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The Current Transcript for May 3, 2020

Host: Matt Galloway

STORIES FROM THIS EPISODE

Prologue

PETER SINGER: I'm most worried going forward about the fact that even though there's been a tremendous amount of suffering and cases and sadly deaths, actually the worst may be yet to come.

MATT GALLOWAY: That's from a year ago. And sadly, Dr. Peter Singer wasn't wrong. In a moment, the World Health Organisation's special advisor talks about India, vaccine equity and how close we actually are to the end of this pandemic. Also this morning, in the midst of this crisis, another pandemic has been raging in the background rooted in opioid overdoses. Patrick Radden Keefe's remarkable new book investigates the history of the family who created OxyContin, funded the art world and tried to stay in the shadows as overdoses erupted. He's here in 30 minutes with the story behind the story of the opioid epidemic. And later, another family with a big legacy.

ALESSANDRO ROSSELLINI: When I was very little, I understood that from the eyes of the people, from the people, I would see that they looked at me as being part of a special clan. Alessandro Rossellini is the grandson of the great Italian director Roberto Rossellini, nephew to Isabella Rossellini. His new documentary explores the weight of that family name. He's here in an hour. We start, though, with a push to share vaccines to end this crisis. Good morning. I'm Matt Galloway and this is The Current.

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Physician Peter Singer on Canada’s third wave and global vaccine inequity

Guest: Peter Singer

TEDROS ADHANOM GHEBREYESUS: Globally, the covid-19 pandemic continues to intensify, cases have now increased for the ninth straight week. And deaths have increased for the sixth straight week. To put it in perspective, there were almost as many cases globally last week as in the first five months of the pandemic.

MG: That is the director general of the World Health Organisation, Dr. Tedros Adhanom Ghebreyesus with sobering words about the international health crisis we've been living with for more than 14 months. Given the astonishing speed of vaccine development and the race to inoculate, many thought that this spring would bring hope. But in many places around the world, the situation is as bad as ever, and in places like India, it is devastatingly worse. Dr. Peter Singer is special advisor to the director general of the World Health Organisation. He's in Geneva.

MG: Dr. Singer, good morning.

PETER SINGER: Good morning, Matt. Thank you so much for having me on your show.

MG: Great to have you back. Why isn't the world further along in controlling this pandemic?

PS: Because this is a very wily adversary, this virus, it has proven to be a very, very difficult virus to control. Having said that, I think that with the increasing vaccinations and with the one two punch of vaccines and public health measures and especially vaccine equity, there is hope and things are going to get better. This will end.

MG: There are a lot of people who don't see that finish line yet. And in this country, I mean, we're dealing with a serious third wave. We're seeing overwhelmed hospitals in parts of the country. There are military personnel brought in. Field hospitals have been set up in major cities. What went wrong, do you think?

PS: You know, Matt, I followed those stories closely and their heart wrenching, the stories in the intensive care units, et cetera, during this third wave. I really think it's the darkness before the dawn. I think that, again, with the public health measures, with the vaccination rolling out, I think we can really see hope. And I think the dawn is going to come.

MG: How worried are you that complacency may set in and that dawn will be stretched further? We've seen, you know, in the past few waves, this battle between, he said, the battle in quotation marks between, you know, public health versus the economy, for example. Do you worry that that could derail progress being made right now?

PS: Yeah, I mean, I think it's very important for people to realise that the end of this pandemic is in people's own hands. It's about their behaviours in terms of the public health measures, the masking, social distancing, the avoiding poorly ventilated indoor spaces. And it's about the vaccination and, you know, taking the vaccine that's offered when it's offered. And with those two things, people will overcome this. But the one really important point, Matt, from the World Health Organisation's point of view is that's important to do in Canada, but it's also important to do in every country around the world, because if this fire is burning anywhere, it's going to be casting off embers everywhere. So the only way for any country to be safe is really to essentially meet the enemy where it's at, make sure every country is safe. And that really involves vaccine equity, making sure that vaccination rates are rolling out everywhere around the world.

MG: Let's talk about the inferno in India. What is the WHO doing to address the appalling situation that we're seeing unfold in that country?

PS: You know, Dr. Tedros has described the situation in India as, quote unquote, beyond heartbreaking, and I really would endorse that whatever he has done is ship, for example, equipment and supplies, thousands of oxygen concentrators and redeploy a couple of thousand personnel. I can assure you we're doing everything that we can to address covid in India and indeed right around the world.

MG: What about the help of member states with the WHO? I mean, what is it that nations like Canada, the United States and others could do to amplify what the WHO is doing in addressing what's happening in India?

PS: Yeah, I mean, you have a lot of countries stepping in. But let me focus in on the topic of vaccine equity, because that's something that's really very, very important. And let me first explain what I mean by that. What I mean by that is that in Canada, for example, roughly one in three people will have had at least one dose of the vaccine. At this point. In a country like in India, it's about one in 10. But of the billion or so doses of vaccine that have been distributed, about 81 percent have gone to upper, middle and high income and upper middle income countries. Put another way, the vaccination rate kind of one dose is about one in three. In Canada, it's less than 100 in low income countries. That is what I mean by vaccine inequity. And then what happens is you get the fire burning out of control in India and other countries and that's how to generate variance. And then those variants travel around the world and keep the inferno going. So what countries can do, which was your question, is to support the efforts of WHO in terms of vaccine equity and also the broader public health measures at home and abroad.

MG: Do you think that I'm going to get to the vaccine equity piece in a moment? But do you think the efforts by nations like Canada and the United States is following suit? We know Britain was ahead of the game in some ways on this by a week or so to restrict flights out of India. Is that going to help stop the spread of those various?

PS: You know, the regulation of international travel is the responsibility of national governments. WHO's advice, which, by the way, is based on some set of regulations developed by countries themselves, is that those restrictions be as time limited as possible and as risk-based as possible. But I think the key point I would like to make is that you have to meet this virus where it's at. So as long as it's raging, like it's raging in India where we have to put the public out, the one two punch of public health measures and vaccination like we have to do in every country in the world, as long as it's raging anywhere, it's a risk everywhere.

MG: So on Saturday, efforts at a vaccination push for those over the age of 18 in India had to be delayed because of a lack of supply of the vaccines, despite the fact that India, we know, is a vaccine manufacturing powerhouse, a number of doses of AstraZeneca, the people you know, we're getting here in Canada, for example, came from India. So what does that tell you about the inequity that you've been speaking to?

