[TV static drones]
[upbeat rock music]
[cheers and applause]
- Welcome, welcome, welcome to "Last Week Tonight"!
I'm John Oliver.
Thank you so much for joining us.
And we have to dive straight in tonight
to the news that has been dominating this week,
and, unfortunately, I'm not talking about the fact
that Nicolas Cage will be starring in a movie
called "Pig" in which he plays a truffle hunter
who wants his pig back.
Which he is, and it's all I want to talk about.
But sadly, instead, we have to talk about this:
- Secret cover-up: the whistleblower complaint
sending shock waves through Washington.
- Troubling new details about the president's phone call
with the leader of Ukraine.
- During the call, Mr. Trump
pressured the Ukrainian president eight times
to investigate former Vice President
Joe Biden's son Hunter.
- Wow. Eight times.
The only time it makes sense
to ask for the same thing eight times in a single phone call
is if you're trying to connect with
a customer service agent for AT&T.
I got you, business daddy! I got you!
You genuinely bad company!
But look, it is true, Trump is at the center
of another looming scandal.
Basically, he's accused of withholding
nearly $400 million in military aid to Ukraine
and then using it as leverage to get dirt on Joe Biden.
It is very, very dumb.
And you might remember,
we called his Russia scandal Stupid Watergate,
which unfortunately means that we now have to work out
what the sequel should be called.
Now, we considered "Stupid Watergate II:
Look Who's Stupid Now-- The Same Guy,"
or "S2pid Watergate" with the number 2 in the word stupid
or "Stwopid Watergate"
with the word two in the word stupid.
But in the end, we settled on simply on this:
"Stupid Watergate II: the Stupidest Watergate."
And that will work fine, you know,
until the next one comes along.
Now, initially, the White House denied any wrongdoing,
even voluntarily releasing their account
of the president's call, claiming that it exonerated him,
except, when you actually read the account,
it emphatically does not do that
because Trump explicitly asks for Biden to be investigated
and follows it by saying,
"I will have Mr. Giuliani give you a call..."
And it's frankly impressive
just how thorough that abuse of power is.
He's looping in both someone so involved in the government
they should be nowhere near this kind of petty dirt
and someone so involved in petty dirt
they should be nowhere near the government.
And it got even worse the next morning
when the whistleblower's complaint was released,
which made it pretty clear that, after the phone call,
the White House worked extremely hard
to cover its tracks.
- The whistleblower says senior White House officials
worked to lock down all records
of a presidential phone call this summer
out of fear that they had witnessed the president
abuse his office for personal gain.
- It's true. The notes from the call
were stored in a separate, code word-level system
meant for highly classified information,
despite the fact there was no legitimate reason to do that.
And why do that if there wasn't something very bad in there?
If you don't want someone to see something embarrassing
on your computer, everyone knows
you just put it in a folder labeled "finance records."
I mean, I wouldn't do that,
because my finance records folder
is too full of finance records.
Wait, no, no, no, don't open it!
Don't open it-- no, no, no, no, no!
Okay, okay, okay. Here's what that is.
Here's what that is.
Yes, you have found my collection of hamsters
in little Speedos. It's not a sex thing!
I mean, that one is a bit of a sex thing.
But we don't have time.
We don't have time to get into it!
The point is, every part of this new Stupid Watergate
is dumber than you can even imagine.
Even Ukraine's president, Volodymyr Zelensky,
is himself ridiculous.
He actually used to be a comedian,
at one point playing the president of Ukraine
in a sitcom.
Although my favorite fact about him
is that one of his old comedy routines
was him and another guy
pretending to play the piano with...
well, you'll see.
[both speaking foreign language]
- Yep, yeah.
He played the piano with his dick.
And just spare a thought for the guy next to him
who did that and somehow didn't get elected
president of Ukraine.
A few years later,
he's stuck playing dick-music alone on an open mic
in the basement of a Chinese restaurant.
Show business is cruel.
But even in a scandal full of absurd figures,
it is worth taking a moment
to appreciate the role played here by Rudy Giuliani,
the New York City subway of New York City mayors,
and--and a man who once fucked his cousin.
Now, is that point strictly relevant here?
No. But I would argue that,
like Giuliani and his first wife,
it is not unrelated.
