Selling Addiction

I thought I was inured to the skulduggery of Big Pharma, but then I read Patrick Radden Keefe’s article about how the philanthropic Sackler family promotes opioid addiction through its company Purdue Pharma (“Empire of Pain,” October 30th). It is time for the beneficiaries of the Sacklers’ name-buying largesse—the Metropolitan Museum, Harvard, Columbia, and the Louvre, to name just a few—to scrutinize the provenance of large donations. They might also consider installing in the lobby of each Sackler Wing, Gallery, Museum, and Institute a large plaque reading “This building is thanks to the generosity of the Sackler family and Purdue Pharma, which started and continues to fuel the epidemic of prescription-opioid addiction that is responsible for two hundred thousand overdose deaths.”

Burns Woodward

Waban, Mass.

Keefe’s article makes painfully clear how Purdue and the Sacklers have benefitted from being able to legally operate in the dark. Purdue, by gaining F.D.A. approval and aggressively marketing a drug that is so highly addictive, has taken full advantage of the law. Even when it has been forced to settle liability suits, business has continued to grow. Its coffers are barely dented, its owners are not personally liable, and nondisclosure agreements have kept adverse publicity to a minimum. As a privately held company, Purdue is under no legal obligation to publicly disclose the details of its business, as would be the case if it were publicly traded. But shareholders and prospective investors are not the only people who have legitimate reasons to know how a company is generating huge sales and profits, and if it is risking liability, damaging the environment, or endangering public health. We all do. While there is no substitute for stronger regulation, privately held companies of a certain size play too large a role in our economy and our society not to be held to the same standards of disclosure and transparency that apply to publicly traded companies.

Nathaniel Spiller

North Chevy Chase, Md.

In 2002, Theresa Sackler acquired in a charity auction the right to name a new variety of rose. She chose to honor her husband, Mortimer. I have an example of this beautiful rose. For many years, as I mulched and pruned, I imagined a Morty of my own: a charming and diffident librarian, a fine public servant whose wife sold their modest house in preparation for a life in a comfortable retirement home.

Oh, dear. Well, a rose by any other name would smell as sweet, and mine is now called Rosa Perez, in honor of Jill and Marianne. It will perhaps be a somewhat dolorous rose, but no less beautiful for that.

Barry Coleman

Northamptonshire, U.K.

I’ve been a heart surgeon for three decades and, at sixty-two, an occasional patient as well. I prescribe opioids to my patients, although only the short-acting variety, and usually without ongoing refills. I had a major chest surgery at the age of fifty, and can attest to the wondrous relief from acute, severe pain that these medications can provide. I took them for several weeks postoperatively, in tapering doses, and then stopped “cold turkey,” in order to return to my operating and on-call duties. So I can also attest to the powerful effect of abrupt cessation. The Sacklers’ true genius was understanding how to sway the hearts and minds of physician prescribers. This vision has blossomed into the direct-to-consumer marketing currently practiced by most major pharmaceutical manufacturers. In the latest iteration of this marketing, the consumer, instead of being pitched the medication itself, is being “sold” a disease for which, conveniently, there just happens to be a pill or an injection available. Patients often arrive in a physician’s office demanding an advertised medication. Given the number of heavily promoted drugs, the industry obviously hopes to actively and expensively medicate millions of people.

Daniel J. Waters

Clear Lake, Iowa

The Real Tulsi Gabbard

As Representative Tulsi Gabbard’s aunt, it gives me no pleasure to publicly air my doubts regarding my niece’s political agenda, which Kelefa Sanneh describes in his Profile (“Against the Tide,” November 6th). However, I take my role as a citizen seriously, and I would be remiss not to share my concerns. Sanneh raises the issue of Gabbard’s lifelong immersion in the Science of Identity Foundation, an opaque religious organization that she and its founder, Chris Butler, have attempted to reframe as a “resource.” Gabbard’s answer to a basic question about Butler is troubling: despite calling him her “guru dev” (spiritual master) in her own promotional video, she denies that he is more important than any of her other teachers. She also has a notably mixed voting record, and associations that veer from certain progressive causes to the apparent courting of such strongmen as Narendra Modi, Bashar al-Assad, and Abdel Fattah el-Sisi (not to mention Trump)—this zigzagging path through positions is vexing. Sanneh’s article walks the fine line of investigation and exposition in a way that points to shadows worthy of further illumination.

Caroline Sinavaiana Gabbard

Honolulu, Hawaii