Walker was arguing that the society must have a say not only in what happens to great wealth, but also in how great wealth comes to be. Without that, in his telling, the philanthropist is fighting against himself: perpetuating, even worsening, by day the very suffering he seeks to soothe after dusk.
The privileged, Walker went on, now benefit from the further advantage of having their language and mentality dominate other domains, including the giving world. They no longer just enjoy the privilege of nice homes and cars; they also now have a say over how so many public problems are solved. “When we talk about economic inequality,” he said, “we might acknowledge an underlying, unspoken hierarchy, in which we relate everything back to capital. In most areas of life, we have raised market-based, monetized thinking over all other disciplines and conceptions of value.”
Walker was presenting the power of the big giver as dangerous. Foundations like his were hobbled by “inherited, assumed, paternalist instincts.” Western givers tended to treat recipients in poor countries as subjects to be ordered around, as implementers rather than partners. Big philanthropy needed to get better at “modeling the kind of equality we hope to achieve by listening, and learning, and lifting others up.” Walker wrote that foundations—built, like Ford, on the fortunes of powerful people, often wielding enormous power themselves—needed to ask hard questions about their own authority and remove from reality: “How does our privilege insulate us from engaging with the most difficult root causes of inequality and the poverty in which it ensnares people?”
In two thousand words, Walker had shaken the intellectual platform on which MarketWorld philanthropy had long stood. The publication of the letter marked a reconciliation of his long dissonance. Like Hilary Cohen and Amy Cuddy, he had both worked the system and worried about it, had grappled with how to position himself relative to it, whether to be quiet, or walk away, or challenge it. The letter only mattered because he had worked the system long enough and well enough to rise to the presidency of the Ford Foundation. But the letter could perhaps only have been written by a man who had known the wrong end of that system before he ascended it, and who refused to let himself enjoy the climb without also making it useful.
* * *
—
The Lincoln wormed up Third Avenue in thick midday traffic as Walker thought through the proper approach for KKR. The nature of his burden had been inverted by the issuance of his new gospel. Now that he had spoken one of the more uncomfortable truths in his arena, his task had changed: It was to stay in the game, to keep the powerful listening, to challenge his plutocrat friends without scaring them away.
As the Lincoln surged some inches and halted and surged again, Walker pondered the pushback he got from these friends—the pleas to “stop ranting at inequality,” to speak of “opportunity” instead. He wondered what the criticism was telling him. Were these rich people aligned with his ideals deep down, wanting the same kind of society he wanted but preferring gentler, more inviting language for it? Or did he and they want fundamentally different things?
At first he defended them, revealing the openheartedness that had won their confidence over the years. They may not use his language of inequality, he said, but “they actually would say, ‘No, I do want a world where there’s opportunity.’ ” He understood their uneasiness about the word “inequality,” and why some of his friends felt he was “hassling” them. It was because, for so many of the winners he had come to know, their narrative of themselves was not of privilege but struggle. “I’m not some privileged kid,” he imagined them saying. “I’m working my ass off. I’m busting my ass out here pitching to these jerks, trying to raise money from them or trying to sell my widgets or whatever it is. So don’t tell me I’m privileged. I’m getting up every day at four o’clock and on the train from Rye and coming to New York, da-da-da.”
A moment later, he reconsidered his own magnanimity. “I think it’s hard, often, for them to want what I want,” he said. “It’s hard to reconcile, because what I want means they would have to give up something. And so the crux of it is, in order to reduce inequality, we actually have to talk about redistribution. We have to talk about equity. And that will impact them.” What he wanted, and what he had spent a long time earning the chance to call for, was a reining in of the power of people like them. He wanted them to pay higher taxes. He wanted them to give up their legacy preferences at the leading universities. He said, “All my friends who want to talk about education, you say, ‘Let’s talk about legacy programs. Do we really think legacy preferences, when we’re getting rid of affirmative action—shouldn’t we be getting rid of legacy?’ Oh, hell no. People will be like, ‘Oh, absolutely not.’ ”
What might have worried his critics the most was Walker’s view that moneymaking had to change. It was one thing to say that rich people needed to pay higher taxes and stop sneaking their children into Harvard; it was another to suggest, as he now did, that the very industry he was about to visit was predatory. “One of the fundamental challenges of private equity is so much of what they are about is efficiency and extracting value from their portfolio companies. And what that translates into is generating more productivity with less expense. So, basically, firing people, laying people off,” he said. “We know the productivity of the last twenty years has been not to the benefit of workers. Workers’ income is flat.” Those resources were “extracted,” he said, and now show up as returns for firms like KKR. Some of that money will end up in charity, soothing the wounds it helped to cut.
If this was what Walker planned to say at KKR, it would surely be one of the more lively of their guest-speaker luncheons.
