The Sackler family uprooted healthcare quandaries and it's the role of pharmacists to help plant solutions.
Michael De Francesco
Published in 1943, “A Tree Grows in Brooklyn” sparked playwright Betty Smith’s path to literary acclaim. Born Elisabeth Lillian Wehner, Ms. Smith—having maintained her marital surname as a divorcée—was a Williamsburg, Brooklyn native who funneled her adolescent memories onto the Bildungsroman’s protagonist: Francie Nolan, a denizen of the inner city. The novel, in turn, is an extensive allegory for dually pronged channels of evocative symbolism: one, to fulfill the potential within, much like a granule seed sprouting into a grand tree, and two, the tenacity to persevere, much like the prevailing durability of a tree—but (more importantly) a tree in Brooklyn. Relative to the real world, however, such ambitions appear mere aphorisms. Overdoses attributable to opioids, particularly for adolescents, are a case in point. Per the 2019 New York State Opioid Annual Report—which received federal funding from the Centers for Disease Control and Prevention (CDC)—Kings County (inclusive to the neighborhood of Williamsburg) has an age-adjusted rate of an 11-year old per 100,000 succumbing an overdose death. Imagine, then, the anguish haunting families bereaved of their pride and joy. Such tragedy is a stark contrast to the optimism of “A Tree Grows in Brooklyn”.
The statistic, subsequently, is a deterrent for any willful aspiration to persevere— by stripping the lives of innocent youth, no worthy future exists to impart meaning. In place of growth, contrarily, lay the spoils of wilted branches and a hollowed core. Unapologetically, the statistic’s afforded realism dwindles the novel to nothing more than a fantastical reflection of its own genre: fiction.
Astonishingly still is the opioid epidemic’s ironic origin. With the first American generation as Brooklyn natives, the Sackler family is largely ascribed blame for the opioid epidemic. Through their family heirloom Purdue Pharma—a pharmaceutical conglomerate notorious for marketing OxyContin: a delayed-release formulation of oxycodone—the Sackler family spearheaded mass-marketing of opioids. Arthur Sackler, MD, the eldest of three siblings, for instance, effectively “invented the field of medical advertising…after aggressively marketing the sedatives Librium (chlordiazepoxide) and Valium (diazepam) [on behalf of Hoffmann-La Roche] to doctors, without a serious study of the addiction risks.” And with millions in remuneration, Dr. Sackler was evermore fueled by a sardonic addiction: to prioritize the capital of clients over the health of patients.
As a result, Dr. Sackler, a psychiatrist, consciously abdicated himself from the Hippocratic Oath, an ethical code sworn by physicians. By first (and foremost) doing harm, he promulgated a blithe disregard for sense and reason. Dr. Sackler’s behavior, in turn, incubated a precedent for generational complacency in the family business—despite passing away a decade before Purdue Pharma’s conception. Following OxyContin’s market approval in 1995, for instance, Richard Sackler (nephew of Dr. Sackler) stated “the [opioid] prescription blizzard will be so deep, dense, and white” (The Economist). How foreseeing, then, that “over 70% of the nearly 71,000 drug overdose deaths in 2019 involved an opioid” (CDC). Such proclamation of delirium, consequently, has exacerbated death of the tree and birth of the poppy.
Yet, consensus on Dr. Sackler’s culpability for the opioid epidemic lacks. Dr. Evan Gerstmann, Ph.D., J.D.—legal contributor to Forbes—is a case in point. In a 2019 publication titled “Harvard, Arthur Sackler And the Perils of Indiscriminate Shaming,” Dr. Gerstmann noted “it is an absurd inversion of logic to say that because Arthur Sackler pioneered direct marketing to physicians, he is responsible for the fraudulent misuse of that technique, which occurred many years after his death”. Seemingly, Dr. Gerstmann attempts to explain a breached usage of syllogistic reasoning. To clarify, take Alan Turing, Ph.D., father of computer science. With his invention of “a-machine” (automatic machine)—a device inspired by a Polish predecessor, “the bombe”—Dr. Turing deciphered cryptic Nazi messages, allowing the Allied forces to coordinate retaliatory measures. History, in turn, acknowledges Dr. Turing as the father of computer science, which—despite being the basis for all computational devices—stands distinctly in not crediting him with each technological advancement hitherto developed.
As an illustration, consider the following: Alan Turing invented computer science; computer science pioneered the production of smartphones; therefore, Alan Turing pioneered the production of smartphones. Such rationale—despite being logically deduced—is characteristically flawed. Dr. Turing did not pioneer the production of smartphones. Instead, his invention facilitated the creation of smartphones, which does not transitively confer credit for their production. Additionally, the creation of smartphones succeeded Dr. Turing’s death by 53 years, when Apple introduced the iPhone in 2007. Consequently, any proposition of inventor-ship is rendered mute by two sheerly incongruent timelines.
