October 7, 2019 • 38 mins
In 1996, a prescription opioid known as OxyContin hit the market. It was among the first opioids to be heavily marketed (yes, legally) and since that time, more than 400,000 Americans have died from opioid overdoses—including some 200,000 from prescription opioids. Millions more continue to struggle with addiction, and entire communities have been devastated by the epidemic. Who or what is to blame? Where is the original sin? Looking for answers, Bethany speaks to NYT reporter Barry Meier about the opioid crisis.
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Speaker 1 (00:00):
Thanks for downloading Making a Killing. I'm Bethany McClain. Usually
I'm talking to guests about topics I haven't covered as
a journalist, but every once in a while there's overlap
between the topic of the show and the pieces I've
written for Vanity Fair, and it's really fun for me
to be able to hear another journalists perspective on a
topic that I also know well. This week, I'm talking
(00:22):
to Barry Meyer about the opioid crisis, and I hope
you're looking forward to next week's show, in which I'll
talk to Lynette Lopez about the cult of Elon Musk.
The opioid crisis is one of the most devastating public
health crisis ever to have hit America. Back in nineteen
ninety six, a prescription opioid known as OxyContin first entered
(00:46):
the market. It was among the first opioids to be
heavily marketed yes legally, and since that time, more than
four hundred thousand Americans have died from opioid overdoses. Millions
more continued to struggle with addiction. An entire community have
been devastated by the epidemic. Today, the major problem isn't
so much prescription opioids, as it is fentanyl, the synthetic
(01:07):
opioid that contributed to the deaths of both Tom Petty
and Prince. But many argue that the fentnyl problem wouldn't
exist at this scale were it not for prescription opioids.
According to a government study, roughly eighty percent of heroin
users who often switched to cheaper and stronger fentnyl started
with prescription opioids. And always curious about the genesis of problems,
(01:29):
particularly giant, culturally devastating problems like this one. Tracing and
untangling the roots helps explain not only the past but
also the present. So who or what is to blame
for the opioid crisis? Where is the original sin? Is
this all about the money or is there a deeper,
scarier story behind what went wrong? Today's favorite villain is
(01:51):
the Sackler's, the secret family that owns Perdue Pharma, the
maker of oxycotton. Journalist Barry Meyer was one of the
first to focus on them. His book Painkiller, was published
back in two thousand and three. Meyer's work was also
among the first to point out the nexus between the
pain management movement and the explosion of opioid use. Pharmaceutical
companies saw that they could increase their sales by arguing
(02:12):
that pain could and should be treated with opioids. Somehow,
the companies argued that this could be done with minimal risk,
even though it flew in the face of literally hundreds
of years of history about the known dangers of opioids.
How did the industry do this essentially with money, paying
millions of dollars to doctors and pain management organizations to
convince them in US that opioids were salvation. I recently
(02:36):
spoke with David Sackler, the grandson of one of the
founders of Purdue, for a vanity Fair piece I did.
David served Unproduced board from two thousand and twelve to
two and eighteen, and he is defensive, to say the
least about the role that his family business played. My
reporting left me even more intrigued by this topic. So
I'm thrilled to have Barry Meyer here with me today.
(02:59):
So I see your book actually is not being just
about the crisis, but of being something of a metaphor
about it. And you wrote in a recent article that
the book appeared at the dawn of the opioid epidemic,
and the sun quickly set on your book. A year
after publication, it went out of print. Why did it
take so long for people to care? I think it
was probably a question of numbers. At the time that
(03:19):
the book came out, which was in two thousand and three,
there were startling numbers. There were approximately sixteen thousand overdose
deaths at that time, So you would think those numbers
alone would be adequate to generate interest, but not just
in terms of the book, but in terms of our
societal response be a legal, regulatory medical That didn't really
(03:46):
start to happen until maybe three or four years ago,
when the numbers started to climb into the forty fifty
sixty thousand a year range of overdose deaths. Right in
your book. A disaster that might have been contained with
an early response had morphed into a hydra. Do you
(04:06):
how should we have seen this earlier? What's the lesson
to draw from this? The lesson to be drawn from
this is that public health officials, lawmakers, regulators, as you mentioned,
had an opportunity to do something. They could have changed
the course of this epidemic very early by taking pretty
(04:29):
simple measures encouraging doctors to prescribe less opioids, asking companies
to take various steps to reduce or limit their marketing,
but none of them did that. As to why they didn't,
I think at that point, the drug industry has always
been a very powerful force. They have a lot of lobbyists,
(04:52):
and they were successful in convincing regulators and lawmakers that
if you do crack down on these drugs, you're going
to restrict the ability of patients who need pain medications
to receive them. That was an interesting argument, and in
(05:12):
some ways a legitimate argument, but it was all predicated
around the idea that drugs or narcotic painkillers were the
only or the most appropriate way to treat pain. So
the entire conversation was centered around the use of these drugs.
(05:32):
So the entire conversation was almost answered before the conversation
was had, in a sense, by the way the question
was framed. You're going to punish patients, you know, So
basically you've got some people out there abusing drugs. They're
bad actors, you know. It was basically a conversation that
was framed in terms of black and white. The people
with the black hats were the drug abusers and they
(05:52):
were sort of like expendable bad actors who were like
violating the trust of doctors, committing crimes create in chaos.
The people with the white hats were the pain patients,
and as long as you made sure that these drugs
were used appropriately by doctors, these people would only benefit
(06:13):
from the drug. You know, a large part of our
conversation about these drugs has been centered strictly around the
notion of overdose disks. But that mass what is also
another issue with these drugs, and that is the many
problematic side effects that they can cause in patients, which is,
(06:34):
you know, everything falls in the elderly to reduce energy
drive to social withdrawal. I mean, I have interviewed many
people over the years who told me that when they
were on high doses of opioids for their chronic pain conditions,
(06:54):
they essentially withdrew from their families, from their social lives,
They withdrew from the world, They withdrew from the world.
Let's go back to the beginning. You mentioned that there
was some legitimacy to the argument that pain was being undertreated.
How legitimate was that when you go back to the
seventies and eighties, when pain was definitely undertreated. It was
(07:14):
very legitimate, and I think that the people who sort
of became the advocates for more appropriate pain treatment, particularly
in cancer pain treatment, end of life pain treatment, were
real heroes in the medical sense. You know, you had
situations in the United States where people were actually dying
(07:38):
in pain. There were cancer patients at the end of
life were in horrible pain, in horrible pain, and basically
they were being viewed as drug addicts or whiners if
they were seeking to have medication to deal with that pain.
