person:nan goldin

The Met Will Turn Down Sackler Money Amid Fury Over the Opioid Crisis - The New York Times
▻https://www.nytimes.com/2019/05/15/arts/design/met-museum-sackler-opioids.html

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The Metropolitan Museum of Art said on Wednesday that it would stop accepting gifts from members of the Sackler family linked to the maker of OxyContin, severing ties between one of the world’s most prestigious museums and one of its most prolific philanthropic dynasties.

The decision was months in the making, and followed steps by other museums, including the Tate Modern in London and the Solomon R. Guggenheim Museum in New York, to distance themselves from the family behind Purdue Pharma. On Wednesday, the American Museum of Natural History said that it, too, had ceased taking Sackler donations.

The moves reflect the growing outrage over the role the Sacklers may have played in the opioid crisis, as well as an energized activist movement that is starting to force museums to reckon with where some of their money comes from.

“The museum takes a position of gratitude and respect to those who support us, but on occasion, we feel it’s necessary to step away from gifts that are not in the public interest, or in our institution’s interest,” said Daniel H. Weiss, the president of the Met. “That is what we’re doing here.”

“There really aren’t that many people who are giving to art and giving to museums, in fact it’s a very small club,” said Tom Eccles, the executive director of the Center for Curatorial Studies at Bard College. “So we have to be a little careful what we wish for here.”

There is also the difficult question of where to draw a line. What sort of behavior is inexcusable?

“We are not a partisan organization, we are not a political organization, so we don’t have a litmus test for whom we take gifts from based on policies or politics,” said Mr. Weiss of the Met. “If there are people who want to support us, for the most part we are delighted.”

“We would only not accept gifts from people if it in some way challenges or is counter to the core mission of the institution, in exceptional cases,” he added. “The OxyContin crisis in this country is a legitimate and full-blown crisis.”

Three brothers, Arthur, Mortimer and Raymond Sackler, bought a small company called Purdue Frederick in 1952 and transformed it into the pharmaceutical giant it is today. In 1996, Purdue Pharma put the opioid painkiller OxyContin on the market, fundamentally altering the company’s fortunes.

The family’s role in the marketing of OxyContin, and in the opioid crisis, has come under increased scrutiny in recent years. Documents submitted this year as part of litigation by the attorney general of Massachusetts allege that members of the Sackler family directed the company’s efforts to mislead the public about the dangers of the highly addictive drug. The company has denied the allegations and said it “neither created nor caused the opioid epidemic.”

Nan Goldin, a photographer who overcame an OxyContin addiction, has led demonstrations at institutions that receive Sackler money; in March 2018, she and her supporters dumped empty pill bottles in the Sackler Wing’s reflecting pool.

“We commend the Met for making the ethical, moral decision to refuse future funding from the Sacklers,” a group started by Ms. Goldin, Prescription Addiction Intervention Now, or PAIN, said in a statement. “Fourteen months after staging our first protest there, we’re gratified to know that our voices have been heard.”

The group also called for the removal of the Sackler name from buildings the family has bankrolled. Mr. Weiss said that the museum would not take the more drastic step of taking the family’s name off the wing, saying that it was not in a position to make permanent changes while litigation against the family was pending and information was still coming to light.

The Met also said that its board had voted to codify how the museum accepts named gifts, formalizing a longstanding practice of circulating those proposals through a chain of departments. The decision on the Sacklers, Mr. Weiss said, was made by the Met leadership in consultation with the board.

#Opioides #Sackler #Musées

La famille Sackler, maître des opioïdes et amie des arts
▻https://www.lemonde.fr/economie/article/2019/04/25/les-sackler-

L’OxyContin, médicament hautement addictif, a fait la fortune de cette famille qui préfère parler de son mécénat plutôt que de sa responsabilité dans la crise sanitaire aux Etats-Unis.

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La cuillère a le fond calciné, et son manche est retourné pour lui donner plus de stabilité. Comme celles utilisées par les toxicomanes qui font fondre leur drogue. Sauf que l’ustensile pèse… près de 360 kg. Le 22 juin 2018, il bloquait l’entrée du siège de Purdue Pharma, à Stamford (Connecticut). La firme, propriété de la famille Sackler, produit l’OxyContin, puissant antidouleur fabriqué à partir de morphine de synthèse.

Ce médicament a fait la fortune des Sackler, dont la richesse est estimée par l’agence Bloomberg à 13 milliards de dollars (11,6 milliards d’euros). Hautement addictif, il est surtout accusé d’avoir fait tomber dans la drogue des milliers d’Américains et d’être responsable de la crise des opioïdes qui frappe les Etats-Unis.
L’OxyContin, commercialisé depuis 1995, aurait fait tomber dans la drogue des milliers d’Américains
Depuis un an, l’artiste Domenic Esposito, 49 ans, mène une guérilla contre la famille Sackler avec sa cuillère. Il l’a de nouveau exposée le 5 avril à Washington, devant l’Agence américaine du médicament (FDA), à qui il est reproché d’avoir autorisé l’OxyContin. M. Esposito se bat pour son frère Danny, de dix-huit ans son cadet, qui a sombré dans la drogue au milieu des années 2000, en commençant par l’OxyContin, avant de se tourner vers l’héroïne.

