One day in March of 2015, Weinstein invited the model Ambra Battilana Gutierrez to his office for a morning meeting
.. To see Weinstein turn himself in on Friday at the same precinct where Gutierrez made her report, in the same neighborhood where he caused so many women anguish and pain, was simply cathartic.
.. For all the handwringing about the mob power of #MeToo, the fact is that most men who have assaulted women will not face criminal charges for doing so.
.. Weinstein had spent time hiding out in Arizona.
.. the news elicited a response similar to the “galvanizing shock” produced in April, when Bill Cosby was found guilty of three counts of sexual assault.
.. is mouth alternated between a grimace and a smirk.
.. Entering the precinct, Weinstein was a spectacle of smugness, as if trying to project the posture of an intellectual dissident.
.. In his hands were three books, two of which have been identified. They were corny totems suggesting, respectively, artistic revolution and false persecution: Todd Purdum’s “Something Wonderful: Rodgers and Hammerstein’s Broadway Revolution,” and Richard Schickel’s biography of Elia Kazan, the Hollywood director who famously “named names” to the House Un-American Activities Committee, in 1952.
.. After he turned himself in, Weinstein was made to do a perp walk, the queasy practice meant to emasculate the suspect and flex the prosecutor’s power.
It is a public humiliation, a feast for the kinds of New York tabloids that Weinstein himself once manipulated so ruthlessly.
.. The books he walked in with had vanished. With his head hung low, Weinstein looked small, insignificant.
.. In the Manhattan Supreme Court, prosecutors charged him with two counts of rape and one count of a criminal sexual act.
.. He surrendered his passport and was released on bail
.. “Will the sight of Harvey Weinstein in handcuffs encourage more women to come forward/press charges?”
Here are the 20 diversionary tactics toxic people use to silence and degrade you.
Gaslighting is a manipulative tactic that can be described in different variations of three words: “That didn’t happen,” “You imagined it,” and “Are you crazy?” Gaslighting is perhaps one of the most insidious manipulative tactics out there because it works to distort and erode your sense of reality; it eats away at your ability to trust yourself and inevitably disables you from feeling justified in calling out abuse and mistreatment.
.. In order to resist gaslighting, it’s important to ground yourself in your own reality – sometimes writing things down as they happened, telling a friend or reiterating your experience to a support network can help to counteract the gaslighting effect. The power of having a validating community is that it can redirect you from the distorted reality of a malignant person and back to your own inner guidance.
One sure sign of toxicity is when a person is chronically unwilling to see his or her own shortcomings and uses everything in their power to avoid being held accountable for them. This is known as projection. Projection is a defense mechanism used to displace responsibility of one’s negative behavior and traits by attributing them to someone else. It ultimately acts as a digression that avoids ownership and accountability.
.. Instead of admitting that self-improvement may be in order, they would prefer that their victims take responsibility for their behavior and feel ashamed of themselves. This is a way for a narcissist to project any toxic shame they have about themselves onto another.
For example, a person who engages in pathological lying may accuse their partner of fibbing; a needy spouse may call their husband “clingy” in an attempt to depict them as the one who is dependent; a rude employee may call their boss ineffective in an effort to escape the truth about their own productivity.Narcissistic abusers love to play the “blameshifting game.”.. Narcissists on the extreme end of the spectrum usually have no interest in self-insight or change. It’s important to cut ties and end interactions with toxic people as soon as possible so you can get centered in your own reality and validate your own identity.
.. 3. Nonsensical conversations from hell.
If you think you’re going to have a thoughtful discussion with someone who is toxic, be prepared for epic mindfuckery rather than conversational mindfulness.
Malignant narcissists and sociopaths use word salad, circular conversations, ad hominem arguments, projection and gaslighting to disorient you and get you off track should you ever disagree with them or challenge them in any way. They do this in order to discredit, confuse and frustrate you, distract you from the main problem and make you feel guilty for being a human being with actual thoughts and feelings that might differ from their own. In their eyes, you are the problem if you happen to exist.