Such is the premise for Dr. Gerstmann’s defense of Dr. Sackler. By disputing the rationale—Arthur Sackler pioneered direct medical advertising; direct medical advertising fraudulently misused marketing to physicians; therefore, Arthur Sackler fraudulently misused marketing to physicians—Dr. Gerstmann seeks to relieve Dr. Sackler of character assassination. Much like the argument against Dr. Turing’s inventorship of smartphones, then, Dr. Sackler can not be consigned credit (or, more appropriately, accountability) for fraudulent marketing, especially since such practices emerged posthumously. Despite Dr. Gerstmann’s argumentation, its reasonable application (in this particular instance) is resolutely untrue.
According to a 2017 article “The Family that Built an Empire of Pain”, published in The New Yorker, Dr. Sackler “produced an ad for a new Pfizer antibiotic, Sigmamycin [which had the business cards of doctors accompanying] the words ‘More and more physicians find Sigmamycin the antibiotic therapy
of choice’. In 1959, an investigative reporter for The Saturday Review tried to contact some of the doctors …they did not exist.” Thus, Dr. Gerstmann’s supposition that Dr. Sackler is being slandered beyond reproach appears ever more fictitious. Now, it appears not to be “an absurd inversion of logic”, but an absolute intention at fraud.
Moreover, that same article details a company of Dr. Sackler's, MD Publications, having “paid…[a former] chief of the antibiotics division of the F.D.A., Henry Welch, nearly three hundred thousand dollars in exchange for Welch’s” promotion of particular drugs—which may or may not eventually draw parallels with the FDA’s recent decision (despite overwhelming demur from its own advisory board) to approve Biogen’s Alzheimer’s drug, Aduhelm (aducanumab). To the disillusion of Dr. Gerstmann’s stance, the “fraudulent misuse” of direct marketing to physicians did not succeed Dr. Sackler’s death. Instead, they occurred in direct conjunction with his life. Evidently, the operations at play attest to a cause of great concern: the pervasiveness of corruption. If Dr. Sackler’s influence permeated to a director of the FDA—a purportedly authoritative and independent government entity—then speculation as to what else he conspired with or for thickens.
Accordingly, money appears the root of the opioid epidemic. In turn, money appears synonymous with evil. Reason to distinguish money and evil, however, stands consideration. Aspiring to make money, for instance, is not evil. There can be good intention—such as providing for one’s family—to become successful and, transitively, make money. Yet, marketing products as something they are not—like Valium being a panacea even for “people with no psychiatric symptoms whatsoever”— as a means to make money, is evil. Such is the case with Dr. Sackler: physician by degree, but businessman by trade. Unlike his burgeoning purse, Dr. Sackler’s shriveling conscience reduced to the size of pills millimeters wide. OxyContin, in particular, is a cursed pill that—despite its white coating—is an impure manifestation for both pain and poison. With it, each consumer swallows the patriarch’s disdain for truth, fellowship, and (above all) life. Here, then, reigned a man abstrusely unable to adjourn exploitive profit. A man so blinded by wealth, that he warped the very definition of patient care. Dr. Sackler was a criminal, a conniving drug dealer who fast-tracked the world on (what continues as) a one-way ticket to death.
En route, the United States boards as one such passenger. With “opioid overdose death rates more than twice those of any other country”, the United States regrettably has suffered the most from this epidemic (The Back Letter, a journal specialized in spinal correction). To its continued dismay, the United States endured an increase in “opioid-involved overdose deaths…from 21,088 in 2010 to 47,600 in 2017 and remained steady in 2018 with 46,802 deaths. This was followed by a significant increase through 2020 to 68,630 overdose deaths.” As a result, the near seven percent increase rendered the previous year’s decrease—the first since 1999, four years after OxyContin’s market approval—effectively null. For Purdue Pharma, such reality parallels living in a winter wonderland, blanketed by the “opioid blizzard[’s]… deep, dense, and white” snow. Hope, however, should not be deterred. Despite an inability to resurrect the dead or prosecute the Sacklers themselves—as their wealth is safeguarded from ongoing Purdue Pharma litigations—closure to the opioid epidemic will be catharsis by proxy. Through decades of captivity, then, the United States must triumph. With it, new meaning will sound to “The American Dream”: liberation from the opioid epidemic.