In spite of these ideas, Walker had a chance that few did to persuade an audience like this, because he knew how to talk to them and because he didn’t believe they were bad people. He did not malign them. He thought that they were trapped, as so many people in MarketWorld are, in a false dogma. He distilled the dogma thus: “You go out there and you make as much money as you can in the world, and you do all you can to make our capitalist system work—and then you’re a philanthropist. It’s phased, and it’s compartmentalized.”
What he had learned from observing the rich was how the dogma made it easier to feel like a good person. “Compartmentalizing is a means of coping,” he said in the back of the limo. “And so, sure, there are things that they know, they see, on a daily basis that must, if they’ve got any morality, appall them.” But they tell themselves that “in my spare time, I’m going to be on that board in that school up in Harlem; or I’m going to mentor these three black boys in Bed-Stuy, and I’m going to get them to Yale.” It makes them feel like decent citizens. “The problem with it,” Walker said, “is that it allows you to park the part of your brain and your morality and your humanity that would make you demand something else of yourself and of the system.”
* * *
—
There are few families in modern American life who embody everything Walker was discussing as well as the Sacklers. They are one of the country’s richest families, and their lives intersected with Walker’s at various points in the philanthropic galaxy: organizations he and they have donated to; an award he had received from a museum of which Elizabeth Sackler was a trustee. The Sacklers were Carnegie’s old gospel incarnate: Give and give, honorably, thoughtfully, abundantly, and expect in return that questions will not be asked about the money’s origins and the system that let it be made.
The Sackler brothers—Elizabeth’s father, Arthur; Raymond; and Mortimer—were doctors and cofounders of a pharmaceutical company that would come to be called Purdue Pharma. The brothers made large gifts to the Metropolitan Museum of Art (which opened a Sackler wing as a result), the Guggenheim, and the American Museum of Natural History in New York; the Smithsonian Institution’s Asian art museum in Washington, D.C., which boasted “some of the most important ancient Chinese jades and bronzes in the world
”; the Tate Gallery and Royal College of Art in London; the Louvre in Paris; the Jewish Museum in Berlin; Columbia, Oxford, Edinburgh, Glasgow, and Salzburg universities; and the medical school at Tel Aviv University.
The brothers gave not only in their personal capacity; their company was also admirably generous to the communities in which it operated. It offered grants to local groups to “encourage the healthy development of youth by reducing high-risk behaviors, such as substance abuse.” It supported organizations that “improve quality of life at a national level and in our own communities.” It funded education programs to “help medical professionals recognize and reduce medication abuse.” In the shadow of its headquarters in Connecticut, it funded the Stamford Boys & Girls Club, a provider of services to the homeless, a library, the Stamford Palace Theatre, the Connecticut Ballet, the Stamford Symphony, the Stamford Chamber of Commerce, the Business Council of Fairfield County, the Stamford Museum and Nature Center, the Maritime Aquarium, United Way, and Making Strides Against Breast Cancer.
In the hubs of power and influence in America and around the world, it was difficult to avoid the generous legacy of the Sacklers. But Walker had now raised the question of whether the givers were obliged not only to contribute to solutions but also to answer about their role in causing the problems.
In business, the Sacklers had engaged in practices that at first raised eyebrows and eventually summoned serious legal problems. Arthur Sackler was, according to the New York Times, “widely given credit (some would say blame) for creating many of the drug industry’s more aggressive marketing techniques—for example, holding conferences for doctors in which attendees learn about the efficacy of the sponsoring company’s drugs.” That legacy of aggressive drug marketing affected the promotion of many different medicines, but it was particularly consequential for Purdue Pharma and its affiliated companies, and for American society, in the case of a painkiller called OxyContin, which it began to sell in 1996. OxyContin is a forceful narcotic that provides up to twelve hours of respite from serious pain. At first it was marketed as a breakthrough, with a time-release formulation that made it less likely to foster addiction and abuse.
“That claim,” the Times reports, “became the linchpin of the most aggressive marketing campaign ever undertaken by a pharmaceutical company for a narcotic painkiller.” In addition to the wining and dining at conferences, the marketers of OxyContin, including Purdue’s partner Abbott Laboratories, were ingenious in their pursuit of doctors—including in the case of an orthopedic surgeon who wouldn’t give the drug reps his time, until they discovered his weakness, according to STAT, a medical publication. “We were told by his nurses and office staff that the best way to capture his attention and develop our relationship was through junk food,” the drug reps noted in a memo disclosed by STAT. The reps were swift to act on the advice. An Abbott rep showed up the following week, according to STAT, bearing a box of donuts and other treats. The sweets had been specially arrayed to spell the word “OxyContin.” This time, the reps got the ear of the doctor. “Every week after that, the Abbott sales personnel visited the doctor to ask him to switch at least three patients to OxyContin from other painkillers,” STAT reported.
Purdue also pursued a strategy of promoting OxyContin to general practitioners, who tended to have the disadvantage (or advantage, depending on your viewpoint) of less training than specialists such as orthopedic surgeons in treating serious pain and in detecting signs of painkiller abuse by patients. There are also, of course, many more general practitioners than there are such specialists. This huge marketing blitz for OxyContin took Purdue from being a small drug maker in the mid-1990s to earning nearly $3 billion in sales in 2001. Four-fifths of that was from OxyContin.