Spend even ten minutes arguing with a toxic narcissist and you’ll find yourself wondering how the argument even began at all. You simply disagreed with them about their absurd claim that the sky is red and now your entire childhood, family, friends, career and lifestyle choices have come under attack. That is because your disagreement picked at their false belief that they are omnipotent and omniscient, resulting in a narcissistic injury.
.. 4. Blanket statements and generalizations.
Malignant narcissists aren’t always intellectual masterminds – many of them are intellectually lazy. Rather than taking the time to carefully consider a different perspective, they generalize anything and everything you say, making blanket statements that don’t acknowledge the nuances in your argument or take into account the multiple perspectives you’ve paid homage to.
5. Deliberately misrepresenting your thoughts and feelings to the point of absurdity.
.. Let’s say you bring up the fact that you’re unhappy with the way a toxic friend is speaking to you. In response, he or she may put words in your mouth, saying, “Oh, so now you’re perfect?” or “So I am a bad person, huh?” when you’ve done nothing but express your feelings. This enables them to invalidate your right to have thoughts and emotions about their inappropriate behavior and instills in you a sense of guilt when you attempt to establish boundaries.
This is also a popular form of diversion and cognitive distortion that is known as “mind reading.” Toxic people often presume they know what you’re thinking and feeling. They chronically jump to conclusions based on their own triggers rather than stepping back to evaluate the situation mindfully.
.. Notorious for putting words in your mouth, they depict you as having an intention or outlandish viewpoint you didn’t possess. They accuse you of thinking of them as toxic – even before you’ve gotten the chance to call them out on their behavior – and this also serves as a form of preemptive defense.
.. Simply stating, “I never said that,” and walking away should the person continue to accuse you of doing or saying something you didn’t can help to set a firm boundary in this type of interaction. So long as the toxic person can blameshift and digress from their own behavior, they have succeeded in convincing you that you should be “shamed” for giving them any sort of realistic feedback.
6. Nitpicking and moving the goal posts.
The difference between constructive criticism and destructive criticism is the presence of a personal attack and impossible standards. These so-called “critics” often don’t want to help you improve, they just want to nitpick, pull you down and scapegoat you in any way they can. Abusive narcissists and sociopaths employ a logical fallacy known as “moving the goalposts” in order to ensure that they have every reason to be perpetually dissatisfied with you. This is when, even after you’ve provided all the evidence in the world to validate your argument or taken an action to meet their request, they set up another expectation of you or demand more proof.
.. The goal posts will perpetually change and may not even be related to each other; they don’t have any other point besides making you vie for the narcissist’s approval and validation.
.. By raising the expectations higher and higher each time or switching them completely, highly manipulative and toxic people are able to instill in you a pervasive sense of unworthiness and of never feeling quite “enough.” By pointing out one irrelevant fact or one thing you did wrong and developing a hyperfocus on it, narcissists get to divert from your strengths and pull you into obsessing over any flaws or weaknesses instead.
They get you thinking about the next expectation of theirs you’re going to have to meet – until eventually you’ve bent over backwards trying to fulfill their every need – only to realize it didn’t change the horrific way they treated you.
.. their motive isn’t to better understand. It’s to further provoke you into feeling as if you have to constantly prove yourself. Validate and approve of yourself. Know that you are enough and you don’t have to be made to feel constantly deficient or unworthy in some way.
..7. Changing the subject to evade accountability.
This type of tactic is what I like to call the “What about me?” syndrome. It is a literal digression from the actual topic that works to redirect attention to a different issue altogether. Narcissists don’t want you to be on the topic of holding them accountable for anything, so they will reroute discussions to benefit them. Complaining about their neglectful parenting? They’ll point out a mistake you committed seven years ago. This type of diversion has no limits in terms of time or subject content, and often begins with a sentence like “What about the time when…”
.. A discussion about gay rights, for example, may be derailed quickly by someone who brings in another social justice issue just to distract people from the main argument.
.. that doesn’t mean that the issues that are being brought up don’t matter, it just means that the specific time and place may not be the best context to discuss them.
.. Don’t be derailed – if someone pulls a switcheroo on you, you can exercise what I call the “broken record” method and continue stating the facts without giving in to their distractions. Redirect their redirection by saying, “That’s not what I am talking about. Let’s stay focused on the real issue.” If they’re not interested, disengage and spend your energy on something more constructive
.. 8. Covert and overt threats.