Was a very puritanical and parochial view of medicine. And
(08:02):
this began to change when people who were advocates of
the hospice movement in England their ideas kind of came
over to the United States and researchers at Sloan Kettering
and other major hospitals here in the US began adopting
more liberal use of opioids in the treatment of pain
(08:22):
or in the treatment of end of life illnesses, and
so in that sense, they really were addressing something that
was an underlying problem. So, to steal your word, this
began as a heroic thing, as a very good thing,
and has ended up as a very terrible thing, and
in that narrative lies a whole bunch of things. Right,
(08:44):
So let's go back to another part at the beginning,
which is Arthur Sackler, who was he Arthur Sackler was
one of three Sackler brothers. They were all trained psychiatrists.
They were all kind of brilliant men in their own ways,
but Arthur Sackler was sort of the leading light of
the three brothers. He was the eldest of the brothers,
(09:07):
and along with being a research psychiatrist, he also became
interested and involved in the drug advertising industry. So, just
to set his career into context, the drug industry as
we know it today, really only began after the Second
World War. That there was a tremendous explosion in the
(09:28):
number of drug companies and the number of drugs those
companies were making, and Arthur Sackler saw an opportunity to
create an allied ancillary industry, which was the advertising of
prescription drugs that had not really existed before, and he
worked for a drug advertising agency and began to develop
(09:50):
ads for drugs that in time would be targeted. He
was a very modern medicine man, totally, totally and brilliant
in so many ways and up with concepts that are
still being used today. For example, he started a magazine
or a series of medical journals or faux medical journals
(10:13):
that published. They were sort of appeared to be a
sort of an entry fee, because you know, they would
publish studies for Arthur Sackler's advertising clients or performed by
his advertising clients. He had a newspaper that went out
to doctors, and many of the so called stories or
(10:37):
articles in those newspapers were basically articles that were written
by his in house admin or pitchmen that were sort
of promoting drugs or promoting treatments by certain drugs. I mean,
he was sort of at the forefront of the explosion
in the use of drugs by the medical profess in
(11:00):
the concept that there was a pill for every ill. Oh,
I like that phrase, a pill for every ill. So
one thing I was surprised about in your book. I
had always thought of doctor Richard Sackler as being more
of a force within the company. You actually portray him
as somewhat meek in the book, somewhat in the shadow
of Arthur. How do you think about his role at
the company at the time that I wrote the book
(11:21):
and I was doing the reporting about Purdue, both Richard
Sackler's father and his uncle were still alive. And I believed,
or at least my sense at the time, you know,
as far as the Sackler family went, they were making
the big thirty thousand foot decisions about what happened at Purdue.
(11:42):
I was surprised when these this recent slew of documents
came out that showed Richard Sackler or portrayed him as
being kind of a micromanager and you know, seemingly harassing
or ordering sales staff or the other thing. And I'm
wondering to what degree is that was something that always
(12:05):
existed or became increasingly the case as first his uncle
and then his father aged and died off, whether he
then took on a mantle that he hadn't previously had.
So do you before we get to oxycon specifically in
the development of it, do you see Purdue as the
(12:28):
Sacklers company? And obviously it is technically, but do you
see the Sacklers as having been in charge of the
decisions that were made at Purdue. They obviously benefited from
those decisions. They've always denied that they were in charge
of the company, and I guess you know, it's an
issue into a game of words. Yeah, how you want
(12:48):
to legally parse that. I mean, the fact the matter
is that they controlled the company from the documentation that
has emerged, that they approved the budgets for the company.
So that at a certain stage, and hopefully we will
know this at some point in the future, we'll know
from board meanings, from board minutes, what decisions they approved
(13:11):
or disapproved of, and that will certainly tell us how
deeply involved in the company they were. So what made
OxyContin so different from its predecessors. OxyContin was not different
in terms of the active ingredient it contained. It contained
a prescription narcotic called oxycodone, which was a very old
(13:32):
drug was used in many drugs like percoset and prescription
pain killers have been around for decades. What made OxyContin
unique is that in these other drugs, oxycodone was combined
with over the counter pain relievers like a set amid effect,
they were weaker, and the amount of OxyContin or oxycodone
(13:55):
these drugs contained was relatively small, as about five milligrams.
So OxyContin was pure oxycodone. It did not have any
other ingredients in it, and it contained oxycodone in increasingly
high amounts. So the weakest those of OxyContin was ten
(14:17):
milligrams of oxycodone, twice as much as the typical per
could said, and from there it went up to eighty milligrams.
So the way that I think I described in the
book was that compared to like a conventional weapon, OxyContin
was sort of the atomic bomb. When I spoke to
David Sackler recently, one of his lines of argument was
(14:40):
that the science changed, and so what was known at
the time and what did change? How much did we
understand at the time that oxyconton was launched in nineteen
ninety six about the drug. The sort of interesting thing
about it is that nothing was really known one way
or another. So to say that the science changed, that existed,
(15:04):
and in fact there wasn't. There was scientific wishful thinking,
I think it would be a more appropriate way to
describe it. I love that when OxyContin was first promoted,
and this is going back to the mid nineteen nineties,
there really hadn't been any clinical trial, which is sort
of like the basic standard for scientific evidence run on
(15:29):
oxy content as a drug to see how it compared
with other drugs to determine what percentage of people might
develop a dependency or addiction to the drug. In fact,
the drug was promoted very forcefully by its advocates based
on data that actually had nothing to do with the
(15:51):
long term use of narcotic painkillers. I mean, one of
the studies that was put forward wasn't even a scientific study.
It was basically a brief letter that had appeared in
the New England Journal of Medicine by some researchers in Boston,
where they were reporting on the experience of hospital patients
(16:13):
who've been treated with narcotic pain killers, and this study
was extrapolated to suggest that people could take narcotic pain
killers for long periods of time at high dosages without
any ill effect, when in fact these doctors had never
followed the patients as soon as they set foot outside
the hospital. Similarly, there was a study done at a
(16:37):
headache clinic in Detroit. I believe the data from that
was actually extrapolated and misconstrued to suggest it was totally
taken out of context to suggest that these headache patients
who had severe migraines could take narcotics and not suffer
(16:59):
any ill effect from them, when, in fact, what I
called the researcher who had actually performed that study and
told him how it had been used. He was stunned
and pointed out the misstatements about the study and the
fact that at the time that the study was being
used to promote the use of long term narcotics like oxycontent,
(17:22):
it was pretty much accepted practice amongst headache experts that
narcotics should never be used in the treatment of migraines
because they caused what is known as rebound headaches, and
in fact, when patients came into his clinic, they were
taken off these types of drugs. So essentially we had
(17:43):
doctors who, having succeeded in expanding the use of prescription
pain closers in the setting of cancer, wards becoming convinced
that the same drugs could be used at high dosages
for long periods of time to treat all kinds of pain.