Perhaps... [laughter, applause]
The stupidest part of Giuliani's involvement
is that he did this in plain sight.
Back in May, he told "The New York Times..."
And even now, he insists he did absolutely nothing wrong.
- Giuliani just did an interview
with "The Atlantic" this afternoon.
He seemed very angry, according to the reporter,
and he said, quote...
- No, you will not be. And I'll tell you why.
Because you will still be Rudy Giuliani.
Best-case scenario here--
you'll one day be one of the masked singers.
People will briefly not know that you are Rudy Giuliani,
and you will nearly be the hero.
But eventually, you'll have to take your mask off,
and then you'll be yourself again
for the rest of your life, and it will be fucking terrible.
Now, Giuliani's role here
is actually unusual for lots of reasons.
He is not working for the government.
He's Trump's personal lawyer.
And he's not actually being paid.
He's working for Trump for free.
Now, why is he doing that?
Well, he's actually going through
a characteristically messy divorce
from his third wife, a woman with whom he has
uncharacteristically very few great-grandparents in common,
and, at least according to her, he's working pro bono
in order to reduce any future alimony.
So the president is paying Giuliani nothing,
and yet, I would argue, he's still overpaying here.
And incidentally, one of Giuliani's reported complaints
against his wife is that she, and I quote...
Leaving him limited to using his iPad to watch TV.
Because Rudy Giuliani,
cybersecurity expert and Donald Trump's lawyer,
is seemingly unaware that you can buy new remote controls
at Best Buy.
But, look, to recap here, it seems the president
pressured a foreign head of state
to investigate his political rival,
then his staff tried to cover it up.
And perhaps the most shocking part of all this is
it might actually hurt him.
And I know that you're probably thinking right now,
"No, it won't, you fucking idiot.
Nothing Trump does ever affects him."
And I do get that.
That has clearly been true, until maybe now.
Because people seem legitimately furious over this.
The House has opened an impeachment inquiry,
and even a few Republicans
seem to be treading with caution for a change.
And it kind of does make you wonder, why now?
The president's done so many terrible things.
Why does this one count?
And it's hard to say, but it might just be
that this one is simpler in some key ways.
'Cause unlike Trump as a candidate
asking Russia to find Hillary's emails, "if they're listening,"
this involves him abusing the power of the presidency.
Unlike the meeting with Russians at Trump Tower,
this time, Trump was undeniably personally involved.
Unlike the multiple potential violations
of the Emoluments Clause,
we already have hard proof that this happened.
Unlike Trump's treatment of migrants, he can't claim
this is just a difference of political opinion--
he pressured Ukraine to gain something for himself.
And unlike the Mueller Report's
legalistic descriptions of obstruction of justice,
Trump pressuring Ukraine to get dirt on his opponent
and then hiding the conversation
is easy to understand.
It's just gettable.
You don't need to know any more than that
to know it's something
presidents should absolutely not be able to do,
just like how they should not sell the White House
or suddenly change the National Anthem to this:
That guy might be a key player
in the impeachment of an American president!
What a fun time to be alive!
And, look, when you put all of that together,
this particular Trump scandal
does start to feel a little different
and something that is
absolutely meriting of impeachment,
especially because the fact that it is so consistent
with all of Trump's other behavior
suggests that it is a pattern that will continue
until he leaves office, one way or another.
Because at this point
it has just become painfully obvious that Trump--
much like all the TV channels in Rudy Giuliani's house--
simply cannot be changed.
And now this.
- There it is, written by your own staff,
and yet nothing happened.
- They closed the case.
- They closed the case.
- You're not allowed to run. - I'm not allowed to run.
- Because of this law. - Because of this law.
- The bad results. - Bad results.
- It's possible. - It's possible.
- It's heavy. - It's heavy.
- This is the blind mouse. - This is a blind mouse.
- This is it? - This is it.
- This is Mission Control? - This is Mission Control.
- And this is what's revealed.
- And this is what's revealed.
- All volunteers. - All volunteers.
- Out of nowhere? - Out of nowhere.
- Pill spill. - Pill spill.
Huge pill spill.
- Tuscany in a box. - Tuscany in a box.
- Chateau Rudy. - Chateau Rudy.
