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Whenever somebody says “Big Pharma,” one can be forgiven for clearing one’s throat, raising one’s eyebrows, and trying to shift the conversation onto other subjects like sports, the weather, or an impending appointment. People with an interest in the subject are often the sorts who think “vaccination” is a dirty word, survey the skies for chemtrails, and are always on the lookout for herbal testosterone supplements.

Big Pharma saves lives every day. If, God forbid, I should get cancer, I will be grateful to have medicine and not green drinks, homeopathy, and acupuncture. We should resist the temptation to fetishize the “natural” and demonize the corporate and the innovative.

Still, there is an opposite temptation. That temptation is to believe that pharmaceutical companies act in our interests at all times and to trust our doctors unreservedly. That temptation is to dismiss as cranks anyone who accuses powerful forces of endangering us. Rarely has this been clearer than in the case of Purdue Pharma and the Sackler family.

More Americans, CNN reported last week, are at risk of dying from opioid abuse than in car accidents. Some of the 70,000 who perished from drug overdoses in 2017 began taking opioids recreationally. Others were prescribed them for pain management but developed addictions. There is no single cause of the opioid epidemic. Various cultural and economic factors are surely at fault. Yet some individuals have to take blame as well, and one does not have to be a dope-addled believer in chemtrails to see that.

At a time when journalists have been embarrassing themselves with opportunistic pseudo-controversies, I am glad to salute a credit to the profession. Patrick Radden Keefe has been following the story of how the Sacklers pioneered new means of marketing pharmaceuticals. The family patriarch, Arthur, knew how much patients trusted their family doctors. To market drugs, then, Keefe explains,

he devised campaigns that appealed directly to clinicians, placing splashy ads in medical journals and distributing literature to doctors’ offices. Seeing that physicians were most heavily influenced by their own peers, he enlisted prominent ones to endorse his products, and cited scientific studies (which were often underwritten by the pharmaceutical companies themselves).

Arthur Sackler, whose brothers Raymond and Mortimer owned Purdue Pharma, built a vast fortune selling Valium and Librium to treat anxiety. Valium especially became ubiquitous. Between 1969 and 1982, its sales outstripped those of any other prescription drug. In the film Starting Over from 1979, Burt Reynolds collapses while shopping, and, as the critic David Denby wrote, “sympathetic onlookers shower him with Valium, a blessing of bourgeois holy water.”

Many found real benefits to taking Valium. Like most drugs, however, it had the potential to be both healthful and harmful. Valium was liable to encourage dependency, which, combined with its sedative effects, impaired people’s daily lives. David Herzberg, in Happy Pills in America, makes an effective case that the subsequent “Valium Scare” was overheated. Valium was not comparable to heroin or other opioids. There were not thousands dying from “Mother’s Little Helper.” Yet it still had unpleasant effects for many of its users, and, more damagingly, the means by which Arthur Sackler marketed the drug to patients and clinicians set the standards by which future drugs would be promoted. Patrick Radden Keefe writes:

Sackler promoted Valium for such a wide range of uses that, in 1965, a physician writing in the journal Psychosomatics asked, “When do we not use this drug?” One campaign encouraged doctors to prescribe Valium to people with no psychiatric symptoms whatsoever: “For this kind of patient—with no demonstrable pathology—consider the usefulness of Valium.”

Arthur Sackler died in 1987, and eight years later his brothers and his nephew Richard released OxyContin, which they claimed was a miracle painkiller. Its release, Richard Sackler is alleged to have claimed, would be followed by “a blizzard of prescriptions that will bury the competition.” Burying the competition, it seems, was a more powerful motivation than helping their fellow man.

OxyContin was hurried through the process of Food and Drug Administration approval. FDA examiner Curtis Wright, Sam Quinones reports in Dreamland: The True Tale of America’s Opiate Epidemic, was concerned about potential addictive qualities, but approved it nonetheless. Two years later, he was working for the Sacklers.

Richard Sackler had learned from his uncle. He promoted the drug through doctors. “Purdue pursued an ‘aggressive’ campaign to promote the use of opioids in general and OxyContin in particular,” wrote Art Van Dee, MD, in a paper titled “The Promotion and Marketing of OxyContin.” “In 2001 alone, the company spent $200 million in an array of approaches to market and promote OxyContin.” Physicians, pharmacists, and nurses were invited to all-expenses-paid conferences and showered with gifts. Doctors who were less discriminate in their prescriptions were identified and targeted. The drug was marketed not just to people with acute and cancer-related pain but those suffering from conditions where, as Van Dee wrote, “benefits are much less clear.”

Meanwhile, Purdue Pharma minimized the risks of addiction. “Delayed absorption as provided by OxyContin tablets, is believed to reduce the abuse liability of a drug,” claimed the label of OxyContin. There were two problems with that. First, this claim wasn’t based on good science, and second, the “delayed absorption” could be circumvented by crushing the pills, as the Sacklers would have known from their experience with previous drugs.

Doctors began to report that patients were becoming addicted to OxyContin, and Purdue had an answer. Doctor J. David Haddox, who worked with Purdue, had promoted the theory of “pseudoaddiction,” which suggested that what looked like addiction was really untreated pain. This was an excellent excuse to sell more drugs, though a paper from Marion Greene and Andrew Chambers found that it “has not been empirically verified.”

The truth soon began to emerge. In 2007, Purdue pled guilty to misleading the public about the addictive potential of OxyContin. The company, its president, its top lawyer, and its chief medical officer paid $634.5 million in fines. This was an impressive sum, to be sure, though observant readers will note that Purdue spent only three times less than that on marketing OxyContin in a single year, and has made tens of billions of dollars from selling the drug.

This month, a case was brought by the Massachusetts attorney general against Purdue. It alleges that the company wanted to sell OxyContin as an uncontrolled drug and had to be dissuaded by its own creator. Richard Sackler, it is claimed, constantly pushed his employees to increase profits and opposed attempts to regulate the drug more severely. “It’s [like] the Genovese family,” commented Patrick Radden Keefe. This seems unfair. The Genovese family, for all its faults, rarely killed anyone.

It is important to avoid two unhelpful responses. The first and most obvious is to demonize pain medication, without which a lot of people suffering from cancer and traumatic injuries would be in even greater distress. The second is to make Purdue Pharma and the Sacklers the sole villains behind the opioid crisis. Other drugs, like fentanyl and Xanax, have also led to thousands of deaths, and they are not created by Purdue.

In addition, making the Sacklers solely responsible would acquit a system in which doctors are easily exploited, in which regulations are painlessly bypassed, and in which millions of people seek a chemical crutch. It would be foolish to reduce a massive, systematic crisis to the evils of a few bad actors. We must seek the truth and hold Purdue Pharma to account, but we must also ask ourselves how they ended up so successful.

Ben Sixsmith is a British writer living in Poland who has written for Quillette, the Spectator USA, the Catholic Herald, Public Discourse, and Unherd.