Table of contents:
- Family business
- Empire of Pain
- What does the Guggenheim have to do with it?
- Opioid crisis
- Why the Sacklers are in trouble
A serious opioid crisis is brewing in the United States and has already been recognized as a national problem. 142 people die here every day from an overdose of opioids. Many become addicted and addicted to prescription pain relievers. One of the most popular is OxyContin, which is manufactured by Purdue Pharma. It is owned by the Sackler family, renowned philanthropists and art trustees. We are figuring out how they managed to amass a multibillion-dollar fortune and hook the whole country on "legal drugs".
On February 9, 2019, the famous American photo artist Nan Goldin held a protest in the Guggenheim, one of the most popular museums in New York, where her work is also exhibited.
On Saturday night, Goldin and activists from her PAIN (Prescription Addiction Intervention Now) movement walked into the museum and dropped a stack of prescription flyers for 80-milligram OxyContin tablets from the top floor. There were different quotes on them, for example, one of them: “If you do not control the use of OxyContin, then with a high degree of probability it will cause addiction. So how much will our sales grow?"
OxyContin is a popular prescription opioid pain reliever in the United States that is twice the strength of morphine. It is produced by Purdue Pharma, owned by the Sacklers, one of the richest American families. Since 1996, when the drug went on sale, more than 200 thousand people have died from overdoses in the United States.
Of course, not all deaths are associated with OxyContin or other pain relievers - many of the victims, starting with opioids, switched to other drugs - for example, heroin. But it is Sackler's Purdue Pharma that has “destigmatized” the use of opioids in medicine and has taken the lead in the long-acting pain reliever market.
Three years ago, the doctor prescribed Nan Goldin OxyContin. She took the drug strictly according to the prescription, but soon could not do without it, increasing the dose and switching to drugs. It took ten months to free myself from the addiction. After that, she declared "war" on the Sackler family and decided at all costs to ensure that they were brought to justice.
“When I got out of treatment, I learned about drug addicts who were dying from my medicine, OxyContin. I learned that the Sacklers, whose surname is familiar to me from museums and galleries, is responsible for these deaths. This family invented, advertised and supplied OxyContin. I decided to bring them out of the shadows and bring them to justice,”says Goldin's petition to Change.org.
We will tell you what the business of the Sackler family is like, how they managed to build an empire based on pain, and why clouds are gathering around them now.
Once upon a time there were three brothers - Arthur, Mortimer and Raymond. Descendants of Jewish immigrants, they grew up in Brooklyn during the Great Depression and quickly discovered not only an aptitude for medicine, but also a strong entrepreneurial grip.
Arthur started his career as a copywriter for an agency that specialized in advertising medical products. As noted by The New Yorker, he showed Don Draper's flair for marketing - he soon became the owner of the agency and revolutionized the drug promotion industry.
Arthur Sackler realized that advertising should be directed not only to patients, but also to doctors, so he began to place ads in specialized medical journals and publications. Realizing that doctors were influenced by colleagues, he won over the most influential of them to leave positive reviews on his product.In parallel with the advertising business, Sackler began publishing the Medical Tribune, an audience of about 600 thousand doctors.
Arthur Sackler was not shy about any methods: in the 1950s, he released an advertisement for the new antibiotic Sigmamycin, which was accompanied by pictures of doctors' business cards and the caption: "More and more doctors are choosing Sigmamycin as therapy."
In 1959, an investigative journalist for The Saturday Review tried to contact some of the doctors whose names were in the advertisements and found out that they never existed. It is also known that he paid $ 300 thousand to the head of one of the departments of the FDA, Henry Welch, so that he could, for example, casually mention the names of certain medicines in his speeches.
In 1952, Arthur and his brothers bought out Purdue Frederic, a company that researched, developed and licensed drugs and health products.
At the same time, Arthur Sackler became the first advertiser in history who managed to convince the editorial board of the Journal of the American Medical Association (the weekly international medical scientific journal, the most widely read medical journal in the world. - Esquire) to include a color advertising brochure.
In the 1960s, the pharmaceutical company Roche hired Arthur to develop a marketing strategy for the new tranquilizer, Valium. It was not an easy task because the drug worked in much the same way as Librium, another Roche product already on the market.
And here's what Sackler came up with: Unlike Librium, which was prescribed as a remedy for anxiety and anxiety, he decided to position Valium as a cure for "emotional stress", which, according to advertising, was the true cause of a number of diseases - heartburn, diseases associated with problems with the gastrointestinal tract, insomnia, restless legs syndrome.
