The book below (click on the cover to go to it) is one of the best piecces of nonfiction I’ve read in a year. It details the story of the Sackler family, in which three Jewish brothers, the sons of immigrants, worked together to push opioids for pain relief, and not in an ethical way. They eventually devised Oxycontin and Oxycodone, marketing them (via the company Purdue Pharma) to doctors as a kind of safe cure-all for pain, in the meantime completely ignoring reports of widespread addiction and deaths. (They also covered their tracks but not going public about what they really did and by becoming philanthropists, always insisting that the name “Sackler” be prominently associated with their buildings and galleries.)
The lawsuits eventually began, detailed by Wikipedia;
By 2017, a series of articles linking the Sacklers to Oxycodone as well as a public campaign by photographer Nan Goldin to link the Sacklers to the opioid crisis, led to stigmatization of the Sackler name with many museums and universities refusing financial gifts from the Sacklers.
While the family was eventually sued, the Sacklers used their company to declare bankruptcy, link their personal finances to the fortunes of Purdue Frederick, and ultimately managed to escape any financial consequences at all. The family continued to maintain that they knew nothing about the abusive and deceptive marketing practices of the company and maintained the lie that their opioids were not addictive and that the few people who abused their drugs were already addicts to begin with.
Eventually, the Justice Department settled with Purdue Pharma for an $8 billion criminal and civil settlement and another $225 million from the Sacklers themselves. Nobody in the family has faced criminal charges, and they’re still living like kings.
The book is a page turner, and well worth reading, but it doesn’t paint a flattering portrait of the Sacklers, who come across as an affable but nefarious family determined to get as rich as possible no matter how much damage they did to humans in pain.
Imagine my surprise, then, to see this long article in yesterday’s New York Times. It details how the National Academies of Science (NAS), a private organization (but partly funded by the government) took millions from the Sacklers at the same time it was producing reports on opioid policy in America. The NAS exists as a body of elite elected scientists and doctors whose job is to produce definitive reports to help steer U.S. government policy. Even if the NAS said it wasn’t swayed by the donations to come up with favorable takes on opioids, this is one of the most arrant conflicts of interest I’ve seen in science. The NAS didn’t even divulge in its reports that there was a “potential conflict of interest.” This has really made me depressed about the NAS, which is supposed to be free of commercial taint.
Click to read the article. And remember, even if the Sacklers didn’t influence policies recommended by the NAS, scientists are still required to disclose potential conflicts of interest no matter what. And why, I wonder, did the Sacklers give so much money to the NAS?
Some excerpts:
For the past decade, the White House and Congress have relied on the National Academies of Sciences, Engineering and Medicine, a renowned advisory group, to help shape the federal response to the opioid crisis, whether by convening expert panels or delivering policy recommendations and reports.
Yet officials with the National Academies have kept quiet about one thing: their decision to accept roughly $19 million in donations from members of the Sackler family, the owners of Purdue Pharma, the maker of the drug OxyContin that is notorious for fueling the opioid epidemic.
The opioid crisis has led to hundreds of thousands of overdose deaths, spawned lawsuits and forced other institutions to publicly distance themselves from Sackler money or to acknowledge potential conflicts of interest from ties to Purdue Pharma. The National Academies has largely avoided such scrutiny as it continues to advise the government on painkillers.
“I didn’t know they were taking private money,” Michael Von Korff, a prominent pain care researcher, said. “It sounds like insanity to take money from principals of drug companies and then do reports related to opioids. I am really shocked.”
Unlike the World Health Organization, which was accused of being manipulated by Purdue and later retracted two opioid policy reports, the National Academies has not conducted a public review to determine if the Sackler donations influenced its policymaking, despite issuing two major reports that influenced national opioid policy.
One of those reports, released in 2011 and now largely discredited, claimed that 100 million Americans suffered from chronic pain — an estimate that proved to be highly inflated. Still, it gave drugmakers another talking point for aggressive sales campaigns, primed doctors to prescribe opioids at an accelerating rate and influenced the Food and Drug Administration to approve at least one highly potent opioid.
Another problem arose in 2016, months after the National Academies received a $10 million Sackler family donation. The F.D.A. had tapped the institution to form a committee to issue new recommendations on opioids. But one senator took exception to some of the members selected by the Academies, complaining they had “substantial ties” to opioid makers, including Purdue. Before work began, four people were removed from the panel.