Opportunities to implement corrective measures are vast. Crackdowns on quid pro quo transactions are a case in point. According to a 2018 study—conducted by Harvard T.H. Chan School of Public Health, Harvard Medical School, and CNN—“the more opioids a [physician] prescribes, the more money he or she gets paid by those same [opioid] manufacturers.” Here, pharmacists may offer resolve. Through Prescription Drug Monitoring Programs (PDMPs), pharmacists can “detect inappropriate prescribing and monitor opioid misuse” (GoodRx, a telemedicine company). Additionally, PDMPs may unveil a potentiality for patients “doctor-shopping”, an illegal and deceptive ploy to obtain prescription medications. Subsequently, usage of PDMPs would substantially deter both perverse profit and illicit behavior.
Similarly, pharmacists could dispense naloxone, an opioid antagonist. By remedying opioid-induced respiratory distress—a collapsed airway coupled with depression in the central nervous system, resulting in decreased oxygen and increased carbon dioxide levels—naloxone allows patients to breathe, and transitively, a means to prevent suffocation.
"Pharmacists, in turn, are within their professional jurisdiction to exercise such prudence. Moreover, patient education is imperative. Pharmacists should counsel patients on opioid-associated risks, along with proper medication administration, storage, and disposal."
Supplementing patients with informative pamphlets, too, may cement the gravitas of opioids.
Furthermore, prescription opioids should be the last line of treatment. Practitioners should not be trigger-happy to prescribe opioids. Instead, practitioners should adhere to a delineated process for pain management—exhausting all plausible options before consideration of opioids. As a result,
"Pharmacists may reinforce the stepwise approach, relaying drug information standards for a coordinated and informed approach on pain management. Therefore, such practices would limit eventualities for opioid usage, addiction, and death."
The avowed policy of healthcare ,as the word itself suggests, is to care for health. For patients, particularly, healthcare is entrusted to be affordable, effective, and truthful–as such, the distinction between healthcare professionals and business tycoons. The Sackler’s path to prominence, in turn, underlines corrupt hypocrisy. Much attributable to their fame, is society itself. Pharmaceutical companies commercializing lies. Government agencies accepting bribes. And academic establishments headlining the name “Sackler”—including Columbia University’s Sackler Institute for Developmental Psychobiology, whose website suspiciously displays zero search results for “opioid”. Even from the bestowal of knighthood (like that of Mortimer Sackler, co-founder of Purdue Pharma, by Queen Elizabeth II in 1995) to eponymy as a rose: Rosa ‘Mortimer Sackler’. Therefore, healthcare must be under responsible auspices. If not, then the stench of greed and artifice will manifest into a Sackler by any other name.
References
1. New York State Department of Health. (2019). Overdose deaths involving any opioid, age-adjusted rate per 100,000 population, by county, New York State, 2016 and 2017 [Chart]. Retrieved from https://www.health.ny.gov/statistics/opioid/data/pdf/nys_opioid_annual_report_ 2019.pdf
2. (2021, May). Patrick Radden Keefe traces the roots of America’s opioid epidemic. The Economist. Retrieved from https://www.economist.com/books-and-arts/2021/05/13/ patrick-radden-keefe-traces-the-roots-of-americas-opioid-epidemic
3. Centers for Disease Control and Prevention. (n.d.). Drug Overdoses in the United States. Retrieved from https://www.cdc.gov/injury/features/prescription-drug overdose/index.html
4. Gerstmann, E. (2019, May 10). Harvard, Arthur Sackler And The Perils of Indiscriminate Shaming. Forbes. Retrieved from https://www.forbes.com/sites/evangerstmann/ 2019/05/10/harvard-arthur-sackler-and-the-perils-of-indiscriminate-shaming/?sh =4987c04f3746
5. Keefe, P. (2017, October 23). The Family That Built an Empire of Pain. The New Yorker. Retrieved from https://www.newyorker.com/magazine/2017/10/30/the-family-that built-an-empire-of-pain
6. (2019). The United States Has Opioid Overdose Death Rates More Than Twice Those of Any Other Country. The Back Letter, 34(1). Retrieved from https://journals.lww.com/backletter/Citation/2019/01000/The_United_States_Has_Opioid_Overdose_Death_Rates.5.aspx
7. National Institutes of Health. (n.d.). Overdose Death Rates. Retrieved from https://nida.nih.gov/drug topics/trends-statistics/overdose-death-rates
8. Kessler, A., Cohen, E., & Grise, K. (2018, March). CNN Exclusive: The more opioids doctors prescribe, the more money they make. Retrieved from https://www.cnn.com/2018/03/11/ ealth/prescription-opioid payments-eprise/index.html
9. Luu, L. (2021, April). Pharmacists Play a Prominent Role in Combating the Opioid Epidemic. Retrieved from https://www.goodrx.com/hcp/pharmacists/pharmacists-role-in-the-opioid-epidemic
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