Writing about the American pharmaceutical industry posed some unique challenges. Three years proved a short time for what turned out to be far more extensive research than I envisioned. I put great demands on many people to obtain information. It would take a chapter to thank all who helped. I want to acknowledge here those who made a distinct contribution to the success of this investigation.
One hurdle was that pharmaceutical insiders were frequently reluctant to cooperate with a journalistic account of their industry. Decades of stinging criticisms from congressional investigations, criminal and civil litigation, and a string of whistleblowers made it difficult to persuade some to talk on the record. Several key interviewees spoke only on the condition of anonymity. Some of those unwilling to be identified still worked in the drug business and were concerned about being blackballed or violating nondisclosure agreements. Others had worked at Purdue Pharma, the company at the center of the opioid epidemic, or had friendships or professional relationships with the Sacklers, Purdue’s owners. They wanted to avoid being dragged into the couple of thousand lawsuits pending during the project’s research. A final group comprised former government employees, mostly law enforcement, the FDA, and CDC officials, who did not want to publicly violate the trust of still-serving colleagues.
Whenever information obtained from any of those unattributed interviews is used in this book, it is identified as such. More important, in every instance, I corroborated its accuracy either by independent documentary sources or from others in a position to know.
As for the dozens who spoke to me for attribution, I could not have gotten the complete story without the assistance of some industry veterans who had personal oversight of how the pharmaceutical business had changed in recent decades. Instrumental in understanding why drug companies have largely abandoned antibiotic research and development and the dangers that creates for a possible pandemic were Barry Eisenstein, Mike Skoien, Richard Baltz, Prabha Fernandes, Karen Bush, Lynn Silver, Steven Projan, Joyce Sutcliffe, Richard Happel, and Richard White. I am not only deeply grateful that Marianne Skolek agreed to once again review the painful details of her daughter’s unnecessary overdose death from OxyContin, but I am indebted to her for sharing her moving unpublished memoir. Finally, a special note of thanks to Michael Sonnenreich. Between his different roles in government service, then as a private attorney and sometimes business partner with Arthur Sackler, and finally as a successful pharmaceutical entrepreneur, he was incredibly patient in many hours of interviews with me and my wife, Trisha. His insights about key figures in the industry proved invaluable. Thanks to Peter Sonnenreich for opening the door to his father.
Besides interviews, the history presented in this book is the result of research in voluminous government and private archives on two continents. Sometimes I benefited from the good journalism of others, including papers that became public only after lawsuits were filed by The New York Times and Kaiser Health News. Once, I was aided in paperwork by an anonymous source. In February 2019, a sealed brown manila envelope without a return address arrived at my Miami-area office. It was postmarked from New York. It contained copies of FDA and DEA documents that helped fill in pieces of the puzzle about why the government had not taken earlier and more forceful action to stop the prescription opioid epidemic from becoming the nation’s most deadly ever.
I requested under the Freedom of Information and Privacy Acts many previously classified files that included important background about how the Sackler family came to such prominence. Tens of thousands of pages of litigation files, court records, and FDA administrative hearings, including decades of contemporaneous testimony from key figures, provided the equivalent of a hidden oral history of the pharmaceutical industry.
In obtaining documentation, I am indebted to the diligence and patience of archivists who assisted with my repeated inquiries. As with previous books, the excellent staff at the National Archives in Washington, D.C., and College Park, Maryland, were indispensable. Particular thanks to Richard Peuser, chief of Textual Reference Operations; Adam Berenbak, archivist, Center for Legislative Archives; Dr. Amanda Weimer and John Perosio, archivists, Special Access and FOIA; and Jessie Hartman, information specialist. Questions about which documents might be relevant to a specific FOIA request never devolved into a dispute thanks to Martha Wagner Murphy, public liaison in the Accessioned Executive Branch Records in Washington, D.C.
I was aided in the production of Freedom of Information and Privacy requests by Leanna Ramsey, Public Information Officer, Record/Information Dissemination Section, FBI-Records Management Division, Winchester, Virginia. The FBI FOIA Negotiation Team at the Information Management Division worked efficiently to narrow the scope of my requests in order to process them expeditiously.
The FDA History Office is a great repository of information, not only about the agency itself but also its predecessor, the Bureau of Chemistry. Its research files, originally curated by FDA historian Suzanne Junod, provided the background on regulatory history and pharmaceutical legislative proposals as well as FDA policy changes. Its records include interviews with former commissioners, early inspectors, research scientists, medical publishers, pharmaceutical executives, and officials from some important drug lobbying groups. Transcripts of the oral histories maintained at the National Library of Medicine at the Bethesda, Maryland, campus of the National Institutes of Health were instrumental in re-creating the contemporaneous settings for milestone pharmaceutical events.
