Nonprofits should not allow themselves to be used by the wealthy to scrub their consciences.
When it comes to blood money for the arts, how bloody is too bloody?
On Wednesday, the Metropolitan Museum of Art decided that money made from selling the opioids that have killed several hundred thousand people is too bloody. It announced it would no longer take donations from members of the Sackler family linked to OxyContin. “On occasion, we feel it’s necessary to step away from gifts that are not in the public interest,” Daniel H. Weiss, the Met’s president, said.
“Gifts that are not in the public interest.” It is a pregnant, important phrase. Coming on the heels of similar decisions by the Tate Modern in London and the Solomon R. Guggenheim Museum in New York, the spurning of Oxy-cash seems to reflect a growing awareness that gifts to the arts and other good causes are not only a way for ultra-wealthy people to scrub their consciences and reputations. Philanthropy can also be central to purchasing the immunity needed to profiteer at the expense of the common welfare.
Perhaps accepting tainted money in such cases isn’t just giving people a pass. Perhaps it is enabling misconduct against the public.
This was the startling assertion made by New York State in its civil complaint, filed in March, against members of the Sackler family and others involved in the opioid crisis. It accused defendants of seeking to “profiteer from the plague they knew would be unleashed.” And the lawsuit explicitly linked Sackler do-gooding with Sackler harm-doing: “Ultimately, the Sacklers used their ill-gotten wealth to cover up their misconduct with a philanthropic campaign intending to whitewash their decades-long success in profiting at New Yorkers’ expense.”
It was strong stuff: The State of New York was officially claiming that in taking Sackler money, arts institutions had allowed themselves to be used as lubricant in a death machine. “It’s a remarkable statement,” Benjamin Soskis, a historian of philanthropy at the Urban Institute in Washington, told me this week, “the sort of thing we heard from critics of philanthropy on the periphery of power but rarely, in recent decades, from those at the center.”
Are museums, opera houses, food pantries and other nonprofits to be held responsible for how their donors have made their money? It is a question being asked more and more as a century-old taboo shatters.
“No amount of charity in spending such fortunes can compensate in any way for the misconduct in acquiring them,” Theodore Roosevelt said after John D. Rockefeller proposed starting a foundation in 1909. It was not a lonely thought at the time.
But in the decades since, not least because of the amount of philanthropic coin that has been spent (can it still be called bribing when millions are the recipients?), touching all corners of our cultural life, attitudes have changed. And, as I found in spending the last few years reporting on nonprofits and foundations, a deeply complicit silence took hold: It was understood that you don’t challenge people on how they make their money, how they pay their taxes (or don’t), what continuing deeds they may be engaged in — so long as they “give back.”
When I speak privately with people working in nonprofits, as I often do, especially younger people, I hear this complaint again and again: They agonize about having to stay quiet not only about their donors’ membership in a class that has benefited from an age of inequality but also about specific conduct by many donors that often worsens the problems the donors and nonprofits are working to solve.
And so the decision by the Met and the other museums may be a small sign that this compact is cracking — and perhaps that nonprofits are taking a broader view of their role in public life: not only as doers of good in a particular area of work but also, if they’re not careful, as enablers of broader, if more generalized, societal harm.
“Turning down money runs against the grain of the thinking that’s long governed charitable boards — that they are stewards of the interests of particular institutions, with considerations of broader public interest being peripheral,” Mr. Soskis, the historian, said when I asked him about the Met. “What we are seeing more and more of, through the spread of social media, and an increased willingness to critically engage major philanthropic gifts, is the assertion of the public’s interest in the philanthropic exchange.”
It remains to be seen whether other arts institutions will follow the lead of the Met, Tate and Guggenheim — and more broadly, whether the nonprofit sector will begin asking itself some deeply uncomfortable questions.
Should anyone working to make cities better and more equitable take money from JPMorgan Chase, which paid a huge sum for its role in helping to bring about the 2008 mortgage disaster and financial crisis? Should anyone working to help families affected by President Trump’s immigration policies take money from Mark Zuckerberg, whose soft-pedaling of Russian interference in the 2016 election allowed anti-immigrant hate to spread and potentially helped Mr. Trump gain votes?
It remains to be seen whether other arts institutions will follow the lead of the Met, Tate and Guggenheim — and more broadly, whether the nonprofit sector will begin asking itself some deeply uncomfortable questions.
Should anyone working to make cities better and more equitable take money from JPMorgan Chase, which paid a huge sum for its role in helping to bring about the 2008 mortgage disaster and financial crisis? Should anyone working to help families affected by President Trump’s immigration policies take money from Mark Zuckerberg, whose soft-pedaling of Russian interference in the 2016 election allowed anti-immigrant hate to spread and potentially helped Mr. Trump gain votes? Should any health institution take money tied to Pepsi or Coca-Cola?