The campaign was such a success that Valium became the # 1 prescription drug in America, and Arthur Sackler became one of the first Americans to enter the Medical Advertising Hall of Fame.
One of the first of its own developments Purdue Frederic, which became interested in the American authorities, was a drug against high cholesterol, which had many side effects, including hair loss. In the early 1960s, Tennessee Senator Estes Kefover, who headed the subcommittee responsible for the pharmaceutical industry, became interested in the brothers' activities.
In his notes, he wrote: “The Sackler empire is a full-cycle production - they can develop a new drug at their facility, conduct clinical testing and receive positive feedback from the hospitals with which they cooperate.
They think of an advertising campaign and promote their product by publishing articles in medical newspapers and magazines that they own or have connections with. " In January 1962, Arthur Sackler was summoned to Washington to testify, but not a single senator was able to offend him or convict him of a lie - the businessman was ready for any questions and answered them sharply and confidently.
When asked if he knew about the side effects of the drug, he calmly stated: "Better to have thin hair, so thick coronary arteries."
In May 1987, Arthur Sackler died of a heart attack, and his brothers Mortimer and Raymond bought his stake in Purdue Frederic for $ 22.4 million. The company was subsequently renamed Purdue Pharma and moved to Connecticut.
The branch of the family tree that goes from Arthur Sackler has since split from the heirs of Mortimer and Raymond and did not take part in the management of the company. Arthur's daughter Elizaber Sackler, a feminist art historian and one of the trustees of the Brooklyn Museum, in her interviews sharply distanced herself from Purdue Pharma and called the activities of her relatives' firm "morally disgusting."
She even publicly spoke out in support of Nan Goldin: “I admire Nan Goldin's courage and her drive to make a difference. My father, Arthur M. Sackler, died in 1987, before OxyContin, and his interest in Purdue Frederick was sold to the brothers a few months later.
None of his direct descendants have ever owned Purdue shares or benefited from the sale of OxyContin. I share the anger of those who oppose the abuse of power that harms or endangers people's lives.”
Liz O. Baylen / Los Angeles Times via Getty Images
Empire of Pain
In the 1970s, opioids were not used in medicine in the United States, and the so-called "opioidophobia" existed among doctors. There was a war in Vietnam, soldiers massively addicted, first to soft drugs, then to opioids, and then to heroin, which they began to produce clandestinely.
After the end of the war, the soldiers returned to their homeland, and the United States faced a real heroin epidemic. Despite the stigmatization of opioids, opioid-based pain relievers have been widely used in hospice services to care for dying patients.
A turning point in Purdue's history came when a London physician working for Cecil Saunders (a famed British nurse and social worker considered the founder of the hospice movement) asked the company's UK arm to develop a delayed-release morphine pill.
So in 1987, the innovative pain reliever MS-Contin appeared on the US market, which became a real hit in the treatment of cancer patients. At the same time, there was a discussion among the medical profession about the need to consider the use of opioids in the treatment of non-cancerous diseases, which can be equally debilitating for the patient.
Scientific articles have appeared that long-term opioid therapy is safe and effective if the patient has no history of drug addiction. The authoritative New England Journal of Medicine even published an open letter in 1980 stating that the risk of addiction with long-term opioid use is less than 1%. The author then disavowed the material, but it was picked up by other specialized publications, and the theses from it were quoted more than 600 times.
Despite its popularity, MC-Contin could not become the # 1 pain reliever, largely due to the prejudice against morphine. “People heard 'morphine' and said, hey, wait, I don't seem to be dying,” Sally Allen Riddle, former managing director of product at Purdue, recalls to Esquire. In addition, his patent was about to expire.
In a 1990 memorandum addressed to Richard Sackler and other top managers of the company, the company's vice president of clinical research, Robert Kaiko, proposed the development of oxycodone, a substance similar to morphine, which was developed in 1916 by German scientists based on the opium poppy.
The advantage of this substance was that it was mistakenly considered weaker than morphine. Plus, inexpensive to manufacture, it has already been used in other drugs in combination with aspirin or paracetamol, which doctors have prescribed for severe injuries and injuries. “Oxycodone didn't have the same negative connotation as morphine,” Riddle recalls.