- Look at your own numbers. - Look at your own numbers.
- And he's only 23. - He's only 23.
- Tires. - Tires.
- That's a lotta kids. - That's a lotta kids.
- You got a good, comfortable chair.
- You got a good, comfortable chair.
- You were a handful. - I was a handful.
- The dynamic changed. - The dynamic changed.
- The office was more important than the man.
- The office is more important than the man.
- Human stories are human stories.
- Human stories are human stories.
- We got Ned's head.
- That's Ned's head? - That's Ned's head.
- Moving on.
For our main story tonight, let's talk about pharmacies.
You know, those places that let you arm-fuck a robot.
Or, as some people insist on calling that,
"getting your blood pressure taken."
Now, when you picture a pharmacy in your mind,
you probably imagine a place
that your doctor calls in a prescription
and someone counts out pills
that were manufactured somewhere else,
but that is actually a relatively new phenomenon.
A lot of pharmacies used to make medication on-site,
as this old film shows.
- A doctor's prescription may seem mysterious
to the average layman,
but it's all very simple to the pharmacist.
It is his responsibility to make sure
that each prescription is filled
exactly as the doctor has ordered.
An error in the compounding of a prescription
could be injurious or even fatal to the patient.
- [snooty voice] "Yes, any error could be fatal,
"which is why we only hire nearsighted men
"to eyeball ratios out of a series of identical bottles.
"And if that doesn't work, do feel free to die.
Happy 1940s to one and all!"
And while that is obviously no longer how it works
in your local CVS, there are places
that do still make their drugs from scratch on-site.
They are called compounding pharmacies,
and they exist for a very good reason.
- Compounding pharmacies make medicine for people
whose needs cannot be met by an FDA-approved product.
Let's say you're allergic to a specific ingredient in a pill.
Your doctor can write a prescription
tailored to your specific needs,
and a compounding pharmacy will mix it.
- That's right.
Compounding pharmacies basically make bespoke medication.
I'd say "designer drugs" if that phrase hadn't already been taken
by egregiously Dutch dealers selling pills to suburban kids.
"Dish ish da good shit. Trusht me.
"It's gonna shend you to outer shpace.
It's for your dance par-teez."
There's actually around 7,500 compounding pharmacies
all over this country,
and they can fill highly specific prescriptions
for all sorts of reasons.
Maybe you're having trouble swallowing pills.
They can make the same drug in liquid form.
Maybe you need a drug in a lower concentration
than what's commercially available.
They can do that for you. So they do very important work,
and it is not just humans that benefit.
- There are no manufactured medications made for birds.
So you need to go to your compounding pharmacist
so they can make the right volume,
because it could be large... - Oh!
- Medium... - Eh.
- Or small. - Ah.
- Each one might like a different flavor
or require a different volume.
She likes piña colada flavor.
[laughter] - Does she?
A tropical bird whose favorite flavor is piña colada?
Look, I'm just gonna say it: that parrot...is basic.
You're a basic bird.
So at this point, so far, so good.
But as you've probably guessed from the very fact
that we're talking about this story in the first place,
there are some huge problems here,
because compounding pharmacies are subject to
much less oversight than large drug manufacturers.
If you get a drug that was mass-produced in a factory,
both the drug and the factory are under a lot of scrutiny.
But if you get one from a compounding pharmacy,
it is very different,
as a former head of the FDA will tell you.
- Compounded drugs are not FDA approved.
- As commissioner of the FDA, then,
you can't tell us, sitting here now,
that every drug being used in the United States
is safe and effective.
I-I really cannot.
- Holy shit.
That's kind of startling to hear, isn't it?
And look, on one level, it does make sense
that if compounding pharmacies are making bespoke medication
the FDA doesn't treat them like they're a giant manufacturer.
You know, you wouldn't subject Mikey's lemonade stand
to the same regulations Coca-Cola has to obey
for mass-producing Minute Maid,
because that would be overkill.
And besides, even if Mikey did pee a little bit
in his lemonade--which, let's face it, he definitely did--
the damage is inherently limited.
But, as you will see, oversight is so lax
that compounding pharmacies have become
the Wild West of the drug industry,
resulting in fraud and, in the worst cases,
many, many people dying.
