Pharma: Greed, Lies, and the Poisoning of America

If anyone wants to know why prescription drugs in America cost on average twice as much as the same drugs do in Europe, Mr. Posner explains it well in Pharma using as a thread a history of the Sackler Family--founders of a small Pharma Empire centered in Purdue Pharmaceuticals. Meticulously footnoted and engrossing (as all of Mr. Posner’s books are) the primary source of his findings is the voluminous discovery resulting from decades of state and federal litigation against pharmaceutical companies including Purdue—a mass marketer and seller of OxyCodin. According to Pharma, the three primary contributors to the highest average drug prices in the world are: (1) non-regulation of drug prices, (2) special federal legislation and regulation favoring Pharma (or the absence or insufficiency of such—e.g. the FDA has only 39 employees to review the veracity of 35,000 drug ads per year); and (3) the unregulated “middlemen” of American drug sales and distribution: Pharmacy Benefit Managers. Perhaps the biggest “Lie” pedaled by Pharma is that their R&D costs are so much higher than drug manufacturers face in Europe. Nonsense points out Mr. Posner. Much of new drug research is actually funded by the federal government in the form of research grants and special legislation. For example, by using the grants and tax credits afforded by the ODA, up to 70% of a new orphan drug’s R&D is paid for by the government. (To read the entire review please see The Reader's Corner at the progressive republican forum.)

It took me the month of May to read this book (539 pages) with a comprehensive bibliography and notes (223 pages). This history of pharmacy and pharmaceutical companies provides you with the stories of what has happened over time that have never been told in a book. As a pharmacist, I highly recommend this book to educate you about what has happened in the United States and why we need affordable healthcare for everyone. I was fortunate to hear a TV interview with Gerald Posner in April as this book was being released. Gerald Posner (and his wife Trisha) spent three years investigating the pharmaceutical industry..."besides interviews, the history presented in this book is the result of research in voluminous government and private archives on two continents". I wish all medical professionals (i.e., prescribers and pharmacists) would read this book since we are part of the problem. Just listen to all the direct advertising of drugs on the TV...only the US and New Zealand allow this to happen. There is one chapter (The Coming Pandemic) about price-gouging and antibiotic-resistant bacteria due to over-prescribing and allowing antibiotics in livestock and spraying on citrus crops. They also mention the cross-species transmission of infections that has caused every major epidemic across the world. The growth of "supergerms" like the coronavirus is going to be a part of our demise without antibiotic and antiviral drug development or vaccines. The Sackler family who owns Purdue Pharma and made OxyContin (that made billions for the company and has killed millions of people in the US) is covered in detail throughout the book. "Besides U.S. holdings that are opaque to investigators, there are offshore trusts, holding companies, and limited partnerships in international tax havens. Many of the foreign OxyContin distributorships are wrapped in a series of contracts between shell companies based in Cypress, Bermuda, Switzerland, Singapore, and the Channel Islands. Whatever ownership stake the Sacklers might have is nearly impossible to determine given the corporate secrecy laws of those tax haven jurisdictions. Their stake in Cap 1 LLC, a closely held company that owns and manages ski resorts, is estimated to be worth close to $2 billion." Rudy Giuliani was once hired by the Sackler family as their company attorney who got a deal for the OxyContin maker to continue sales of the drug despite it causing opioid deaths (May 2018). The family-owned company has voted themselves at least four billion dollars in company profits from 2008 to 2016...and this has been distributed to a dozen entities and trusts they control. On September 13, 2019 Purdue filed for bankruptcy protection and they have yet admitted to any personal liability for inappropriate marketing of OxyContin. For example, the Sackler family owns Mundipharma and has limited partnership in two other companies (Imbrium and Adlon Therapeutics) who want to market an ADHD and an insomnia medication. They also want to market two opiate overdose medications: nalmefene and an OTC naloxone nasal spray. I am so thankful that I understand more about the maze of the pharmaceutical industry and hope that Gerald and Trisha Posner continue their investigative work.

I was pleasantly surprised when Mr. Posner included the history of pharmacology. Growing up in a family of pharmacists, owning a pharmacy gives such insight into the "family business". The discoveries were fascinating. It started to get a bit bogged down in the middle with too much detail. I certainly am not criticizing Mr. Posner as I have enjoyed other works by him.