« Il a bousillé douze années de sa vie », confie Domenic Esposito, qui nous reçoit à Westwood, dans son atelier, en face de sa maison perdue dans les forêts du Massachusetts. Sa famille veut croire à une rémission, mais la désillusion n’est jamais loin. « Ma mère m’a souvent appelé en pleurant après avoir trouvé les résidus dans une cuillère, raconte-t-il. Cette cuillère est le symbole du combat macabre de ma famille. »

Epidémie

Ancien gestionnaire de capitaux reconverti dans l’art, M. Esposito a décidé de passer à l’action quand il s’est aperçu que son frère n’était pas un cas isolé.
Le déclic s’est produit lors des journées de charité du diocèse de Boston, pendant le Carême de 2016. Catholique et bon orateur, il vante l’action du diocèse en faveur des victimes de la drogue. Et évoque son frère. Une fois son discours achevé, une dizaine de personnes viennent partager leur expérience. A chaque fois, le même scénario : une blessure banale mais nécessitant un antidouleur, et une ordonnance d’OxyContin. S’amorce alors l’engrenage de l’addiction avec, souvent, un basculement vers l’héroïne. Il s’agit bien d’une épidémie, provoquée par Purdue et les Sackler.
Pourquoi ferrailler avec une œuvre d’art ? Parce que c’est là une des failles du clan. Si le nom de Purdue est peu connu, celui de la famille Sackler est, depuis un demi-siècle, synonyme de mécénat artistique. Au Metro­politan Museum (Met) et au Musée Guggenheim de New York, à la National Portrait Gallery de Londres ou au Louvre, à Paris, avec l’« aile ­Sackler des antiquités orientales », leur patronyme est omniprésent.

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Puisque les Sackler s’abritent derrière les arts, les artistes veulent les faire périr par eux, comme le montre l’initiative de M. Esposito et comme le revendique la photographe américaine Nan Goldin, devenue dépendante à l’OxyContin après une opération. « Pour qu’ils nous écoutent, nous allons cibler leur philanthropie. Ils ont lavé leur argent maculé de sang grâce aux halls des musées et des uni­versités », accuse Mme Goldin, qui a photographié son propre calvaire.

« Un blizzard d’ordonnances »

En mars 2018, au Met, cinquante militants se sont allongés, feignant d’être morts, dans l’aile financée par les Sackler. En février 2019, au Musée Guggenheim, des activistes ont jeté de fausses ordonnances d’OxyContin, cruel rappel adressé à Richard Sackler, 74 ans, fils d’un des fondateurs et ex-PDG de Purdue, qui avait prédit « un blizzard d’ordonnances qui enterrerait la concurrence ».
L’étau se resserre sur le front judiciaire, avec 1 600 plaintes déposées et des poursuites pénales engagées par les parquets de Boston et de New York

Cela paie. En mars, le Guggenheim a fait savoir qu’il n’accepterait plus de dons de la famille, ­ tandis que Mortimer Sackler, ancien membre actif du conseil d’administration (CA) de Purdue et cousin de Richard, a dû se retirer du CA. A Londres, la Tate Gallery a fait de même, et la National Portrait Gallery a décliné une promesse de don de 1 million de livres (1,15 million d’euros).
Parallèlement, l’étau se resserre sur le front judiciaire, avec 1 600 plaintes déposées et des poursuites pénales engagées par les parquets de Boston et de New York. Au point que la société pourrait déposer le bilan. Prolixes sur leurs activités philanthropiques et artistiques, les Sackler sont mutiques sur leur entreprise.

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L’histoire débute avec les trois frères Sackler, fils d’immigrants juifs de Galicie et de Pologne nés à Brooklyn. Tous trois médecins psychiatres, ils se lancent dans la pharmacie, en rachetant une petite entreprise de Greenwich Village, qui vend des produits comme la Betadine ou fait le marketing du Valium. Ils conquièrent des patients et, surtout, des médecins prescripteurs (en 1997, le patriarche, Arthur Sackler, a été distingué à titre posthume pour ses talents publicitaires).

« Méthodes agressives »

C’est cette recette qui, à partir de 1995, permet d’écouler l’OxyContin. A une époque où l’on cherche à apaiser les douleurs insupportables des malades du cancer, le produit apparaît comme une solution magique : il n’est pas addictif et soulage le patient pendant douze heures. Cela représente un formidable argument publicitaire, notamment parce qu’il se diffuse en continu.
Cependant, au lieu d’être réservé aux patients en soins palliatifs, il est distribué comme de l’aspirine, à coups d’intéressement (pour les vendeurs) et de séminaires dans des palaces de Floride (pour les médecins). Les dosages très élevés créent une accoutumance mortifère. Les précieuses pilules, qui ont des qualités ­similaires à celles de l’héroïne lorsqu’elles sont brûlées, attirent l’attention des narcotrafiquants qui organisent un commerce de ­ contrebande très lucratif, avec la complicité de médecins véreux.

Quand il apparaît que le produit est addictif, la firme choisit de ­blâmer les consommateurs. Dès 2003, l’Agence fédérale de ­contrôle des stupéfiants (DEA) l’accuse d’avoir, par ses « méthodes agressives », favorisé l’abus d’OxyContin et minimisé « les risques associés au médicament », raconte The New Yorker dans une enquête-fleuve publiée en octobre 2017 et intitulée « Un empire de douleur », qui estime à 35 milliards de dollars le chiffre d’affaires généré par le médicament.
En 2007, Purdue accepte de verser 600 millions de dollars d’amende pour avoir prétendu que son médicament était moins addictif que ceux de ses concurrents. Trois ans plus tard, la firme élabore une nouvelle version de son produit, qui ne peut pas être transformée comme l’héroïne.