Narcissistic abusers and otherwise toxic people feel very threatened when their excessive sense of entitlement, false sense of superiority and grandiose sense of self are challenged in any way. They are prone to making unreasonable demands on others – while punishing you for not living up to their impossible to reach expectations.
.. Rather than tackle disagreements or compromises maturely, they set out to divert you from your right to have your own identity and perspective by attempting to instill fear in you about the consequences of disagreeing or complying with their demands. To them, any challenge results in an ultimatum and “do this or I’ll do that” becomes their daily mantra.
If someone’s reaction to you setting boundaries or having a differing opinion from your own is to threaten you into submission, whether it’s a thinly veiled threat or an overt admission of what they plan to do, this is a red flag of someone who has a high degree of entitlement and has no plans of compromising. Take threats seriously and show the narcissist you mean business; document threats and report them whenever possible and legally feasible.
Narcissists preemptively blow anything they perceive as a threat to their superiority out of proportion. In their world, only they can ever be right and anyone who dares to say otherwise creates a narcissistic injury that results in narcissistic rage. As Mark Goulston, M.D. asserts, narcissistic rage does not result from low self-esteem but rather a high sense of entitlement and false sense of superiority.
The lowest of the low resort to narcissistic rage in the form of name-calling when they can’t think of a better way to manipulate your opinion or micromanage your emotions. Name-calling is a quick and easy way to put you down, degrade you and insult your intelligence, appearance or behavior while invalidating your right to be a separate person with a right to his or her perspective.
Name-calling can also be used to criticize your beliefs, opinions and insights. A well-researched perspective or informed opinion suddenly becomes “silly” or “idiotic” in the hands of a malignant narcissist or sociopath who feels threatened by it and cannot make a respectful, convincing rebuttal.
Rather than target your argument, they target you as a person and seek to undermine your credibility and intelligence in any way they possibly can. It’s important to end any interaction that consists of name-calling and communicate that you won’t tolerate it. Don’t internalize it: realize that they are resorting to name-calling because they are deficient in higher level methods.
10. Destructive conditioning.
Toxic people condition you to associate your strengths, talents, and happy memories with abuse, frustration and disrespect. They do this by sneaking in covert and overt put-downs about the qualities and traits they once idealized as well as sabotaging your goals, ruining celebrations, vacations and holidays. They may even isolate you from your friends and family and make you financially dependent upon them. Like Pavlov’s dogs, you’re essentially “trained” over time to become afraid of doing the very things that once made your life fulfilling.
Narcissists, sociopaths, psychopaths and otherwise toxic people do this because they wish to divert attention back to themselves and how you’re going to please them. If there is anything outside of them that may threaten their control over your life, they seek to destroy it. They need to be the center of attention at all times.
.. Narcissists are also naturally pathologically envious and don’t want anything to come in between them and their influence over you. Your happiness represents everything they feel they cannot have in their emotionally shallow lives. After all, if you learn that you can get validation, respect and love from other sources besides the toxic person, what’s to keep you from leaving them?
.. 11. Smear campaigns and stalking.
When toxic types can’t control the way you see yourself, they start to control how others see you; they play the martyr while you’re labeled the toxic one. A smear campaign is a preemptive strike to sabotage your reputation and slander your name so that you won’t have a support network to fall back on lest you decide to detach and cut ties with this toxic person.
They may even stalk and harass you or the people you know as a way to supposedly “expose” the truth about you; this exposure acts as a way to hide their own abusive behavior while projecting it onto you.
Some smear campaigns can even work to pit two people or two groups against each other. A victim in an abusive relationship with a narcissist often doesn’t know what’s being said about them during the relationship, but they eventually find out the falsehoods shortly after they’ve been discarded.
Toxic people will gossip behind your back (and in front of your face), slander you to your loved ones or their loved ones, create stories that depict you as the aggressor while they play the victim, and claim that you engaged in the same behaviors that they are afraid you will accuse them of engaging in. They will also methodically, covertly and deliberately abuse you so they can use your reactions as a way to prove that they are the so-called “victims” of your abuse.