Oxy, as it came to be called, was a powerful new weapon against pain, but it also swiftly became a widely abused street drug. It was meant to be swallowed, which allowed for the extended release. But, the Times wrote, “both experienced drug abusers and novices, including teenagers, soon discovered that chewing an OxyContin tablet or crushing one and then snorting the powder or injecting it with a needle produced a high as powerful as heroin.” And so OxyContin began to be implicated in a growing number of overdoses and deaths, concentrated in rural areas down on their luck. These deaths around the turn of the millennium turned out to be early signs of what years later would come to be called a national “opioid epidemic.” As the New Yorker reports, “though many fatal overdoses have resulted from opioids other than OxyContin, the crisis was initially precipitated by a shift in the culture of prescribing—a shift carefully engineered by Purdue.” Eventually, the Centers for Disease Control and Prevention would report that overdose deaths from prescription opioids quadrupled between 1999 and 2014, claiming fourteen thousand lives in that last year. That same year, nearly two million Americans “abused or were dependent on prescription opioids,” and a quarter of patients who used the drugs for noncancer purposes battled addiction. The opioids were sending more than a thousand people a day to emergency rooms. And in online forums, people traded notes about the best ways to get the best highs without killing themselves:
RE: CHEW OR SWALLOW WHOLE?
just keep in mind your tolerance will grow very very quickly!!!
I ate 2 x 80;’s today since 10am and snorted 1 as of 10pm.
Thats with 3 yrs experience and I suffer from 2 major conditions that require pain treatment, but 2.5 or 2.25 could do it. I let loose on weekends. and it also varies with how much I am active. Walking, etc…
Be careful. I started with 4 x 20mg per day……and now @ 300mg / Day.
You dont wanna go through withdrawals if you run out man. if you could have been with me December 24th last year I was out 1 week early at this level and had to suffer bad. You dont wanna know.
Sometimes no one sees a massive social problem like this coming. This was not one of those times. In 2001, as sales of OxyContin and other opioids soared, officials at the state employee health plan in West Virginia noticed something strange. As the insurer for state employees, it received paperwork when they died, including the coroner’s account of the cause of death. Officials at the insurer took note of a rising number of deaths attributed to something called oxycodone, the active ingredient in OxyContin, according to STAT. The officials were familiar with the drug, because prescriptions for it were exploding among their clients, who ingested $11,000 worth of it in 1996 and $2 million worth in 2002.
The officials were quick to speak up. They pushed for regulations that would require doctors to secure prior authorization before prescribing OxyContin, which was intended to confine usage of the drug to people who genuinely needed it and to keep it away from known addicts and others with a record of abusing it. But these efforts met furious resistance from Purdue Pharma. STAT reported that beating back any attempt to limit OxyContin prescriptions became a “top priority” for Purdue in 2001. A memo obtained by that news outlet, describing the annual goals of the company’s West Virginia operation, found “Stop any preauthorization efforts for OxyContin” prominent among them. Another memo mentioned a meeting with officials in West Virginia to “interrupt” any efforts on their part to slow the prescription of OxyContin.
As a former Purdue official explained to STAT, “We like to keep prior authorization off of any drug.” The official was casting these efforts as flowing from a generic aversion to regulation. Purdue found a clever workaround, using third-party companies known as pharmacy benefits managers to ensure that West Virginians could receive OxyContin without prior authorization. It made an arrangement to pay the benefits managers a “rebate” if they prescribed the drug without that additional safeguard.
Publicly, Purdue worked to project an image in keeping with its charitable spirit and that of its owners—that it existed to help people and was as keen as the state to prevent abuse or harm. Still, according to motions filed by the state’s lawyers:
Contrary to the picture of helpfulness and cooperation Purdue attempts to paint, Purdue’s employees were actively and secretly trying to prevent West Virginia from imposing any control on the sale of OxyContin.
McDowell County, West Virginia, turned out to be “a proverbial canary in a coal mine when it came to the emerging national opioid crisis,” STAT noted. Back in 2001, when officials at the insurer first spoke up, the state as a whole was still at 6 deaths per 100,000 residents from opioid overdoses. McDowell was already at 38 per 100,000, however, and its fate foreshadowed West Virginia’s, which would see its death rate more than triple in the ensuing decade, giving it the country’s highest rate of deaths from overdoses and of painkiller prescriptions in general. Many of those deaths might have been prevented if state officials had not faced the opposition they had to regulating OxyContin prescriptions. The McDowell sheriff, Martin West, said to visiting reporters, “Listen to the scanner here every night. It’s first responders out every night going up and down hollers for an overdose. It’s pitiful what is going on.”
Winners Take All: The Elite Charade of Changing the World Page 20
