Падение Отравленной Империи
Из свеженького Лансета (vol 399, № 10320, р. 135), про опиоиды. Кому интересно, я скопировал английский текст полностью.
Arthur M Sackler (1913–87) was a psychiatrist, researcher, and the owner of a boutique marketing agency. When he was inducted into the Medical Advertising Hall of Fame in 1997, his citation was: “No single individual did more to shape the character of medical advertising than the multi-talented Dr Arthur Sackler”. The US Centers for Disease Control and Prevention says that between 1999 and 2019, nearly 500000 people in the USA died from an opioid overdose, including prescription and illicit opioids. Medical advertising has been the glossy front end of this opioid epidemic, described by Barack Obama as “costing lives…devastating communities”. As Arthur Sackler was seeking funding to research drug interventions for mental illness, he was also publishing The Medical Tribune, itself funded by pharmaceutical advertising and distributed free to doctors. In 1952, along with his brothers Mortimer and Raymond, he bought a small pharmaceutical company, Purdue Frederick. Some 50 years later, the misery of addiction to the OxyContin (oxycodone) manufactured by the Sackler-owned companies was recognised when Purdue Pharma pled guilty to criminal charges related to its marketing of the drug, including kickback payments to doctors, and settled with a bankruptcy agreement and massive fines. Patrick Radden Keefe’s Empire of Pain: The Secret History of the Sackler Dynasty traces the entanglement of the Sackler dynasty in the opioid crisis: their influence over prescribing, advertising, research, medical “education”, and regulation. As Radden Keefe relates, Arthur Sackler said in the early 1960s that he had two careers in medicine and in business, “concurrently in time but independently of each other”. Radden Keefe debunks this fantastical imagining: “They could develop a drug, have it clinically tested, secure favourable reports from the doctors and hospitals with which they had connections, devise an advertising campaign in their agency, publish the clinical articles and the advertisements in their own medical journals, and use their public relations muscle to place articles in newspapers and magazines.” Arthur Sackler also co-founded IMS, a market research company monitoring individual doctors’ prescribing. When a later Sackler acquisition, Napp Pharmaceuticals, developed a “continuous” version of morphine via the use of a coating on the tablet, Radden Keefe describes it as “genuinely innovative”. Purdue wanted rapid approval and started manufacture and promotion. Pain control conferences were sponsored by Purdue, where doctors were accused of undertreating pain, and informed that addiction did not occur when used in non-terminal illnesses. One conference agreed “morphine is the safest and best drug for the control of severe chronic pain”. On reading this account of the conference, it is impossible not to feel shame for the medical profession, itself drugged on ignorance and arrogance. Commercial pressures trumped. Under threat of patent expiration, Kathe Sackler suggested using the new delivery system with an older, more potent opioid, oxycodone. Purdue Pharma would produce it, and use for non-cancer pain was aggressively pursued. “You might suppose that Purdue would conduct tests of the additive properties of its new drug. But the company didn’t”, Radden Keefe writes. They argued that the tablet coating negated “highs”, and thus addiction. As the book highlights, internal memos from Purdue showed “informal contacts” and “a positive relationship” with the US Food and Drug Administration: Richard Sackler credited “unparalleled teamwork” that resulted in the package insert saying the coating “was believed to reduce the abuse liability of the drug”. The Sacklers determined to keep their name from their numerous businesses, but wanted it displayed prominently for their numerous acts of philanthropy. Prestigious recipients of Sackler money now grapple with a poisoned name. This is a story of failed capitalism and regulation. Radden Keefe provides a forensic analysis of the Sacklers and his book won the 2021 Baillie Gifford Prize for Non-Fiction. He writes that “no details are invented or imagined; in instances in which I attribute thoughts or feelings to people it is because they have described them to me or to someone else, or I am relying on a characterisation by someone who knew them.” However, this approach risks undermining his factbased telling, which already has plentiful opportunity for the reader to draw conclusions. The family appear as partly filled jigsaw puzzles: they declined to be interviewed for the book. Yet this rich, scholarly work is fine with detail: “broad spectrum” was a term for antibiotics coined by advertisers; marketers see drugs as having “personalities”; US$9 million was budgeted by Purdue in a year to buy food for doctors; reps had no cap to their bonuses. The immense damage wrought to the world by a small group of energetic and ambitious people is sobering. The total failure of regulators to stop it happening is damning, and devastating in the telling.
