Is the Business World All About Greed?

Laurence Fink, the chief executive of the investment firm BlackRock and one of the biggest investors in the world, shook the business world last week with an implicit threat to punish small-minded companies that “only deliver financial performance” without “a positive contribution to society.”

What’s driving the rethink isn’t a tingling of the tycoon conscience but brutal self-interest. Millennials want to work for ethical companies, patronize brands that make them feel good and invest in socially responsible companies.

Some of this is shallow and some is deep, but it’s authentic: Doing good is no longer a matter of writing a few checks at the end of the year, as it was for my generation; for many young people, it’s an ethos that governs where they work, shop and invest.

C.E.O.s tell me that this forces their hand. If companies protect groping scumbags, that hurts recruitment and they lose in the war for talent. Increasingly, a company that ignores social value loses shareholder value.

.. I believe the best industries for doing good are law (pro bono work) and certain pharmaceuticals (drug donation programs). That’s because they are held accountable by metrics: Big law firms are ranked by American Lawyer for their pro bono work (Jenner & Block is top of the list), and pharma donations are rated by the Access to Medicines Index (GSK is No. 1).

.. Other companies hailed as model global citizens include Unilever, Starbucks, Whole Foods, Mastercard, Danone and Chobani.

The Family That Built an Empire of Pain

The Sackler dynasty’s ruthless marketing of painkillers has generated billions of dollars—and millions of addicts.

 

An addiction specialist said that the Sacklers’ firm, Purdue Pharma, bears the “lion’s share” of the blame for the opioid crisis.

 

..  The Brooklyn-born brothers Arthur, Mortimer, and Raymond Sackler, all physicians, donated lavishly during their lifetimes to an astounding range of institutions, many of which today bear the family name: the Sackler Gallery, in Washington; the Sackler Museum, at Harvard; the Sackler Center for Arts Education, at the Guggenheim; the Sackler Wing at the Louvre; and Sackler institutes and facilities at Columbia, Oxford, and a dozen other universities. The Sacklers have endowed professorships and underwritten medical research. The art scholar Thomas Lawton once likened the eldest brother, Arthur, to “a modern Medici.

.. Marissa Sackler, the thirty-six-year-old daughter of Mortimer
.. she finds the word “philanthropy” old-fashioned. She considers herself a “social entrepreneur.”

.. When the Met was originally built, in 1880, one of its trustees, the lawyer Joseph Choate, gave a speech to Gilded Age industrialists who had gathered to celebrate its dedication, and, in a bid for their support, offered the sly observation that what philanthropy really buys is immortality:

.. the Sacklers are now one of America’s richest families, with a collective net worth of thirteen billion dollars—more than the Rockefellers or the Mellons.

.. Purdue Pharma—a privately held company, based in Stamford, Connecticut, that developed the prescription painkiller OxyContin.

.. four out of five people who try heroin today started with prescription painkillers.

.. a hundred and forty-five Americans now die every day from opioid overdoses.

.. it’s in 1996 that prescribing really takes off,” Kolodny said. “It’s not a coincidence. That was the year Purdue launched a multifaceted campaign that misinformed the medical community about the risks.” When I asked Kolodny how much of the blame Purdue bears for the current public-health crisis, he responded, “The lion’s share.”

.. Although the Sackler name can be found on dozens of buildings, Purdue’s Web site scarcely mentions the family, and a list of the company’s board of directors fails to include eight family members, from three generations, who serve in that capacity.

.. The Sacklers were especially interested in the biological aspects of psychiatric disorders, and in pharmaceutical alternatives to mid-century methods such as electroshock therapy and psychoanalysis.

.. In 1942, Arthur helped pay his medical-school tuition by taking a copywriting job

.. He recognized that selling new drugs requires a seduction of not just the patient but the doctor who writes the prescription.

.. in selling new drugs he devised campaigns that appealed directly to clinicians, placing splashy ads in medical journals and distributing literature to doctors’ offices. Seeing that physicians were most heavily influenced by their own peers, he enlisted prominent ones to endorse his products, and cited scientific studies (which were often underwritten by the pharmaceutical companies themselves).

