly risky operations. And we should warn you: there are some highly graphic images in this report.
BEIJING(Reuters) – China’s factory activity expanded at the fastest clip in nearly a decade in August, bolstered by the first increase in new export orders this year as manufacturers ramped up production to meet rebounding demand, a private survey showed on Tuesday.
The world’s second-biggest economy has largely managed to bounce back from the coronavirus crisis, and the emerging bright spot in the forward-looking gauge of export orders could herald a more durable and broad-based recovery for the Chinese economy in the months to come.
The Caixin/Markit Manufacturing Purchasing Managers’ Index(PMI) rose to 53.1 last month from July’s 52.8, marking the sector’s fourth consecutive month of growth and the biggest rate of expansion since January 2011.
It beat analysts’ forecasts for a slight dip to 52.6. The 50-mark separates growth from contraction on a monthly basis.
The upbeat findings contrasted with an official survey on Monday, which showed China’s factory activity grew at a slightly slower pace in August as floods across southwestern China disrupts production, but there were positive signs in both PMIs.
The official PMI’s improving trend in new export orders was similar to the private survey, while the former also showed solid growth in the crucial services sector in a boost to the economy’s continued recovery from the coronavirus shock.
In Tuesday’s Caixin, Chinese factories reported the first increase in new export orders this year in August as overseas countries eased COVID-19 restrictions to kick start their economies. The pick-up in business also led to a further expansion in production, marking the sharpest gain in almost a decade.
The labour market also saw signs of improvement, with some companies increasing recruitment to meet production needs, although the gauge of employment continued to stay in negative territory for the eight straight month.
Wang Zhe, senior economist at Caixin Insight Group, said a turning point is approaching for employment as factories’ backlogs of work rose at a faster pace.
“Employment remained an important focus. An expansion of employment relies on long-term improvement in the economy. Macroeconomic policy supports are essential, especially when there are still many uncertainties in domestic and overseas economies,” said Wang, in a commentary accompanying the data release.
A mirror factory in the Chinese city of Yiwu, which supplies to retail giants such as Walmart and Home Depot, has been inundated with new business beyond the factory’s current operating capacity, with the management sending the entire sales team down to factory floors, a 23-year-old salesman at the company told Reuters.
“We laid off workers when the pandemic first started but now, with this many orders, we cannot find enough people,” said the salesman, adding that the firm was having issues booking shipments as finished goods piled up at their warehouses.
Business optimism towards the year ahead among Chinese factories remained strong overall, although it dipped slightly in August. Firms are concerned about the severity of the global pandemic over the long term.
(Reporting by Stella Qiu and Ryan Woo; Editing by Shri Navaratnam)
Young users of a major video-sharing social media platform are creating and distributing a huge amount of content promoting “extremely unsafe” weight-loss techniques, eating disorder experts have warned.
Young people are sharing videos on TikTok which show “dangerous restrictive eating”
The Butterfly Foundation said it had been “increasingly alerted” to the videos
A TikTok spokesperson said the platform has a range of moderation strategies
Since its launch by a Chinese company in 2016, TikTok has grown a worldwide user base of more than 800 million people, about half of whom are estimated to be under the age of 34.
“These videos depict potentially harmful content that has the ability to reinforce negative feelings, attitudes and behaviours — in relation to body image, food and diet — to a vulnerable youth audience,” national helpline team leader Amelia Trinick said.
Potentially thousands of users are sharing videos — often captioned with the words “what I eat in a day” and overlaid with pop music — which count calories of every meal, offer recipes for water-based weight-loss drinks, and provide tips on how to rapidly lose weight.
Another with the caption “how did u loose weight?” (sic) was followed by a photo of cigarettes.
A self-professed eating disorder survivor posted a video from what appeared to be a hospital room, saying she was on fluids and “so scared of water weight” she had gained.
Another video shows a young girl wandering into a room with a bag of potato chips, then watching a video of model Emily Ratajkowski, before putting down the chips.
The caption states: “TikTok reminds me not to eat”.