I am grateful to Jack McPeters, New York State Archives. And I owe special thanks to several university and private collections: Sarah Coggrave, Archives Services Officer at King’s College London Archives, and Chris Olver, Archives Project Officer at King’s College London Archives, for the assistance with the papers of Cicely Saunders; the Center for the History of Medicine at Harvard’s Countway Library; Morgan Swann at the Rauner Special Collections Library at Dartmouth; Dylan Claussen for his assistance with the Marietta Lutze Sackler manuscript; Genevieve Coyle and Jessica Dooling for the Félix Martí-Ibáñez papers at Yale University’s Manuscripts and Archives; Deborah Shapiro at the Smithsonian Institution Archives; Jenna Mocklis at Crain Communications; the reference staff at the American Philosophical Society Library; and Rachel Gould at Oxford University Press.
Although I prefer reviewing files at a library or archive, quality online databases are increasingly necessary for a project of this scope. Special thanks to Jennifer Bourque at SAGE Knowledge; and Tara Bauer at Casetext who helped navigate their online database of legal cases, attorneys’ briefs and filings, and statutory and regulatory law. Equally helpful was Lauren Mattiuzzo at William S. Hein, whose digital database included many of the government hearings and legislative histories I required.
Professors Alan Wald and Ben Harris were very helpful in putting into perspective the Sacklers’ communist sympathies against the backdrop of the 1950s Red Scare. The late Roy Andrew Miller, professor of Asian studies and literature at the University of Washington, saved me many hours in assessing the value of Arthur Sackler’s Asian collection that was bequeathed to the Smithsonian.
Paul Rosenblatt was patient with my many attempts to locate his father’s oral history. I could not have gotten the complete story without the assistance of Drs. Leslie Baumann and Steve Mandy, Richard and Judy Wurtman, Dr. Vinay Prasad, Harry Martin, Diane Dimond, Nick Spill, Victoria Narkin, Mark Shapiro, Mark Zaid, Lynne Pauls Baron, Jessica Packer, Chip Fisher, Adam Tanner, and Sean Cassidy. Rick Lippin was tireless in finding relevant stories in often obscure medical journals and blogs.
Three friends, Christopher Petersen, Frank DelVecchio, and Ann Froelich, generously agreed to read early manuscript drafts and their insights made it a better book. Drs. David and Jane Cohen were kind enough to take the time from running their private practices to check that the manuscript was free of medical errors.
I am fortunate to be represented by David Kuhn and Nate Muscato at Aevitas Creative Management. Their sage advice and enthusiasm for the project was always appreciated.
I am lucky to have Simon & Schuster, and its new imprint Avid Reader Press, as my publisher. Simon & Schuster’s president, Jonathan Karp, and Ben Loehnen, Avid Reader’s editor-in-chief, took a risk on Pharma. They realize that the subjects of my book proposals are mostly mysteries to me. What I get from them is the faith that given enough time I will dig up a story worthy of a book. For that I am forever grateful.
I owe thanks at my publisher to Carolyn Kelly, editorial assistant. Fred Chase had the unenviable task of copyediting this book, as he did my last, God’s Bankers. Fred has a great eye for consistency and detail. Jonathan Evans, Associate Director of Copyediting, not only oversaw the editorial production, but served at times as everything from a vital fact checker to a much needed enforcer of consistency and style. His extraordinary efforts and incredibly long hours meant the project met its tight deadline.
Ben Loehnen is a sublime editor. His line editing cleaned and tightened the text without ever stepping on my voice. If he ever expresses doubts or second thoughts when I send a manuscript more than double the size he expected, he is kind enough not to take me to task for it. Most important, his edit and advice helped me stay focused on the story, keeping me from too many detours. This would not be remotely as good a book without him.
Anyone familiar with my work knows that Pharma would not be possible without my wife, the author Trisha Posner. She had completed her own book in 2017, one with a different pharmaceutical theme. The Pharmacist of Auschwitz was the first nonfiction account of the Bayer druggist who ran the dispensary at the largest Nazi death camp. Trisha might have liked a break before going directly from the dark tale of Nazi medicine to the often disturbing history of the American pharmaceutical industry. If that was the case, she never mentioned it. Instead, she once again threw herself enthusiastically into this project, sifting thousands of pages of documents and sharing with me every interview. It was her idea to convert the only blank wall in our home office into a whiteboard. With its dozens of arrows and circles and groupings it looked at times more like the schematic for a complex criminal investigation than the outline for a book about the drug industry.
This was, at times, all-consuming. For days on end, we did not leave our apartment but stayed in our “book cave” to meet a seemingly endless series of self-imposed deadlines. When a friend asked once how long we expected to spend on the story of American pharma, Trisha had a ready answer. “It’s a six-year project, but we are doing it in three.”
Putting Trisha’s name on the front cover as a coauthor would do her justice. Until she agrees to that one day, this public acknowledgment shall have to suffice in showing that Pharma is as much hers as mine.