.. “Most of the questionable practices that propelled the pharmaceutical industry into the scourge it is today can be attributed to Arthur Sackler.”

.. Arthur’s techniques were sometimes blatantly deceptive.

.. “More and more physicians find Sigmamycin the antibiotic therapy of choice.”

.. The Saturday Review tried to contact some of the doctors whose names were on the cards. They did not exist.

.. One Librium ad depicted a young woman carrying an armload of books, and suggested that even the quotidian anxiety a college freshman feels upon leaving home might be best handled with tranquillizers.

.. Win Gerson, who worked with Sackler at the agency, told the journalist Sam Quinones years later that the Valium campaign was a great success, in part because the drug was so effective. “It kind of made junkies of people, but that drug worked,”

..  By 1973, American doctors were writing more than a hundred million tranquillizer prescriptions a year, and countless patients became hooked.

.. He scoffed at suggestions that there was a conflict of interest between his roles as the head of a pharmaceutical-advertising company and the publisher of a periodical for doctors.

.. a company he owned, MD Publications, had paid the chief of the antibiotics division of the F.D.A., Henry Welch, nearly three hundred thousand dollars in exchange for Welch’s help in promoting certain drugs. Sometimes, when Welch was giving a speech, he inserted a drug’s advertising slogan into his remarks.

“The Sackler empire is a completely integrated operation in that it can

  • devise a new drug in its drug development enterprise, have the drug clinically tested and
  • secure favorable reports on the drug from the various hospitals with which they have connections,
  • conceive the advertising approach and prepare the actual advertising copy with which to promote the drug,
  • have the clinical articles as well as advertising copy published in their own medical journals, [and]
  • prepare and plant articles in newspapers and magazines.”

.. A panel of senators assailed him with pointed questions, but he was a formidable interlocutorslippery, aloof, and impeccably prepared—and no senator landed a blow.

.. Arthur’s children fought bitterly with Gillian, and sparred with Mortimer and Raymond, over the estate. They accused Gillian of trying to steal their inheritance, and of being “inspired variously by greed, malice, or vindictiveness toward her stepchildren.”

.. A family lawyer told the children, “There were no absolutely white lilies here on either side.”

.. for the Romans, the poppy was a symbol of both sleep and death.

.. MS Contin became the biggest seller in Purdue’s history. But, by the late eighties, its patent was about to expire, and Purdue executives started looking for a drug to replace it.

.. “In terms of narcotic firepower, OxyContin was a nuclear weapon.”

.. Highly regarded doctors, like Russell Portenoy, then a pain specialist at Memorial Sloan Kettering Cancer Center, in New York, spoke out about the problem of untreated chronic pain—and the wisdom of using opioids to treat it.

.. Describing opioids as a “gift from nature,” he said that they needed to be destigmatized.

.. claiming that it was indicative of “opiophobia,” and suggesting that concerns about addiction and abuse amounted to a “medical myth.”

.. the American Pain Society published a statement regarding the use of opioids to treat chronic pain. The statement was written by a committee chaired by Dr. J. David Haddox, a paid speaker for Purdue.

.. the F.D.A., in an unusual step, approved a package insert for OxyContin which announced that the drug was safer than rival painkillers, because the patented delayed-absorption mechanism

.. launched OxyContin with one of the biggest pharmaceutical marketing campaigns in history

.. A major thrust of the sales campaign was that OxyContin should be prescribed not merely for the kind of severe short-term pain associated with surgery or cancer but also for less acute, longer-lasting pain: arthritis, back pain, sports injuries, fibromyalgia.

.. Purdue similarly spoke of reaching patients who were “opioid naïve.”

.. “the goal should have been to sell the least dose of the drug to the smallest number of patients.” But this approach was at odds with the competitive imperatives of a pharmaceutical company, he continued. So Purdue set out to do exactly the opposite.

.. Purdue had a speakers’ bureau, and it paid several thousand clinicians

.. The marketing of OxyContin relied on an empirical circularity: the company convinced doctors of the drug’s safety with literature that had been produced by doctors who were paid, or funded, by the company.