The best way to handle a smear campaign is to stay mindful of your reactions and stick to the facts. This is especially pertinent for high-conflict divorces with narcissists who may use your reactions to their provocations against you. Document any form of harassment, cyberbullying or stalking incidents and always speak to your narcissist through a lawyer whenever possible.
.. Your character and integrity will speak for itself when the narcissist’s false mask begins to slip.
.. 12. Love-bombing and devaluation.
Narcissistic abusers do this all the time – they devalue their exes to their new partners, and eventually the new partner starts to receive the same sort of mistreatment as the narcissist’s ex-partner. Ultimately what will happen is that you will also be on the receiving end of the same abuse. You will one day be the ex-partner they degrade to their new source of supply. You just don’t know it yet. That’s why it’s important to stay mindful of the love-bombing technique whenever you witness behavior that doesn’t align with the saccharine sweetness a narcissist subjects you to.
.. slowing things down with people you suspect may be toxic is an important way of combating the love-bombing technique. Be wary of the fact that how a person treats or speaks about someone else could potentially translate into the way they will treat you in the future.
.. 13. Preemptive defense.
When someone stresses the fact that they are a “nice guy” or girl, that you should “trust them” right away or emphasizes their credibility without any provocation from you whatsoever, be wary.
Toxic and abusive people overstate their ability to be kind and compassionate. They often tell you that you should “trust” them without first building a solid foundation of trust. They may “perform” a high level of sympathy and empathy at the beginning of your relationship to dupe you, only to unveil their false mask later on. When you see their false mask begins to slip periodically during the devaluation phase of the abuse cycle, the true self is revealed to be terrifyingly cold, callous and contemptuous.
.. Genuinely nice people rarely have to persistently show off their positive qualities – they exude their warmth more than they talk about it and they know that actions speak volumes more than mere words.
.. To counter a preemptive defense, reevaluate why a person may be emphasizing their good qualities. Is it because they think you don’t trust them, or because they know you shouldn’t?
.. 14. Triangulation.
Bringing in the opinion, perspective or suggested threat of another person into the dynamic of an interaction is known as “triangulation.” Often used to validate the toxic person’s abuse while invalidating the victim’s reactions to abuse, triangulation can also work to manufacture love triangles that leave you feeling unhinged and insecure.
Malignant narcissists love to triangulate their significant other with strangers, co-workers, ex-partners, friends and even family members in order to evoke jealousy and uncertainty in you. They also use the opinions of others to validate their point of view.
.. This is a diversionary tactic meant to pull your attention away from their abusive behavior and into a false image of them as a desirable, sought after person. It also leaves you questioning yourself – if Mary did agree with Tom, doesn’t that mean that you must be wrong? The truth is, narcissists love to “report back” falsehoods about others say about you, when in fact, they are the ones smearing you.
.. To resist triangulation tactics, realize that whoever the narcissist is triangulating with is also being triangulated by your relationship with the narcissist as well. Everyone is essentially being played by this one person. Reverse “triangulate” the narcissist by gaining support from a third party that is not under the narcissist’s influence – and also by seeking your own validation.
.. 15. Bait and feign innocence.
Toxic individuals lure you into a false sense of security simply to have a platform to showcase their cruelty. Baiting you into a mindless, chaotic argument can escalate into a showdown rather quickly with someone who doesn’t know the meaning of respect. A simple disagreement may bait you into responding politely initially, until it becomes clear that the person has a malicious motive of tearing you down.
.. Remember: narcissistic abusers have learned about your insecurities, the unsettling catchphrases that interrupt your confidence, and the disturbing topics that reenact your wounds – and they use this knowledge maliciously to provoke you.
After you’ve fallen for it, hook line and sinker, they’ll stand back and innocently ask whether you’re “okay” and talk about how they didn’t “mean” to agitate you. This faux innocence works to catch you off guard and make you believe that they truly didn’t intend to hurt you, until it happens so often you can’t deny the reality of their malice any longer.
- .. Provocative statements,
- hurtful accusations or
- unsupported generalizations, for example,
are common baiting tactics.