(18:04):
You know, backaches, are thriatus, dental pains, sports injuries, you
name it. And to kind of promote that narrative, they
grasped onto whatever little pieces of data they could and
shoehorned it into the story that they wanted to tell,
(18:25):
and thus was born this claim that the risk of
addiction was less than one percent? Right? And how does
that happen? I mean we're supposedly scientific culture, right and
we're talking about doctors, we're talking about scientists. Why was
everybody willing to let very very clear? You and I
as lay people, can understand that this was a dramatic
(18:46):
misreading of what was available. How does that happen? And
does that tell a larger story about our pharmaceutical industry. Well,
there's a lot of medical wishful thinking, and there always
is in this case that was combined with what doctors.
You know, pain is a real problem for people, but
(19:07):
for doctors it's one of those conditions that in some
ways is something that they don't want to deal with,
because you have patients come in complaining of pain. They
try this thing, they try that thing, it doesn't work,
the patient comes back, and doctors who really want to
solve problems become extremely frustrated. So they're looking for a
(19:30):
sou how convenient to believe? You found the silver bullet
right exactly, And you know it's so there's medical wishful thinking.
And what I was surprised by because I actually went
back in the early two thousands when I was first
reporting on this and looked at these studies, I as
a layman, was stunned that it was so obvious, And
(19:53):
it was obvious to me, and and what was also
obvious to me was that none of these doctors had
actually gone back and done this themselves. They had taken
the word of the so called experts. And I think
that it's not unique to pain drugs. I mean, in
my career as a reporter, I've seen this type of
(20:14):
thing happened time and time and time again. Someone smarter
than I am said it is so thus it must
be so right. And they're giving me a solution. They're
giving me an answer, They're giving me a way of
dealing with something, or making more money as a doctor,
or increasing my own standing as a doctor. So not
(20:37):
to disparage in any way, shape or form the people
that weren't involved with this, because I think many of
them had good intentions. They also there was also a
bit of ego involved for them, like who would not
want to be known as the doctor who solved what
had been an age old medical problem? You know, who
(21:01):
would not want to have that as part of their legacy?
So while some people might say, well, these doctors around
the take or they're taking money from the drug industry,
what I came away believing was that there are things
even more powerful than money, Oh think, and that's ideology.
(21:22):
And you know, once you buy into an ideology and
you make that ideology your own, breaking that or coming
to terms with the fact that you might have been
wrong is virtually impossible. Combine ego the ability to rely
on an expert convenience, and you end up with a
(21:44):
recipe for good intentions gone terribly wrong. Right, And I
think there's a there's a broader life lesson in that. Actually,
how did you come to think about the role of
the FDA in all of this? By I found that
horrant for the most part. I mean, because they allow
PRDUE to make these claims for oxyconton when it was
first rolled out in nineteen ninety six. Well, I mean,
(22:06):
they did not require PRDUE to produce the types of
studies that would have justified the claims that Prdue was
allowed to make. And in my view, that wasn't necessarily
on Prdue. That was on the FDA. It's their job
(22:26):
to make sure that claims that are being made by
a drug manufacturer are consistent with some semblance of science.
And then when it became apparent within a couple of
years that the drug was being abused, they were very
slow to take action. Why do you think that is?
(22:47):
Are they simply again, is it just a question of
money and the fact that the FDA, under the Prescription
Drug User Act is largely funded by drug companies. Is
it just money or is there something more complicated at work.
I think it's more implicated. I think it's says they're
institutionally disinclined to go back and revisit decisions and acknowledge
(23:08):
that they were wrong. And once a decision has been made,
they stick with it. Yeah, I mean they have, they
have to defend it, but they you know, it's really
was really only after the Times and other newspapers started
reporting about the growing abuse of OxyContin beginning in two thousand,
(23:29):
in early two thousand and one, that the FDA kind
of started taking action, and then they were pretty slow
in what they did even then. What about on those
reports of abuse? Another of David Sackler's arguments, and in
a sense, is that the reports of abuse were largely anecdotal.
They were just scattered and isolated in anecdotal Do you
(23:51):
agree with that? And even if we grant him that,
when do reports of anecdotal abuse become powerful enough that
someone should say this is more than an anecdote, this
is more than an isolated event. Well, I don't know
what reports specifically David Sackler was referring to. I don't
know what reports David Sackler was aware of. When I
(24:13):
was first writing Painkiller, that question came up in my
own mind, like, well, when when did produce first really
know about this? Right? And they had testified publicly that
they first became aware of the drugs abuse. I believe
in the spring of two thousand, when the US Attorney
(24:35):
in Maine A sent to notice the doctors there, warning
them that people were coming in to basically calm them
into prescribing oxycontent. When I started looking at that statement,
I started backtracking and came up with numerous newspaper reports
from small towns in Appalachian other places, other kinds of
(24:59):
police warnings that were issued, interactions between doctors who've been
arrested for running pill mills or charged with running pill mills,
and Purdue executives. So you know where this tipping point
happened is really impossible to know, although I'll add that
(25:23):
when I came into possession a few years ago of
the report of the prosecutors who had investigated Purdue in
the mid two thousands, they had access to something that
I didn't have access to, and I suspect David Sackler
didn't have access to, which was like an internal database
(25:45):
of reports. And what they found was that there were
one hundred and seventeen reports that have been filed by
sales reps working for Purdue who visited doctors, and that
was between nineteen ninety six and nineteen ninety nine, really
the first few years of Oxyconton was on the market,
(26:06):
hundred seventeen separate reports in which the words like abuse, diversion,
or street sell words that would be red flags for abuse.
So where was that anecdotal? Were those scattered? I don't know,
but it suggested that there was information that was coming
(26:28):
to Purdue that could have tipped them off. And you
would hope. I think that whether anecdotal or not, the
bar should be higher when we're talking about people's lives.
In other words, if you're getting anecdotal evidence that somebody's
eating too many cheetahs. It's a little bit different than
anecdotal evidence that people are dying because of prescription drugs,
(26:49):
right right, Well, you know, I think Purdue would make
the argument that, Okay, everybody knows that, or everyone's always
known that prescription our conducts can be abused. I mean,
that's happened always, right. But this was a slightly different situation,
which is that this drug was being marketed essentially as
(27:11):
less abusable, yes, than the run of the mill prescription PAINKILLO.
That's how Purdue was setting OxyContin apart from competing drugs.
So were they under special duty to pay attention to
that because they were marketing it differently? Did they think, yeah,
(27:32):
this is just what you'd expect to happen. I think perhaps, yes,
there's something there's something about this argument that, well, we
told you it was addictive, so we're covered even though
we marketed it as non addictive. That's this very dark
version of trying to have your cake and eat it too.