Perdue Pharma has released pure oxycodone with a controlled release formula similar to MC-Continu. The company produced tablets in dosages of 10, 80 and 160 milligrams, which were stronger than any prescription opioid. Journalist and Pulitzer nominee Barry Meyer wrote in his book Pain Killer: "In terms of drug power, Oxycontin was a nuclear weapon."
In 1995, the FDA approved the use of OxyContin for moderate to severe pain. Purdue Pharma was allowed to label the packaging that the drug's long-term exposure "diminishes" its attractiveness to drug addicts compared to other pain relievers (it was removed in 2001 and no opioid drug has been labeled this way since then).
Dr. Curtis Wright, who oversaw the FDA's expertise, soon left the organization. Two years later, he went to work for the Sacklers.At a company meeting celebrating the launch of a new drug, Richard Sackler (son of Raymond Sackler) said, “The launch of OxyContin will be followed by a prescription blizzard that will bury the competition. She will be strong, dense and white."
Jessica Hill / AP
Mortimer, Raymond and Richard Sackler adopted Arthur's marketing tactics and launched one of the largest advertising campaigns in pharmaceutical history. They hired thousands of sales representatives, trained them, and armed them with charts describing the benefits of the drug.
The company aimed to change the prevailing opinion among doctors that OxyContin should be prescribed only in cases of severe short-term pain in oncology and surgery, but also in cases of arthritis, back pain, injuries, and so on. One of the company's managers, Stephen May, told The New Yorker that they had special trainings to "overcome doctors' objections."
At Purdue Pharma, they learned how to properly answer questions about possible drug abuse and convince professionals that it is virtually non-addictive.
Of course, no one took their word for it: the company paid thousands of medical practitioners to participate in various workshops (all costs covered) and report on the benefits of OxyContin.
Purdue approached the promotion from every angle: wholesalers received discounts, first-time pharmacists were reimbursed, patients received coupons for 30-day starter packs, academics received grants, medical journals received multimillion-dollar advertisements, and members of Congress received generous donations.
Add to this massive advertising in professional publications and literature, advertisements with happy and satisfied patients on TV, and even specialized merchandise - fishing hats, plush toys, luggage tags, and so on.
It soon became known that OxyContin was being used as a drug. On the packaging of the product there was a warning about a possible narcotic effect: it said that if you inhale the powder from the crushed drug or inject it, it will lead to a rapid release of the drug and the absorption of a potentially toxic dose.
Some patients who were prescribed OxyContin prescriptions started selling the drug on the black market - at a price of one dollar per milligram.
In an interview with Esquire, Curtis Wright (the same FDA official who gave the green light to the prescription use of OxyContin) said that the drug use of OxyContin came as a shock to everyone: … It wasn't Perdue's invention, it wasn't a secret plan or a clever marketing gimmick. Chronic pain is terrible. When used correctly, opioid therapy is nothing short of a miracle; we brought people back to life."
Between 1996 and 2001, the number of prescriptions for OxyContin in the United States grew from 300,000 to almost six million - and the drug began to bring Purdue Pharma $ 1 billion a year. And in 2016, Forbes estimated the Sackler family's fortune at $ 13 billion. This is just a rough figure: Purdue Pharma does not disclose its details. In the ranking of the richest American families, the Sacklers overtake the Rockefellers.
Temple of Dendur at the Metropolitan Museum, Sackler Wing
What does the Guggenheim have to do with it?
The Sackler family are great philanthropists, they sponsor dozens of museums around the world, fund various scientific and research programs, universities and other institutions. “Unlike Andrew Carnegie, who has built hundreds of libraries in small towns, and Bill Gates, whose foundation serves the world, the Sacklers have woven their name into a patronage network of the world's most prestigious and wealthy institutions.
The name Sackler is everywhere - and automatically evokes reverence. At the same time, the Sacklers themselves are almost invisible,”wrote the American Esquire.
In the summer of 2017, after extensive renovation, the courtyard of the Victoria and Albert Museum in London was reopened.The space of six tennis courts is decorated with a mosaic of 11 thousand porcelain tiles, handcrafted by the oldest Dutch company Koninklijke Tichelaar Makkum.
The courtyard is now known as the Sackler Courtyard - the museum does not disclose information about its donors, so it is not known for certain how much the family donated to V&A. The grand opening of the courtyard was attended by the Duchess of Cambridge, Kate Middleton. Stepping onto the shiny ceramic surface, she just said, "Wow," Esquire recalls.
The Sackler family's portfolio is not limited to the Victoria and Albert Museum.