Margaret McCartney @mgtmccartney
Arthur M Sackler (1913–87) was a psychiatrist, researcher, and the owner of a boutique marketing agency. When he was inducted into the Medical Advertising Hall of Fame in 1997, his citation was: “No single individual did more to shape the character of medical advertising than the multi-talented Dr Arthur Sackler”. The US Centers for Disease Control and Prevention says that between 1999 and 2019, nearly 500000 people in the USA died from an opioid overdose, including prescription and illicit opioids. Medical advertising has been the glossy front end of this opioid epidemic, described by Barack Obama as “costing lives…devastating communities”. As Arthur Sackler was seeking funding to research drug interventions for mental illness, he was also publishing The Medical Tribune, itself funded by pharmaceutical advertising and distributed free to doctors. In 1952, along with his brothers Mortimer and Raymond, he bought a small pharmaceutical company, Purdue Frederick. Some 50 years later, the misery of addiction to the OxyContin (oxycodone) manufactured by the Sackler-owned companies was recognised when Purdue Pharma pled guilty to criminal charges related to its marketing of the drug, including kickback payments to doctors, and settled with a bankruptcy agreement and massive fines. Patrick Radden Keefe’s Empire of Pain: The Secret History of the Sackler Dynasty traces the entanglement of the Sackler dynasty in the opioid crisis: their influence over prescribing, advertising, research, medical “education”, and regulation. As Radden Keefe relates, Arthur Sackler said in the early 1960s that he had two careers in medicine and in business, “concurrently in time but independently of each other”. Radden Keefe debunks this fantastical imagining: “They could develop a drug, have it clinically tested, secure favourable reports from the doctors and hospitals with which they had connections, devise an advertising campaign in their agency, publish the clinical articles and the advertisements in their own medical journals, and use their public relations muscle to place articles in newspapers and magazines.” Arthur Sackler also co-founded IMS, a market research company monitoring individual doctors’ prescribing. When a later Sackler acquisition, Napp Pharmaceuticals, developed a “continuous” version of morphine via the use of a coating on the tablet, Radden Keefe describes it as “genuinely innovative”. Purdue wanted rapid approval and started manufacture and promotion. Pain control conferences were sponsored by Purdue, where doctors were accused of undertreating pain, and informed that addiction did not occur when used in non-terminal illnesses. One conference agreed “morphine is the safest and best drug for the control of severe chronic pain”. On reading this account of the conference, it is impossible not to feel shame for the medical profession, itself drugged on ignorance and arrogance. Commercial pressures trumped. Under threat of patent expiration, Kathe Sackler suggested using the new delivery system with an older, more potent opioid, oxycodone. Purdue Pharma would produce it, and use for non-cancer pain was aggressively pursued. “You might suppose that Purdue would conduct tests of the additive properties of its new drug. But the company didn’t”, Radden Keefe writes. They argued that the tablet coating negated “highs”, and thus addiction. As the book highlights, internal memos from Purdue showed “informal contacts” and “a positive relationship” with the US Food and Drug Administration: Richard Sackler credited “unparalleled teamwork” that resulted in the package insert saying the coating “was believed to reduce the abuse liability of the drug”. The Sacklers determined to keep their name from their numerous businesses, but wanted it displayed prominently for their numerous acts of philanthropy. Prestigious recipients of Sackler money now grapple with a poisoned name. This is a story of failed capitalism and regulation. Radden Keefe provides a forensic analysis of the Sacklers and his book won the 2021 Baillie Gifford Prize for Non-Fiction. He writes that “no details are invented or imagined; in instances in which I attribute thoughts or feelings to people it is because they have described them to me or to someone else, or I am relying on a characterisation by someone who knew them.” However, this approach risks undermining his factbased telling, which already has plentiful opportunity for the reader to draw conclusions. The family appear as partly filled jigsaw puzzles: they declined to be interviewed for the book. Yet this rich, scholarly work is fine with detail: “broad spectrum” was a term for antibiotics coined by advertisers; marketers see drugs as having “personalities”; US$9 million was budgeted by Purdue in a year to buy food for doctors; reps had no cap to their bonuses. The immense damage wrought to the world by a small group of energetic and ambitious people is sobering. The total failure of regulators to stop it happening is damning, and devastating in the telling.
Margaret McCartney @mgtmccartney