So Prdue famously settled with a Justice Department in two
thousand and seven, paying six hundred million dollars in fines.
(27:56):
Was this a lost opportunity in some ways? In your view.
I think that had this trial gone forward, settlement, or
even if the Justice Department had released more documents that
they had gathered, things could have changed. A lot of
evidence that the government had assembled to make their case
(28:20):
would have come to public light, and I think the
import of that would have gone far beyond credu because
I think doctors and patience and lawmakers would have begun
to realize at that point that these drugs were in
(28:42):
a panacea, that these drugs had a variety of problems
connected with them. I mean, the thing that I keep
coming back to when I think about what might have
been different had the circumstances surrounding this settlement played out differently,
is the fact of the matter than in the four
years after this settlement, around one hundred thousand people died
(29:05):
from overdoses involving narcotic painkillers. During that same period, doctors
kept prescribing more and more of these drugs. So the
societal change that would take place in twenty thirteen or fourteen,
with the realization that this is out of hand and
(29:26):
we need to do something about it might have happened
back then had this situation played out. We talked about
doctors in the medical establishment. Is this largely being a
story of good intentions gone wrong? Do you see that
more broadly writ with Purdue, with the FDA, with the DA.
How much do you see it as as a broad
(29:47):
story of good intentions gone wrong versus willful evil? You know?
I see it as a story of starting out good
intentions yep, gone wrong, and then morphing into one where
the forces in our society, or the players in our
society who we look to to check excesses, to address wrongs,
(30:12):
to right the scales, if you will, and that is
everyone from lawmakers to regulators, to lawyers to public health officials,
failed to do their job, failed to step up when
it was needed. I mean, I can recall very vividly,
(30:33):
you know. I tried to like step back from this
at a certain point, and I would watch as year
after year after year, the number of overdoses increase, it's
a number of adverse reactions increase, and I would think
to myself, how long are people going to allow this
(30:55):
to go on? And it kept going on, and it
didn't make a difference what party was in political power.
I remember very clearly having a discussion with a person
who was in the White House Office of Drug Control Policy.
This was during the Obama administration, and you know, people
(31:17):
for a long time had promoted the idea that doctors
who prescribed these drugs should have some basic training right
to be able to recognize people who might be prone
to abuse, to know how to use these drugs better.
It was not to restrict the use of the drugs,
just make doctor, idea, yeah, smarter in the use of
the drugs. And this person like broached the idea to
(31:42):
the American Medical Association, and the American Medical Association stopped
the idea dead in its tracks because they didn't want
to impose that requirement upon doctors, exactly because they were
defending the doctor who was too busy, too lazy, to whatever,
to want to go through this training. Is it too
strong to call it a tale? This entire saga, the
(32:06):
tale of a corrupt system? Is that too strong a word.
I don't know if I would call it a tale
of a corrupt system, but I would say that it
certainly illuminates how people and organizations and institutions fail to
step up and do what's needed to be done when
(32:27):
a problem is staring them square in the face because
they are more interested in their own be it financial, professional,
whatever interests, and they're unwilling to see the greater good
that can come out from stepping forward. You write in
your book, as we've been talking about drug regulators, lawmakers,
(32:49):
medical associations, and even public health officials seem frozen, uncertain
of what to do or how to respond. In some ways,
it would almost be better if it were a tale
of corruption, but it's us a tale of convenience, right, yeah, yes,
and entropan convenience. It was just it was just more
convenient not to look at it, right, And in a
lot of cases it would have required organizations to do
(33:12):
an about face. For example, there was hospital organization that
had made pain the so called commission, right yeah, the
fifth final Sign, and as a result of that, the
use of these drugs in hospital settings became much more liberalized.
There were even system you know, companies that were making
money selling surveys to rate your doctor on how well
(33:36):
they treated your pain. So there was a whole not
only market, but after market of services and organizations and
what have you that were tied in one shape or
form into the liberal use of these medications. And so
anything that kind of would upset that apple Cart was
(33:59):
some skin off. They are back in some ways. So
you end your book by pointing out that the lesson
of the past two decades is a clear one. Change
is not optional, And David Sackler made a similar argument
to me that we need to focus on fixing this now,
And of course his is a self interested one in
the sense that the argument is stop suing us, let's
all focus on fixing this instead. What would you do
(34:21):
if you could waive your magic wand if there is
one to make things better? What would you do from here?
I think they are two important things that have to happen,
without a doubt. The most important thing that has to
happen is that we need to provide adequate treatment for
people who have drug abuse problems, and we can't hope
(34:43):
to solve it easily. We can't be fooled into thinking
that there's a pill for this ill as well, because
these are very complicated medical conditions and people need both
drug treatment and behavioral and psychological counseling for long periods
of time, and it's very costly. The other thing that
I personally think is extremely important is for the truth
(35:08):
to come out. The truth about what people knew, what
people knew when they knew it, and that we have
a wrecking name with what occurred. And that is only
going to happen if the documents in all the litigation
that is going on right now come to light, become public.
(35:31):
And my great concern is that that once again there
will be a settlement. Yes, and through the transactional relationships
that exist between plaintiff's lawyers and corporations, the plaintiff's lawyers
will see it to their benefit to settle these cases
and seal these documents, and judges will go along with that,
(35:54):
and so the history of this horrible crisis and the
real causes will be sealed away, and to me, that
would be tragic, buried in the shadows. I am going
to hope that that is not the outcome, so I
could keep talking to you forever. But thank you so
much for coming. This has been fascinating. I almost don't
(36:17):
know where to start. I find the OxyContin saga itself
endlessly fascinating, but the bigger picture aspects, the ways in
which this is a universal story, are also both fascinating
and frightening. For instance, to what extent are truly horrible
stories like this one a function of people who set
out to do evil versus this odd, almost more terrifying
(36:39):
mixture of good intentions gone wrong, convenience and, as Barry says, entropy.
On a previous episode, Alex Gibney and I talked about belief,
how it is almost more dangerous and frightening than people
setting out to tell lies. There's plenty of the worst
kind of belief at work in this story. And to
what extent is this an indictment of our system, not
(37:01):
just the ways in which money influences and yes, corrupts
the pharmaceutical industry, but also an indictment of the inaptitude
of regulators we depend on to protect us, and maybe
even an indictment of the justice system itself because of
the ways in which the pieces of this story that
we most need to understand have stayed in the shadows
and may well continue to do so. Making a Killing
(37:26):
is a co production of Pushkin Industries and Chalk and Blade.
It's produced by Ruth Barnes and Laura Hyde. My executive
producers are Alison mcclein no relation in Making Casey. The
executive producer at Pushkin is Mia Loebell Engineering by Jason
Gambrell and Jason Rastkowski. Our music is by Jed Flood.