.. OxyContin’s success can be attributed partly to the fact that so many doctors wanted to believe in the therapeutic benefits of opioids.

.. Purdue gave money to continuing medical education, to state medical boards, to faux grassroots organizations.”

.. Purdue instructed sales representatives to assure doctors—repeatedly and without evidence—that “fewer than one per cent” of patients who took OxyContin became addicted. (In 1999, a Purdue-funded study of patients who used OxyContin for headaches found that the addiction rate was thirteen per cent.)
.. Internal budget plans described the company’s sales force as its “most valuable resource.” In 2001, Purdue Pharma paid forty million dollars in bonuses.

.. The fact that Purdue is privately held is a major reason that the Sacklers’ connection to OxyContin has remained obscure.

.. Mortimer Sackler  .. He renounced his U.S. citizenship in 1974, reportedly for tax reasons, and lived a flamboyant life in Europe, shuttling among residences in England, the Swiss Alps, and Cap d’Antibes.

.. If you ground the pills up and snorted them, or dissolved them in liquid and injected them, you could override the time-release mechanism and deliver a huge narcotic payload all at once

.. Purdue insisted that the only problem was that recreational drug users were not taking OxyContin as directed.

.. One night, after four months on the drug, she died in her sleep, from respiratory arrest, leaving behind a six-year-old son. Her mother, Marianne Skolek Perez, was a nurse.

.. Robin Hogen ..  had launched a vigorous campaign to defend the drug, warning newspapers to be careful about their coverage

.. He had also enlisted Rudolph Giuliani, the former mayor of New York, and his associate Bernard Kerik to preëmpt any government crackdown.

.. “We have to be politically Machiavellian, often, to win the day,”

.. Purdue’s senior medical adviser, J. David Haddox, who insisted that OxyContin was not addictive. He once likened the drug to a vegetable, saying, “If I gave you a stalk of celery and you ate that, it would be healthy. But if you put it in a blender and tried to shoot it into your veins, it would not be good.”

.. it was Purdue’s position that OxyContin overdoses were a matter of individual responsibility, rather than the drug’s addictive properties.

.. Howard Udell, Purdue’s general counsel, who had been a longtime legal adviser to the Sacklers

.. Udell was clearly aware, however, of the abuse potential of OxyContin. According to court documents, his own secretary became addicted to the drug, and was subsequently fired by Purdue.

.. for Purdue and the Sacklers, “there was a sense almost of betrayal—how could people put the availability of that product in jeopardy by abusing it for pleasure?”

.. the dangers of OxyContin were intrinsic to the drug—and Purdue knew it.

.. They could sleep through the night—a crucial improvement over conventional painkillers, such as morphine

.. Roughly half the women required more medication before the twelve-hour mark.

.. the claim of twelve-hour relief was an invaluable marketing tool. But prescribing a pill on a twelve-hour schedule when, for many patients, it works for only eight is a recipe for withdrawal, addiction, and abuse.

.. many people who were not drug abusers—and who took OxyContin exactly as their doctors instructed—began experiencing withdrawal symptoms between doses.

.. patients were coming to them with symptoms of withdrawal (itching, nausea, the shakes) and asking for more medication. Haddox had an answer. In a 1989 paper, he had coined the term “pseudo-addiction.” As a pain-management pamphlet distributed by Purdue explained, pseudo-addiction “seems similar to addiction, but is due to unrelieved pain.”

..  Pseudo-addiction generally stopped once the pain was relieved—“often through an increase in opioid dose.”

.. though Sackler presided over the tremendously successful launch of OxyContin, he has never given an on-the-record interview about the drug.

..  Purdue refused to concede that it posed risks. Company leaders worried mainly that attempts to stem overdoses might deprive pain patients of access to the drug.

..  it had maintained a contract with I.M.S., a little-known company, co-founded by Arthur Sackler, that furnished its clients with fine-grained information about the prescribing habits of individual doctors. Purdue’s sales representatives used the data to figure out which doctors to target.

.. “They know exactly what people are prescribing,” Kolodny said. “They know when a doctor is running a pill mill.