And you may not even know
that you're taking a compounded drug,
'cause they can be used in clinics or hospitals
without your or your doctor's knowledge.
So tonight, let's take a look at this industry.
Let's start with the fraud.
A few years back, Tricare,
the military's health insurance program,
noticed a big increase in being billed
for veterans' specially compounded
scar and pain creams.
But there was a problem,
as man who oversaw the program admitted.
- Are these creams a viable alternative
for treating the pain of wounded warriors?
- They don't appear to be.
We don't have any evidence that supports that.
- And he was right about that.
Those creams were total bullshit.
One study found they didn't work any better
than treatments that contained no medicine at all.
And it's shocking that that was allowed
and it is why I'm excited to announce
my amazing new pain cream, Johnny Gel.
It's great for relieving
tenderness in your back, neck, and joints,
and yes, it is just mayonnaise.
Ask your doctor if Johnny Gel is right for you.
Now, what happened was,
a number of compounding pharmacies realized
that there was a loophole where they could bill Tricare
for the cost of each individual ingredient in their creams,
so they simply added as many expensive ingredients
as they could, and by the time
the military realized what was happening,
the costs had gotten ridiculous.
- It's just been an astronomical,
an explosion of the charges
in a relatively short period of time.
We're on track this year to spend over $2 billion
unless we get our hands around this--2 billion.
- $2 billion!
When we talk about overspending in the military,
I don't think anyone would've guessed
a not-insignificant chunk of that
has gone to fucking lotion.
And unfortunately, even when there isn't fraud,
it is not rare for compounded medication to be ineffective.
When the FDA tests drugs from commercial manufacturers,
the failure rate is typically below 2%.
But when they ran tests on compounded drugs,
around 33% of the drugs failed.
That's one in three!
To put that in perspective, compounded drugs
have about the same failure rate
as the Jonas Brothers.
We all know--we all know which one I'm talking about.
And it is not you, Kevin.
You are doing great.
[quietly] Shh, come on, guys,
he's been through enough.
[normal voice] You're doing really great, Kevin.
You're actually my favorite.
But a drug simply not working
is by no means the worst-case scenario here.
Because while, again, you would not expect the FDA
to be testing every small-batch drug made,
you would at least hope that someone was making sure
the places they were made were clean.
But conditions can be appalling,
as multiple investigations have found over the years,
with some particularly revolting examples:
- In one Miami pharmacy,
a compounded drug for lung disease
was found in the same refrigerator
as the employees' lunch.
At another pharmacy,
compounded drugs were stored in the employees' bathroom.
- It sickened me. It really did.
It bothered me a lot.
It should have sickened you,
'cause you should not store an open box of loose pills
next to a toilet.
I've never been to pharmacy school,
but I'm pretty sure lesson one is
"don't put the pills where you poop."
So how could that happen?
Well, in the absence of FDA oversight,
state pharmacy boards are supposed to send inspectors
to make sure conditions are sanitary,
but in many states,
there is an extreme shortage of them.
As of 2016, Hawaii had only one inspector,
Kansas had two,
and Illinois had just three,
despite the fact it has nearly 2,700 pharmacies,
meaning each inspector would have been tasked
with 900 locations to keep an eye on.
And the only way that is possible
is if the inspectors are just texting each pharmacy,
And this lack of oversight can be especially dangerous
if a lab is producing sterile drugs
that are injected into the body.
A few years back,
one compounding pharmacy made national headlines
after it was found to be the source
of a massive meningitis outbreak.
- The Food and Drug Administration
is telling doctors don't use any products
from the New England Compounding Center.
You know, when they went in there,
they actually found fungus in a vial
that you could see... - [gasps]
- With the naked eye.
They saw some guck, for want of a better word,
in it, they put it under a microscope,
and it was a fungus.
- That is disgusting.
The only worse thing to find in a vial of medicine
than visible "guck" would be a visible duck.
'Cause, putting aside the issue of hygiene,
how did you miss this?
How did you not hear the quacking?
Your oversight's a fucking mess!
And while it would've been comfortably bad enough
if that pharmacy, NECC, was just making drugs
for individual patients,
it was actually producing medication in bulk--
the thing, remember, it was absolutely not supposed to do.
