The 8th Annual Alexander Awards: The Best Tox Reading of 2017

January 2, 2018, 4:17 pm

Alexander Gettler

Once again, last year’s outstanding examples of long-form journalism dealing with topics related to medical toxicology were dominated by coverage of the opioid crisis, its origins and the resulting carnage.

The must-read article of the year was “The Family That Built a Empire of Pain,” Patrick Radden Keefe’s massive history of the Sacklers, one of America’s richest clans, much of whose wealth comes from their ownership of Purdue Pharma and the marketing and distribution of Oxycontin.

The article, which appeared in the New Yorker, notes that the clan’s patriarch, Arthur Sackler, worked his way through medical school in the 1940s by serving as a copywriter for a New York ad agency that targeted targeted physicians and medical workers. He was so successful at melding the then disparate worlds of Marcus Welby M.D. and Don Draper that ultimately he took over the entire company:

“Until then, pharmaceutical companies had not availed themselves of Madison Avenue pizazz and trickery. As both a doctor and an adman, Arthur displayed a Don Draper-style intuition for the alchemy of marketing. He recognized that selling new drugs requires a seduction of not just the patient but the doctor who writes the prescription.”

Sackler began using medical thought leaders to endorse specific products. Keefe quotes psychiatrist Allen Frances: “Most of the question practices that propelled the pharmaceutical industry into the scourge it is today can be attributed to Arthur Sackler.”

In the 1960s, Sackler’s marketing genius helped turn Valium and Librium into blockbuster drugs.By the early 1970s, physicians were writing more than 100 million scripts a year for tranquilizers.

In 1952, Arthur Sackler, along with his brothers Raymond and Mortimer — both physicians — bought Purdue Frederick, a small company that made such non-prescription products as laxatives and earwax remover.

The rest, as they say, is history, and that history is described in exquisite detail in Keefe’s article.

A similar article, also long and well worth reading, is Christopher Glazek’s “The Secretive Family Making Billions From the Opioid Crisis” in Esquire. Glazed is especially good at detailing the Sacklers’ involvement with Purdue Pharma, and their plans, as sales of opioids in the United States flag, to expand into other areas such as South American and Asia.

There were, of course, other notable long-form articles last year, not totally focusing on opioids:

So God Made the World’s Hottest Pepper“: In The Atlantic, Nicholas Hunt asks the question: Is the Carolina Reaper really the world’s hottest pepper? And what does that title even really mean? The single pod with the highest reading on the Scoville scale? Or the highest average Scoville reading among all peppers of a specific type? Hunt takes us on a deep dive into Habanero heuristics.

When the Cure is the Cause; The Case of the Green Hairy Tongue“: This fascinating article by Jeanne Lenzer describes at mass poisoning disaster that I had not been aware of. Subacute myelo-optic neuropathy (SMON) is a neurotoxic condition that can cause paralysis, blindness or death. In Japan during the 1960s, at epidemic outbreak of SMON affected 30,000 people and killed about 900. The disease often started with GI manifestations (diarrhea, vomiting) and was sometimes associated with a “green hairy tongue” and green-colored urine. Eventually, the cause was identified as exposure to the drug clioquinol, an antiprotozoal drug that was used to treat amoebic dysentery. Lenzer’s article appears on Unmark, a website edited by Deborah Blum and dedicated to exploring the interaction between science and society.

Addicts Who Can’t Get Opioids Are Overdosing on a Diarrhea Drug“:   In The Atlantic, Sarah Zhang writes about how opioid addicts are drinking smoothies made of 100s of loperamide pills at a time to ward off symptoms of opioid withdrawal. High-dose loperamide can increase the QT interval, leading to cardiac arrhythmias. Fatalities have been reported.

The Very Drugged Nazis“: In the New York Review of Books, Antony Beevor reviewed Norman Ohler’s Blitzed: Drugs in the Third Reich, which argued that drug abuse was prevalent in the Third Reich among the military, the general population, and Adolph Hitler himself. Ohler writes that the main agent abused was Pervitin, a form of methamphetamine:

This is an interesting thesis, but one that is quite controversial although based on known fact. Some commentators argue that attributing much of the history of the Third Reich to drug abuse is mindlessly simplistic and naive, and borders on an attempt at exculpation.

As a reminder, the Alexander awards are named for Alexander Gettler, who has been called the “father of forensic toxicology” in the United States. They were inspired by David Brooks’ yearly Sidney Awards in the New York Times. This year, one of Brooks’ Sidneys went appropriately to a spellbinding article in Emergency Physicians Monthly by Kevin Menes and Judy Tintinalli describing Dr Menes’s experience as attending in charge of the emergency department at Sunrise Hospital in Las Vegas the night of October 1, 2017, when 58 people were killed and hundreds more injured at a country music concert outside the Mandalay Bay hotel.




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