.. James Greenwood, a Pennsylvania congressman, asked Friedman whether Purdue would take any action if, say, I.M.S. data revealed that a rural osteopath was writing thousands of prescriptions.

Friedman replied that it was not up to Purdue to assess “how well a physician practices medicine.”

.. overprescribing generated tremendous revenue for the company.

.. such prescribers were given a name that Las Vegas casinos reserve for their most prized gamblers: whales.

.. in 2004 Blumenthal filed a complaint against Purdue, on behalf of the State of Connecticut.

.. If OxyContin was being widely prescribed at intervals of fewer than twelve hours, the company might lose its “two pills a day” marketplace advantage against cheaper alternatives, like generic morphine, and insurers could start refusing to cover the costs.

.. “These pronouncements about how safe the drug was emanated from the marketing department, not the scientific department. It was pretty shocking. They just made this stuff up.”

.. In 2006, Purdue settled with Hanly’s clients, for seventy-five million dollars

.. Rudolph Giuliani had tried, on Purdue’s behalf, to get the lead prosecutor to scuttle the case.

.. Arlen Specter, the Republican senator from Pennsylvania, remarked that such fines amounted to “expensive licenses for criminal misconduct.”

.. one of his fixations was the unethical behavior of tobacco companies.

.. the tobacco companies had more money to spare than Purdue does. “To resolve the opioid problem, you’re going to need billions,” he said. “Treatment alone could be fifty billion dollars or more. And you need prevention and education programs on top of that.”

.. Prescriptions are expensive, and taxpayers often foot the bill, through programs like Medicaid. Then, as the ruinous consequences of opioid addiction take hold, the public must pay again—this time for emergency services, addiction treatment, and the like. Moore feels that the Sackler family, as the initial author and a prime beneficiary of the epidemic, should be publicly shamed.

.. They duped the F.D.A., saying it lasted twelve hours. They lied about the addictive properties. And they did all this to grow the opioid market, to make it O.K. to jump in the water.

.. Purdue fought the suit with its customary rigor, pushing to move the proceedings elsewhere, on the ground that the company could not get a fair trial in Pike County, Kentucky—the rural stretch of coal country where the state intended to try the case.

.. The report was revealing in ways that Purdue may not have intended: according to the filing, twenty-nine per cent of the county’s residents said that they or their family members knew someone who had died from using OxyContin. Seven out of ten respondents described OxyContin’s effect on their community as “devastating.”

..  Sackler’s demeanor during the session reminded him of Jeremy Irons’s portrayal of Claus von Bülow, the aristocrat accused of murdering his wife, in the 1990 bio-pic “Reversal of Fortune.” “A smirk and a so-what attitude—an absolute lack of remorse,”

.. the 1997 Pikeville High School football team. “Nearly half the players had died of overdoses, or were addicted,” he said. “It was going to be a pretty good visual.”

.. Purdue has sometimes claimed to have never “lost a case” related to OxyContin, but it’s more accurate to say that the company has never allowed a case to go to trial, often settling rather than litigating the culpability of the company—and the Sacklers—in open court.

.. the main reason these folks don’t go to trial,” Denham said. “Because all these documents could end up in the public record.” The Kentucky prosecutors were required to destroy millions of documents, or return them to Purdue.

.. The idea that they’re fighting so hard to keep this deposition hidden should tell you something.

.. These were urbane, expensively educated, presumably well-informed people. Could they conceivably be unaware of the accumulated evidence about the tainted origins of their fortune?

.. Someone who knows Mortimer, Jr., socially told me, “I think for him, most of the time, he’s just saying, ‘Wow, we’re really rich. It’s fucking cool. I don’t really want to think that much about the other side of things.’ ”

..  I wondered whether philanthropy might represent, for at least some of the Sacklers, a form of atonement. But, when you consider the breadth of the family’s donations, one field is conspicuously lacking: addiction treatment, or any other measures that might serve to counter the opioid epidemic.

.. companies often make a minor tweak to a branded product shortly before the patent expires, in order to obtain a new patent and reset the clock on their exclusive right to produce the drug. The patent for the original OxyContin was set to expire in 2013.