It’s a total disaster, and the NAS hasn’t even investigated whether there may have been a real conflict of interest, even though the organization took at least $31 million from the opioid-pushers and issued two reports about opioids, one of which has already been discredited.
A wee bit more from Lisa Bero, “chief scientist at the University of Colorado Center for Bioethics and Humanities”:
Accepting millions of dollars from the Sackler family while advising the federal government on pain policy “would be considered a conflict of interest under almost any conflict-of-interest policy I’ve ever seen,” Dr. Bero said.
Indeed. So what does the NAS say when caught with its pants down? They simply equivocate. This is NOT the NAS I know of:
Megan Lowry, a spokeswoman for the National Academies, said in a statement that the Sackler donations “were never used to support any advisory activities on the use of opioids or on efforts to counter the opioid crisis.” Ms. Lowry added that the organization had been prevented from returning the Sackler money because of legal restrictions and “donor unwillingness to accept returned funds.” The Academies declined to make senior officials available for interviews.
And there’s more:
Soon after the National Academies report was issued, Dr. Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing, emailed the institution and asked whether it would disclose that Ms. Christopher’s organization [Myra Christopher was an NAS panelist whose own group took Purdue money] had received funds from Purdue.
This is another conflict of interest, for panelists have to disclose their own conflicts.
“No, sorry, can’t do that,” Clyde Behney, an official with the Academies, replied in an email in August 2011 reviewed by The New York Times. “Keep in mind that the report is done and released, so the future is more important than the past.”
Seriously?? What kind of bullshit answer is that?
In its reports, some involving panelists who took money from Purdue, the NAS never disclosed any potential conflicts of interest.
In the end, the NAS now has millions of Pharma/Sackler money that it can’t use. As the paper suggests, perhaps the NAS should emulate Brown and Tufts, who used their Sackler money to help alleviate drug addiction:
Given the devastation of the opioid crisis, Michael West, senior vice president of the New York Council of Nonprofits, said that it would be worth the effort for the Academies to follow their lead.
“This would be a way,” he said, “of trying to make it right.”
Never in my life would I have expected the august NAS to be so sleazy. It’s not just that they took the money and didn’t disclose it, but also that they’re now pretending they didn’t do anything wrong.
This is very disturbing. We should remember this when we evaluate other scientific pronouncements on controversial but lucrative subjects. I especially think of Monsanto’s work to influence public opinion, or British Petroleum, or the Heartland Institute. I think this is much more common than we scientists expect.
What I would like to know is why the Sacklers are not facing prosecution. Also why no individuals at NAS are being fired.
Small time drug peddlers and money launderers face far worse.
Actually, Mark, small time drug peddlers are hardly ever prosecuted now. They are called drug workers and are seen as contributors to the communities in which they are embedded, like bartenders, illegal cigarette dealers, bicycle thieves, fences, and prostitutes, none of whom we are supposed to look down on now. At the low end of the market they don’t get rich, partly because they are addicts themselves, partly because drugs are cheap, like all crap from China. Some free-lance dealers masquerade as addicts in order to obtain legal drugs like suboxone intended for treatment of addiction but which have significant demand for diversion to the street.).
The whole business of the drug trade is being de-stigmatized as deliberate social policy. The Sacklers almost singlehandedly eliminated heroin from existing urban drug scenes while substantially widening the reach of panacea opiates to every little town that had a drug store. That taste is now being met by fentanyl which is infinitely easier to import, cut, and distribute than bales of heroin or tabs of Oxy-Contin. The preoccupation with harm-reduction and avoiding incarceration does ignore the impact of drug addiction on non-addicts who have not much alternative but to just leave. If they complain about tent encampments they get rebuked for being intolerant rednecks who want to bring back the War on Drugs. While the daily cost of a drug habit in San Francisco is now as low as $10, according to Shellenberger and we have the Sacklers to thank for showing the market how to achieve that efficiency, there are so many addicts all trying to steal enough to generate $10, that many retail stores can no longer operate. But at least the addicts aren’t breaking into houses and mugging people like in the old $100 a day—1970s dollars!—heroin years.