Compounding pharmacies are supposed to do small batches
based on individual prescriptions.
But NECC skirted those rules to make more money,
shipping their gucky medication to 23 different states,
eventually killing more than 100 people.
And it's a little weird
that you don't remember that story, right?
Although to be fair, it was 2012,
and we were all distracted
trying to find Kony at the time.
Where's Kony? Did we get him?
Did we get Kony? Does anyone remember?
It seemed so important at the time.
I bet we got him.
We wouldn't have just given up, would we?
And, look, while regulations required them to have
an individual prescription for each patient,
they managed to get around that
by simply faking patient names
and not even seeming to try that hard.
- Investigators also allege
that employees falsified prescriptions
with fake names like...
- Oh, come on!
It's like they were trying to get caught.
And it didn't even stop there.
They also filled prescriptions with names--
and this is real--like...
That is such a gloriously random group of people.
Most people would see no connection between them,
unless you are me, and you have some very specific,
very bold theories about who killed JFK.
I've nearly cracked it. None of you leave the country.
I think there may have been a second Schwimmer.
This scheme, though, was incredibly lucrative.
In fact, the President of NECC, Barry Cadden,
made over $60 million
in the three years leading up to the outbreak.
And he seemed to know what he was doing was wrong,
because he was once asked
at a filmed employee training session
about keeping records of patient names and prescriptions
and his answer was comically suspicious.
- Is it one-to-one patient names
for the bulbar blocks?
that's something for another time.
Yeah, let's not--that's--
We can talk about that.
Those--that's actually one of
the more difficult things we do.
Let's just talk about the products now--
- Okay, that's fine. - While we're being recorded.
If you're being recorded saying you don't want to say something
while being recorded, you've probably already said too much.
"All right, so this is where we keep the guns,
"the ski masks, and the big bags of money
"with dollar signs on them.
"Where does that money come from?
"Well, I probably shouldn't talk about that
while we're being recorded."
The defining hallmark of NECC was just how clearly
everyone knew that they were breaking the law.
At one point, the company's national sales director
even sent out an email with the unassuming subject line
which reads, in part...
Which is an incredible thing
to put in writing.
Now, thankfully, Cadden eventually went to prison,
and Congress passed a law
toughing up enforcement of regulations
among compounding pharmacies, which is great...in theory.
The problem is, they wrote in some massive loopholes.
For instance, the law required any pharmacy that wanted to
mass-produce drugs, you know, the way that NECC did,
to register as something called an "outsourcing facility"
and submit to much stricter inspections,
but it made doing so completely voluntary.
And if you need everyone
to obey a rule,
it just can't be voluntary.
It's why stop signs say "stop" and not "shrug emoji"?
And so, perhaps unsurprisingly,
only 77 facilities are currently registered.
That's just 1% of compounding pharmacies.
And because the FDA had no system to catch violators,
many pharmacies just carried on exactly as they were,
with some being pretty bold about it.
How bold? Just watch this.
- The FDA's inspection of Downing Labs in July found...
Ashley Downing is the co-owner of Downing Labs.
They asked you to recall your sterile products.
- That's correct. - And you decided what?
- Just "no." That's it.
She responded to a request for a drug recall
the way most of us responded
to seeing the trailer for the movie "Cats."
"I refuse to acknowledge that this is happening.
[cheers and applause]
Now, she claimed the FDA had no jurisdiction over her
and that she'd followed all state requirements,
but the FDA disagreed,
and while they eventually did manage to force her to comply,
that didn't happen until almost a full year
after that interview.
And when oversight is this weak,
compounding pharmacies can hurt large numbers of people
for a long time.
Just look at what happened recently in Texas
with a company called Guardian Pharmacy Services.
This is it here.
They apparently mass-produced medicine
which was injected into people's eyes
and which turned out to contain formaldehyde and acetone--
two things pretty high up the list
of things to keep away from your eyes
right above jalapeno peppers
and just below the trailer for "Cats."
No. I said "no."
Now, Guardian didn't opt in for FDA oversight,
so it was regulated at the state level,
but not, it seems, very well,
because nearly 70 people who were injected with their drugs
are now partially or completely blind.