.. Purdue had long denied that the original OxyContin was especially prone to abuse. But, upon receiving its patents for the reformulated drug, the company filed papers with the F.D.A., asking the agency to refuse to accept generic versions of the original formulation—because they were unsafe.

.. Younger people, who can less readily secure prescriptions for pain—and for whom OxyContin may be too expensive—have increasingly turned to black-market substitutes, including heroin.

.. “How the Reformulation of OxyContin Ignited the Heroin Epidemic.” A survey of two hundred and forty-four people who entered treatment for OxyContin abuse after the reformulation found that a third had switched to other drugs. Seventy per cent of that group had turned to heroin.

.. Purdue pinpointed “communities where there is a lot of poverty and a lack of education and opportunity,” adding, “They were looking at numbers that showed these people have work-related injuries, they go to the doctor more often, they get treatment for pain.”

The Xalisco boys offered potential customers free samples of their product. So did Purdue.

.. Purdue likes to emphasize that there are many other powerful painkillers, and that OxyContin never had more than two per cent of the market for opioids

..  But most painkillers are prescribed for very short periods—following surgery, for instance—and in relatively small doses, whereas OxyContin’s sales have been driven by long-term, high-dose prescriptions

..  If one measured market share by the actual volume of narcotics administered, OxyContin’s would be considerably higher. Some doctors I spoke with estimated that it could be as high as thirty per cent.

.. Purdue acknowledged that even patients “who take OxyContin in accordance with its F.D.A.-approved labeling instructions will likely develop physical dependence.”

.. It may also be that OxyContin has achieved market saturation.

.. Last year, in Ohio, a state particularly hard hit by the epidemic, 2.3 million residents—roughly one in five people in the state—received a prescription for opioids.

.. “Opioids really do afford pain relief—initially,” he said. “But that relief tends to diminish over time. That’s, in part, why people increase the dose. They are chasing pain relief from a drug that has failed.

.. The Sackler family and Purdue Pharma could have taken responsibility in a similar spirit: apologizing for their role in unleashing a national catastrophe while noting that, during the nineties, they had relied on a series of mistaken assumptions about the safety of OxyContin. But Purdue has continued to fight aggressively against any measures that might limit the distribution of OxyContin, in a way that calls to mind the gun lobby’s resistance to firearm regulations.

Confronted with the prospect of modest, commonsense measures that might in any way impinge on the prescribing of painkillers, Purdue and its various allies have responded with alarm, suggesting that such steps will deny law-abiding pain patients access to medicine they desperately need. Mark Sullivan, a psychiatrist at the University of Washington, distilled the argument of Purdue: “Our product isn’t dangerous—it’s people who are dangerous.”

.. after Purdue made its guilty plea, in 2007, it assembled an army of lobbyists to fight any legislative actions that might encroach on its business. Between 2006 and 2015, Purdue and other painkiller producers, along with their associated nonprofits, spent nearly nine hundred million dollars on lobbying and political contributions—eight times what the gun lobby spent during that period.

.. Since Purdue made it more difficult to grind OxyContin pills, prescriptions have reportedly plummeted by forty per cent. This suggests that nearly half of the original drug’s consumers may have been crushing it to get high.

.. In August, 2015, over objections from critics, the company received F.D.A. approval to market OxyContin to children as young as eleven.

.. the Sacklers continue to receive some seven hundred million dollars a year

.. the real future of OxyContin may be global

.. But the Sackler family has only increased its efforts abroad, and is now pushing the drug, through a Purdue-related company called Mundipharma, into Asia, Latin America, and the Middle East

.. Part of Purdue’s strategy from the beginning has been to create a market for OxyContin—to instill a perceived need by making bold claims about the existence of large numbers of people suffering from untreated chronic pain.

.. Mundipharma commissioned studies showing that millions of people in these countries suffered from chronic pain.

.. In Mexico, Mundipharma has asserted that twenty-eight million people—a quarter of the population—suffer from chronic pain.