PS: I mean, it tells me that vaccine equity is a problem. I talked about the numbers, you know, one in three in Canada, less than one in 100 in low income countries. But why is that bad? It's bad because it generates variances as we just talked about. It's bad because every human life has equal worth. So there's ethical issues. It's bad because you can't restart the world economy. Now, if you zero down on vaccines, because, by the way, Matt, the key lesson of the pandemic has been equity, equity, equity. That's the lesson in countries and around the world. If you zero down on vaccine equity, you have to ask yourself where the scarcity is. And it could be dollars, it could be doses or it could be domestic manufacturing. And that brings us to the support of countries for vaccine equity. Canada has been a great donor to the Covax facility, which is redistributing and accelerating the production of an equitable distribution of vaccine doses around the world. Brings us to dose sharing. And as you just asked, it brings us to domestic production of vaccines, at least at the regional level, if not at the national level, because that's the ultimate form of self-reliance for countries. And so that's really, really important. So what it tells me is the supply is not enough and that more supply is needed. And we really have to ramp up the production of vaccines around the world. That's what it tells me.

MG: Why is this issue still top of mind, though, I mean, I remember having conversations on this program with Dr. Seth Berkley, for example, the head of GAVI, which is trying to get vaccines into the arms of people around the world. That was a year ago before there were even vaccines. We now have vaccines. Why is this issue of inequity still an issue?

PS: Because there's not enough supply, there is not enough production of vaccines. That's the current limiting factor. And so the WHO is working on efforts to ramp up production. And that's actually what covax is, accelerated production and redistribution, more than 40 million doses distributed to more than 100 countries. And so that's one, that covax facility, WHO and partners like you mentioned, GAVI, also UNICEF and the SEPI, which is an innovation group. But secondly WHO has also established a call for expressions of interest for essentially technology transfer on the MRNA vaccines so more production can happen. And then thirdly are the issues of intellectual property. To put it in a nutshell, Matt.... Everyone, every government, WHO,needs to do everything we can to increase the supply. About a billion doses have been distributed. As I mentioned, they haven't been distributed equitably around the world. But the best way to deal with scarcity is actually to make it go away by increasing supply.

MG: Canada has been accused of vaccine hoarding. The deputy prime minister of this country, Chrystia Freeland, has said that she won't apologise for making sure that Canadians get vaccinated as quickly as possible, but that we are also doing our part with covax. How do you square that?

PS: So the efforts of Canada and covax really are appreciated that they're one of the top donors to covax. Not only are they donating.... Not only is Canada donating money, but it's been engaged in helping to shape the direction of covax, which I think is important. And I see even from the papers this morning that Canada is considering its options in relationship to sharing doses. And of course, WHO is supportive of countries sharing doses because it doesn't matter if you've got I mean, money alone is not enough. You also need the doses. You need to be able to translate the money into doses, either through sharing or through more production.

MG: Who should be getting vaccinated right now, do you think? And who should be waiting? I mean, is it... if you're trying to address this in a meaningful way, should it be those on the front lines around the world that are getting vaccinated now before people who might be able to work from home, who may not be facing, you know, the sharp edge of this pandemic? Who could wait?

PS: Yeah, you know, if you take a global perspective and that's perspective you're asking about in your question, towards the beginning of 2021, Dr Tedros launched a 100 day campaign where he asked for every country to start vaccinating at least their health workers and people at highest risk in the first 100 days of 2021. In fact, most countries almost all did initiate in that time period at that prompting. And the reason the focus was on health workers is these are people who are caring for others in their community and exposing themselves to extra risk. So, you know, every human life is of equal worth right around the world. And the people at highest risk should be the people who are first in line. And that's why vaccine equity is so important. And that's why it's a bad thing that, for example, just to use another statistic, in high income countries, 43 percent of people have had some population coverage, first dose of vaccine and upper middle income countries, 15 percent lower middle income countries, seven percent, low income countries, 0.3 Percent. That's basically saying the same thing we said before, which is thi,s it’s a very inequitable distribution around the world. So those health workers in low income countries aren't necessarily yet vaccinated. And that's obviously not right.

MG: As you say, in many ways, this goes back to the issue of supply. You raised the issue of patents. There are calls on the World Trade Organisation to waive patents on vaccines, at least temporarily. So the companies in developing countries could make those vaccines. Would that help?

PS: Yes, WHO's supported a multipronged approach to this issue, including the transfer of technology, which is extremely important, and I mentioned that specific initiative around a technology hub for MRNA, a vaccine technology transfer, and WHO's also supported the call from India and South Africa for a temporary suspension of patents, as you just mentioned. I mean, Matt, I think what people need to realise is this is a once in 100 years global health crisis. It really is. And so we have to do everything we can to end it as soon as possible. And that means the one two punch of public health measures and actually the new scientific tools generally not only vaccines, but also drugs and diagnostics and of course, life saving oxygen. So that's the one two punch we need. It's a historic moment. You know, what I would say is this is our Mandela moment. This is our Mandela moment. And we each need to do everything we can to end this tragedy as soon as we can.

MG: Do you think that the pharmaceutical companies that have been responsible for creating the vaccines that we have been talking about are likely to get onside with that call?

PS: You know, the first thing I would say is use the word astonishing when you talked about scientific progress earlier, astonishing scientific progress when I went to medical school and even up to a year or two ago, you know, if you ask me how long would it take to develop a vaccine, I would have said 10 years. And yet WHO first heard of this outbreak on December 31st, 2019, and by January 31st, 2020, we had issued our first emergency use authorization for the first of the vaccines. And it's plural, right? Because it's multiple effective vaccines. That's completely astonishing. And, you know, that's a credit to the researchers, the innovators and the pharmaceutical companies. Having said that, I think everybody, including the pharmaceutical companies, needs to do everything possible to end this epidemic as soon as possible. And that means increasing supply. And that means looking seriously at the types of measures that we were talking about before.

MG: A story in The New York Times this morning suggests that ending this epidemic is not going to be possible anytime soon, that the idea of herd immunity in the United States may never be possible, in part because of variants that are spreading from around the world. Are we going to be with this for a long time? Is this going to be part of our lives for years to come?

