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Sackler Courtyard, V and A museum, London. 2018
A number of recent news articles, including reports in Esquire and The New Yorker, have documented the enormous philanthropic reach of the Sackler family, whose estimated $13 billion fortune has been driven in large part by sales of the prescription painkiller OxyContin, linked to the opioid addiction epidemic.
As an ethical debate swirls around whether artistic institutions and universities should accept philanthropic donations tied to a public health crisis, little attention has been paid to the large sums of money the Sacklers have donated to scientific organizations that have helped influence how painkillers like OxyContin have been prescribed and regulated.
The prestigious National Academies of Sciences, Engineering, and Medicine has to date received at least $14 million from Raymond and Beverly Sackler and their foundation, according to its 2016 annual financial report.
This figure, confirmed by the Academies, makes the Sacklers among the largest private-sector donors to this prestigious, private scientific body, which the U.S. Food and Drug Administration calls on for independent scientific advice on the public-health crisis related to opioid addiction.
In a 2008 press release announcing a “substantial gift” from the Sacklers, the National Academies noted that Raymond Sackler (who died in July) was a founder and board member at Purdue Pharma—the firm that produces OxyContin.
Over the years, the Academies has also received millions of dollars from Pfizer, Johnson & Johnson, and Novartis—other pharmaceutical companies that have been involved in manufacturing or distributing opioid drugs. The revelation of these financial ties raises new conflict-of-interest questions around the Academies’ work on opioids, which has long been criticized as being too closely linked to pharmaceutical interests.
A spokesperson from the Academies refused to comment on how the organization managed these and other conflicts of interest reported here. The Raymond and Beverly Sackler Foundation also did not provide responses to questions about their giving to the Academies.
“Of course, taking money from pharmaceutical companies including opioid manufacturers is going to have some effect. Why would the companies give the money?” Dr. Sidney Wolfe, senior advisor to Public Citizen, a nonprofit public-interest group founded by Ralph Nader, told The Progressive. Wolfe notes that the Academies have a long history of financial conflicts of interest related to its private sector ties, which are investigated in the 1975 book-length study The Brain Bank of America (published by the then-Center for Responsive Law, also founded by Nader).
The study concluded that more than 100 million Americans—about 40 percent of the nation’s adult population—suffered from chronic pain. Critics warned that this finding would be used to justify continued reliance on opioid painkillers.
In recent years, the Academies’ scientific studies on opioids have been publicly criticized because the authors—outside experts who serve on a pro-bono basis—have had undisclosed ties to prescription opioid producers and distributors. Nine of the nineteen scientists recruited to author a 2011 National Academies study on opioid painkillers, funded by the federal government, had ties to pharmaceutical companies, according to reporting by the Milwaukee Journal Sentinel.
The study concluded that more than 100 million Americans—about 40 percent of the nation’s adult population—suffered from chronic pain. Critics warned that this finding would be used to justify continued reliance on opioid painkillers. The FDA cited the statistic as it weighed how to deal with the growing opioid painkiller epidemic.
The Academies at the time disputed the conflict-of-interest findings in an op-ed, saying “Conflict of interest is not an issue for the authors of the report” because they had been “thoroughly vetted.”
In the years that followed, the public health crisis around opioids continued. According to the Centers for Disease Control and Prevention, more than 1,000 people each day receive emergency room treatment for misuse of prescription opioids. According to the CDC, there were more than 183,000 deaths related to prescription opioid overdoses in the U.S. from 1999 to 2015. Estimates show the economic cost of the opioid crisis amounts to tens or even hundreds of billions of dollars each year.
In 2016, the FDA again looked to the Academies for scientific advice. The panel of scientists recruited by the Academies prompted Senator Ron Wyden, Democrat of Oregon, to fire off a letter that noted the Academies’ failure “to fully disclose or address important information related to potential conflicts of interest and bias.” A week later, the National Academies removed several experts from the panel, including two individuals cited by Wyden as having undisclosed conflicts.