.. In China, the company has distributed cartoon videos about using opioids for pain relief; other promotional literature cites the erroneous claim that rates of addiction are negligible.

.. The term “opiophobia” has largely fallen into disuse in America, for obvious reasons. Mundipharma executives still use it abroad.

.. “It’s a parallel to what the tobacco industry did,” Mike Moore told me. “They got caught in America, they saw their market share decline, so they export it to places with even fewer regulations than we have.

.. Yale, announced that the university will rename a residential college that was named for John C. Calhoun, because Calhoun’s “legacy as a white supremacist and a national leader who passionately promoted slavery as a ‘positive good’ fundamentally conflicts with Yale’s mission and values.”

.. in the time it likely took you to read this article six Americans have fatally overdosed on opioids.

.. “A truly philanthropic family, looking at the last twenty years, would say, ‘You know, there’s several million Americans who are addicted, directly or indirectly, because of us.’ Real philanthropy would be to contribute money to taking care of them.

.. adding their name to a building—it rings hollow. It’s not philanthropy. It’s just a glorification of the Sackler family.”

..  more than two and a half million Americans have an opioid-use disorder.

..  “If the Sacklers wanted to clear their name, they could take a very substantial fraction of that fortune and create a mechanism for providing free treatment for everyone who’s become addicted.”

.. Alfred Nobel, the inventor of dynamite, created the Nobel Peace Prize.

.. the descendants of John D. Rockefeller have devoted resources to addressing climate change and critiquing the environmental record of the oil company he founded

..tobacco-company C.E.O.s: “We asked them, ‘What do you want?’ And they said, ‘We want to be able to go to cocktail parties and not have people come up and ask us why we’re killing people.’

.. An addicted baby is now born every half hour.

.. In places like Huntington, West Virginia, ten per cent of newborns are dependent on opioids.

Nearly Half the Pentagon Budget Goes To Contractors

In fiscal year 2016, the Pentagon issued $304 billion in contract awards to corporations—nearly half of the department’s $600 billion-plus budget for that year.

the biggest beneficiaries by a country mile were

  1. Lockheed Martin ($36.2 billion),
  2. Boeing ($24.3 billion),
  3. Raytheon ($12.8 billion),
  4. General Dynamics ($12.7 billion), and
  5. Northrop Grumman ($10.7 billion).

Together, these five firms gobbled up nearly $100 billion of your tax dollars, about one-third of all the Pentagon’s contract awards in 2016.

Health care companies like

  1. Humana ($3.6 billion),
  2. UnitedHealth Group ($2.9 billion), and
  3. Health Net ($2.6 billion) cash in as well,

and they’re joined by, among others, pharmaceutical companies like

  • McKesson ($2.7 billion) and

universities deeply involved in military-industrial complex research like

  • MIT ($1 billion) and
  • Johns Hopkins ($902 million).

.. The heads of the top five Pentagon contractors—Lockheed Martin, Boeing, Raytheon, General Dynamics, and Northrop Grumman—made a cumulative $96 million last year.

These are companies that are significantly or, in the cases of Lockheed Martin and Northrop Grumman, almost entirely dependent on government dollars.

.. Donald Trump initially spent a fair amount of tweeting energy bragging about how he was going to bring such contractors to heel on their pricing practices for weapons systems. In fact, he’s already turned out to be good news indeed for major contractors, most of whom have seen sharp upturns in revenues and profits

.. Trump has proven eager to lift restrictions on U.S. weapons sales abroad (and enlist State Department and Pentagon officials to spend more of their time shilling such weaponry).

.. The arms industry’s investment in lobbying is even more impressive. The defense sector has spent a total of more than $1 billion on that productive activity since 2009, employing anywhere from 700 to 1,000 lobbyists in any given year.

.. you’re talking about significantly more than one lobbyist per member of Congress, the majority of whom zipped through Washington’s famed “revolving door”; they moved, that is, from positions in Congress or the Pentagon to posts at weapons companies from which they could proselytize their former colleagues.

.. Two analysts from U.S. war colleges have estimated that about 300 deliverable nuclear warheads would be enough to dissuade any nation from attacking the United States with a nuclear weapon.