Rumeurs de faillite

Mais The New Yorker note qu’il s’agissait aussi de contrer l’arrivée de médicaments génériques, l’OxyContin devant tomber dans le domaine public en 2013. Et que l’effet paradoxal de l’affaire a été d’amplifier le basculement des drogués vers l’héroïne. « C’est un terrible paradoxe de l’histoire de l’OxyContin : la formule originelle a créé une génération accro aux pilules. Et sa reformulation (…) a créé une génération accro à l’héroïne. »
L’Oklahoma, particulièrement touché, est parvenu fin mars à une transaction de 270 millions de dollars. Purdue préfère payer pour éviter un procès public et la publication de documents internes potentiellement désastreux. Des rumeurs de faillite courent, et certains Etats pourraient être tentés de conclure des transactions rapides plutôt que de ne rien obtenir.
Pour d’autres, l’argent ne suffit pas. Il faut poursuivre les vrais coupables, et en premier lieu les Sackler. Les trois frères fondateurs sont morts, mais la famille, qui a touché 4,3 milliards de dollars de dividendes entre 2008 et 2016, dirige de facto la compagnie. Celle-ci ne s’exprime que par des communiqués laconiques, se disant soucieuse de « contribuer à lutter contre cette crise de santé publique complexe ».

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Purdue répète qu’elle ne représente que 2 % des ventes d’opioïdes aux Etats-Unis, et ne peut être tenue, à elle seule, pour respon­sable de ladite crise. La procureure générale du Massachusetts, Maura Healey, ne s’en satisfait pas et a mis en examen huit membres de la famille impliqués dans l’entreprise. Elle s’appuie, entre autres, sur un courriel du patron de Purdue, Craig Landau, qui, selon la plainte, énonçait une évidence : « La famille dirigeait l’entreprise pharmaceutique mondiale Sackler et le conseil de surveillance jouait le rôle de PDG de facto. »

« Les Sackler méritent la peine capitale »

Les héritiers, qui estiment n’y être pour rien, se désolidarisent. C’est le cas des descendants du frère aîné et grand mécène Arthur, disparu en 1987 et dont les parts ont été récupérées non par ses enfants mais par ses frères. « Le rôle de Purdue [dans la crise des opioïdes] m’est odieux », a ainsi déclaré la fille d’Arthur, Elizabeth Sackler. Fondatrice d’un centre d’art féministe à Brooklyn, elle a aussi salué, dans le New York Times, « le courage de Nan Goldin ».
Ses détracteurs ne l’entendent pas ainsi : ils estiment que ce sont les méthodes de marketing adoptées à partir des années 1950 par Arthur qui ont fait merveille pour l’OxyContin – méthodes auxquelles Purdue n’a renoncé que… début 2018. « Leur nom est terni pour toujours (…). Aujourd’hui, il y a des gens qui estiment que les Sackler méritent la peine capitale. Ils sont responsables de milliers de morts », accuse Domenic Esposito.
Dans une manœuvre de sauve-qui-peut, les membres de la famille se retirent tous, depuis deux ans, du conseil d’administration de Purdue. Sans doute trop tard pour échapper aux poursuites de Mme Healey, à qui M. Esposito a offert sa cuillère militante.

Sackler family money is now unwelcome at three major museums. Will others follow? - The Washington Post
▻https://www.washingtonpost.com/entertainment/museums/two-major-museums-are-turning-down-sackler-donations-will-others-follow/2019/03/22/20aa6368-4cb9-11e9-9663-00ac73f49662_story.html

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By Philip Kennicott
Art and architecture critic
March 23

When the National Portrait Gallery in London announced Tuesday that it was forgoing a grant from the Sackler family, observers could be forgiven for a certain degree of skepticism about the decision’s impact on the art world. The Sacklers, owners of the pharmaceutical behemoth Purdue Pharma, which makes OxyContin, had promised $1.3 million to support a public-engagement project. The money, no doubt, was welcome, but the amount involved was a relative pittance.

Now another British institution and a major U.S. museum, the Guggenheim, have said no to Sackler money, which has become synonymous with a deadly and addictive drug that boosted the family fortune by billions of dollars and caused immeasurable suffering. The Tate art galleries, which include the Tate Modern and the Tate Britain in London as well as outposts in Liverpool and Cornwall, announced Thursday that it will also not accept money from the family.

The Sacklers are mired in legal action, investigations and looming congressional inquiries about their role in marketing a drug blamed for a significant early role in an epidemic of overdose deaths that has claimed the lives of hundreds of thousands of Americans since 1997.

Is this a trend? These moves may affect immediate plans but won’t put much of a dent in the museums’ budgets. The impact on the Sackler family’s reputation, however, will force American arts institutions to pay attention.

The Sackler family, which includes branches with differing levels of culpability and involvement with the issue, has a long history of donating to cultural organizations. Arthur M. Sackler, who gave millions of dollars’ worth of art and $4 million for the opening of the Smithsonian’s Sackler Gallery in 1987, died long before the OxyContin scandal began. Members of the family involved with OxyContin vigorously contest the claims that Perdue Pharma was unscrupulous in the promotion of a drug, though company executives pleaded guilty to violations involving OxyContin in 2007 and the company paid more than $600 million in fines.

A million here or there is one thing. Having a whole building named for a family with blood on its hands is another, and seeking yet more money for new projects will become even more problematic. And every institution that bears the Sackler family name, including New York’s Metropolitan Museum of Art (which has a Sackler wing) and the University Art Museum at Princeton (which has a Sackler gallery) is now faced with the distasteful proposition of forever advertising the wealth of a family that is deeply implicated in suffering, death and social anomie.

Will any major U.S. institution that has benefited from Sackler largesse remove the family’s name?