PS: You know, I saw some modelling that was done by Canada's chief public health officer, Dr. Tam, from a couple of days ago, which was quite hopeful in terms of the uptake of vaccines and reaching a particular threshold and using that plus public health measures to really tamp down the pandemic. So we're kind of coming back to where we started. This is the darkness before the dawn. There is hope. Now, you also asked about variance and, you know, variance. Make this harder, not easier, but variance can be controlled by the same public health measures. And if anything, they make an even stronger case for increasing vaccine production. So they really up the game, up the odds, make it an even more difficult enemy. But it's an enemy that will be defeated because there is hope this pandemic will end. And I think that's a very, very important message for people to take from this, even though I fully understand the type of suffering and heartbreak that's occurring at this moment. And I really feel that as I see those, as I feel those stories.

MG: So you don't believe that this is the kind of thing I mean, there's going to be like a seasonal flu or something like that, that we would need to have a booster shot year after year to try to keep it in check?

PS: You know, I think the answer to that question is unknown, to be honest. I think that and certainly WHO hasn't taken that position up until now, the evidence is evolving. But what I would say is that overall, this is going to get much, much, much, much better. It may not feel like that right now as we're seeing those stories and we're in the midst of the wave, even though that may be cresting, I'm talking about in Canada. But this is going to end. This is going to get better, but it's only going to end and it's only going to get better in a sustainable way if it ends everywhere in the world. Which highlights, by the way, the importance of the multilateral system and if I may say of the WHO and of the support of all member states to that. The main point I want to make is that this is in people's hands, equity is in people's hands and especially young people. Matt, you know, that's what really gives me hope that the kind of problem solving ability of young people. But this is going to end, hope is there. And that's, I think, a key message. But it's got to be everywhere.

MG: Just in the last few seconds that we have. What have you learnt through this?

PS: You know, what I've learnt is that leadership really matters. Character really matters. And it's important to be kind. To me, that's the most fundamental lesson. The pandemic, in a sense, is an X-ray of our soul and an X-ray of our character. And that's why I referred to the Mandela moment earlier. And that is on a foundation of equity, which is the second thing I've learnt. Again, the three lessons of the pandemic are equity, equity, equity within countries and amongst countries. And I know Matt, that's a theme that's always been very close to your heart over the years. And so I think this very important lesson and the point in the recovery is to redress the inequities that have been exposed by the pandemic.

MG: We will speak again. In the meantime, it's good to have you back on the program, Dr. Singer. Thank you very much.

PS: Thank you so much, Matt. It's really great to be with you.

MG: Dr. Peter Singer, special advisor to the director general of the World Health Organisation. He was in Geneva.

MG: Well, coming up after your CBC News, they were once an American empire, the Sackler family, the elite of the elite. Now they will be forever known as the family at the centre of the opioid epidemic. In six minutes, an empire of pain. I'm Matt Galloway. You're listening to The Current on CBC Radio One.

Writer Patrick Radden Keefe on the Sackler family’s role in the opioid crisis

Guest: Patrick Radden Keefe

MG: Good morning. I'm Matt Galloway, and you're listening to the current.

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MG: Still to come, growing up in the shadow of the famous Rossellini name can be a daunting existence. In 30 minutes, how Alessandro Rossellini came to terms with his name and himself. But first, another family dynasty. This one at the centre of the opioid epidemic.

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Stephen MacGillivary: I was taking two OxyContin 20s every 12 hours, and it not only took the pain away, it took a lot of things away. It overtook my life. All of a sudden, it's just like... it's got a hold of you and it's got a hold of you like nothing. At the end of it you don't take that to get, you know, "high". You just take that to get normal. And then when you take it, then the next thing is, OK, so where do I get my next one? And of course, you know, they're illegally on the street and, you know, there is a lot of money. And so you have to do things to get it. And it's just... it was just like one great big horror show.

MG: Stephen MacGillivary from Nova Scotia was prescribed OxyContin to treat his pain after surgery for a broken collarbone in 1997.

SM: I walked away from my job. I was that sick. If I didn't have you know, I didn't have 100 dollars worth of OxyContin at, you know, 6:30/ seven o'clock in the morning. I just couldn't go to work. I lost my family. You know, I was out on the street, you know, for a guy that was, you know, that had a lot going for him. And, you know, we were looked on as good people. But, you know, OxyContin and drugs, they don't they don't they don't discriminate.

MG: Steven spoke on The Current in 2017 after the makers of OxyContin paid twenty million dollars to settle a class action lawsuit involving allegations about how the pain pills were marketed. The payout came after a decade-long court battle on behalf of roughly 2000 Canadians who became addicted to the drug after their doctors prescribed it. The company behind OxyContin was Purdue Pharma, run by the Sackler family in the United States. Their name was once plastered across college campuses or in the halls of art galleries. Now it is linked to a trail of destroyed lives. Patrick Radden Keefe writes for The New Yorker magazine and has spent years looking at the OxyContin disaster. His fantastic new book is called Empire of Pain: The Secret History of the Sackler Dynasty.

MG: Patrick Radden Keefe, good morning.

PATRICK RADDEN KEEFE: So good to be with you.

MG: Great to have you here. How typical is the story we just heard of OxyContin addiction?

PATRICK RADDEN KEEFE: Incredibly typical. I've heard so many stories like that. That's a type of story that the company Purdue Pharma and the Sackler family tend to want to obscure, because I think there's a version of the story that they've told, which is that there's legitimate pain patients prescribed OxyContin. And what they've always claimed is that those people don't become addicted, they don't develop a problem. And then there's another category of people who are drug abusers who kind of electively seek out these drugs to abuse them. And so that's always been a kind of a suggestion, a defence by the company and by the family. But I think it's one that right from the beginning really wasn't true. And you hear it in that story.

MG: Let's talk about the family. The Sackler family is at the heart of this story. Tell me a little bit about the three brothers who started the family's connection to the pharmaceutical industry. Who were they?