16. Boundary testing and hoovering.
Narcissists, sociopaths and otherwise toxic people continually try and test your boundaries to see which ones they can trespass. The more violations they’re able to commit without consequences, the more they’ll push the envelope.
That’s why survivors of emotional as well as physical abuse often experience even more severe incidents of abuse each and every time they go back to their abusers.
.. In the abuser’s sick mind, this boundary testing serves as a punishment for standing up to the abuse and also for being going back to it. When narcissists try to press the emotional reset button, reinforce your boundaries even more strongly rather than backtracking on them.
Remember – highly manipulative people don’t respond to empathy or compassion. They respond to consequences.
17. Aggressive jabs disguised as jokes.
Covert narcissists enjoy making malicious remarks at your expense. These are usually dressed up as “just jokes” so that they can get away with saying appalling things while still maintaining an innocent, cool demeanor. Yet any time you are outraged at an insensitive, harsh remark, you are accused of having no sense of humor. This is a tactic frequently used in verbal abuse.
The contemptuous smirk and sadistic gleam in their eyes gives it away, however – like a predator that plays with its food, a toxic person gains pleasure from hurting you and being able to get away with it. After all, it’s just a joke, right?
Wrong. It’s a way to gaslight you into thinking their abuse is a joke – a way to divert from their cruelty and onto your perceived sensitivity. It is important that when this happens, you stand up for yourself and make it clear that you won’t tolerate this type of behavior.
Calling out manipulative people on their covert put-downs may result in further gaslighting from the abuser but maintain your stance that their behavior is not okay and end the interaction immediately if you have to.
18. Condescending sarcasm and patronizing tone.
Belittling and degrading a person is a toxic person’s forte and their tone of voice is only one tool in their toolbox. Sarcasm can be a fun mode of communication when both parties are engaged, but narcissists use it chronically as a way to manipulate you and degrade you. If you in any way react to it, you must be “too sensitive.”
Forget that the toxic person constantly has temper tantrums every time their big bad ego is faced with realistic feedback – the victim is the hypersensitive one, apparently.
.. So long as you’re treated like a child and constantly challenged for expressing yourself, you’ll start to develop a sense of hypervigilance about voicing your thoughts and opinions without reprimand. This self-censorship enables the abuser to put in less work in silencing you, because you begin to silence yourself.
“You should be ashamed of yourself” is a favorite saying of toxic people. Though it can be used by someone who is non-toxic, in the realm of the narcissist or sociopath, shaming is an effective method that targets any behavior or belief that might challenge a toxic person’s power. It can also be used to destroy and whittle away at a victim’s self-esteem: if a victim dares to be proud of something, shaming the victim for that specific trait, quality or accomplishment can serve to diminish their sense of self and stifle any pride they may have.
.. Malignant narcissists, sociopaths and psychopaths enjoy using your own wounds against you – so they will even shame you about any abuse or injustice you’ve suffered in your lifetime as a way to retraumatize you. Were you a childhood abuse survivor? A malignant narcissist or sociopath will claim that you must’ve done something to deserve it, or brag about their own happy childhood as a way to make you feel deficient and unworthy.
What better way to injure you, after all, than to pick at the original wound? As surgeons of madness, they seek to exacerbate wounds, not help heal them.
If you suspect you’re dealing with a toxic person, avoid revealing any of your vulnerabilities or past traumas. Until they’ve proven their character to you, there is no point disclosing information that could be potentially used against you.
Most importantly, toxic abusers love to maintain control in whatever way they can. They isolate you, maintain control over your finances and social networks, and micromanage every facet of your life. Yet the most powerful mechanism they have for control is toying with your emotions.
That’s why abusive narcissists and sociopaths manufacture situations of conflict out of thin air to keep you feeling off center and off balanced. That’s why they chronically engage in disagreements about irrelevant things and rage over perceived slights. That’s why they emotionally withdraw, only to re-idealize you once they start to lose control. That’s why they vacillate between their false self and their true self, so you never get a sense of psychological safety or certainty about who your partner truly is.
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 interlocutor—slippery, 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.