(37:46):
Special thanks to Jacob Weisberg at Pushkin and everyone on
the show. I'm Bethany McLain. Thanks so much for listening.
Find me on Twitter at Bethany mac twelve and let
me know which episodes you've most enjoyed.
Thanks for downloading Making a Killing. I'm Bethany McClain. Usually
I'm talking to guests about topics I haven't covered as
a journalist, but every once in a while there's overlap
between the topic of the show and the pieces I've
written for Vanity Fair, and it's really fun for me
to be able to hear another journalists perspective on a
topic that I also know well. This week, I'm talking
(00:22):
to Barry Meyer about the opioid crisis, and I hope
you're looking forward to next week's show, in which I'll
talk to Lynette Lopez about the cult of Elon Musk.
The opioid crisis is one of the most devastating public
health crisis ever to have hit America. Back in nineteen
ninety six, a prescription opioid known as OxyContin first entered
(00:46):
the market. It was among the first opioids to be
heavily marketed yes legally, and since that time, more than
four hundred thousand Americans have died from opioid overdoses. Millions
more continued to struggle with addiction. An entire community have
been devastated by the epidemic. Today, the major problem isn't
so much prescription opioids, as it is fentanyl, the synthetic
(01:07):
opioid that contributed to the deaths of both Tom Petty
and Prince. But many argue that the fentnyl problem wouldn't
exist at this scale were it not for prescription opioids.
According to a government study, roughly eighty percent of heroin
users who often switched to cheaper and stronger fentnyl started
with prescription opioids. And always curious about the genesis of problems,
(01:29):
particularly giant, culturally devastating problems like this one. Tracing and
untangling the roots helps explain not only the past but
also the present. So who or what is to blame
for the opioid crisis? Where is the original sin? Is
this all about the money or is there a deeper,
scarier story behind what went wrong? Today's favorite villain is
(01:51):
the Sackler's, the secret family that owns Perdue Pharma, the
maker of oxycotton. Journalist Barry Meyer was one of the
first to focus on them. His book Painkiller, was published
back in two thousand and three. Meyer's work was also
among the first to point out the nexus between the
pain management movement and the explosion of opioid use. Pharmaceutical
companies saw that they could increase their sales by arguing
(02:12):
that pain could and should be treated with opioids. Somehow,
the companies argued that this could be done with minimal risk,
even though it flew in the face of literally hundreds
of years of history about the known dangers of opioids.
How did the industry do this essentially with money, paying
millions of dollars to doctors and pain management organizations to
convince them in US that opioids were salvation. I recently
(02:36):
spoke with David Sackler, the grandson of one of the
founders of Purdue, for a vanity Fair piece I did.
David served Unproduced board from two thousand and twelve to
two and eighteen, and he is defensive, to say the
least about the role that his family business played. My
reporting left me even more intrigued by this topic. So
I'm thrilled to have Barry Meyer here with me today.
(02:59):
So I see your book actually is not being just
about the crisis, but of being something of a metaphor
about it. And you wrote in a recent article that
the book appeared at the dawn of the opioid epidemic,
and the sun quickly set on your book. A year
after publication, it went out of print. Why did it
take so long for people to care? I think it
was probably a question of numbers. At the time that
(03:19):
the book came out, which was in two thousand and three,
there were startling numbers. There were approximately sixteen thousand overdose
deaths at that time, So you would think those numbers
alone would be adequate to generate interest, but not just
in terms of the book, but in terms of our
societal response be a legal, regulatory medical That didn't really
(03:46):
start to happen until maybe three or four years ago,
when the numbers started to climb into the forty fifty
sixty thousand a year range of overdose deaths. Right in
your book. A disaster that might have been contained with
an early response had morphed into a hydra. Do you
(04:06):
how should we have seen this earlier? What's the lesson
to draw from this? The lesson to be drawn from
this is that public health officials, lawmakers, regulators, as you mentioned,
had an opportunity to do something. They could have changed
the course of this epidemic very early by taking pretty
(04:29):
simple measures encouraging doctors to prescribe less opioids, asking companies
to take various steps to reduce or limit their marketing,
but none of them did that. As to why they didn't,
I think at that point, the drug industry has always
been a very powerful force. They have a lot of lobbyists,
(04:52):
and they were successful in convincing regulators and lawmakers that
if you do crack down on these drugs, you're going
to restrict the ability of patients who need pain medications
to receive them. That was an interesting argument, and in
(05:12):
some ways a legitimate argument, but it was all predicated
around the idea that drugs or narcotic painkillers were the
only or the most appropriate way to treat pain. So
the entire conversation was centered around the use of these drugs.
(05:32):
So the entire conversation was almost answered before the conversation
was had, in a sense, by the way the question
was framed. You're going to punish patients, you know, So
basically you've got some people out there abusing drugs. They're
bad actors, you know. It was basically a conversation that
was framed in terms of black and white. The people
with the black hats were the drug abusers and they
(05:52):
were sort of like expendable bad actors who were like
violating the trust of doctors, committing crimes create in chaos.
The people with the white hats were the pain patients,
and as long as you made sure that these drugs
were used appropriately by doctors, these people would only benefit
(06:13):
from the drug. You know, a large part of our
conversation about these drugs has been centered strictly around the
notion of overdose disks. But that mass what is also
another issue with these drugs, and that is the many
problematic side effects that they can cause in patients, which is,
(06:34):
you know, everything falls in the elderly to reduce energy
drive to social withdrawal. I mean, I have interviewed many
people over the years who told me that when they
were on high doses of opioids for their chronic pain conditions,
(06:54):
they essentially withdrew from their families, from their social lives,
They withdrew from the world, They withdrew from the world.
Let's go back to the beginning. You mentioned that there
was some legitimacy to the argument that pain was being undertreated.
How legitimate was that when you go back to the
seventies and eighties, when pain was definitely undertreated. It was
(07:14):
very legitimate, and I think that the people who sort
of became the advocates for more appropriate pain treatment, particularly
in cancer pain treatment, end of life pain treatment, were
real heroes in the medical sense. You know, you had
situations in the United States where people were actually dying
(07:38):
in pain. There were cancer patients at the end of
life were in horrible pain, in horrible pain, and basically
they were being viewed as drug addicts or whiners if
they were seeking to have medication to deal with that pain.
Was a very puritanical and parochial view of medicine. And
(08:02):
this began to change when people who were advocates of
the hospice movement in England their ideas kind of came
over to the United States and researchers at Sloan Kettering
and other major hospitals here in the US began adopting
more liberal use of opioids in the treatment of pain
(08:22):
or in the treatment of end of life illnesses, and
so in that sense, they really were addressing something that
was an underlying problem. So, to steal your word, this
began as a heroic thing, as a very good thing,
and has ended up as a very terrible thing, and
in that narrative lies a whole bunch of things. Right,
(08:44):
So let's go back to another part at the beginning,
which is Arthur Sackler, who was he Arthur Sackler was
one of three Sackler brothers. They were all trained psychiatrists.
