For those who get a rise out of following the plight of plundering plutocrats, forget about pop culture shows like Succession, Dynasty, or Empire. Instead, it may be worth peeking in on the true-life Sackler family saga. It also underscores the truth of this idea: Never get between Big Pharma and a buck.
The Sackler story, turning on the fate of the family’s Purdue pharmaceutical firm and a fortune estimated at $13 billion, has been ripe with recent developments, including a potential settlement of thousands of claims by states, counties, cities, Indian tribes, and others — all claiming billions of dollars in damages due to the maker’s aggressive and less than accurate sales and marketing of its prescription painkiller OxyContin.
With a federal judge in Ohio consolidating and pushing a “global resolution” of a giant number of opioid-related lawsuits, Purdue and the Sacklers announced a tentative settlement of many of the governments-filed claims. Roughly half the plaintiffs were eager to get what money they could — to not only help constituents staggered by damages due to opioids, overdoses, and addictions, but also to refill government coffers depleted by the huge costs of dealing with nightmares caused by the painkillers.
But roughly half the plaintiffs rejected a complex deal, as described by the New York Times. It called for Purdue to file for Chapter 11 bankruptcy, dissolving itself and creating a new firm as a public trust. That company would keep selling OxyContin and other drugs, with its profits paying opioid plaintiffs. Purdue would donate drugs for addiction treatment and overdose reversal. The settlement might be worth $10 billion to $12 billion, the Washington Post reported. Under the deal, the Sacklers would pay $3 billion in cash over seven years, including proceeds from a prospective sale of Mundipharma, another family business selling drugs globally.
The split showed a partisan rift, with Republican attorneys general (e.g. Ohio and Texas) supporting a proposed settlement and their Democratic counterparts (from California, Connecticut, North Carolina, New York, New Jersey, Maryland and Pennsylvania) balking.
How the wealthy wriggle
The negotiations got even more contentious when New York state, a big dissenter to the settlement, said that just one set of court orders it had followed up on had shown the Sacklers spiriting $1 billion from Purdue’s treasuries to tough-to-track and secretive offshore accounts.
As the family wriggled and went from the Ohio federal court to another jurisdiction — now a bankruptcy court — the Sacklers added a twist to the complex case. They insisted that family money be treated separately from their company’s kitty. The family demanded that states agree to not them over opioid and overdose claims. The family sought to safeguard their sizable personal stash, billions of dollars that not only keeps the Sacklers in high living but also supports their aspirations as arts-and-culture philanthropists.
The family threatened to pull Purdue out of the prospective settlement, if their demands were not met.
Oh, and by the way, the family also told the courts they needed to reward select executives of Purdue with tens of millions of dollars in bonuses and incentives for sticking with the business.
The family persists in denying what media reports, officials, and court records show — that their firm played a leading role in turning powerful painkillers into a lethal gateway to addiction and abuse of legal prescription medications, then synthetic opioids (nee fentanyl), and potent illicit drugs, including heroin, cocaine, and methamphetamines.
Further, the Sacklers, while professing sympathy for those ravaged by opioids, including those damaged by OxyContin, insist they and their company have done no wrong and acted within legally accepted bounds.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the havoc that can be wreaked on them, their loved ones, friends, and whole communities by dangerous drugs like opioids. The Council on Economic Advisers, the folks who offer sage counsel to the President, estimated that in 2015 alone the cost of the opioid and overdose crisis amounted to more than half a trillion dollars. The group said the total toll will be “substantially higher than thought.” It took the nation a long time and there is plenty of blame to go around for this epidemic — including for doctors, nurses, hospitals, insurers, and, yes, Big Pharma.
The pursuit of justice and the correction of wrongdoing in the civil system, however, is never easy, especially when not only are there thousands of claimants involved and they each may represent millions of people. Big Pharma, as personified in the Sacklers, also can add insult to injury by adopting the notion that throwing money at plaintiffs is a finger-snapping, easy way to make problems go away. In civil suits, such as medical malpractice cases, it can be vital for the injured to get closure and justice when defendants show humility, admit wrongdoing, apologize, and help figure how to avoid similar problems from ever occurring again. This concept oddly escapes doctors, hospitals, and Big Pharma — all of whom espouse the healing powers of compassion and caring conduct.
The political quest for curbs on skyrocketing drug costs
Big Pharma’s obsession with money, of course, will be on flush display as politicians in the nation’s capital try to help their constituents with proposals to deal with staggering prescription drug prices.
The Trump Administration earlier had rolled out its ideas, which went over with a thud and haven’t gained much traction since. House Democrats, led by Speaker Nancy Pelosi, just issued their proposal, which actually adopts some Trump suggestions, including new roles for the federal government in negotiating pharma costs and the idea that some American medications might see price controls based on rates drug markers charge internationally, notably in European markets. Mitch McConnell, the Kentucky Republican and Senate Majority Leader, promptly declared the Democrats’ plan “dead on arrival.” In contrast, the president welcomed Pelosi’s plan, focusing, of course, on any similarities with his own.
With polls showing health care to be a dominating issue on voters minds for the 2020 elections, Democrats and Republicans both are eager to show real progress on the critical issue of prescription drug costs. Lest optimists get ahead of themselves, though, credit must be given to news organizations like the independent, nonpartisan Kaiser Health News and their tracking of lobbying expenditures. Big Pharma set a record in spending more than $27 million on political influencing in 2018, and KHN reports that:
“Members of Congress raked in almost $4 million from pharmaceutical manufacturers and their trade groups in the first six months of 2019. Two members — Sen. Chris Coons (D-Del.) and Sen. Thom Tillis (R-N.C.) — each received over $100,000. Rep. Greg Walden (R-Ore.) is $5,000 shy of qualifying for the ‘million-dollar club,’ a group of current members who’ve received $1 million or more since 2007.”
Meantime, as CBS News reported of prescription drug price increases at mid-year:
“So far in 2019, more than 3,400 drugs have boosted their prices, a 17% increase compared with the roughly 2,900 drug price increases at the same time in 2018, according to a new analysis by Rx Savings Solutions, a consultant to health plans and employers. The average price hike for those 3,400 drugs stands at 10.5%, or about 5 times the rate of inflation, the study found. About 41 drugs have boosted their prices by more than 100%, including one version of the antidepressant fluoxetine — also known as Prozac — whose cost has surged 879%.”
It also is worth noting that new research adds yet more questions the speed and methods with which some of the most expensive drugs around — those for cancer care — get approved. The work focused on the European body that reviews and approves drugs before they are allowed on the market. But the central concerns — notably how experts green-light drugs based on statistical and less rigorous measures without giving highest weight to the central issue, that of whether medications improve patients’ quality of life and longevity — applies as much if not more to this country and the federal Food and Drug Administration.
We’ve got a lot of work to do to make prescription drugs safer, more effective, and accessible for patients — who also shouldn’t be bankrupted by Big Pharma.