The National Portrait Gallery in London. (Daniel Leal-Olivas/AFP/Getty Images)
The usual arguments against this are stretched to the breaking point. Like arguments about Koch family money, which has benefited cultural institutions but is, to many, inextricably linked to global warming and the impending collapse of the Anthropocene, the issues at stake seem, at first, to be consistency and pragmatism. The pragmatic argument is this: Cultural organizations need the money, and if they don’t take it, that money will go somewhere else. And this leads quickly to the argument from consistency. Almost all of our major cultural organizations were built up with money derived from family fortunes that are tainted — by the exploitation of workers, slavery and the lasting impacts of slavery, the depredations of colonialism and the destruction of the environment. So why should contemporary arts and cultural groups be required to set themselves a higher, or more puritanical, standard when it comes to corrupt money? And if consistency matters, should we now be parsing the morality of every dollar that built every opera house and museum a century ago?

Both arguments are cynical. Arts organizations that engage in moral money laundering cannot make a straight-faced claim to a higher moral purpose when they seek other kinds of funding, including donations and membership dollars from the general public and support from government and foundations. But the consistency argument — that the whole system is historically wrapped up in hypocrisy about money — needs particular reconsideration in the age of rapid information flows, which create sudden, digital moral crises and epiphanies.

[The Sacklers have donated millions to museums. But their connection to the opioid crisis is threatening that legacy.]

Moral (or social) hazard is a funny thing. For as long as cultural institutions are in the money-laundering business, companies such as Perdue Pharma will have an incentive to take greater risks. If the taint of public health disaster can be washed away, then other companies may choose to put profits over public safety. But this kind of hazard isn’t a finely calibrated tool. It involves a lot of chance and inconsistency in how it works. That has only increased in the age of viral Twitter campaigns and rapid conflagrations of public anger fueled by new social media tools.

Why is it that the Sackler family is in the crosshairs and not any of the other myriad wealthy people whose money was made through products that are killing us? Because it is. And that seeming randomness is built into the way we now police our billionaires. It seems haphazard, and sometimes unfair, and inefficient. Are there worse malefactors scrubbing their toxic reputations with a new hospital wing or kids literacy program? Surely. Maybe they will find their money unwelcome at some point in the future, and maybe not. The thing that matters is that the risk is there.

[Now would be a good time for museums to think about our gun plague]

The Arthur M. Sackler Gallery of Art in Washington. (Bill O’Leary/The Washington Post)
Much of the Sackler family money was made off a drug that deadens the mind and reduces the human capacity for thought and feeling. There is a nice alignment between that fact and what may now, finally, be the beginnings of a new distaste about using Sackler money to promote art and cultural endeavors, which must always increase our capacities for engagement with the world. It is immensely satisfying that the artist Nan Goldin, whose work has explored the misery of drug culture, is playing a leading role in the emerging resistance to Sackler family money. (Goldin, who was considering a retrospective of her work at the National Portrait Gallery, said to the Observer: “I have told them I would not do it if they take the Sackler money.”)

More artists should take a lead role in these conversations, to the point of usurping the usual prerogatives of boards and executive committees and ethical advisory groups to make decisions about corrupt money.

[‘Shame on Sackler’: Anti-opioid activists call out late Smithsonian donor at his namesake museum]

Ultimately, it is unlikely that any arts organization will manage to find a consistent policy or somehow finesse the challenge of saying all that money we accepted from gilded-age plutocrats a century ago is now clean. But we may think twice about taking money from people who are killing our planet and our people today. What matters is that sometimes lightning strikes, and there is hell to pay, and suddenly a name is blackened forever. That kind of justice may be terrifying and swift and inconsistent, but it sends a blunt message: When the world finally learns that what you have done is loathsome, it may not be possible to undo the damage through the miraculous scrubbing power of cultural detergent.

#Opioides #Sackler #Musées #Shame

The Opioid that Made a Fortune for Its Maker — and for Its Prescribers - The New York Times
▻https://www.nytimes.com/interactive/2018/05/02/magazine/100000005878055.app.html

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For Insys, Chun was just the right kind of doctor to pursue. In the late 1990s, sales of prescription opioids began a steep climb. But by the time Subsys came to market in 2012, mounting regulatory scrutiny and changing medical opinion were thinning the ranks of prolific opioid prescribers. Chun was one of the holdouts, a true believer in treating pain with narcotics. He operated a busy practice, and 95 percent of the Medicare patients he saw in 2015 had at least one opioid script filled. Chun was also a top prescriber of a small class of painkillers whose active ingredient is fentanyl, which is 50 to 100 times as powerful as morphine. Burlakoff’s product was a new entry to that class. On a “target list,” derived from industry data that circulated internally at Insys, Chun was placed at No. 3. The word inside the company for a doctor like Chun was a “whale.”

In the few months since Subsys was introduced, demand was not meeting expectations. Some of the sales staff had already been fired. If Burlakoff and Krane could persuade Chun to become a Subsys loyalist, it would be a coup for them and for the entire company. The drug was so expensive that a single clinic, led by a motivated doctor, could generate millions of dollars in revenue.

Speaker programs are a widely used marketing tool in the pharmaceutical business. Drug makers enlist doctors to give paid talks about the benefits of a product to other potential prescribers, at a clinic or over dinner in a private room at a restaurant. But Krane and some fellow rookie reps were already getting a clear message from Burlakoff, she said, that his idea of a speaker program was something else, and they were concerned: It sounded a lot like a bribery scheme.