And yet it took six months from the first injections
for state regulators to even be notified
that there was a problem,
which is something understandably frustrating
for the people who ended up losing their sight.
- By the time Susie Pope
went in for cataract surgery at a Dallas eye clinic,
dozens of patients had gone before her.
- How could 68 people be involved
before they pull that off the shelf?
- Many of them have the same question.
- We notice real quick how, when lettuce is bad,
we pull it off the shelf every week.
- Yeah. and of course, he's right.
It's frankly not unreasonable to want a world
where you can feel confident
that something that's about to be injected into your eyeball
is at least as safe as lettuce.
'Cause I'll tell you what is as safe as lettuce,
and that is Johnny Gel.
I have to say, Johnny Gel may not be as safe as lettuce.
And yet, incredibly,
not only did the Texas State Pharmacy Board
not shut down Guardian,
they haven't shut down a single compounding pharmacy
in at least five years.
Now, you should know,
they did put Guardian's license on probation,
but the man behind it simply shut it down
and opened up a pharmacy called Medical Park Pharmacy
at the exact same location.
So their door simply changed from this to this.
And it is hard to notice any meaningful differences there,
even if you weren't recently blinded
by some tainted eye medication.
And look, again, compounding pharmacists
play an important role, but that is all the more reason
why they should be properly regulated.
So at the very least,
we need more inspectors at the state level,
the outsourcing facility designation
should not be voluntary,
and compounders should have to alert regulators
whenever they fuck up.
And until then, bad facilities could probably really benefit
from a message from some of the very real names
that they've thrown around in their nonsense prescriptions.
- Hey, I'm David Schwimmer.
- I'm Method Man.
- I am obviously RuPaul.
- I'm Jimmy Kimmel,
America's favorite late-night host.
- And I'm the one and only Michael Bolton.
- And we'd like to say a few words
to compounding pharmacies.
- Please don't use our names in your bullshit prescriptions.
- We're not just random words to be thrown around
so you can evade the law.
We're real people.
- Well, some of us are.
Like me, Jack Bauer.
- And me, Sarah Marshall.
- Who? - [scoffs]
Do not tell me you forgot Sarah Marshall.
You're the one who broke up with Jason Segel's dick.
- Sure did. - [laughs] Girl...
- The point is, we're mad.
- Real mad.
- Because our names don't belong
on your fraudulent spinal medication.
- Mine belongs on a platinum album.
- Mine belongs on the list of
America's top pretend paleontologists.
- And mine belongs on the Emmy
for outstanding variety talk series
that somebody else keeps winning over and over again.
- So stop using our names to turn your compounding pharmacy
into an unregulated drug manufacturer.
- And while we're at it, don't even think about
trying to sell us any of that $15,000 skin cream.
- We don't want to be involved in your lotion scam.
- No, no, no, no, no, no, honey.
I'm not getting mixed up in your ointment scheme.
- And if you're an outsourcing facility,
let yourself be regulated like one.
[music winds down, stops] Because if you don't...
- I will tie you up in a dark basement in a black site
in southern Turkmenistan, and I will inflict
a level of pain on you you could not imagine
in your darkest, most terrifying nightmares!
- Jesus Christ.
- But even more importantly,
we need to make sure that compounded drugs
are coming from labs that fully comply with safety guidelines.
- Because keep in mind,
lots of people need compounded drugs.
- And it's not just people.
My bird needs them too.
- Yeah, my--What?
Michael Bolton has a parrot?
- Of course I do. I love parrots.
Do people not realize that
"How Am I Supposed to Live Without You"
is about a lady parrot?
I loved that parrot.
And she left me. [sad music]
- She did leave him. [chuckles]
Fuck you, Michael Bolton.
- Yeah, fuck you, Michael Bolton.
- Fuck you!
- And finally,
until you're better regulated,
you should stick to what you were designed to do.
- Making piña coladas for birds.
- I miss you.
- What the fuck?
- That's our show. Thanks so much for watching.
See you next week. Good night!
- Girl, look, I-I'm a queen, okay?
So I've been involved with some real shady schemes, okay,
but I'm not getting mixed up in some shady ointment scheme.
Look, I'm not opposed to schemes.
I'm a queen!
But I'm not getting mixed up
in some shady ointment scheme.