They were all kind of brilliant men in their own ways,
but Arthur Sackler was sort of the leading light of
the three brothers. He was the eldest of the brothers,
(09:07):
and along with being a research psychiatrist, he also became
interested and involved in the drug advertising industry. So, just
to set his career into context, the drug industry as
we know it today, really only began after the Second
World War. That there was a tremendous explosion in the
(09:28):
number of drug companies and the number of drugs those
companies were making, and Arthur Sackler saw an opportunity to
create an allied ancillary industry, which was the advertising of
prescription drugs that had not really existed before, and he
worked for a drug advertising agency and began to develop
(09:50):
ads for drugs that in time would be targeted. He
was a very modern medicine man, totally, totally and brilliant
in so many ways and up with concepts that are
still being used today. For example, he started a magazine
or a series of medical journals or faux medical journals
(10:13):
that published. They were sort of appeared to be a
sort of an entry fee, because you know, they would
publish studies for Arthur Sackler's advertising clients or performed by
his advertising clients. He had a newspaper that went out
to doctors, and many of the so called stories or
(10:37):
articles in those newspapers were basically articles that were written
by his in house admin or pitchmen that were sort
of promoting drugs or promoting treatments by certain drugs. I mean,
he was sort of at the forefront of the explosion
in the use of drugs by the medical profess in
(11:00):
the concept that there was a pill for every ill. Oh,
I like that phrase, a pill for every ill. So
one thing I was surprised about in your book. I
had always thought of doctor Richard Sackler as being more
of a force within the company. You actually portray him
as somewhat meek in the book, somewhat in the shadow
of Arthur. How do you think about his role at
the company at the time that I wrote the book
(11:21):
and I was doing the reporting about Purdue, both Richard
Sackler's father and his uncle were still alive. And I believed,
or at least my sense at the time, you know,
as far as the Sackler family went, they were making
the big thirty thousand foot decisions about what happened at Purdue.
(11:42):
I was surprised when these this recent slew of documents
came out that showed Richard Sackler or portrayed him as
being kind of a micromanager and you know, seemingly harassing
or ordering sales staff or the other thing. And I'm
wondering to what degree is that was something that always
(12:05):
existed or became increasingly the case as first his uncle
and then his father aged and died off, whether he
then took on a mantle that he hadn't previously had.
So do you before we get to oxycon specifically in
the development of it, do you see Purdue as the
(12:28):
Sacklers company? And obviously it is technically, but do you
see the Sacklers as having been in charge of the
decisions that were made at Purdue. They obviously benefited from
those decisions. They've always denied that they were in charge
of the company, and I guess you know, it's an
issue into a game of words. Yeah, how you want
(12:48):
to legally parse that. I mean, the fact the matter
is that they controlled the company from the documentation that
has emerged, that they approved the budgets for the company.
So that at a certain stage, and hopefully we will
know this at some point in the future, we'll know
from board meanings, from board minutes, what decisions they approved
(13:11):
or disapproved of, and that will certainly tell us how
deeply involved in the company they were. So what made
OxyContin so different from its predecessors. OxyContin was not different
in terms of the active ingredient it contained. It contained
a prescription narcotic called oxycodone, which was a very old
(13:32):
drug was used in many drugs like percoset and prescription
pain killers have been around for decades. What made OxyContin
unique is that in these other drugs, oxycodone was combined
with over the counter pain relievers like a set amid effect,
they were weaker, and the amount of OxyContin or oxycodone
(13:55):
these drugs contained was relatively small, as about five milligrams.
So OxyContin was pure oxycodone. It did not have any
other ingredients in it, and it contained oxycodone in increasingly
high amounts. So the weakest those of OxyContin was ten
(14:17):
milligrams of oxycodone, twice as much as the typical per
could said, and from there it went up to eighty milligrams.
So the way that I think I described in the
book was that compared to like a conventional weapon, OxyContin
was sort of the atomic bomb. When I spoke to
David Sackler recently, one of his lines of argument was
(14:40):
that the science changed, and so what was known at
the time and what did change? How much did we
understand at the time that oxyconton was launched in nineteen
ninety six about the drug. The sort of interesting thing
about it is that nothing was really known one way
or another. So to say that the science changed, that existed,
(15:04):
and in fact there wasn't. There was scientific wishful thinking,
I think it would be a more appropriate way to
describe it. I love that when OxyContin was first promoted,
and this is going back to the mid nineteen nineties,
there really hadn't been any clinical trial, which is sort
of like the basic standard for scientific evidence run on
(15:29):
oxy content as a drug to see how it compared
with other drugs to determine what percentage of people might
develop a dependency or addiction to the drug. In fact,
the drug was promoted very forcefully by its advocates based
on data that actually had nothing to do with the
(15:51):
long term use of narcotic painkillers. I mean, one of
the studies that was put forward wasn't even a scientific study.
It was basically a brief letter that had appeared in
the New England Journal of Medicine by some researchers in Boston,
where they were reporting on the experience of hospital patients
(16:13):
who've been treated with narcotic pain killers, and this study
was extrapolated to suggest that people could take narcotic pain
killers for long periods of time at high dosages without
any ill effect, when in fact these doctors had never
followed the patients as soon as they set foot outside
the hospital. Similarly, there was a study done at a
(16:37):
headache clinic in Detroit. I believe the data from that
was actually extrapolated and misconstrued to suggest it was totally
taken out of context to suggest that these headache patients
who had severe migraines could take narcotics and not suffer
(16:59):
any ill effect from them, when, in fact, what I
called the researcher who had actually performed that study and
told him how it had been used. He was stunned
and pointed out the misstatements about the study and the
fact that at the time that the study was being
used to promote the use of long term narcotics like oxycontent,
(17:22):
it was pretty much accepted practice amongst headache experts that
narcotics should never be used in the treatment of migraines
because they caused what is known as rebound headaches, and
in fact, when patients came into his clinic, they were
taken off these types of drugs. So essentially we had
(17:43):
doctors who, having succeeded in expanding the use of prescription
pain closers in the setting of cancer, wards becoming convinced
that the same drugs could be used at high dosages
for long periods of time to treat all kinds of pain.