But the new reps were right to be worried. The Insys speaker program was central to Insys’ rapid rise as a Wall Street darling, and it was also central to the onslaught of legal troubles that now surround the company. Most notable, seven former top executives, including Burlakoff and the billionaire founder of Insys, John Kapoor, now await trial on racketeering charges in federal court in Boston. The company itself, remarkably, is still operating.

The reporting for this article involved interviews with, among other sources, seven former Insys employees, among them sales managers, sales reps and an insurance-authorization employee, some of whom have testified before a grand jury about what they witnessed. This account also draws on filings from a galaxy of Insys-related litigation: civil suits filed by state attorneys general, whistle-blower and shareholder suits and federal criminal cases. Some are pending, while others have led to settlements, plea deals and guilty verdicts.

The opioid crisis, now the deadliest drug epidemic in American history, has evolved significantly over the course of the last two decades. What began as a sharp rise in prescription-drug overdoses has been eclipsed by a terrifying spike in deaths driven primarily by illicitly manufactured synthetic opioids and heroin, with overall opioid deaths climbing to 42,249 in 2016 from 33,091 in 2015. But prescription drugs and the marketing programs that fuel their sales remain an important contributor to the larger crisis. Heroin accounted for roughly 15,000 of the opioid deaths in 2016, for instance, but as many as four out of five heroin users started out by misusing prescription opioids.

By the time Subsys arrived in 2012, the pharmaceutical industry had been battling authorities for years over its role in promoting the spread of addictive painkillers. The authorities were trying to confine opioids to a select population of pain patients who desperately needed them, but manufacturers were pushing legal boundaries — sometimes to the breaking point — to get their products out to a wider market.

Even as legal penalties accrued, the industry thrived. In 2007, three senior executives of Purdue Pharma pleaded guilty in connection with a marketing effort that relied on misrepresenting the dangers of OxyContin, and the company agreed to pay a $600 million settlement. But Purdue continued booking more than $1 billion in annual sales on the drug. In 2008, Cephalon likewise entered a criminal plea and agreed to pay $425 million for promoting an opioid called Actiq and two other drugs “off-label” — that is, for unapproved uses. That did not stop Cephalon from being acquired three years later, for $6.8 billion.

Subsys and Actiq belong to a class of fentanyl products called TIRF drugs. They are approved exclusively for the treatment of “breakthrough” cancer pain — flares of pain that break through the effects of the longer-acting opioids the cancer patient is already taking around the clock. TIRFs are niche products, but the niche can be lucrative because the drugs command such a high price. A single patient can produce six figures of revenue.

Fentanyl is extremely powerful — illicitly manufactured variations, often spiked into heroin or pressed into counterfeit pills, have become the leading killers in the opioid crisis — and regulators have made special efforts to restrict prescription fentanyl products. In 2008, for instance, the F.D.A. rebuffed Cephalon’s application to expand the approved use for a TIRF called Fentora; in the company’s clinical trials, the subjects who did not have cancer demonstrated much more addictive behavior and propensity to substance abuse, which are “rarely seen in clinical trials,” F.D.A. officials concluded. An F.D.A. advisory committee reported that, during the trials, some of the Fentora was stolen. The agency later developed a special protocol for all TIRF drugs that required practitioners to undergo online training and certify that they understood the narrow approved use and the risks.

Despite these government efforts, TIRF drugs were being widely prescribed to patients without cancer. Pain doctors, not oncologists, were the dominant players. This was common knowledge in the industry. Although it is illegal for a manufacturer to promote drugs for off-label use, it is perfectly legal for doctors to prescribe any drug off-label, on their own judgment. This allows drug makers like Insys to use a narrow F.D.A. approval as a “crowbar,” as a former employee put it, to reach a much broader group of people.

That points to a major vulnerability in policing the opioid crisis: Doctors have a great deal of power. The F.D.A. regulates drug makers but not practitioners, who enjoy a wide latitude in prescribing that pharmaceutical companies can easily exploit. A respected doctor who advocates eloquently for wider prescribing can quickly become a “key opinion leader”; invited out on the lucrative lecture circuit. And any doctor who exercises a free hand with opioids can attract a flood of pain patients and income. Fellow doctors rarely blow the whistle, and some state medical boards exercise timid oversight, allowing unethical doctors to continue to operate. An assistant district attorney coping with opioids in upstate New York told me that it’s easy to identify a pill-mill doctor, but “it can take five years to get to that guy.” In the meantime, drug manufacturers are still seeing revenue, and that doctor is still seeing patients, one after another, day after day.

Kapoor believed that he had the best product in its class. All the TIRF drugs — for transmucosal immediate-release fentanyl — deliver fentanyl through the mucous membranes lining the mouth or nose, but the specific method differs from product to product. Actiq, the first TIRF drug, is a lozenge on a stick. Cephalon’s follow-up, Fentora — the branded market leader when Subsys arrived — is a tablet meant to be held in the cheek as it dissolves. Subsys is a spray that the patient applies under the tongue. Spraying a fine mist at the permeable mouth floor makes for a rapid onset of action, trials showed.

Once the F.D.A. gave final approval to Subsys in early 2012, the fate of Insys Therapeutics rested on selling it in the field. The industry still relies heavily on the old-fashioned way of making sales; drug manufacturers blanket the country with representatives who call on prescribers face to face, often coming to develop personal relationships with them over time.

The speaker events themselves were often a sham, as top prescribers and reps have admitted in court. Frequently, they consisted of a nice dinner with the sales rep and perhaps the doctor’s support staff and friends, but no other licensed prescriber in attendance to learn about the drug. One doctor did cocaine in the bathroom of a New York City restaurant at his own event, according to a federal indictment. Some prescribers were paid four figures to “speak” to an audience of zero.