This book is an important piece in understanding the selling of disease. Over time I have come to the conclusion that the germ-theory of disease has outlived its usefulness, and eventually the medical industrial complex is due to implode in on itself. Welcome alternatives are emerging such as lifestyle medicine, but it pays to understand deeply how and why things went wrong. Here is a message I left for the author on his website. quote Reading your Pharma book is amazing. I am reliving my youth. I am the son of a psychiatrist who, in the 50's and 60's took the alternative path, talk therapy only, amidst the rising tide of psychopharmaca, and the general rise to power of the medical-industrial complex. In one way he completely avoided the Libriums and Valiums, and drug reps could not even get an appointment with him. In recent years I've become a reader of some of Dr. Peter Breggin's work who as an expert witness stood on the other side, and helped fight pharmageddon, and documented the damages done by psychopharmaca, which my father had seen coming before it happened. In your recounting, I am reliving those years, and many many conversations with my father and some of his medical colleagues about the total corruption of medicine by big pharma as it was then coming to prominence. So, this is to say thank you for putting it all together in your Pharma book!!! One grateful reader. unquote

What a racket. These legal drugs & their pushers create a problem then invent another drug to combat the original drug's problem. I know there are situations that need a chemical aid but first try diet & behavior modification. "Nothing sets you free like self control" (P. Bottoms). I wonder if doctors feel a moral dilemma when they know diet & exercise would be better than drugs but figure that the patient won't do it -- so it's just easier to prescribe a drug that will lead the people down a path they can't get off of. NOT to mention that a few years later to hear that a popular drug has caused even worse problems & pulled off the shelf. We're all Guinea pigs. Commercials are overwhelmingly inundated by Big Pharma because these businesses are mostly interested in their bottom line. The book Pharma gives a wonderful history of how this all started & how it's all perpetuated.

Gerald Posner is the consummate journalist/storyteller whose work is firmly grounded in fact and in this sweeping pharmaceutical saga, science. Everyone who has ever taken a drug, and will ever take a drug, should consider this book required reading to gain a grasp of what the process is and isn't in getting a substance to market through the FDA and into their mouths. Told from an historical, chronological perspective as well as through the scheming and intricate machinations of the Sackler family, there are characters galore--scientists, charlatons, corrupt and inattentive government officials, drug salesmen, addicted victims of pain medication, a heroine and the ever-present institutions in the US as well as Europe eager to accept the ill-gotten gains of the Sackler family. In the midst of a worldwide pandemic, we are all critically vulnerable to those who are in the business of formulating medicines. Let Mr. Posner's work be a cautionary tale and the basis for greater responsibility and subjective oversight.

While several books cover the opioid crisis and the Sackler family, this book tells the shocking history of the pharma industry and Arthur Sackler’s early years. Some of the fascinating details include: • Several of today’s largest drug companies began by selling (then-legal) heroin, morphine, cannabis, and cocaine-based medicine for huge profits. • Despite being raised in the 1940s as New York Socialist party members, the Sackler brothers would seek profits without constraint and go on to spend lavishly on mansions and art. Mortimer Sackler even left the US to lower his taxes. • Arthur Sackler’s campaign to promote Valium in the 1960s made it the first $100 million drug. By the 1970s, it had accumulated more than a billion dollars in sales. • When promoting OxyContin, Purdue Pharma spent an average of $40,000 for every top-tier, prescribing doctor. • In 2002, when the DEA began looking into a spike in overdoses from OxyContin, Purdue Pharma hired Rudy Giuliani and former NYC police commissioner, Bernard Kerik, to escape meaningful regulation. Think of the number of overdose deaths since 2002. Even though this is a long book, Posner breaks it up into short chapters, and it is easy to read. Some readers may feel Posner spends too much time covering the schemes of drug companies to evade safety regulations and inflate prices. But this is the MOST IMPORTANT part of the book that US citizens should know.