Here are just some of the cultural institutions to which they are related: an entire wing in the New York Metropolitan Museum is named after them - it contains a grandiose artifact of ancient Egypt, the Dendur Temple, saved during the construction of a power plant on the Nile.
The Sackler wing is in the Louvre and the British Royal Academy of Arts, its own museums - at Harvard and the University of Beijing, the Arthur Sackler gallery - at the Smithsonian Institution in Washington, the Sackler Center operates at the Guggenheim Museum in New York, and an educational laboratory at the Natural History Museum in Manhattan … Family members are known in museum circles for giving projects their names, Esquire notes.
In 1974, when Arthur and his brothers made a $ 3.5 million donation to the Metropolitan Museum, they carefully prescribed that every sign, catalog and newsletter entry in the Sackler wing, included the names of all three brothers with the MD subscript.
One of the museum officials even sarcastically: "It only remained to indicate their working schedule." More modest projects have also received the Sackler name: for example, the Sackler Staircase at the Jewish Museum in Berlin, the Sackler escalator at the Tate Modern, and the Sackler Crossroads at the Royal Botanic Gardens Kew in southwest London. A variety of pink roses is even named after them. And an asteroid.
Duchess of Cambridge Kate Middleton at the opening of the Victoria and Albert Museum after a major renovation
According to the US Centers for Disease Control and Prevention (a federal agency within the US Department of Health), 53,000 Americans died of opioid overdose in 2016.
The Opioid Crisis Commission, established by Donald Trump, cited an even more shocking figure of 64,000 - more than the combined death toll from car accidents and from gun violence.
According to the commission, 142 people die every day from opioid overdose - as if 9/11 happened every three weeks. The opioid crisis has already been designated a health emergency. According to the medical publication STAT, if urgent measures are not taken, then about 500 thousand people can die from opioid overdose in the United States in the next 10 years.
Before the crisis entered its dangerous phase, the total economic burden of the state from opioid addicts was about $ 80 billion, including costs of health care and criminal justice.
Why the Sacklers are in trouble
Purdue Pharma has been repeatedly prosecuted in court, but for a long time, the company has managed to avoid real liability. It was only in 2007 that the company admitted in a criminal proceeding that it had used doctors' misconceptions about the potency of oxycodone to its advantage.
The materials say that the company "was well aware that the belief of doctors that oxycodone is weaker than morphine is wrong" and "did not want to take any action on this matter." Under the agreement, Purdue Pharma paid $ 600 million in fines, and three senior company executives pleaded guilty and were sentenced to multimillion-dollar fines and community service.
However, not a single Sackler figured in the lawsuit, despite the fact that Richard Sackler led the company during the most active period of promotion of OxyContin.This may now be changing: Last June, Massachusetts attorney general Maura Haley sued Purdue Pharma, its top executives and eight members of the Sackler family.
The state's lawsuit contains dozens of internal Purdue Pharma documents, which conclude that the Sackler family was much more involved in the company's affairs than it was alleged.
The Sacklers were aware that the company had not released information about the drug's use of OxyContin and its sale on the black market to authorities, according to the lawsuit. Purdue Pharma has also aggressively promoted the product to boost sales, notably through pharmacy discount cards.
Richard Sackler, who was president of Purdue Pharma from 1999 to 2003, is named in court documents as the man responsible for all key decisions to promote OxyContin and cover up drug abuse.
In particular, when Richard Sackler became aware of the 59 deaths from an OxyContin overdose in Massachusetts, he did not attach much importance to this: “It's not that bad. It could have been much worse,”he wrote to his subordinates.
However, as Esquire notes, the Sacklers are very likely to get off the water: in the agreement to waiver of prosecution, which the company entered into in 2007, after paying a huge fine, the new charges will mainly relate to the company's activities after 2007. Neither Richard Sackler nor other family members have held senior management positions at Purdue Pharma since 2003.
The company claims that the number of prescriptions for OxyContin dropped by 33% from 2012 to 2016, but at the same time it is expanding into the international market.
An investigation by The Los Angeles Times says Purdue is promoting OxyContin in Mexico, Brazil and China using the same marketing strategies: organizing panels and discussions on chronic pain, pays speakers to talk about the drug as an effective pain reliever, cites horrific numbers about millions of people suffering from "silent pain".
Following an investigation by The Los Angeles Times in May 2017, a number of congressmen sent a letter to the World Health Organization stating that Sackler-owned companies were preparing to flood foreign countries with legal drugs.