‘Pharma’ paints a troubling picture of an unchecked industry

Gerald Posner’s book covers the history of drugs and drugmakers, in particular the Sackler family, whose Purdue Pharma is implicated in the opioid crisis.

Gerald Posner’s “Pharma: Greed, Lies, and the Poisoning of America” could be seen as the 2020 equivalent of Upton Sinclair’s 1906 novel, “The Jungle,” which led to public outrage over the meat-packing industry.

His unsettling book, five years in the making and buttressed by a trove of documentation, is not only a careful history, it’s also a staggering indictment of pharmaceutical companies. 

“[T]he drug business has turned America into a medicated society,” Posner writes. “Successive waves over the decades of so-called wonder drugs, some real and some hyped, have resulted in huge profits while also creating tens of millions of dependent patients waiting for the next pill to solve an ever-expanding range of illnesses and disorders.”

“Pharma” covers in very readable detail the exponential drugging of America, with demand for “happy pill” benzodiazepines surging in the late 1950s and early ’60s, as increasingly powerful drug companies pressure the medical establishment to “medicalize” more and more ailments. Then those same companies patented and sold chemical “solutions,” with a handful of families pulling most of the strings – and reaping huge profits.

Posner focuses on the Sackler family, the people behind Purdue Pharma, which launched the opioid painkiller OxyContin in 1996 and which has realized huge dividends from sales of the drug. He’s pulled together original reporting on Arthur Sackler and his family, who, according to Posner, circumvented the law and spent millions to keep the Sackler name from becoming associated with the opioid crisis. [Purdue Pharma filed for Chapter 11 bankruptcy protection in September 2019. A settlement is pending between Purdue Pharma and municipal and state governments, which filed more than 2,000 lawsuits against the company to recover costs associated with fighting the opioid crisis.]

The book also delves into the “largely anonymous and mostly unfathomable” world of pharmacy benefit managers (PBMs), “the only segment of the drug distribution system that knows what everyone else is paying and getting paid.” PBMs bill insurance companies for prescription claims made by patients – bills that are often in excess of what is actually reimbursed to pharmacists. As Posner notes, “The PBMs pocket the difference.”

Not all of the stories are dark. Posner looks at the hard-working health care providers who bravely treated AIDS patients in the 1980s while demanding research toward a cure for the disease. He also notes that then-President Ronald Reagan had begun his tenure by cutting the budget for the Centers for Disease Control and Prevention in half. Among the health care professionals was Anthony Fauci, then chief of the Laboratory of Immunoregulation, who is now coordinating and overseeing the Trump administration’s response to the COVID-19 virus.

On page after page, Posner describes incidents of drug companies lying to investigators, manipulating politicians and political systems, twisting regulations, and intentionally foisting unnecessary, dangerous, and overpriced products on some of the most vulnerable segments of society. 

The penultimate chapter of Posner’s book, “The Coming Pandemic,” refers to the troubling side effect, according to Posner and others, of the pharmaceutical industry’s flooding of the market with antibiotic drugs: the steady rise of drug-resistant strains of bacteria. The blame for that development, as well as for the opioid crisis, Posner lays squarely at the feet of Big Pharma.