(18:04):
You know, backaches, are thriatus, dental pains, sports injuries, you
name it. And to kind of promote that narrative, they
grasped onto whatever little pieces of data they could and
shoehorned it into the story that they wanted to tell,
(18:25):
and thus was born this claim that the risk of
addiction was less than one percent? Right? And how does
that happen? I mean we're supposedly scientific culture, right and
we're talking about doctors, we're talking about scientists. Why was
everybody willing to let very very clear? You and I
as lay people, can understand that this was a dramatic
(18:46):
misreading of what was available. How does that happen? And
does that tell a larger story about our pharmaceutical industry. Well,
there's a lot of medical wishful thinking, and there always
is in this case that was combined with what doctors.
You know, pain is a real problem for people, but
(19:07):
for doctors it's one of those conditions that in some
ways is something that they don't want to deal with,
because you have patients come in complaining of pain. They
try this thing, they try that thing, it doesn't work,
the patient comes back, and doctors who really want to
solve problems become extremely frustrated. So they're looking for a
(19:30):
sou how convenient to believe? You found the silver bullet
right exactly, And you know it's so there's medical wishful thinking.
And what I was surprised by because I actually went
back in the early two thousands when I was first
reporting on this and looked at these studies, I as
a layman, was stunned that it was so obvious, And
(19:53):
it was obvious to me, and and what was also
obvious to me was that none of these doctors had
actually gone back and done this themselves. They had taken
the word of the so called experts. And I think
that it's not unique to pain drugs. I mean, in
my career as a reporter, I've seen this type of
(20:14):
thing happened time and time and time again. Someone smarter
than I am said it is so thus it must
be so right. And they're giving me a solution. They're
giving me an answer, They're giving me a way of
dealing with something, or making more money as a doctor,
or increasing my own standing as a doctor. So not
(20:37):
to disparage in any way, shape or form the people
that weren't involved with this, because I think many of
them had good intentions. They also there was also a
bit of ego involved for them, like who would not
want to be known as the doctor who solved what
had been an age old medical problem? You know, who
(21:01):
would not want to have that as part of their legacy?
So while some people might say, well, these doctors around
the take or they're taking money from the drug industry,
what I came away believing was that there are things
even more powerful than money, Oh think, and that's ideology.
(21:22):
And you know, once you buy into an ideology and
you make that ideology your own, breaking that or coming
to terms with the fact that you might have been
wrong is virtually impossible. Combine ego the ability to rely
on an expert convenience, and you end up with a
(21:44):
recipe for good intentions gone terribly wrong. Right, And I
think there's a there's a broader life lesson in that. Actually,
how did you come to think about the role of
the FDA in all of this? By I found that
horrant for the most part. I mean, because they allow
PRDUE to make these claims for oxyconton when it was
first rolled out in nineteen ninety six. Well, I mean,
(22:06):
they did not require PRDUE to produce the types of
studies that would have justified the claims that Prdue was
allowed to make. And in my view, that wasn't necessarily
on Prdue. That was on the FDA. It's their job
(22:26):
to make sure that claims that are being made by
a drug manufacturer are consistent with some semblance of science.
And then when it became apparent within a couple of
years that the drug was being abused, they were very
slow to take action. Why do you think that is?
(22:47):
Are they simply again, is it just a question of
money and the fact that the FDA, under the Prescription
Drug User Act is largely funded by drug companies. Is
it just money or is there something more complicated at work.
I think it's more implicated. I think it's says they're
institutionally disinclined to go back and revisit decisions and acknowledge
(23:08):
that they were wrong. And once a decision has been made,
they stick with it. Yeah, I mean they have, they
have to defend it, but they you know, it's really
was really only after the Times and other newspapers started
reporting about the growing abuse of OxyContin beginning in two thousand,
(23:29):
in early two thousand and one, that the FDA kind
of started taking action, and then they were pretty slow
in what they did even then. What about on those
reports of abuse? Another of David Sackler's arguments, and in
a sense, is that the reports of abuse were largely anecdotal.
They were just scattered and isolated in anecdotal Do you
(23:51):
agree with that? And even if we grant him that,
when do reports of anecdotal abuse become powerful enough that
someone should say this is more than an anecdote, this
is more than an isolated event. Well, I don't know
what reports specifically David Sackler was referring to. I don't
know what reports David Sackler was aware of. When I
(24:13):
was first writing Painkiller, that question came up in my
own mind, like, well, when when did produce first really
know about this? Right? And they had testified publicly that
they first became aware of the drugs abuse. I believe
in the spring of two thousand, when the US Attorney
(24:35):
in Maine A sent to notice the doctors there, warning
them that people were coming in to basically calm them
into prescribing oxycontent. When I started looking at that statement,
I started backtracking and came up with numerous newspaper reports
from small towns in Appalachian other places, other kinds of
(24:59):
police warnings that were issued, interactions between doctors who've been
arrested for running pill mills or charged with running pill mills,
and Purdue executives. So you know where this tipping point
happened is really impossible to know, although I'll add that
(25:23):
when I came into possession a few years ago of
the report of the prosecutors who had investigated Purdue in
the mid two thousands, they had access to something that
I didn't have access to, and I suspect David Sackler
didn't have access to, which was like an internal database
(25:45):
of reports. And what they found was that there were
one hundred and seventeen reports that have been filed by
sales reps working for Purdue who visited doctors, and that
was between nineteen ninety six and nineteen ninety nine, really
the first few years of Oxyconton was on the market,
(26:06):
hundred seventeen separate reports in which the words like abuse, diversion,
or street sell words that would be red flags for abuse.
So where was that anecdotal? Were those scattered? I don't know,
but it suggested that there was information that was coming
(26:28):
to Purdue that could have tipped them off. And you
would hope. I think that whether anecdotal or not, the
bar should be higher when we're talking about people's lives.
In other words, if you're getting anecdotal evidence that somebody's
eating too many cheetahs. It's a little bit different than
anecdotal evidence that people are dying because of prescription drugs,
(26:49):
right right, Well, you know, I think Purdue would make
the argument that, Okay, everybody knows that, or everyone's always
known that prescription our conducts can be abused. I mean,
that's happened always, right. But this was a slightly different situation,
which is that this drug was being marketed essentially as
(27:11):
less abusable, yes, than the run of the mill prescription PAINKILLO.
That's how Purdue was setting OxyContin apart from competing drugs.
So were they under special duty to pay attention to
that because they were marketing it differently? Did they think, yeah,
(27:32):
this is just what you'd expect to happen. I think perhaps, yes,
there's something there's something about this argument that, well, we
told you it was addictive, so we're covered even though
we marketed it as non addictive. That's this very dark
version of trying to have your cake and eat it too.
So Prdue famously settled with a Justice Department in two
thousand and seven, paying six hundred million dollars in fines.
(27:56):
Was this a lost opportunity in some ways? In your view.
