The Most Evil People in Medicine

The Sacklers made billions selling addiction. They weren’t the first. They won’t be the last.

Medicine has a hero problem. We talk about it in terms of breakthroughs and miracles, brilliant researchers and selfless practitioners. That framing is often true. It also makes it easier to ignore the other story — the one about the people who knew their drugs were killing people and kept selling them anyway.

This is that story.

The Sacklers

Purdue Pharma’s OxyContin launched in 1996 with a marketing campaign built on a lie. The claim — that the drug’s extended-release formula made it less addictive than other opioids — was not supported by the evidence available at the time and was directly contradicted by the evidence that emerged afterward.

The Sackler family, who owned Purdue, knew. Internal documents revealed in litigation showed company executives were aware of widespread misuse and addiction while simultaneously pushing sales teams to increase prescriptions. They targeted high-prescribing doctors. They downplayed addiction risk to regulators. They made approximately $11 billion from OxyContin sales while over 500,000 Americans died from opioid overdoses in the years that followed.

The family ultimately paid around $6 billion in settlements while largely avoiding criminal prosecution. Many of them remain billionaires. The Sackler name still adorns museums and universities across the world, though several institutions have begun removing it.

Thalidomide

In the late 1950s, a West German pharmaceutical company called Chemie Grünenthal developed thalidomide and marketed it across Europe and parts of the developing world as a sedative and treatment for morning sickness. They had evidence of neurological side effects before launch and buried it. They knew the drug crossed the placental barrier and chose not to investigate what that meant for fetal development.

What it meant was phocomelia — a severe limb reduction defect. Approximately 10,000 children were born with thalidomide-related disabilities. Thousands more died in utero. The drug was kept on the market in some countries for years after the connection became clear.

The United States was largely spared because an FDA reviewer named Frances Kelsey refused to approve the drug without adequate safety data, despite significant pressure from the manufacturer. She was right. The company was not held meaningfully accountable.

Vioxx

Merck’s painkiller Vioxx was approved in 1999 and prescribed to approximately 80 million people worldwide. By 2000, internal data showed the drug significantly increased cardiovascular risk. Merck continued marketing it aggressively until 2004, when it was withdrawn from the market.

A subsequent analysis estimated Vioxx may have caused between 88,000 and 140,000 cases of serious heart disease during the years it remained available after the cardiovascular signal became clear. An FDA scientist who tried to publish findings on the cardiac risk was pressured by the agency and ultimately left.

Merck paid $4.85 billion in settlements. No executives were criminally charged.

The Pattern

What connects these cases isn’t accident or negligence — it’s the consistent choice, made by named individuals with full information, to prioritize revenue over human life. In each case, the harm was known before it was acknowledged. In each case, accountability was financial rather than criminal. In each case, the companies survived.

The uncomfortable conclusion is that the current system makes this math rational. If the penalty for knowingly harming people is a settlement that represents a fraction of the profit generated by the harm, the incentive structure points in one direction.

Frances Kelsey was given the President’s Award for Distinguished Federal Civilian Service in 1962 for stopping thalidomide at the border. The people who tried to get it approved faced no consequences. That asymmetry — between those who do the right thing and those who don’t — is the actual scandal.

Tags: #Healthcare #BigPharma #PublicHealth #MedicalHistory #Opioids