The Sacklers

I recently listened to an entertaining talk by economist Ha-Joon Chang. He was quite critical about economists and at the end of his talk he lamented the fact that they could get things spectacularly wrong without it damaging their reputation. He gave the example of 1995 Nobel prize winner Robert Lucas who announced that the problem of depression-prevention had been solved – a few years before the recession. Dr Chang invited the audience to imagine how improbable a similar scenario would be in other disciplines, for example, in medicine. Supposing someone made some pills and the pills ended up killing thousands of people? They would, he said, be hung, drawn and quartered.

Except they wouldn’t. Instead they would make lots of money, give some of it to museums, galleries, universities, etc., and become respected members of the philanthropic community.

As if on cue, the BBC ran a story about opioid use in the US and how the drugs killed about 33,000 people in 2015. Purdue Pharma was mentioned as the manufacturer of  “popular opioid painkiller” OxyContin but the article did not say how many deaths they were responsible for. It must however be thousands every year. The 30 October 2017 edition of the New Yorker magazine has an article about how the Sackler family, owners of Purdue Pharma, made a fortune from OxyContin and distributed some of that fortune to institutions around the world. At Ha-Joon Chang’s own university, Cambridge, there are Sackler fellowships and scholarships, a Sackler lecture theatre, a Sackler prize and a Sackler distinguished lecture.

In 1956, a few years after they had acquired Purdue Pharma, the three psychiatrist Sackler brothers, Arthur, Mortimer and Raymond, together with another psychiatrist Felix Marti-Ibanez, edited a book with the title Great physiodynamic therapies in psychiatry: an historial appraisal. The book includes contributions by Ugo Cerletti (electroshock), Egas Moniz (leucotomy), Laszlo Joseph Meduna (convulsive treatment and carbon dioxide treatment), Manfred J. Sakel (the classical Sakel shock treatment), and Roy G. Hoskins (hormone therapy). Jakob Klaesi was supposed to contribute a chapter on deep sleep treatment but was prevented, the editors said, by ill health.

The grandiose language of the title of the book is continued in the editors’ foreword, where centuries of care and treatment of those deemed insane are dismissed in a couple of paragraphs about how mental disorders  were often considered to be due to possession by devils or divine punishment and how therapeutic nihilism prevailed, until, that is, the invention of the “great physiodynamic” therapies. (In fact, the history of the insane is far more complicated. Yes there were cases of horrific abuse and neglect – just as there are now – but in other cases people were treated decently and often recovered. Medical and legal authorities in those days, as in these, attempted to understand why people became insane and to what extent they were responsible for their actions.) The authors predict that the physiodynamic therapies, together with the more recent “narcobiotic” (tranquillising) drugs, will lead to the “advance from empiric therapeutic benefit to a clearer understanding of the metabolic processes that mediate them and to the ultimate biochemical deviations out of which the disease process arises”. (They were wrong about that one; sixty years on and still no sign of the “ultimate biochemical deviations”.)  Neither are they modest about their own achievement in editing a book, describing their volume as “unprecedented in the annals of medicine”. As for the contributors, they are described as having a “fame whose green laurels are represented by the gratitude of the mentally sick to the men who devote their lives and genius to their treatment”.

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