PATRICK RADDEN KEEFE: So this story goes back a long way. I mean, its origins really are in Brooklyn, New York. During the Great Depression, you had a couple of immigrants from Europe, Isaac and Sophie Sackler, who had three sons, Arthur, Mortimer and Raymond. It was kind of a classic immigrant success story. They had huge hopes invested in their sons. The idea was that this would be the generation that assimilated and really made its mark on America. They wanted that to happen through education. They very intently wanted their sons to be doctors. And sure enough, these three brothers become physicians. They all become psychiatrists. But they also had a very entrepreneurial sensibility, an interest not just in practising medicine, but in getting into business. And so Arthur Sackler, the oldest of the brothers, becomes a kind of whiz of pharmaceutical advertising. He makes the first great Sackler fortune, marketing Valium, another quite addictive drug, and becomes very, very wealthy. And at a certain point, he buys his brothers this little pharmaceutical company called Purdue Frederick, which they take over and start running in 1952.

MG: You write that the House of Sackler, to your point, was built in many ways on Valium. What did they do with Valium and how did that in some ways foreshadow some of the problems that came later?

PATRICK RADDEN KEEFE: Arthur Sackler, the oldest of these brothers, dies in 1987, so he dies before OxyContin is ever introduced. But the seeds of the OxyContin story are all there in the biography of Arthur Sackler and in these innovations that he makes in the 1950's. So Sackler was this kind of Don Draper like figure in the fifties who became very, very creative about ways in which you could promote drugs. And you know, one of his big revelations was. The consumer is kind of secondary, the person you really need to sell is the doctor. Often there were deceptive tactics employed. So, you know, you've got sales reps who are overplaying the therapeutic benefits of a drug and underplaying the potential side effects and risks and possible addictiveness. And so Arthur really devised this template. There were old men who I interviewed. I interviewed a bunch of people who were in their 90s, close to 100 years old, who'd been involved in the industry back in the 1950's, who said, you know, Arthur Sackler invented the wheel when it came way in which pharmaceuticals are advertised, and he did that and became fabulously wealthy.

MG: What did he do with his wealth?

PATRICK RADDEN KEEFE: Well, he started collecting art and he started giving money away, but he gave it away in this interesting manner. So I think for a lot of people, to the degree that the Sackler name was familiar until recently, it was familiar because this was a great philanthropic dynasty. If you go to the British Museum or the Metropolitan Museum in New York or the Guggenheim or the Louvre in Paris, the Sackler's have given a great deal of money away to museums and universities, and their name is often prominently displayed. And so starting in the 50s, Arthur Sackler starts donating money, but always with this condition that his name go on things, that his name go on halls and buildings and even individual works of art that he contributed, that there will always be a little plaque saying a gift from the Sackler's.

MG: Why did they do that and why did he do that? I mean, somebody says that in some ways the philanthropy that he was involved in isn't charity. It's a business deal. And it's an exercise in family branding in some ways.

PATRICK RADDEN KEEFE: That's right. I mean, it was actually his lawyer, his longtime lawyer who says with a kind of an admirable candour that if you're asking to put your name on it, it's not charity. That's a transaction. There's a moment that I discovered in the life of these brothers that I think is very telling. At the height of the Great Depression, their father, Isaac Sackler, he basically lost his shirt. He had hit some financial troubles and he summons his three boys to him and says, listen, I'm not going to be able to finance your education. You know, the bad news is you're going to have to go out there and really just kind of pay your own way through school. But the good news is that given you the most important thing that a father can give his sons, I've given you a good name. And he says if you lose a fortune, you can always earn another. But if you lose your good name, you can never get it back. And so there was this kind of talismanic significance that this family attached to the name. And I think you see that right from the earliest gifts of the Sackler's in the 50s, a kind of almost myth building, a sense in which they are kind of building up the Sackler name, making it stand for something.

MG: You write about a conference on pain that took place at the University of Toronto. I want to jump ahead a bit. This is in 1984. And this is, you know, the Sackler family and the work that they are doing is well established. What was going on at that conference? What was the purpose of what was happening in Toronto.

PATRICK RADDEN KEEFE: At the time Purdue Frederick, the family business was getting into more ambitious territory of pharmaceuticals. For decades it had been very profitable, but a purveyor of kind of unglamorous over-the-counter products, they made a laxative that was very, very successful. These kind of staples. I mean, they had, there was an ear wax remover that they made. So reliably profitable, but not very exciting products. And what happened was that in the 80s, the 70s and 80s, they started researching new pharmaceuticals that they could launch and they devised a very innovative new painkiller, a morphine based painkiller called MS-Contin. And they released it in the UK first. And when they were poised to release it in North America, they orchestrate this conference in Toronto. So this pharmaceutical company sponsors a conference on pain. And the university, the administration of the university is sort of happy to take the generous funding of the pharma company. And they summoned doctors from all over the world to come and give talks about pain and the appropriate treatment of pain. And the takeaway from this conference, which has this kind of ostensibly academic feel to it, is that we should really be prescribing more morphine. And this happens just as the company is about to launch its morphine drug. And this to me, is kind of emblematic of the way in which the pharma industry operates, is that it has a huge amount of money. And what it's looking for is validation from physicians, from researchers, from academics using the money in order to create. Sort of an echo chamber.

MG: What was discussed at that conference around the issue of addiction? When it came particularly to pain medication and particularly around the MS-Contin, which as you say, is a morphine based drug.

PATRICK RADDEN KEEFE: So when we talk about opioids, these are drugs that are derived from the opium poppy. And for thousands of years, humans have known two things about products that come from the opium poppy. One is that they have a miraculous ability to ease pain and another is that they can be potentially very addictive. The second concern meant that for a long time, many doctors were reluctant to prescribe strong opioids too freely, particularly with something like morphine. There was a perception that it would be used for cancer pain, it would be used for end of life care. But it was a very extreme solution that you graduated to. And there was a movement under way in the 80s to re-evaluate this and say maybe we've been too cautious about using these drugs to relieve pain and maybe we should be prescribing them more freely. Maybe people's pain is not being treated adequately out of a kind of hysterical fear of the danger of opioids. And so one message that got repeated again and again at that conference, and this becomes a real mantra, particularly when Purdue releases OxyContin, is, you know, there's too much hysteria around opioids. In fact, if you take them for pain in the care of a doctor, if a doctor prescribes them to you, they're not addictive at all. Addiction is really a matter of people's addictive personalities. Some people have addictive personalities, and that's kind of on them. But there's no intrinsic quality of these drugs that is inherently addictive.

MG: And so in that context, I mean, you mentioned Ms-Contin, which is the morphine drug. When does OxyContin enter the story?