I’m not really sticking up for the Sacklers. For doctors to have been prescribing long-acting opiates for chronic pain was folly, a folly I was lucky to be able to avoid but would not have been able to resist had I been confronted with it. But to prove beyond reasonable doubt they or their company did any of this with criminal intent seems unlikely. More efficient to sue and settle for a billion here and there.
People like to get high. As long as we indulge and subsidize addiction, we will have more addicts. You could put the Sacklers in jail and the Chinese would still keep mailing fentanyl.
“Prescribing long-acting opiates for chronic pain was folly, a folly I was lucky to be able to avoid but would not have been able to resist had I been confronted with it.”
Things are bad enough even with acute pain management. In my country (Bulgaria), many educated young people are interested in the Work & Travel USA program. They share tips, and one of them is that you have to carry your own painkillers (based mostly on metamizole or ibuprofen) to avoid using locally sold painkillers. The youths say that painkillers used in the USA are often dangerous, and this danger is overlooked by US doctors as well as the general population.
My friend’s son, while taking part in the program, broke his hand. The doctors prescribed him a painkiller which made him feel a personality change. He expressed his concern, which was patronizingly dismissed. As soon as he was discharged, he stopped taking the drug and relied instead on the painkillers he had brought from home, though they hadn’t been meant for such a serious trauma. I have read in the Web dozens of descriptions of American patients getting addicted after similar incidents.
My personal opinion is that, in addition to unscrupulous Big Pharma crooks and the desire of some users to get high, there is an underlying cultural weakness that makes the most advanced societies susceptable to the opioid crisis: an unspoken conviction that the progress of science and technology somehow entitles us to pain-free life, and when in pain, we should take enough painkillers to make it disappear, rather than just bring it down to a bearable level.
“there is an underlying cultural weakness”
An issue that nobody knows how to address thus few want to confront or even acknowledge. Widespread self-medication and drug addiction are only one manifestation.
See the YouTube John Oliver video I put below.
TL;DW Byzantine legalese and more.
[ just making this link clear ]
“… why the Sacklers are not facing prosecution.”
See this John Oliver video : https://youtu.be/uaCaIhfETsM
The book is an excellent read. I think I picked up on it from a recommendation here – detailed throughout how they continually tried to buy respectability via philanthropy, and how enigmatic the source of their wealth was. Much easier to stay below radar when your company is private.
The part about the court case in Abingdon VA was particularly interesting to me since I visit there often and was familiar with the locations of the courthouse, “The Martha”, the very cool and historic hotel where the defendants stayed, and the unassuming bldg the prosecutors worked out of.
(When in Abingdon, The Tavern is a great eatery, and Wolf Hills Brewing is a great venue.)
Thank you for this very important, though depressing, post.
It’s probably only semi-relevant here, but something I find increasingly disturbing: Politics and the press are under heavy influence from “NGOs” at least here in Germany, organizations that pretend to be independent. The main funding of the smaller NGOs is usually not from small donors (as some like to pretend) but from an opaque network of other NGOs behind which tends, in the end, to be either oligarch money or government institutions (domestic or foreign). Press releases, “studies” or reports produced by such NGOs tend to have a heavy skew, yet are reported uncritically as fact by the quality press:.
I agree there is relevance, particularly in the promotion of gender ideology. This does not appear to be a grassroots movement, but is pushed by powerful donors to groups like the Transgender Law Center, Transgender Europe, Humans Rights Campaign, the ACLU, and GLAAD, as well as lesser-known activist groups. It takes a lot of money to convince people that humans can change their sex (or at least intimidate them into silence.)
Good article by Helen Joyce: https://www.nationalreview.com/2021/08/trans-activisms-long-march-through-our-institutions/
Sadly, a major consequence of this corruption is increased levels of belief in conspiracy theories around the Covid-19 vaccines with the resulting reduction in the effectiveness of public health measures.
There’s a fall in vaccine uptake in the UK. (Saw a headline say 7% of teenagers)
We were a covid success story, we made our own vaccines, we were among the first to vaccinate the public, and have some of the highest covid vaccination rates.
And now less people are having their normal vaccinations?
The American alt medicine industry are going to get a lot richer thanks to sackler and the nas.
