This op-ed features opinion and analysis from the fitness aficionado and thought leader Raw Egg Nationalist which may not represent the views of Valiant News. His book, The Eggs Benedict Option, is available on his website and from popular book sellers. His magazine, Man’s World, is available both online and in print.
Mallinckrodt. You’ve probably never heard of them. The name hardly rolls off the tongue like “Purdue Pharma,” does it? But if you know about Purdue Pharma and oxycontin—about how millions of Americans were deliberately hooked on prescription opioids and how hundreds of thousands died, and are still dying—you should know about Mallinckrodt, because they’re just as responsible as the infamous Sackler family, if not more.
There isn’t just one “empire of pain” in the US, to borrow the title of Patrick Radden Keefe’s devastating book on the Sacklers: there are multiple empires, and for a time Mallinckrodt was the biggest and the worst of all. The empire of empires, if you will.
Between 2006 and 2012, Mallinckrodt, not Purdue Pharma, was the single largest producer of prescription opioids in the US. During that period, they saw sales of $12 billion or c.40% of all opioid pills on the US market. Their baby-blue oxycodone 30mg tablets became an icon for the trail of destruction opioids cut across America, and especially its poorer regions like the mountain communities of Appalachia.
The branding was so strong that M30 knockoffs laced with fentanyl, in that signature baby blue, are a fixture of the illegal street trade even today.
Drug Enforcement Administration / Flickr
Like Purdue, Mallinckrodt was made to pay big—but hardly big enough—for its role in America’s opioid crisis, reaching a settlement of $1.7 billion with the US government, in 2022. Or rather, that’s what was supposed to happen.
Mallinckrodt has since filed twice for bankruptcy and repeatedly missed settlement payments of hundreds of millions of dollars. They may never pay the full amount, or anything near it.
For whatever reason, unlike Purdue, Mallinckrodt were willing for internal documents related to their opioid products to be released to the public as part of their official settlement. Perhaps Mallinckrodt thought the sheer volume of company documents—some 1.3 million—would prevent a thorough examination of their business practices. But even a cursory analysis is enough to reveal some very ugly truths about the way the company marketed and sold its products.
Two university academics from Canada and the Netherlands recently looked in depth at 900 Mallinckrodt contracts, and their findings have now been published in the British Medical Journal, under the title, “How an opioid giant deployed a playbook for moulding doctors’ minds.”
The authors outline a deliberate strategy they call “the ghost management of medicine,” in which Mallinckrodt kept a stable of paid scientists and physicians, euphemistically referred to as “key opinion leaders,” and used them to craft narratives that would distract physicians from the mounting pile of human wreckage they could see, or should have seen, right in front of their eyes.
As the noughties drew to a close, there was already serious concern about the extent of opioid addiction in the US. Purdue had settled charges of fraudulent marketing with a payout of $600 million, and the FDA had introduced new rules requiring opioid makers to educate healthcare providers, doctors and patients about the nature of opioids and their risks. Magazines and newspaper ran stories about “addiction by prescription” and described pharmacies as glorified “pill mills” dispensing drugs like oxycontin and oxycodone without a second thought for the consequences.
Waiting room after a raid of a “pill mill” (FBI / public domain)
Mallinckrodt had other ideas. They wanted to sell even more opioids and, in particular, they wanted to bring to market a new class of stronger, extended-release opioid. They devised a strategy targeting 10,000 physicians across the US, with the aim of reaching nearly 90,000 designated “prescribers” — medical professionals prescribing Mallinckrodt opioids — by 2017. To do this, Mallinckrodt had to allay fears about opioid addiction, and this is where their network of “key opinion leaders” came in.
One of those “key opinion leaders” was Charles Argoff, who worked for Mallinckrodt and wrote a book called Defeat Chronic Pain Now! that touted the company line on opioids to the letter. Argoff was paid $200,000 by opioid manufacturers between 2013 and 2022.
Another “key opinion leader” was Lynn Webster, who was paid $75,000 in a single year by Mallinckrodt. Webster just happened to be the co-author of a new ten-point pain questionnaire to assess whether opioids should be prescribed to patients, and in 2013 he became the president of the American Academy of Pain Medicine.
Argoff, Webster and their fellow “key opinion leaders” provided the legitimacy for totally new concepts like “pseudoaddiction” and “chronification” (to describe how acute pain becomes chronic pain, and how this process can be stopped) and they also revived old fringe concepts like “opioid-phobia,” to suggest that fears about addiction to opioids were anything but rational. They published articles and books explaining how, finally, we must recognise that pain is not a side effect of disease, but a disease in itself. Mallinckrodt took its “key opinion leaders” to training weekends at plush resorts, to ensure they knew exactly what to say and exactly which studies to cite when they were hosting the company’s extensive education programmes for physicians.
Of course, there was little real evidence to support any of these ideas, or even none, but that didn’t matter. The motive wasn’t to advance medicine or address the real causes and harms of chronic pain. The aim was to sell as many opioids as possible.
Or as one Mallinckrodt sales manager put it in an email to his reps, “You only have 1 responsibility… SELL BABY SELL!”
This is not a story with a happy ending. The dead cannot be brought back. And while the living victims of the opioid crisis go without the money Mallinckrodt agreed to pay them, the company continues to rake it in from opioid sales: $262 million last year, an increase of 25% on the year before.
It is, nevertheless, a story with a moral: a moral about the nature of medicine in the 21st century and how science is twisted to serve the corporate profit motive—at any human cost.
If we ever want to redeem medicine, to ensure the profession honours its ancient commitment of “first, do no harm,” we must pay close attention to what Mallinckrodt did and how they did it, and we must ensure that it never happens again.
This op-ed features opinion and analysis from Raw Egg Nationalist, the popular health and fitness author profiled in the Tucker Carlson Originals documentary, “The End of Men“. His book, The Eggs Benedict Option, is available on his website and from popular book sellers. His magazine, Man’s World, is available both online and in print.