PATRICK RADDEN KEEFE: So what happened was that Ms-Contin was this very successful drug and at a certain point, the patent looks like it's going to be running out. And so the Sackler family and Purdue executives start talking about, well, what could we use as a substitute? What would be our follow on product B? And they arrive at the idea of using oxycodone, which is another strong opioid, which is actually stronger than morphine and the same what they call the contin coating seal. So a seal on the pills that regulates the flow of the drug into your bloodstream. And so they devised this idea of selling this more powerful drug, OxyContin. But their big pivot was they had done very well and the cancer pain market, but that wasn't enough for them. There are these amazing emails that I found where they talk about this very explicitly and they say, oh, cancer's a niche market. We want a drug that we can sell to anyone who has even moderate pain. You know, they estimated that in the United States alone, that could be 40 to 50 million people. That was the market they were after.

MG: This is what they call the painkiller to start and stay with.

PATRICK RADDEN KEEFE: Yeah. I mean, it's incredible to think about this now at this distance in 2021. But yeah, in 1996, they launched this drug OxyContin, and their tag phrase is "it's the one to start with and the one to stay with". So, you know, it's not some nuclear solution that you graduate to after other remedies have failed. The idea is if, you know, any kind of injury or postoperative pain or a sports injury or hurt on the job, that you would start with OxyContin and then stay with it.

MG: You mentioned Arthur's work with doctors and the work that he did to try to pitch directly to doctors. How aggressive was the company in promoting OxyContin to doctors?

PATRICK RADDEN KEEFE: Extremely. They hired a huge sales force, hundreds and hundreds of sales representatives who fanned out across the United States, across Canada and made the pitch to doctors, nurses, hospitals, pharmacists. And they were armed with a lot of official looking literature. You know, remember, these sales reps are not doctors, but they had been kind of trained with a marketing sales pitch. And we now know that the big elements of that marketing sales pitch are not true. So probably the number one thing they would say is that the drug wasn't addictive, OxyContin wasn't addictive. And what they would say again and again was, it's addictive less than one percent of the time. I've interviewed all these former sales reps and they said we just repeated that like a mantra all day, every day, hundreds and hundreds of meetings with doctors. We would tell them that. There were seminars that they would invite doctors to for pain management, these kind of all expenses paid junkets in resorts. They did thousands of these seminars. They set up a speakers bureau in which they would hire doctors to go and give speeches to other doctors about the virtues of OxyContin and strong opioids in the treatment of pain. Purdue some years would spend as much as nine million dollars just buying food for doctors. And if you talk to doctors, they'll say, oh, you know, I would never be influenced by a steak dinner. But there have been studies on this showing that a small... a meal of maybe 20 dollars is enough to influence the way in which a doctor prescribes. And you better believe if Purdue wasn't seeing a return on their investment, they wouldn't keep spending nine million dollars a year on food.

MG: They also gave away samples, as you say, to acquaint patients with oxy is acquaint, a different word for hook patients on oxy.

PATRICK RADDEN KEEFE: It's a great question. You know, I've wondered about this because there is a... there's a history in the pharma business of issuing free samples. For me, I come at this from a strange angle, because long before I ever read about the Sackler's, I had done a great deal of writing for The New Yorker about the illegal drug business, about Mexican drug cartels. And if you talk to anyone involved in a Mexican drug syndicate, they'll tell you, oh, come on, you know, if you have an addictive product that the first hit is always free, it'll pay for itself many times over. It's hard for me to know how to interpret that with Purdue. I actually don't think it's a situation where they set out to get people addicted, per say. I think it's more a case of unintended consequences and that their heads were in the sand.

MG: When did Purdue realise that there was an enormous abuse problem connected with OxyContin?

PATRICK RADDEN KEEFE: The interesting thing about the timing is that for years and years and really right up until the present day, Purdue Pharma and the Sackler family have always claimed that they didn't know anything about there being a serious problem, for about four years. So the drugs released in early 1996 and what they have always claimed very consistently was that in early 2000, they learnt that there was a big problem of abuse of the drug and they learnt it from reading the newspaper. They learnt from press accounts. And I should say for me, I was always a little bit intuitively just dubious of that. Having written about companies for years, it seemed a little strange to me that if there was a problem, they would only know by reading about in the paper. Generally companies know before we reporters do. And what I found and was able to substantiate in the book is a really extensive paper trail dating back as far as 1997. So really about a year after the drug was released of internal knowledge at the company at high levels, that there were real problems, that people were abusing these pills and becoming addicted to them.

MG: You say that there was probably a moment early on when the Sackler family could have chosen to respond differently to the unfolding crisis around OxyContin. Why didn't they?

PATRICK RADDEN KEEFE: There's probably an easy temptation to say it was just purely greed, and I do think that greed is a very, very important element in this story. But I think there's something else going on too, there's a kind of hubris. There was this notion when they developed OxyContin that for thousands of years there's been this paradox of opioids, you know, that they have therapeutic benefits, but also dangers. And I think there was this sense that they had, that they'd cracked it, they'd figured out how to uncouple those two aspects of this drug, and that they would relieve pain for millions of people and make billions and billions of dollars at the same time. And what happens is that suddenly there are these indications that they were wrong. And I think there's a kind of stubbornness to the encroaching reality that you screwed up and that people are dying. And I think that in some ways that's as powerful as the greed, a kind of refusal to admit error and then a doubling down on that, where they try and stifle and suppress reporting by people who see that there are problems to a point where even today the Sackler's think, you know, they certainly think I have it all wrong and that the 49 states that are suing their company have it all wrong, that everybody has it wrong, and that, in fact, they you know, they never made any mistakes at all.

MG: We asked Purdue Pharma to comment on the book, and they declined to comment. The Sackler family has denied the allegations that you make in the book. The family has never been charged with offences related to the sale of OxyContin. We got a statement from a spokesperson for members of the family, particularly the late Dr. Mortimer Sackler, who wrote "Our focus is on concluding a resolution that will provide help to people and communities in need rather than on this book". We got a comment from Daniel S. Connolly, who's an attorney for the Raymond Sackler family, who wrote "This author has refused to correct errors in his past reporting and has also blatantly violated journalistic ethics by refusing to meet with representatives for the Sackler family. During the reporting of this book, documents being released and Purdue's bankruptcy now demonstrate that Sackler family members who served on Perdue's board of directors acted ethically and lawfully. Did you refuse to meet with representatives from this family?

