"...name one of these reputable companies for me."

You're right of course, I cannot (and I fully agree with your points and sentiments). What I should have said is 'pharmaceutical companies that employ proper industrial control processes to ensure that what's inside the box is the same as printed on the packet' but that seemed a bit long-winded. In hindsight, putting 'reputable' in quotes would have been a better option.

Apologies for the following rave but I'm likely a stronger advocate on these points than you are. ;-)

In my defense I would let you know that if you were to look back into the archives of my HN posts—mind you, I'm not suggesting that you waste time actually doing so—then you would note that I've been one of the most outspoken, voracious and unquenchable critics of the Sackler family and Purdue Pharmaceuticals to post on HN. I consider what happened over the opioid epidemic not only an unforgivable failure on the part of the Sacklers and Purdue and that they have essentially gotten away with murder—the settlement being an unmitigated damn farce—but also a major systemic failure of Government (of the regulators/FDA) and of the medical profession in general.

How 150-plus† years of knowledge about opiates and opiate addiction—basic info that's a compulsory default requirement in 101 pharmacy/medicine—can be chucked out and ignored by the regulators and the medical profession alike simply defies adequate description let alone understanding. How the fuck did this happen, why have others, regulators, guilty MDs, etc., also not been brought to task over the matter? After all, everyone knows that outside certain radioactive nuclides and chemical weapons, VX etc., opiates are the most controlled and regulated chemicals on earth and have been governed by international treaties for going on 100 years. We still don't know how this happened and we still need a full and better accounting of what exactly went wrong.

Moreover, I've been an advocate for much tighter government control and regulation of drug companies and have held this view long before the Purdue incident. Similarly, I believe that we need to review drug patent laws to stop pharmaceutical companies exploiting consumers—I could write pages on this but I'll spare you the details.

I'd also ban drug advertisements, especially so those that are aimed at the public. I have a particular concern over the continued promotion of drugs on TV and elsewhere, especially so the promotion of the coal-tar antipyretic class of drugs—the NSAIDs such as ibuprofen, paracetamol (acetaminophen), etc. as being safe, fix-all painkillers (even if not mentioned, that's the effect of such promotions). They aren't as safe as made out in ads, and they're especially dangerous with long-term use, but drug companies promote them as safe and governments continue to allow such promotions without warnings and caveats. (Incidentally, expert medical knowledge isn't necessary to determine the dangers of using these drugs as their dangers are well documented in any number of pharmacopeias, even Wiki has their side-effects well covered.)

These antiquated 19th-Century drugs [paracetamol possibly made as early as 1852—see Wiki] are more dangerous than even many medicos think (the possible exception being the salicylates (aspirin) but even it has dangers). We have been progressively eliminating numbers of these ancient NSAIDs from the pharmacopeia since the 1930s—that is whenever we realize their kill-rate has become unacceptably high we move on to the next least dangerous one on the list instead of banning all of them outright (the last of the old ones still standing is paracetamol, its immediate forerunner, phenacetin, having since fallen). For example: acetanilide, pyrazolone, phenazone, amidopyrin (pyramidon), phenacetin, phenylbutazone (butazolidin) all derive from the 19th C. or from precursors that do. All have been progressively banned over a 30-40 year period (or in some instances their use limited to very specific applications), however it was obvious early on that these drugs were very dangerous and should not have been put in service (or at least withdrawn much earlier).

Back in the late 1950s and 1960s there was a huge kerfuffle over the dangers of use of phenacetin, especially so when mixed with aspirin and caffeine in a combination known as 'APC'—a concoction which had been in prior use for some 40 or so years. There were many thousands of cases of rotted-out kidneys as a result of their use. What's not generally understood is that phenacetin is metabolized into paracetamol and it's the paracetamol that provides the pain relief (but paracetamol can easily be life-threatening and kills many people every year). Wiki states that phenacetin was withdrawn in Canada in 1973 and by the U.S. FDA in 1983. Why the delay of some 10 - 20 years after it was known for certain that phenacetin was dangerous, even carcinogenic? I know this delay to be factual because I can remember the widespread publicity about the dangers of phenacetin as a kid in the 1960s.

(Incidentally, in recent years I've had both a pharmacist and a medico tell me that I could use paracetamol over long periods without any ill-effects and that combining it with aspirin was no problem so long as I didn't exceed the recommended maximum daily dose (exceeding the dose is extremely injurious to the liver). The pharmacist even suggested it was one of the safest drugs known. (Despite warnings in almost every pharmacopeia about the dangers, unfortunately it seems that lessons from the phenacetin incident haven't been well learned—if anyone knows the reasons for this then we ought to know about it.)

Moreover, nothing changed with the introduction of the newer COX-2 selective NSAIDs, rofecoxib (Vioxx), etc. The pharmaceutical companies were still up to their usual deceptive tricks, in this instance Merck was the main culprit in that it deliberately withheld important information about dangers of the drug.

Quoting Wiki: "Merck withdrew the drug after disclosures that it withheld information about rofecoxib's risks from doctors and patients for over five years, allegedly resulting in between 88,000 and 140,000 cases of serious heart disease."

The utter fucking hide of Merck!

I recall this well: in the early 2000s I read an article in Science mag that provided graphic stats that rofecoxib was causing heart attacks. It was of particular interest to me as I was taking the drug for my sore back. At the time I remember thinking that the drug would soon be banned even if it turned out that the article's data was found to be exaggerated (the damaging stats were too bad to think otherwise). That said, rofecoxib wasn't banned immediately despite overwhelming evidence against it; in fact, it took about three years from the publication of the Science article before Merck withdrew the drug from the market. That delay was unforgivable.

If ever there were a case to regulate these pharmaceutical bastards tightly then the Vioxx/rofecoxib incident is a quintessential example.

__

† The problems of opiate addiction became widely understood by the medical profession in the light of the US Civil War when the hypodermic needle first came into widespread use to administer opiates on the battlefield.