Make no mistake: To ask these questions opens a can of worms. The Sacklers are an easy case. Once the complicity turns more diffuse, it is hard to say whether a nonprofit is participating in an injustice by taking money — or doing the best it can in a flawed reality. What’s next after this? Is there a statute of limitations on looking for blood money? What kind of moral purity test are these institutions supposed to use? Once you begin to raise these dilemmas, how do you actually draw those lines around what’s acceptable?
The Met has already drawn some lines. It won’t remove the Sackler name from its galleries; it won’t return money already donated. What it should do is go beyond a single act of rebuffing to model a new process for evaluating money.
Past and future donations could be judged on various criteria:
- Was the money legally and fairly made?
- Is the money owed to tax evasion or extreme legal tax avoidance?
- Is the museum effectively selling a modern papal indulgence for a sin that shouldn’t be so easily pardoned?
- Does the donor have a duty of reparation to people they have exploited or harmed that gives those parties more of a right to the money?
And the public should be brought into the process. Public-facing institutions enjoy the privilege of being untaxed, so citizens should be able to comment on and scrutinize prospective donations.
These questions will long be with us. These museums have forced an essential conversation. For far too long, generosity has been allowed to serve as a wingman of injustice; giving back disguises merciless taking; making a difference becomes inseparable from making a killing — sometimes literally. It is high time to reject these alibis for treachery.
Montana Is Latest State to Sue Purdue Pharma Over Opioid Crisis
Lawsuit claims company didn’t clearly state addiction dangers of OxyContin
“The epidemic began not with an outbreak, but with a business plan,” Montana Attorney General Timothy Fox said in a lawsuit filed Thursday in Lewis and Clark County state court. The suit claims Purdue violated state laws on consumer protection and unfair trade practices by misrepresenting the likelihood that long-term use of its opioids, including its signature drug OxyContin, would lead to addiction.
.. Montana joins more than a dozen other states that have individually sued drug manufacturers and distributors, including New Hampshire, New Jersey, South Carolina, Missouri, New Mexico and Kentucky.
.. The suit seeks reimbursement for money the state spent on opioid treatments and addiction treatment through state Medicaid and other health plans.
The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy
I focus on issues surrounding the promotion and marketing of controlled drugs and their regulatory oversight. Compared with noncontrolled drugs, controlled drugs, with their potential for abuse and diversion, pose different public health risks when they are overpromoted and highly prescribed. An in-depth analysis of the promotion and marketing of OxyContin illustrates some of the associated issues.
.. When Purdue Pharma introduced OxyContin in 1996, it was aggressively marketed and highly promoted. Sales grew from $48 million in 1996 to almost $1.1 billion in 2000.1 The high availability of OxyContin correlated with increased abuse, diversion, and addiction, and by 2004 OxyContin had become a leading drug of abuse in the United States.2
.. The promotion and marketing of OxyContin occurred during a recent trend in the liberalization of the use of opioids in the treatment of pain, particularly for chronic non–cancer-related pain. Purdue pursued an “aggressive” campaign to promote the use of opioids in general and OxyContin in particular.1,12–17 In 2001 alone, the company spent $200 million18 in an array of approaches to market and promote OxyContin.
.. From 1996 to 2001, Purdue conducted more than 40 national pain-management and speaker-training conferences at resorts in Florida, Arizona, and California. More than 5000 physicians, pharmacists, and nurses attended these all-expenses-paid symposia, where they were recruited and trained for Purdue’s national speaker bureau.19(p22) It is well documented that this type of pharmaceutical company symposium influences physicians’ prescribing, even though the physicians who attend such symposia believe that such enticements do not alter their prescribing patterns.20
..One of the cornerstones of Purdue’s marketing plan was the use of sophisticated marketing data to influence physicians’ prescribing. Drug companies compile prescriber profiles on individual physicians—detailing the prescribing patterns of physicians nationwide—in an effort to influence doctors’ prescribing habits. Through these profiles, a drug company can identify the highest and lowest prescribers of particular drugs in a single zip code, county, state, or the entire country.21 One of the critical foundations of Purdue’s marketing plan for OxyContin was to target the physicians who were the highest prescribers for opioids across the country.1,12–17,22 The resulting database would help identify physicians with large numbers of chronic-pain patients. Unfortunately, this same database would also identify which physicians were simply the most frequent prescribers of opioids and, in some cases, the least discriminate prescribers.
.. A lucrative bonus system encouraged sales representatives to increase sales of OxyContin in their territories, resulting in a large number of visits to physicians with high rates of opioid prescriptions
.. In 2001, in addition to the average sales representative’s annual salary of $55 000, annual bonuses averaged $71 500, with a range of $15 000 to nearly $240 000.