One star rep in Florida, later promoted to upper management, told another rep that when she went in search of potential speakers, she didn’t restrict herself to the top names, because, after all, any doctor can write scripts, and “the company does not give a [expletive] where they come from.” (Some dentists and podiatrists prescribed Subsys.) She looked for people, she said, “that are just going through divorce, or doctors opening up a new clinic, doctors who are procedure-heavy. All those guys are money hungry.” If you float the idea of becoming a paid speaker “and there is a light in their eyes that goes off, you know that’s your guy,” she said. (These remarks, recorded by the rep on the other end of the line, emerged in a later investigation.)

As a result of Insys’s approach to targeting doctors, its potent opioid was prescribed to patients it was never approved to treat — not occasionally, but tens of thousands of times. It is impossible to determine how many Subsys patients, under Kapoor, actually suffered from breakthrough cancer pain, but most estimates in court filings have put the number at roughly 20 percent. According to Iqvia data through September 2016, only 4 percent of all Subsys prescriptions were written by oncologists.

Insys became the year’s best-performing initial public offering, on a gain of over 400 percent. That December, the company disclosed that it had received a subpoena from the Office of the Inspector General at Health and Human Services, an ominous sign. But a CNBC interviewer made no mention of it when he interviewed Babich a few weeks later. Instead he said, “Tell us what it is about Insys that has investors so excited.”

In 2014, the doctors each averaged one prescription for a controlled substance roughly every four minutes, figuring on a 40-hour week. A typical pill mill makes its money from patients paying in cash for their appointments, but Ruan and Couch had a different model: A majority of their scripts were filled at a pharmacy adjacent to their clinic called C&R — for Couch and Ruan — where they took home most of the profits. The pharmacy sold more than $570,000 of Subsys in a single month, according to Perhacs’s criminal plea. Together the two men amassed a collection of 23 luxury cars.

Over dinner, according to the Boston indictment, Kapoor and Babich struck a remarkable agreement with the pharmacists and the doctors, who were operating a clinic rife with opioid addiction among the staff: Insys would ship Subsys directly to C&R Pharmacy. An arrangement like this is “highly unusual” and a “red flag,” according to testimony from a D.E.A. investigator in a related trial. As part of the terms of the deal, the pharmacy would make more money on selling the drug, with no distributor in the loop. And there would be another anticipated benefit for all involved: Everyone could sell more Subsys without triggering an alert to the D.E.A.

The local medical community felt the impact of the raid. Because refills are generally not allowed on controlled substances, patients typically visited the clinic every month. For days, dozens of them lined up outside in the morning, fruitlessly trying to get prescriptions from the remaining staff or at least retrieve their medical records to take elsewhere. But other providers were either booked up or would not take these patients. “Nobody was willing to give the amount of drugs they were on,” a nurse in the city said. Melissa Costello, who heads the emergency room at Mobile Infirmary, said her staff saw a surge of patients from the clinic in the ensuing weeks, at least a hundred, who were going through agonizing withdrawal.

Two months after the raid in Mobile, Insys’ stock reached an all-time high.

Insys itself is still producing Subsys, though sales have fallen considerably. (Overall demand for TIRFs has declined industrywide.) The company is now marketing what it calls the “first and only F.D.A.-approved liquid dronabinol,” a synthetic cannabinoid, and is developing several other new drugs. Some analysts like the look of the company’s pipeline of new drugs and rate the stock a “buy.” In a statement, the company said its new management team consists of “responsible and ethical business leaders” committed to effective compliance. Most of its more than 300 employees are new to the company since 2015, and its sales force is focused on physicians “whose prescribing patterns support our products’ approved indications,” the company said. Insys has ended its speaker program for Subsys.

#Opioides #Pharmacie #Bande_de_salopards

Our Incomplete List of Cultural Institutions and Initiatives Funded by the Sackler Family
▻https://hyperallergic.com/419850/our-incomplete-list-of-cultural-institutions-and-initiatives-funded-b

https://hyperallergic.com/wp-content/uploads/2018/01/serpentine-sackler-1000.jpg

As the opioid epidemic continues — according to a Quartz headline published earlier this month “US millennials were almost 20% more likely to die in 2016 than 2014” — everyone from politicians to everyday citizens is trying to not only help those already addicted, but to also hold accountable the pharmaceutical companies that precipitated the rise of dangerously addictive opioid prescriptions.

In this month’s Artforum (which is still co-owned by Knight Landesman), photographer Nan Goldin wrote a heartbreaking account of how she got hooked on OxyContin herself and barely survived. As many others have already done, Goldin noted that the Sackler family, whose name we see on so many museum, library, and hospital walls, is the one responsible. “They have washed their blood money through the halls of museums and universities around the world,” she wrote. “We demand that the Sacklers and Purdue Pharma use their fortune to fund addiction treatment and education. There is no time to waste.”

The Sacklers are one of the wealthiest families in the world (more than the Rockefellers or Mellons, according to an October article in The New Yorker), at least partially due to the success of their pharmaceutical company, Purdue Pharma, and their deliberate downplaying of the addictiveness of OxyContin. Although Purdue Pharma pleaded guilty to felony charges in 2007 for misleading doctors, the Sackler family has never been held personally responsible.

While Goldin’s #shameonsackler movement seeks to force the Sacklers to admit accountability, we’ve created a guide to many of the arts and cultural organizations that receive funding from the family. We recognize that this is an incomplete list; we will keep adding to it in the coming days.