.. And note that the current trillion-dollar “modernization” program for the nuclear arsenal was initiated under President Barack Obama, a man who won the Nobel Prize for his urge to abolish all such weaponry.

.. In 2011, a study by economists from the University of Massachusetts made this blindingly clear.  What they showed was that military spending is the worst way to create jobs. Putting the same money into any other area—from infrastructure to transportation to alternative energy to healthcare or education—creates up to twice as many jobs as military spending does.

.. Contractors aid and abet the process of investing in the Pentagon by routinely exaggerating the number of jobs their programs create.

.. the best jobs generated by Pentagon spending are the ones for well-heeled lobbyists and overpaid corporate executives.

.. So the next time someone suggests that the Pentagon needs yet more money for the troops, just remember that what they’re actually talking about are troops of overpaid defense contractors, not members of the armed forces.

Hurricane Damage in Puerto Rico Leads to Fears of Drug Shortages Nationwide

Pharmaceuticals and medical devices are the island’s leading exports, and Puerto Rico has become one of the world’s biggest centers for pharmaceutical manufacturing. Its factories make 13 of the world’s top-selling brand-name drugs, from Humira, the rheumatoid arthritis treatment, to Xarelto, a blood thinner used to prevent stroke, according to a report released last year.

.. drug companies and device makers are confronting a range of obstacles on the island: locating enough diesel fuel for generators to run their factories; helping their employees get to work from areas where roads are damaged and blocked

.. Thirteen of the drugs, Dr. Gottlieb said, are “sole-source,” meaning the product is only made by one company. Those include H.I.V. medications injectable drugs and sophisticated medical devices, although he did not name the products. The biggest problem, he said, was not damage to the factories, but the instability of the electric supply.

.. Ms. Fox said companies typically do not disclose where they manufacture their drugs because it is considered a trade secret. Several companies declined to list which products they made in Puerto Rico.

.. Pharmaceutical and medical manufacturing accounted for nearly three-quarters of Puerto Rico’s exports in 2016, of $14.5 billion

Everyone Wants to Reduce Drug Prices. So Why Can’t We Do It?

The pharmaceutical and health products industries spent $145 million on lobbying for the first half of 2017, according to the Center for Responsive Politics.

Drug makers gave $4.5 million to congressional campaigns in that period, including six-figure donations to House Speaker Paul Ryan; Representative Greg Walden, a Republican of Oregon who heads the House Energy and Commerce Committee; and Senator Orrin Hatch, Republican of Utah and chairman of the Senate Finance Committee, a Kaiser Health News analysis found.

The drug lobby has spent $28 million so far this year to air six ads depicting heroic researchers about 4,600 times on national TV, according to iSpot.tv, an ad tracker.

The industry hired the former F.B.I. director Louis Freeh to study the impact of importation. He concluded that it would “leave the safety of the U.S. prescription drug supply vulnerable to criminals seeking to harm patients.” Import proponents argue the Food and Drug Administration could easily ensure safety by licensing and inspecting Canadian suppliers.

.. Mr. Trump’s feud with congressional Republicans, especially the Senate majority leader, Mitch McConnell, means “you’re not going to get any strong direction or leadership out of the White House” on drug prices

Pharma Gets Roped Into the Trumpcare Maelstrom

With this change, insurers would still offer such benefits, letting consumers choose which ones they want. But insurers would likely charge substantially more for them than for bare-bones plans, which would appeal mainly to young and healthy people.

.. sicker people will gravitate toward the more-generous coverage, making it even more expensive and further stratifying the market.

Prescription-drug coverage could get caught on the wrong side of this divide, becoming ever more expensive and causing healthier people to skip it.

.. This could force the industry to reckon on a deeper level with the way it prices drugs.

.. So many medicines carry massive price tags because most patients typically pay just a small fraction of those list prices, while insurers handle the rest. That generous coverage is possible partly because everyone with insurance pays for it; healthy 27-year-olds help insure older diabetics.