You probably did not know that you could buy a dose of cocaine and a syringe from Sears Roebuck for the very reasonable price of $1.50 in the latter part of the 19th century. Or that heroin was invented in 1898 by Bayer, the company that was originally built on a foundation of aspirin, and that despite heroin being 10x more powerful than morphine, was marketed as a cure for everything from schizophrenia to morphine addiction! Also, as "safe for children". Or that until World War 2, the pharma industry in the US was largely supported by the sale of narcotics. Then, antibiotics entered the scene, in the form of penicillin, invented in an Oxford University lab but manufactured and sold in gigantic quantities by the dozen or so pharma companies authorized to do so by the US government as an emergency measure. Those companies still make up the bulk of the leading American pharma companies to this day. These are other fascinating facts litter this 600+ page book. It is, for the most part, quite fascinating, though the book could certainly have stood with further editing to chop out 100 or so pages. In particular, the author is quite obsessed with the Sacklers of Purdue Pharma fame, who are revealed as the most successful narcotics traffickers in the country. They put the Columbian narcotraficantes to shame, and don't have to live with the constant fear of being killed by rival drug lords or the army either. The fact that the Sacklers had so little to fear from government regulation -- and to the contrary were major beneficiaries of the protection against competition afforded by government regulation -- explains much of their success. Credit must also go in large measure to Arthur Sackler, who largely built the company through his marketing genius in the early decades of the company before it began to devote itself almost wholly to peddling the opioid Oxycontin, and killing tens if not hundreds of thousands of Americans in the process over the past 20+ years. The respectability that the Sackler family bought, with hundreds of millions in philanthropic donations, despite the plague they visited on the country with "hillbilly heroin", has worn very thin indeed. Yet no member of the family or of the management team has gone to jail, despite the death toll and despite the dangers of Oxycontin having been known since at least 2001. Through all of this, government regulators at the FDA remained almost entirely inert, abetted in part by the opportunity for these public servants to move into lucrative private sector jobs at Purdue and other pharma firms. The same bureaucrat at FDA who approved Oxycontin in 1997 was hired by Purdue a year later. Another significant factor in Oxycontin's rise was the relentless advocacy of lax regulation by well-compensated lobbyists such as Rudy Giuliani, former mayor of New York City and well-connected in Republican circles in particular. Giuliani, friend of Donald Trump, has been instrumental in helping to kill off the small town and rural voters who form the backbone of Trump's white working class support. Today, Oxycontin remains the #1 best-selling drug in its category, despite the firm having filed for Chapter 11 bankruptcy protection in 2019. A particularly good chapter is the one entitled "Happy Pills", which documents the rise of mood altering drugs such as Thorazine and its many successors such as Valium and Prozac. So successfully marketed were these drugs that Americans became, far and away, the largest consumers of these drugs, downing many times more per capita on an annual basis than other countries' citizens. These drugs served as part of the rationale for the mass closing of psychiatric institutions in the 1960's, helping to lay the foundations of today's homelessness crisis, as the alternative forms of treatment provided failed to deal with the problems of society's more troubled members. One thing you will not read about in this tome is very much about the positive effects of the pharma industry. Throughout the period covered by this history of the US pharma industry, American life expectancy has risen by several decades (until reversing course in past few years due to the opioid crisis). The pharma industry deserves some credit for this, particularly for drugs such as antibiotics, statins and anti-cancer treatments. Life in this country and worldwide is much better for having had polio vaccines since the 1950's, a disease which used to cripple or kill millions. That said, U.S. pharma remains an under-regulated and over-priced industry, one of the chief causes of the out-of-control cost of healthcare that yields such poor public health results for Americans as compared with every other developed country. We spend twice as much per person as the average developed country, yet live lives that are five years shorter on average. This is an industry that desperately needs to be fixed, and only government action is likely to do it.

An enormous amount of work has gone into the writing of this book, that is clearly evident. If we could have this kind of research and evidence on subjects that are vital for us to understand, I honestly believe we could change the world. I am in awe of the information provided, and believe this to be one of the best books I have ever read ... we need to know the truth, it gives me hope that this can occur again and again.

AWESOME

Good 👍

The author brings us the reality of pharma industry. The greed and lies imposed to the people. A serious question is why there is almost none investment on antibiotics because this kind of medication is indicaded for short treatments. When will occur the next pandemics, caused by bacteria???

Very informative and well written account of the US and in some part European pharma industry in general and the Sackler family in particular