PATRICK RADDEN KEEFE: No, I didn't refuse to meet with them. I mean, this is fairly typical of the way in which the family has handled this. They've been threatening to sue me since before I started writing the book. After it was announced that I was writing the book, they started sending me legal threats and sent dozens of emails and letters over the next couple of years since I've been working on the book. And they you know, they never actually responded to... what happened is that I sent them a huge list of queries, of course, I asked repeatedly for interviews with the Sackler's and was told that they wouldn't speak with me until I made changes to this article I wrote in 2017 about them in The New Yorker, which I, you know, I refused to do. And The New Yorker, had independently re fact checked the piece in response to their critique and decided independently of me not to change a word. They didn't respond to the many, many, many, you know, over 100 substantive queries that I sent them. And so it's fairly typical now that what they try and do is raise questions about my integrity as a reporter and not respond to the substantive allegations in the book of which there are a great many.

MG: What do you think the legacy of this scandal will be for the Sackler family?

PATRICK RADDEN KEEFE: Well, I think that the end game is playing out right now. In November, Purdue Pharma, the company, pled guilty a second time to federal criminal charges. Purdue Pharma is in bankruptcy court, in part because the family has taken ten billion dollars out of the company. So that remains to be seen how the bankruptcy case will play out. But I do think we can see the broad outlines of how this will end. And the answer is that the Sackler's will end up paying some number of billions of dollars to help remediate the opioid crisis. They will... they've proposed four and a quarter billion dollars. Some states, I think, would be very happy to take that money because they're desperate for the funds. Other states feel that that's not nearly enough, given how much the family took out of the company at a time when it was committing federal crimes. But they will almost certainly walk away with much more. There are recent documents that came out substantiating that the two wings of the family, the Raymond and Mortimer Sackler families, have a fortune of at least 11 billion dollars derived almost entirely from OxyContin. So you can see how they'll walk away with vastly more wealth, probably never face criminal charges. But I do think if you go back to Isaac Sackler, you know, he said to his sons, if you lose a fortune, you can always gain another. But if you lose the good name, you'll never get it back. And so you have this kind of strange notion, right, that almost a century later, they fought so hard to hold on to the fortune, but I don't think they'll ever get the good name back again.

MG: Patrick Radden Kefee, it's a real pleasure to talk to you. Thank you very much.

PATRICK RADDEN KEEFE: Thank you.

MG: Patrick Radden Keefe is a reporter at large for The New Yorker magazine. And his new book is Empire of Pain: The Secret History of the Sackler Dynasty. Coming up after your regional update, Alessandro Rossellini grew up in the shadow of one of the most famous last names in both Italy and the film world. He has just released his first film, and it brings the family together to find out what it means to be a Rossellini. I'm Matt Galloway you're listening to The Current on CBC Radio One.

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Alessandro Rossellini on his famous, film-making family, and his role in it

Guest: Alessandro Rossellini

MG: Hi, I'm Matt Galloway, you're listening to The Current. Tomorrow, we are taking you to Peel Region just northwest of Toronto, where the covid third wave is raging. Right now the test positivity rate in that community is around 20 percent. And we're going to bring you a documentary highlighting how that community is coping with overrun hospitals, outbreaks in warehouses and factories and why this matters to all of Canada. You will hear from the essential workers who live there helping to get the food on your table and move goods around the country every day. And while they work, many of those workers are getting sick. We'll also hear from community members who are trying to help those in need.

FEMALE VOICE: In the community right here in Brampton, I see the challenges like way more than what we see around the province of Ontario or nationally in Canada,

MALE VOICE: Because my fever is like crazy is going up all the time and I'm getting weakness day by day. So I gave up. I said, no, I can't survive like that sixth or seventh day. I got my conscience back. Opened my eyes, then they told me that you are on a ventilator for six, seven days. I surprised myself.

MALE VOICE 2: A lot of family. I know, you know, even the immediate family, they had covid, my brother, my sister. I haven't seen my parents for almost one year now. [inaudible] We just want to get out of this mess. It's better for everybody, just not for our community, for everybody. I just pray for everybody that we all in a mess.

FEMALE VOICE 2: People did not get the help they needed at the first place. And the people like I use the example of grocery stores or other essential workers. If we look at in Brampton around 60 percent, you have seen so many trucks driving by while we are standing here so we can see the percentage of people who are contributing in this country for essential services.

MALE VOICE: I tell her, I asked the nurse, can you call my home to tell them that I'm back? She said, we already called and they are you know, the thing is that all the hell my family go through, I can't explain anyone.

MG: Those stories tomorrow right here on The Current.

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MG: You're listening to The Current on CBC Radio One. My name is Matt Galloway.

ALESSANDRO ROSSELLINI: His name was Roberto Rossellini. He was my grandfather. People say he was a revolutionary director. The world saw him as a genius. For us, his family, it was much more complicated than that. My grandfather left the world his masterpieces and not a penny to any of us. Instead, he left us an enormous inheritance of family conflicts. And after that day, nothing was ever the same.

MG: That was June six, 1977, the funeral of the great Italian director, Roberto Rossellini. And the voice you heard there is that of Alessandro Rossellini, his documentary about his grandfather and his large, famous, far flung and fractious family is called simply, The Rossellini's, and it's screening as part of the Hot Docs Film Festival.

MG: Alessandro Rossellini, good morning.

AR: Hello. Thank you for having me with The Current.

MG: Thank you for being here. Take me back to that day in Rome in 1977. What do you remember about that day?

AR: I remember it well. Now I confuse, I think a little bit the images of that document that you see my film and my own memories but what I feel is what, you know, I felt is being lost. What's going to happen now? Very sad because I used to see a lot of my grandfather and it was a lot of fun being around him, especially in movies sets, but also because he was a very affectionate grandfather. And I could see the sorrow and the fear in my relatives, my father, my grandmother, who I grew up with. So it was a very strong day for me and my family

MG: And an incredibly public day as well. I mean, you see the footage of that. Your grandfather's films are extraordinary and people know them, "Open City" and others as being incredible films, but they're huge crowds that came out to pay tribute to him. What do you think he meant to the Italian community, to people around the world?