I think that had this trial gone forward, settlement, or
even if the Justice Department had released more documents that
they had gathered, things could have changed. A lot of
evidence that the government had assembled to make their case
(28:20):
would have come to public light, and I think the
import of that would have gone far beyond credu because
I think doctors and patience and lawmakers would have begun
to realize at that point that these drugs were in
(28:42):
a panacea, that these drugs had a variety of problems
connected with them. I mean, the thing that I keep
coming back to when I think about what might have
been different had the circumstances surrounding this settlement played out differently,
is the fact of the matter than in the four
years after this settlement, around one hundred thousand people died
(29:05):
from overdoses involving narcotic painkillers. During that same period, doctors
kept prescribing more and more of these drugs. So the
societal change that would take place in twenty thirteen or fourteen,
with the realization that this is out of hand and
(29:26):
we need to do something about it might have happened
back then had this situation played out. We talked about
doctors in the medical establishment. Is this largely being a
story of good intentions gone wrong? Do you see that
more broadly writ with Purdue, with the FDA, with the DA.
How much do you see it as as a broad
(29:47):
story of good intentions gone wrong versus willful evil? You know?
I see it as a story of starting out good
intentions yep, gone wrong, and then morphing into one where
the forces in our society, or the players in our
society who we look to to check excesses, to address wrongs,
(30:12):
to right the scales, if you will, and that is
everyone from lawmakers to regulators, to lawyers to public health officials,
failed to do their job, failed to step up when
it was needed. I mean, I can recall very vividly,
(30:33):
you know. I tried to like step back from this
at a certain point, and I would watch as year
after year after year, the number of overdoses increase, it's
a number of adverse reactions increase, and I would think
to myself, how long are people going to allow this
(30:55):
to go on? And it kept going on, and it
didn't make a difference what party was in political power.
I remember very clearly having a discussion with a person
who was in the White House Office of Drug Control Policy.
This was during the Obama administration, and you know, people
(31:17):
for a long time had promoted the idea that doctors
who prescribed these drugs should have some basic training right
to be able to recognize people who might be prone
to abuse, to know how to use these drugs better.
It was not to restrict the use of the drugs,
just make doctor, idea, yeah, smarter in the use of
the drugs. And this person like broached the idea to
(31:42):
the American Medical Association, and the American Medical Association stopped
the idea dead in its tracks because they didn't want
to impose that requirement upon doctors, exactly because they were
defending the doctor who was too busy, too lazy, to whatever,
to want to go through this training. Is it too
strong to call it a tale? This entire saga, the
(32:06):
tale of a corrupt system? Is that too strong a word.
I don't know if I would call it a tale
of a corrupt system, but I would say that it
certainly illuminates how people and organizations and institutions fail to
step up and do what's needed to be done when
(32:27):
a problem is staring them square in the face because
they are more interested in their own be it financial, professional,
whatever interests, and they're unwilling to see the greater good
that can come out from stepping forward. You write in
your book, as we've been talking about drug regulators, lawmakers,
(32:49):
medical associations, and even public health officials seem frozen, uncertain
of what to do or how to respond. In some ways,
it would almost be better if it were a tale
of corruption, but it's us a tale of convenience, right, yeah, yes,
and entropan convenience. It was just it was just more
convenient not to look at it, right, And in a
lot of cases it would have required organizations to do
(33:12):
an about face. For example, there was hospital organization that
had made pain the so called commission, right yeah, the
fifth final Sign, and as a result of that, the
use of these drugs in hospital settings became much more liberalized.
There were even system you know, companies that were making
money selling surveys to rate your doctor on how well
(33:36):
they treated your pain. So there was a whole not
only market, but after market of services and organizations and
what have you that were tied in one shape or
form into the liberal use of these medications. And so
anything that kind of would upset that apple Cart was
(33:59):
some skin off. They are back in some ways. So
you end your book by pointing out that the lesson
of the past two decades is a clear one. Change
is not optional, And David Sackler made a similar argument
to me that we need to focus on fixing this now,
And of course his is a self interested one in
the sense that the argument is stop suing us, let's
all focus on fixing this instead. What would you do
(34:21):
if you could waive your magic wand if there is
one to make things better? What would you do from here?
I think they are two important things that have to happen,
without a doubt. The most important thing that has to
happen is that we need to provide adequate treatment for
people who have drug abuse problems, and we can't hope
(34:43):
to solve it easily. We can't be fooled into thinking
that there's a pill for this ill as well, because
these are very complicated medical conditions and people need both
drug treatment and behavioral and psychological counseling for long periods
of time, and it's very costly. The other thing that
I personally think is extremely important is for the truth
(35:08):
to come out. The truth about what people knew, what
people knew when they knew it, and that we have
a wrecking name with what occurred. And that is only
going to happen if the documents in all the litigation
that is going on right now come to light, become public.
(35:31):
And my great concern is that that once again there
will be a settlement. Yes, and through the transactional relationships
that exist between plaintiff's lawyers and corporations, the plaintiff's lawyers
will see it to their benefit to settle these cases
and seal these documents, and judges will go along with that,
(35:54):
and so the history of this horrible crisis and the
real causes will be sealed away, and to me, that
would be tragic, buried in the shadows. I am going
to hope that that is not the outcome, so I
could keep talking to you forever. But thank you so
much for coming. This has been fascinating. I almost don't
(36:17):
know where to start. I find the OxyContin saga itself
endlessly fascinating, but the bigger picture aspects, the ways in
which this is a universal story, are also both fascinating
and frightening. For instance, to what extent are truly horrible
stories like this one a function of people who set
out to do evil versus this odd, almost more terrifying
(36:39):
mixture of good intentions gone wrong, convenience and, as Barry says, entropy.
On a previous episode, Alex Gibney and I talked about belief,
how it is almost more dangerous and frightening than people
setting out to tell lies. There's plenty of the worst
kind of belief at work in this story. And to
what extent is this an indictment of our system, not
(37:01):
just the ways in which money influences and yes, corrupts
the pharmaceutical industry, but also an indictment of the inaptitude
of regulators we depend on to protect us, and maybe
even an indictment of the justice system itself because of
the ways in which the pieces of this story that
we most need to understand have stayed in the shadows
and may well continue to do so. Making a Killing
(37:26):
is a co production of Pushkin Industries and Chalk and Blade.
It's produced by Ruth Barnes and Laura Hyde. My executive
producers are Alison mcclein no relation in Making Casey. The
executive producer at Pushkin is Mia Loebell Engineering by Jason
Gambrell and Jason Rastkowski. Our music is by Jed Flood.
(37:46):
Special thanks to Jacob Weisberg at Pushkin and everyone on
the show. I'm Bethany McLain. Thanks so much for listening.
Find me on Twitter at Bethany mac twelve and let
me know which episodes you've most enjoyed.
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