.. Exposing more patients to high prices will crush demand, hurting sales. And the political pressure drugmakers already feel over prices will only intensify. The more Americans have to pay the actual list prices of drugs, the harder those prices will be to defend.

How America Made Donald Trump Unstoppable

Before the speech, the PA announcer had told us not to “touch or harm” any protesters, but to instead just surround them and chant, “Trump! Trump! Trump!” until security can arrive (and presumably do the touching and/or harming).

.. The same way Sarah Palin can see Russia from her house, Donald on the stump can see his future. The pundits don’t want to admit it, but it’s sitting there in plain view, 12 moves ahead, like a chess game already won:

President Donald Trump.

.. It’s been well-documented that Trump surged last summer when he openly embraced the ugly race politics that, according to the Beltway custom of 50-plus years, is supposed to stay at the dog-whistle level. No doubt, that’s been a huge factor in his rise.

.. That put him in position to understand that the presidential election campaign is really just a badly acted, billion-dollar TV show whose production costs ludicrously include the political disenfranchisement of its audience.

.. Trump’s basic argument is the same one every successful authoritarian movement in recent Western history has made: that the regular guy has been screwed by a conspiracy of incestuous elites.

.. What Trump understands better than his opponents is that NASCAR America, WWE America, always loves seeing the preening self-proclaimed good guy get whacked with a chair.

.. rump had said things that were true and that no other Republican would dare to say. And yet the press congratulated the candidate stuffed with more than $100 million in donor cash who really did take five whole days last year to figure out his position on his own brother’s invasion of Iraq.

.. Why do the media hate Trump? Progressive reporters will say it’s because of things like his being crazy and the next Hitler, while the Fox types insist it’s because he’s “not conservative.” But reporters mostly loathe Trump because he regularly craps on other reporters.

.. Reporters have focused quite a lot on the crazy/race-baiting/nativist themes in Trump’s campaign, but these comprise a very small part of his usual presentation. His speeches increasingly are strikingly populist in their content.

.. His pitch is: He’s rich, he won’t owe anyone anything upon election, and therefore he won’t do what both Democratic and Republican politicians unfailingly do upon taking office, i.e., approve rotten/regressive policies that screw ordinary people.

.. He talks, for instance, about the anti-trust exemption enjoyed by insurance companies, an atrocity dating back more than half a century, to the McCarran-Ferguson Act of 1945. This law, sponsored by one of the most notorious legislators in our history (Nevada Sen. Pat McCarran was thought to be the inspiration for the corrupt Sen. Pat Geary in The Godfather II), allows insurance companies to share information and collude to divvy up markets.

.. Neither the Republicans nor the Democrats made a serious effort to overturn this indefensible loophole during the debate over the Affordable Care Act.
.. Trump isn’t lying about any of this. Nor is he lying when he mentions that the big-pharma companies have such a stranglehold on both parties that they’ve managed to get the federal government to bar itself from negotiating Medicare prescription-drug prices in bulk.

.. He claims (and with Trump we always have to use words like “claims”) how it was these very big-pharma donors, “fat cats,” sitting in the front row of the debate the night before. He steams ahead even more with this tidbit: Woody Johnson, one of the heirs of drug giant Johnson & Johnson ..  .. is the finance chief for the campaign of whipping boy Jeb Bush.

.. Trump, incidentally, will someday be in the Twitter Hall of Fame

.. But that wasn’t because of the principle itself, but because it was always coupled with the more effective politics of resentment: Big-government liberals are to blame for your problems.

.. Elections, like criminal trials, are ultimately always about assigning blame. For a generation, conservative intellectuals have successfully pointed the finger at big-government-loving, whale-hugging liberals as the culprits behind American decline.

.. No one should be surprised that he’s tearing through the Republican primaries, because everything he’s saying about his GOP opponents is true. They really are all stooges on the take, unable to stand up to Trump because they’re not even people, but are, like Jeb and Rubio, just robo-babbling representatives of unseen donors.

.. Patinkin believed Cruz didn’t do that line because Cruz is himself in the revenge business, promising to “carpet-bomb [ISIS] into oblivion” and wondering if “sand can glow.”