AR: Well, my grandfather wasn't only popular because of his films, it was also because he had encountered incredible women like my grandmother, Anna Magnani, then Ingrid Bergman, and then was very scandalous and something not common to also being married with Indian woman. And so he was on newspapers and magazines very often. And also he was a public figures because of these ideas. And so that were at the time very modern. And therefore, he had a following. Yes.

MG: What was he like as a grandfather? I mean, your Aunt Neur says that there was a rivalry for his attention.

AR: OK. My grandfather was very affectionate, a lot of fun, as I said, but was always also an opportunity, if I can say, because if you were close to him, you could travel, you could see interesting people, places you would feel special around him. Therefore, the chosen one of the time would have some privileges. Pretty much that's the idea.

MG: And so is that when you make reference to, you know, the family conflicts and the tension that emerged in the wake of his death, is that in some ways the source of that tension?

AR: Well, it was a lot of different things. I think everybody loved him very much before, all because he was such a wonderful warm man. But, you know, in the complexity of relations, I think also who he represented was part of the deal.

MG: What did it mean growing up as a Rossellini? I mean, he is an incredible talent. His second wife, as you mentioned, Ingrid Bergman, Oscar winning actor, Isabella Rossellini, your aunt, a model and film star, your father, Renzo, your uncle, were both directors as well. What was it like growing up with that name?

AR: For me, it wasn't very easy. For many years, when I was very little, I understood that from the eyes of the people, from the people, I would see that they looked at me as being part of a special clan. Afterwards, it was even more complicated because of the fact that I came from the family hired to do things which were better and bigger. And therefore I think that for me created some kind of a void. But also, you know, it was fun and I did have a lot of opportunity because I could meet people that were connected. You know, I had good things and also some bad negative things about growing up as a young Rossellini.

MG: You talk in the film a number of times about kind of a family's sickness, the Rossellini itis. What is that?

AR: Ok. Growing up, the son of Roberto Rossellini for my father and uncle and aunts even for them, you know they had a lot of expectations. So they had a relation with success. So Rossellini itis, as I call it, it's a disease of about values that we inherited and that with the passing of time got less feasible in the sense that the world changed. And if it was possible to do a film like Rome Open City after the Second World War, try to redo something as big nowadays would be much harder.

MG: Did you feel when you were growing up that you were unworthy of that last name? I mean, that's something that comes up in the movie.

AR: Yes, yes, It's not you know, I didn't know what I had to do to be what people thought a Rossellini should be, so it was, I couldn't see myself for what it was, but I would see myself through the eyes of people looking at me. So I created the fantasy and there I got lost.

MG: It's not just you. I mean, your aunt Ingrid also describes feeling like a loser and feeling ugly growing up. I mean, what did you think when you heard that, that that's how she felt growing up with that name?

AR: Well, I was expecting for her to talk about those things. And I was... she was very generous and courageous and but I wasn't surprised. She had a mother three times Oscar winning the beautiful Ingrid Bergman and brother and sister, they were of incredible beauty. You know, everybody knows about Isabella Rossellini as one of the most beautiful woman. And Robertino was just as beautiful, was, you know, incredible, stunningly handsome. And she was normally beautiful. And, you know, that wasn't enough.

MG: What about Robertino? I mean, he lives alone on this deserted island off the coast of Sweden. What do you think that's all about?

AR: Well, he explains it in the film. His explanation is that he had enough of being under the spotlight and, you know, living with a Playboy figure, you know, facade. But also, I think, you know, he had some kind of insight of a different way of living life. I think he just got very tired of what he was and wanted to be just simply being more in touch with himself. And also, you know, and when you're not as beautiful, because your looks change with age, your energy is not the same. And also maybe also the amount of money that you need to live up to a certain life are not as present then. You know, it's a smart move to change things drastically all around.

MG: Why did you make this film, given all of what you've just said? Why did you feel like you needed to make this film? This is your first film.

AR: Yes, well. The formal official, you know, answer is because I was doing my own journey, you know, reconstructing myself and in recovery, which is absolutely true. But there is another truth is that when I start thinking of the film, I was totally broke. I just had lost the apartment to where I was living because I couldn't pay rent. And, you know, I had two children. And I start thinking, what can I now do to reinvent myself? And I was liking to be able to construct this film. But if I can pass a message to whoever is listening, documentaries don't change much for your money situation.

MG: How did your family feel when you approached each member of the family and said, I want to have this conversation or these series of conversations? What was their response in terms of were they willing to to participate in something like this immediately?

AR: Yes, yes, absolutely. Because I was the one that needed help. They were there for me in the sense nobody said no about doing this film, everybody were up for it. And I'm very glad. But afterwards, when I started confronting them and my questions sometimes were very private and personal, then, you know, things change a little. I move to things that brought up some pain. So it was hard for them at a certain point. But they were going through I mean, since they opened up, they were extremely, I think, sincere. And they gave me even more than what I was hoping, you know, to put this story together.

MG: One of those exchanges is with your aunt Isabella Rossellini. She is somewhat sceptical that other members of this family suffer from the Rossellini itis. Take a listen to a little bit of this exchange that you had with her and her daughter, Elletra.

AR: [Alessandro speaking Italian] My question is that the other ones from the family, do they have it and are they aware of having Rossellini itis?

ELETTRA ROSSELLINI: I think you're the only one. [laughter]

MG: What do you think? Is it possible that perhaps you're the only one with a case of this disease?

AR: I'm not going to answer. I will ask people to watch the film and then they can decide. In the sense that I think it reveals that probably in their own way, everybody has been affected. Coming from parents that have such a big history and I think, you know, my sincere idea is that everybody still is affected today. But that's normal. You know, just like I'm sure there is some of your father and some of your mother in you in the sense that there are some values which are in my family's [inaudible], you know, [inaudible]. But the truth is that in every family there is this kind of relations where children are affected by their own parents. In positive and negative ways, of course.

MG: Let me ask you about your mother. I mean, your mother's black. Her relationship with your father was very short lived. And she... the end of that relationship is really painful and kind of complicated in terms of what she was looking for and how in some ways she was dismissed from that family. How did that impact your position within the Rossellini's?