Following the July 2017 report issued by that panel, the Academies convened a workshop on “public-private” partnerships around pain management, part of a National Academies' forum sponsored in part by pharmaceutical companies. This includes Janssen Research & Development, a part of Johnson & Johnson, which markets opioid-based prescription drugs. According to the workshop agenda, representatives from Pfizer and the Purdue-sponsored Chronic Pain Research Alliance were among the invited speakers and panelists.
In September, the National Academy of Medicine, released a “special publication” on the opioid crisis. Among the invited co-authors were the executive director of Academy of the Integrative Pain Management, whose “corporate council” includes Purdue Pharma; the president and CEO of the Federation of State Medical Boards, which took $100,000 from Purdue Pharma in 2011 (a spokesperson said in an email the group has not taken pharma money in the last five years); a former director of clinical guidelines at the American Pain Society, whose website reports funding from Purdue Pharma; and a former president of the American Academy of Pain Medicine, which has also received funding from Purdue.
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The Keck Center of the National Academies in Washington, D.C.
Industry-funded pain advocacy groups have long been cited for the influential role they have played in scientific and political forums. In 2012, the Senate Finance Committee launched an investigation into several of these groups, including the American Pain Foundation, American Academy of Pain Medicine, American Pain Society, and the Federation of State Medical Boards.
A March 2017 study published in JAMA Internal Medicine examined conflicts of interest in public-policy-making around opioids, including the role of third-party pain advocacy groups. Co-author Caleb Alexander, an associate professor at the Johns Hopkins University Bloomberg School of Public Health, noted in an interview that “Any potential conflicts of interest are a big deal because of the ways that pharmaceutical companies have effectively marketed and promoted these products through third parties, often in ways that are opaque to the public.”
Alexander, who has provided expert testimony around opioids to the National Academies, expressed surprise at learning the Academies itself was receiving millions of dollars in funding from the pharmaceutical industry, finding it “hard to believe.”
“This group serves a terribly important role in advising the government on vital issues of science and medicine,” he said.
In the last year, a number of news articles have highlighted financial conflicts of interest in the Academies’ work on a different topic, genetically modified organisms (GMOs). This includes the millions of dollars the Academies receives from companies marketing GMOs, like Monsanto and DuPont, as well as a revolving door of National Academies staff with the private sector.
Last spring, as these industry ties generated news attention, the Academies announced it was revising its internal policy on conflicts of interest. That policy has yet to be published, and the Academies did not respond to questions about when the new policy will be released--or whether the policy will require public disclosure of Academies’ funding from the Sacklers in its published work on opioids.
“Any potential conflicts of interest are a big deal because of the ways that pharmaceutical companies have effectively marketed and promoted these products through third parties, often in ways that are opaque to the public.”
-Caleb Alexander, associate professor at Johns Hopkins University Bloomberg School of Public Health
The Academies’ annual financial reports list three specific grants from the Sacklers, including $2 million in 2008 to create a scientific forum between U.S. and U.K. researchers, $2 million in 2011 to support biomedical studies, and $10 million in 2015 to fund a research prize.
However, the Academies’ recent reports on opioids have not issued conflict-of-interest statements for the Academies—or any study authors—regarding ties to pharmaceutical companies or the Sacklers. One report does mention, on page 439, that one of its authors received up to $3,000 from Purdue Pharma, but this is not explicitly listed as a conflict of interest.
In the scientific reports it produces for the federal government, the National Academies is subject to the Federal Advisory Committee Act, which requires it to avoid recruiting scientists with conflicts of interest—or, if conflicts are unavoidable, to publicly disclose them. These rules fall in line with scientific norms requiring public disclosure of financial conflicts, which are widely linked to bias in science.
Tim Schwab is a freelance journalist who writes about conflicts of interest. He previously worked for a watchdog NGO, Food & Water Watch, where he uncovered conflicts of interest in the National Academies work on GMOs.