.. Purdue paid $40 million in sales incentive bonuses to its sales representatives that year.19
.. A consistent feature in the promotion and marketing of OxyContin was a systematic effort to minimize the risk of addiction in the use of opioids for the treatment of chronic non–cancer-related pain.
.. Purdue trained its sales representatives to carry the message that the risk of addiction was “less than one percent.
How the Reformulation of OxyContin Ignited the Heroin Epidemic
We attribute the recent quadrupling of heroin death rates to the August, 2010 reformulation of an oft-abused prescription opioid, Oxycontin. The new abuse-deterrent formulation led many consumers to substitute to an inexpensive alternative, heroin. Using structural break techniques and a difference-in-differences analysis, we find that opioid consumption stops rising in August, 2010, heroin deaths begin climbing the following month, and growth in heroin deaths was greater in areas more likely to substitute from opioids to heroin. The reformulation did not generate a reduction in combined heroin and opioid mortality—each prevented opioid death was replaced with a heroin death.
.. OxyContin is a name-brand opioid pain killer marketed by Purdue Pharma.13 The active ingredient in OxyContin is Oxycodone, an opioid that has been in clinical use since 1917 (Kalso, 2005) and is the active ingredient in such pharmaceuticals as Percodan (Oxycodone and aspirin) and Percocet (Oxycodone and Tylenol). OxyContin is an extended-release formulation that allows for up to 12 hours of pain relief and hence there is typically a high milligram (mg) content of Oxycodone in the pills.14 Since its release in 1996, OxyContin has been one of the most successful pharmaceuticals of all time with worldwide sales totaling $35 billion.15
.. OxyContin was introduced at a time when the medical profession was beginning to re-evaluate its use of opioid-based pain killers. Historically, opioids were reserved for those with acute pain such as postsurgical and cancer patients. Given the limited use of opioids, pain from chronic conditions often went untreated. This was viewed by many as a failure of the medical profession. In the middle 1990s, a number of physicians began to argue for much greater use of opioids for patients with chronic pain. In the 1995 presidential address of the American Pain Society, James Campbell introduced the notion that pain is the “5th vital sign.” Campbell (1995) argued that “Quality care means pain is measured. Quality of care means pain is treated.”
.. an important study used by Purdue Pharma in their advertising materials, Porter and Jick (1980), reported that of “11,882 patients who received at least one narcotic preparation [opioid], there were only four cases of reasonably well documented addiction in patients who had no history of addiction.”
.. This “study” was in actuality a 100-word letter to the editor in the New England Journal of Medicine, the entire substance of which is contained in the quote above.
.. in 1996, the FDA allowed Purdue Pharma to claim that addiction was rare if opioids were legitimately used in the treatment of pain.
.. Between 1996, when OxyContin was released, and 2003, sales of OxyContin increased from $44.8 million to $1.5 billion per year (United States General Accounting Office, 2003)
.. The movement to an abuse-deterrent formulation made OxyContin less desirable for recreational use.
.. Of confiscated heroin, 79 percent is now from Mexico
.. The price has fallen from more than $3,000 per pure gram in 1981 to less than $500 in 2012
.. Groups like the Xalisco Boys have transformed the supply of heroin to suburban and rural US markets. Within their distribution network, independent “cells” within a city are operated by cell managers and each cell is supplied with high-quality Mexican heroin by the cell’s owner. The cell manager employs a telephone operator who receives orders and then relays those orders to the drivers. A driver meets the client at a designated spot or delivers the drugs directly to the customer’s location. Each cell operates almost completely independently and constantly cycles through lower level employees to help prevent detection by authorities.
.. 30 years ago, the typical heroin user was an urban resident. Heroin use in the 1990s and 2000s has now “spread to users in suburban and rural areas, more affluent users, younger users, and users of a wider range of ages. There is no longer a typical heroin user.” The entry into heroin is now much easier because of the purity level. In the 1970s, heroin was mostly an injected drug. Because of increased purity, the drug can now be smoked or inhaled, decreasing the cost of drug initiation
.. the costs of the opioid crisis seem to be driven primarily by the costs associated with mortality. Inocencio et al. (2013) put the total costs at $20.4 billion in 2011 dollars, but 89 percent of these costs, more than $18 billion, are due to lost earnings from higher mortality. Although we do not do a formal cost-benefit analysis, the fact is that Purdue Pharma’s abuse-deterrent formulation of OxyContin was unable to affect the vast majority of the crisis’s costs.
.. While some individuals die from heroin overdoses shortly after initiation, on average, it takes between 5 and 10 years for a heroin user to overdose and die