AR: Well, I think it was my grandmother defended me from my mother in her own way, maybe wasn't the best way. And my father and my grandfather did the same because my mother was a difficult woman being bipolar and an alcoholic. But the truth is that they probably could have done it in a different way. I understand the fact that my mother was [inaudible] because I remember it and I felt it very hard to deal with. But excluding her, I think it was... made things worse for me and for her. In a way.

MG: You refer to yourself. I mean, in some ways this comes up in the film as the little black nephew, is that how people saw you, do you think, in the family?

AR: Oh, I think in some ways, yes, little and black was like Alessandro's little and piccolo e nero. Yes. I guess it is a part. Yes. You know, it's funny because if maybe people tells you with affection but then you end up wearing that dress, you know, it's like they're telling you a way of being for yourself. And I don't think it's done on purpose. But then, you know, it has an impact.

MG: Where did that lead you, whether it's that or that idea of feeling inadequate and not living up to the name. You talked about being in recovery. And there are a few references in the film to struggles that you've had with drugs. Where did that lead you?

AR: OK, learning about drug dependency and alcoholism I can tell you that I cannot have the certainty that I began that because of my upbringing and because of my family. But of course, I had you know, that must have been part at least part of it, you know. And what happened is, yes, I started to do drugs and I continued doing drugs for many years. Until one moment, you know, as it happens, I lost completely the control of my life. And I had many difficult years, not days, but years. But nowadays, I don't regret it because from there on, recovery was where I've learnt a lot of things about myself, about also drug dependency, and I was able to recover. I'm in recovery. I'm a recovering addict. And that's helps me today because it's also my other job, maybe even my main job. You know, I work for a rehab and I work with the relatives of addicts and make a living out of that, helping people. So in the end, it wasn't all bad.

MG: Your aunt Isabella was a huge part of your recovery. But before that happened, I mean, and we see this in the film, she's really angry with you about things that happened in past, feels as though you took advantage of her, that you took money from her over the years and what have you. What was it like? I mean, to have that conversation is one thing, but to have that conversation with cameras rolling for a documentary that you're making is something very different. What was it like to be faced with that anger that she has?

AR: Well, interviewing Isabella was terrifying, not only because of what she said it's just because I respect her immensely. I mean, you know, we have a very strong bond. And I think it goes beyond being a nephew and aunt and also because she has such a big personality. So it was there, I really needed a lot of courage. She got upset because of where I was going. And it was important and it was actually a gift. And I tried. I will try to explain to you why, for her to tell me the ordeal about me stealing money to buy also a Rolex watch.

MG: And that was because it was money that she gave you that was supposed to be for the birth of your daughter,

AR: For the birth of my daughter, instead of you know, we are in Italy. We have a very good free health care. And anyway, so what happened is that it was a very important part of the film. You know, these were things that became crude and real and it was very central. I think that part because it's where you see that we are not kidding around. We are really confronting each other. I like to think, since I know she very intelligent and she is very strategic, that she said that part because it was a great part to put in the movie. But also it was a great reminder of who she is and who I am or who I was. So, you know, it was also to say, OK, but let's keep our places clean, you know? And it was very painful. It was hard for me, but it was a beautiful things to put in the documentary.

MG: Did the whole process feel like therapy to you, in doing this film?

AR: Well, it's not something that you realize while you're doing it, but now I benefit from it in many ways because I really reconstructed my persona throughout their eyes. And the great thing, I think, in the end is that if you know, you try to recover. You know, people that really love you give you the chance. And so in the end, I felt a lot of love from my relatives in the film. And that's healing. That's something that, you know, you feel accepted, that you feel you know, even though I am who I am, that is good enough to be loved.

MG: I don't want to give everything away. But there is this extraordinary moment at the end of the film when the family is together. And is it Isabella who says to you, now do you believe that we love you?

AR: Yeah. Yes. Yes. Yes. That's. And I get you know, unfortunately, I didn't want to cry, but a little tear came out. Yes. Yes. That was Isabella.

AR: What did it mean to you when she said that? I mean, having gone through all of this and as you say, you're terrified and talking to her in addition to her being your aunt, she's Isabella Rossellini and is bracingly intelligent and you're bringing up really difficult things. So when she says that to you, having gone through that, what does that mean to you?

AR: Well, it's I think my film has, one real thing I like is that it's very honest. I think it was a moment where I actually felt what she was saying, and I thought about it and I felt sincerely the love of the family. And so it was just a very beautiful, touching moment of commotion. And also, you know, it was a moment of great truth and honesty.

MG: Are you now part of the family business as a filmmaker?Are you now a Rossellini filmmaker?

AR: Well, you know, I'll try to explain this to you, what I feel, obviously my situation within the family has changed a bit because of the film, because the film had success. And for some of my relative success is something that has a meaning. You know, I of course, I know that I have to be careful as a man, as a person in recovery. But I must tell you, I love the interview from what happened is that I got to know the spotlight and feels great. And unfortunately, that part I still have to work a lot on because I became a sucker for interviews.

MG: But is that the cure for the Rossellini itis to do a film like this and to work through this kind of stuff?

AR: Well, no, it's exactly what we were talking about, which is actually the theme of the film.

MG: It is a wonderful film. As I say, it made me want to be in Italy. But it also, we know of your family and I learnt a lot more about it and about you through this. Congratulations.

AR: Thank you very much. Thank you very much for this very important interview. I'm very, very grateful.

MG: Alessandro Rossellini, grandson of the late, great Italian director Roberto Rossellini. The Rossellini's is screening as part of the Hot Docs Film Festival, which this year is taking place online.

MG: And that's it for The Current for this Monday. Coming up next on CBC Radio One, it's Q. This is a neat story. Sierra Teller Ornelas is the showrunner and co-creator of the new series Rutherford Falls. She created this with a couple of comedy powerhouses, Ed Helms from The Office and Mike Schur from The Office and Parks and Rec, and The Good Place. Rutherford Falls has one of the biggest indigenous writing staffs on major television. Sierra is Navajo Mexican-American, has never written alongside other indigenous writers, until this show, you will hear her talk about representation and what a room like that can do in terms of what we see on television. That's coming up in just a few moments on CBC Radio One. And tomorrow, a reminder, we head to Peel Region in Ontario to hear how people there are coping with covid-19 and why their crisis is in many ways a crisis for all of Canada. That is tomorrow on The Current. I'm Matt Galloway. Thanks for listening. Take care. And we will speak with you tomorrow.

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