#Opioides #Opioids

Opioid Protest at Met Museum Targets Donors Connected to OxyContin - The New York Times
▻https://www.nytimes.com/2018/03/10/us/met-museum-sackler-protest.html

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Anti-opioid activists unfurled banners and scattered pill bottles on Saturday inside the Sackler Wing of the Metropolitan Museum of Art in New York, which is named for a family connected to the powerful painkilling drug OxyContin.

The protest, which was organized by a group started by the celebrated photographer Nan Goldin, started just after 4 p.m., when several dozen people converged at the Temple of Dendur inside the wing.

The wing is named after Arthur, Mortimer and Raymond Sackler, brothers who in the 1970s donated $3.5 million toward its construction. Their scientific and marketing skills also transformed a small business into what became Purdue Pharma, the company that developed OxyContin, which has been widely prescribed and abused. The drug is among the most common painkillers involved in prescription opioid overdose deaths, which have become an unrelenting crisis in the United States.

On Saturday the protesters called for cultural institutions to reject money from the Sackler family. They also demanded, among other things, that Purdue, which has been accused of using deceptive and aggressive tactics to market OxyContin, fund addiction treatment.

#Opioides #Sackler #Nan_Goldin

LesInrocks - Addiction aux opioïdes : la photographe Nan Goldin s’attaque à l’industrie pharmaceutique américaine
▻http://www.lesinrocks.com/2018/01/09/style/addiction-aux-opioides-la-photographe-nan-goldin-sattaque-lindustrie-pha

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Elle a photographié toutes les addictions dans les années 80 en s’immisçant dans l’intimité de ses amis. Aujourd’hui, après plusieurs années de lutte contre les opioïdes, Nan Goldin s’exprime en texte et en images contre l’industrie pharmaceutique qui délivre sciemment ces drogues.

Photographe phare des années 80, Nan Goldin a mis en images toutes les souffrances de sa génération : les drogues, le sida, l’amour, autant de sujets qui tenaient au corps de l’époque et ont marqué au fer rouge les esprits des jeunes de ces années-là. Toutefois, les démons toxiques n’ont pas épargné la photographe, qui partage aujourd’hui dans les pages d’ArtForum son combat de vingt ans contre les opioïdes, accompagné d’une série photographique. Ces puissants anti-douleur connus sous le nom d’OxyContin lui ont été prescrits à Berlin après une opération, raconte-elle dans son essai, aussi publié sur son compte Instagram.

L’addiction était née “en une nuit”, explique-t-elle. “C’était la drogue la plus propre que j’ai connue. Au début, 40 mg étaient trop forts, mais au fil de l’habitude aucune dose n’était suffisante. Je tenais les chose sous contrôle dans un premier temps. Puis c’est devenu de plus en plus le bordel. J’ai travaillé dans le médical pour obtenir des prescriptions.”

L’industrie pharmaceutique dans le radar

Outre les déboires de santé, de finances et dans sa vie personnelle, c’est la perversité de l’industrie pharmaceutique et notamment de la famille Sackler que Nan Goldin tacle dans son texte. Son travail photographique, accompagné de l’article relayé par ArtForum, porte le nom de Sackler/PAIN. “PAIN” signifie “douleur” en anglais, mais s’avère être également l’acronyme de Prescription Addiction Intervention Now, soit “intervention contre l’addiction aux prescriptions maintenant”, un groupe contre l’addiction à l’OxyContin, qui s’obtient uniquement sur ordonnance... ou par des circuits aléatoires et douteux que Nan Goldin explique avoir employés pour se procurer ses doses à la fin de son addiction.

Pour venir à bout de ces drogues prescrites comme médicaments, elle s’attaque à leur fabricant, la famille Sackler qui détient Perdue Pharma, l’entreprise qui a fait fortune grâce aux opioïdes. Pour appuyer son appel à l’aide, la photographe annonce des chiffres à glacer le sang : aux Etats-Unis en 2015, on a recensé 33 000 morts par overdose d’opioïdes dont la moitié étaient des patients avec ordonnance. De même, toujours selon elle, 80 % des addicts à l’héroïne ont commencé leur addiction par une prescription d’opioïde.

Sackler/PAIN, se battre

Une Nan Goldin visiblement larguée, le regard dans le vide qui tente de regarder l’objectif. La première photographie de la série Sackler/PAIN parle à celui qui la regarde, prévient et démontre par l’image des dommages que causent les opioïdes. Derrière ce texte et cette image, la volonté d’une bataille contre la famille Sackler – par ailleurs de grands mécène de l’art aux Etats-Unis – pour faire cesser une épidémie mortelle que Goldin compare à l’hécatombe causée par le VIH : “La plupart de ma communauté est morte du VIH. Je ne supporterai pas de voir une autre génération disparaître. Les Sackler ont fait leur fortune en promouvant l’addiction. (…) Ils ont fait de la publicité et distribué leur médicament en pleine connaissance de ses dangers. Les Sackler et leur entreprise privée, Purdue Pharma, ont construit un empire sur la vie de milliers de gens.”

A ce jour, la famille Sackler n’a toujours pas communiqué à propos de l’action de Nan Goldin ou de ses groupes PAIN. Les images à retrouver ici.

#sackler #Opioides

COOKIE MUELLER « FEMALE TROUBLE »
▻https://laspirale.org/photo-534-cookie-mueller- female-trouble.html

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Muse de John Waters et de Nan Goldin, cette reine de l’underground fut décrite par le cinéaste comme « un écrivain, une mère, une hors-la-loi, une actrice, une styliste, une go-go danseuse, une sorcière-guérisseuse, une harpie des arts, et par dessus tout, une déesse ».