Not a conspiracy exactly but there is a collectivist authoritarian mindset in Public Health that I recognized in my student days. Much admiration for Chairman Mao. Canada’s Chief Medical Officer of Health—our Dr. Fauci— has commissioned a series of focus groups and interviews of public health workers and external stakeholders, some quite senior and influential (well, for Canada), as to their vision of public health “going forward” as they say. A common theme is summed up in the linked story:
. . . [T]he report concludes that climate change and poor public health are caused by many of the the same things: “White supremacy, capitalism, colonialism and racism [and too much liberty]”.
Those interviewed were big on mission creep: dismantling capitalism, promoting low-meat diets, influencing housing policy, expanding indigenous rights and influence on policy, and, of course curtailing the extraction and use of fossil fuels using the coercive powers of the public health apparatus. They also argued their activies should exist outside government—the very government that provides their authority—to insulate themselves from public objections.
https://nationalpost.com/opinion/public-health-agency-of-canada-report-calls-for-toppling-of-capitalism-liberty/wcm/72fc8a29-b1a7-4215-9cb4-afb171ff6b2a/amp/
Empire of pain sounds like a sequel to bad blood.
Ps, I’m not overly against people taking sacklers money. But not disclosing you’ve taken their money is an admission of guilt. All this corruption just adds to the reproducibility crisis, which just makes the anti-science preachers sound more reasonable.
I’ve spent about 30 years reading up (and writing articles) on the medicine, policy, law, etc of illegal drugs. And taking not ALL the drugs on earth (I like to leave some for others, I’m generous like that), but MOST of them. I defended a lot of clients in drug court and regular court here also.
Two brief observations.
Our opiate problem is caused by the prohibition of opiates. Nearly all of our drug problems are due to prohibition of them. This mistake started with the Harrison Act in 1913.
A bigger problem (now) is that due to our war on drugs (policy and at the UN, Dpt of State) there is a HUUUGE deficit of pain management worldwide, particularly in the 3rd world.
D.A., J.D.
NYC
Firstly, the sacklers used doctors to sell drugs to anyone. So opiates weren’t prohibited.
Secondly, there’s plenty of other countries that aren’t the USA, that don’t have an opiate crisis, and do prohibit opiates.
I doubt the 3rd world need to get hooked on drugs. If america, a rich, well educated (no laughing), stable democracy can have a crisis from an over the counter easily available drug, then the poorer less, educated countries, prone to wars and famine, are going to suffer far worse.
I think the book failed to show that there was a big problem with legitimate users but did show that the Sacklers knew, and encouraged the use as a recreational drug by feeding the pill mills. They also made sure that the price was much more than the cost of the drug.
The downside of the backlash against pain medication is felt by people with serious pain issues. I was one of them for a while, recovering from back surgery.
Sometimes the pain would hit me in the middle of the night. I would take the pill, and go downstairs pacing and clapping my hands, hoping the stimulus from my hands and feet would block enough of the pain to make it bearable for the 40 minutes or so until the meds kicked in.
When I got better, I stopped taking them, which was not an easy process. A tough couple of days.
Fr. Dr. Blancke always said that she could not cure everything, but at least it was possible to relieve their pain.
It is a lot harder to do that these days. They are rightfully worried about addicts and drug abuse. The other side of it is that it overly tight restrictions on prescribing pain medication means that maybe grandma ends her own life because she cannot take the agony any more.
Waiting 40 minutes for the pills to kick in was pretty bad at times. If you had told me that I was just going to have to learn to live with it for a few months, I don’t know what I would have done.
Part of it is perspective. People who have never experienced actual severe pain really cannot fathom what it feels like.
It’s not just grandma ending her own life because of unbearable agony. I’ve known four people, all relatively young, who took their own lives because of unendurable pain.
‘“No, sorry, can’t do that,” Clyde Behney, an official with the Academies, replied in an email in August 2011 reviewed by The New York Times. “Keep in mind that the report is done and released, so the future is more important than the past.”’
“Looking forward,” as the fatuous locution goes.
How much of this opioid addiction is attributable to the offshoring of U.S. jobs? Investors don’t care. No doubt they support the flower of American youth joining the armed forces and going in harm’s way to be killed or maimed for life to protect American (investor) “interests.”
I never paid attention to any of this til now. Read s bit, found a John Oliver video-piece on the whole thing – but I did not see the NAS in the writing scrolled at about ~15:00 of so : https://youtu.be/uaCaIhfETsM