Ms Trinick said the Butterfly Foundation has been “increasingly alerted to problematic content” on TikTok in recent months.
“The videos also highlight our fixation with the societal ideal that ‘thin is best’ and promote extremely unsafe weight loss methods to an impressionable audience.”
The Butterfly Foundation’s annual Insights in Body Esteem survey of more than 5,000 Australians last year showed “alarming” results, demonstrating social media’s influence in how young people view their bodies.
Of those surveyed, 48 per cent indicated they were dissatisfied or very dissatisfied with their appearance.
“People living with an eating disorder during this time have indicated a significant increase in eating disorder behaviours and thoughts due to the high levels of stress and uncertainty associated with COVID-19,” Ms Trinick said.
‘Loopholes’ allowing children to bypass restrictions
Under the self-harm section of TikTok’s terms and conditions, the company stipulates content that promotes eating habits that are “likely to cause health issues” is “not allowed on the platform”.
“Do not post content that supports pro-ana [anorexia] or other dangerous behaviour to lose weight,” it states.
Despite those warnings, Ms Trinick said many videos showed young people engaging in “dangerous restrictive dieting behaviours to lose excessive amounts of weight”.
“While this in itself is an issue, what is even more worrying is that these behaviours are being shared with other TikTok users who may then engage in the same behaviours or make body, weight, shape, appearance comparisons to the person in the original video — who may indeed have an eating disorder,” she said.
“Unfortunately, the issue of exposure to harmful content such as this is heightened by the fact that TikTok, unlike other social media platforms, is relatively unmoderated.”
The Butterfly Foundation’s head of communications Melissa Wilson echoed those sentiments, saying it was “incumbent on the platform providers to include safety messaging and other support mechanisms to mitigate this risk”.
She said while TikTok had added some “help” functions and banned certain hashtags, the foundation had “identified loopholes” that allowed people — including children younger than the app’s minimum age of 13 — to access potentially harmful content.
“While we are concerned that TikTok is targeted at a younger demographic … the bigger concern is the lack of moderation and safety messaging,” Ms Wilson said.
“Due to the user-generated and largely unmoderated nature of TikTok, protecting people from harmful content is extremely challenging.
Ms Wilson said that on other social media channels, such as Instagram, there are “greater search restrictions”, and that help functions “are more obvious”.
Flinders University senior lecturer and psychologist Ivanka Prichard is also concerned about the videos on TikTok, and on other image-based platforms accessed by young people.
“They idealise thinness and being skinny, and present people who appear to have no qualifications providing nutrition and fitness advice,” Dr Prichard said.
“Experimental research on other platforms shows that exposure to this type of imagery leads to greater body image concern and negative mood.
“Adhering to advice from social media in relation to diets … is associated with greater dietary restraint.”
TikTok ‘committed’ to safe content
Dr Prichard said it was unlikely the people filming and sharing the videos in question recognised the issues associated with them.
“For the most part, young people are probably sharing them because they may want to help others or to share with others what they are doing,” she said.
“They probably don’t realise the potential harm that these types of videos could have.”
A TikTok spokesperson said the platform’s content moderation is undertaken by “global safety teams”.
The spokesperson said the platform’s safety teams “comprise experienced industry professionals” who “collaborate closely with regional regulators, policymakers, government, and law enforcement agencies” to promote safety.
TikTok filters and removes “red-flag language including those related to eating disorders”, along with directing users searching for that content to support resources, the spokesperson said.
“We care deeply about the complex and multi-faceted issue of eating disorders,” the spokesperson said.
“If we become aware of any content that violates our terms of service and community guidelines, we will take immediate action to remove content, terminate accounts, and report cases to law enforcement as appropriate.”
The Butterfly Foundation has welcomed TikTok’s plans to establish an Australian office and said it had engaged with the company “to work together on these issues”.
If you or anyone you know is experiencing body image concerns or an eating disorder, you can call the Butterfly Foundation National Helpline on 1800 33 4673.