Native de Baltimore, une ville ruinée, minée par les conflits raciaux, la drogue et la criminalité, #Cookie_Mueller a croisé sur son parcours chaotique Jim Morrisson, Jimi Hendrix, la Manson Family, Anton LaVey, Basquiat, Keith Haring, les Ramones, Klaus Nomi, Patti Smith, Blondie, Sonic Youth et le photographe Robert Mapplethorpe. Ses écrits cultes, enfin traduits en français, sont publiés chez Finitude, l’occasion de revenir sur la légende de cette icône méconnue.

Portraits de Cookie Mueller par Nan Goldin, Robert Mapplethorpe, John Waters, Lawrence Irvine, Anthony Scibelli, Don Herron.

#laspirale

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Dreamland news is a site devoted to the life and work of filmmaker #John_Waters.
Here you’ll find the latest news about Waters personal appearances, films, books, DVDs, his vigilant Fans, and a tribute to the one and only Divine.
▻http://dreamlandnews.com

Marysia Lewandowska
12.07.2017 (79’ 41’’)
▻http://rwm.macba.cat/en/sonia/-marysia-lewandowska/capsula

▻http://rwm.macba.cat/uploads/downloader.php?fichero=/uploads/songs/sonia243-marysia-lewandowska.mp3

The Women’s Audio Archive is a collection of recordings of private conversations, seminars, talks, conferences, and public events that Polish-born, London based artist Marysia Lewandowska carefully compiled from 1985 to 1990. Over 200 hours of audio that began as a fictitious archive that provided an interface and a cover for approaching key female figures in the arts and talking to them at length. The ideas and concerns of the second wave of feminism run through these mostly informal recordings, underpinned by Marysia’s intuition and her desire “to write that history with them, and to find myself in the present.”

In 2009, Lewandowska was invited by Maria Lind, Director of the Centre for Curatorial Studies at the time, to digitize the material and work with the collection in an effort of making it available online and decided to turn this private collection into an online public archive under a Creative Commons license. The process includes documenting the negotiations involved in bringing about this change of status, twenty years later.

SON(I)A talks to Marysia Lewandowska about the Women’s Audio Archive, about the crucial need to generate counter-narratives in totalitarian regimes, about networking before networks, about the boundaries between the private and the public, the negotiations generated by the shift from one sphere to another, the responsibilities of the archive, and the potential to generate conversation through art.

This podcast includes fragments from the Women’s Audio Archive and the voices of (in order of appearance): Marysia Lewandowska, Nourbese Philip, Nan Goldin, Nancy Spero, Allan Kaprow, Jo Spence, Lynne Tillman, Donald Judd, Maureen O. Paley, Susan Hiller, Lynne Tillman, Judy Chicago. The complete recordings are available at Women’s Audio Archive.

Timeline
03:10 Marysia Lewandowska: A good moment to reflect on the Women’s Audio Archive.
03:26 M. Nourbese Philip: the loss of the original tongue, in search of a missing text.
07:37 Marysia Lewandowska: Setting up a mode of working to be in control and to understand the culture around.
09:10 Nan Goldin and Marysia Lewandowska: The desire for conversation.
12:30 Marysia Lewandowska: From public recordings to private conversations
14:10 Judy Chicago: The way women communicate.
15:07 Marysia Lewandowska: A conversation can’t be scripted.
16:00 Allan Kaprow: Post-68.
18:35 Marysia Lewandowska: Thinking of self-archiving, keeping a record of what happens.
21:36 Jo Spence: A split subjectivity.
25:10 Marysia Lewandowska: Developing a voice.
29:15 Lynne Tillman: Chit-chatting about the menu.
29:45 Marysia Lewandowska: The previous experience in Poland, clubs, discussions, amateur films and other strategies to survive.
36:01 Marysia Lewandowska: Making it public and the question of access.
38:08 Donald Judd: The challenge of making things permanent
40:09 Marysia Lewandowska: A new structure for an archive and the negotiation process
51:19 Maureen O. Paley: Women have led, women have fought
52:40 Marysia Lewandowska: Important conversations.
53:40 Susan Hiller and Marysia Lewandowska: Saying the one thing you want to say.
56:40 Marysia Lewandowska: The need for the archive to be intact.
58:52 Susan Hiller: I believe in reciprocity.
01:01:24 Marysia Lewandowska: Self-instituting by giving it a name.
01:02:35 Judy Chicago: Being lady-like.
01:03:13 Marysia Lewandowska: Many of the women were feminists.
01:04:53 Nancy Spero: My vulnerability through the language of Artaud.
01:08:49 Marysia Lewandowska: A network before email, before digitization and before the internet.
01:11:25 Judy Chicago: Discrimination.
01:12:44 Marysia Lewandowska: Bad recordings.
01:13:13 Judy Chicago
01:14:35 Marysia Lewandowska: How the Museum gets distributed, artworks starting a conversation.
01:16:57 An unsuspected archival finding to end this conversation.

À voir en #Europe : opéra chaotique, #Hockney graveur et Nan Goldin
▻http://fr.myeurop.info/2014/02/11/sortir-agenda-opera-chaotique-hockney-saxo-et-nan-goldin-13125

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Camille Guillot Francesca Spinelli Effy Tselikas Marie-Line Darcy Ariel Dumont Tristan de Bourbon Benjamin Leclercq (...)

#Musiques #Expos #Belgique #Grèce #Italie #Portugal #Royaume-Uni #Turquie #Agenda #Bruxelles #ciné #culture #expo #Festival #Istanbul #lisbonne #Londres #saxophone #sortir