How Veterans are Victims of Big Pharma

Yves here. While this post makes an important point about the degree to which veterans are targets for opioid marketing, as well as the creation of a large and multiheaded “pain lobby” to promote the idea that pain was undertreated (which may have been true, but not to the degree suggested). However, the article also tries to pin the promotion of opioids in the VA system to Koch Brother via a single lobby where they were allegedly power players.

This making one of the pet targets of Team Dem the alleged moving force behind a particularly nasty form of rent extraction from vulnerable vets hangs on thin evidence. While as the article indicates, the Kochs player a role, it seems to be a stretch to describe them as the moving force. The lead actor has been the maker of Oxy-Contin, Purdue Pharma, and its owners, the Sackler family (note that there was a new Sackler building build to expand Harvard’s Fogg Art Museum back in the 1980s, so they have long been wealthy). Purdue Pharma has engaged in brazen and effective marketing strategies, like targeting not-well-educated MDs in districts with high concentrations of older people and/or blue collar workers, meaning patients more likely to suffer from orthopedic problems, and also high patient loads. The drug detail men d were very effective in persuading them these doctors that OxyContin was a good way to treat a wide range of problems quickly, ie, get patients in and out quickly.

From Forbes in 2015:

The richest newcomer to Forbes 2015 list of America’s Richest Families comes in at a stunning $14 billion. The Sackler family, which owns Stamford, Conn.-based Purdue Pharma, flew under the radar when Forbes launched its initial list of wealthiest families in July 2014, but this year they crack the top-20, edging out storied families like the Busches, Mellons and Rockefellers.

How did the Sacklers build the 16th-largest fortune in the country? The short answer: making the most popular and controversial opioid of the 21st century — OxyContin.

Purdue, 100% owned by the Sacklers, has generated estimated sales of more than $35 billion since releasing its time-released, supposedly addiction-proof version of the painkiller oxycodone back in 1995. Its annual revenues are about $3 billion, still mostly from OxyContin. The Sacklers also own separate drug companies that sell to Asia, Latin America, Canada and Europe, together generating similar total sales as Purdue’s operation in the United States.

The Kochs are number 2 on the Forbes richest families list, at $82 billion, but the Sacklers have more than enough money to have enormous political influence and are keenly focused on promoting their huge, addictive cash cow.

By Ann Jones, the author most recently of  They Were Soldiers: How the Wounded Return from America’s Wars — the Untold Story, a Dispatch Books original. This piece is adapted from the keynote address she recently gave to the annual convention of Veterans for Peace. She is a member of the international advisory board of that organization. Cross posted from TomDispatch

A friend of mine, a Vietnam vet, told me about a veteran of the Iraq War who, when some civilian said, “Thank you for your service,” replied: “I didn’t serve, I was used.” That got me thinking about the many ways today’s veterans are used, conned, and exploited by big gamers right here at home.

Near the end of his invaluable book cataloguing the long, slow disaster of America’s War for the Greater Middle East, historian Andrew Bacevich writes:

“Some individuals and institutions actually benefit from an armed conflict that drags on and on. Those benefits are immediate and tangible. They come in the form of profits, jobs, and campaign contributions.  For the military-industrial complex and its beneficiaries, perpetual war is not necessarily bad news.”

Bacevich is certainly right about war profiteers, but I believe we haven’t yet fully wrapped our minds around what that truly means. This is what we have yet to take in: today, the U.S. is the most unequal country in the developed world, and the wealth of the plutocrats on top is now so great that, when they invest it in politics, it’s likely that no elected government can stop them or the lucrative wars and “free markets” they exploit.

Among the prime movers in our corporatized politics are undoubtedly the two billionaire Koch brothers, Charles and David, and their cozy network of secret donors.  It’s hard to grasp how rich they really are: they rank fifth (David) and sixth (Charles) on Business Insider’s list of the 50 richest people in the world, but if you pool their wealth they become by far the single richest “individual” on the planet. And they have pals. For decades now they’ve hosted top-secret gatherings of their richest collaborators that sometimes also feature dignitaries like Clarence Thomas or the late Antonin Scalia, two of the Supreme Court Justices who gave them the Citizens United decision, suffocating American democracy in plutocratic dollars.  That select donor group had reportedly planned to spend at least $889 million on this year’s elections and related political projects, but recent reports note a scaling back and redirection of resources.

While the contest between Trump and Clinton fills the media, the big money is evidently going to be aimed at selected states and municipalities to aid right-wing governors, Senate candidates, congressional representatives, and in some cities, ominously enough, school board candidates. The Koch brothers need not openly support the embarrassing Trump, for they’ve already proved that, by controlling Congress, they can significantly control the president, as they have already done in the Obama era.

Yet for all their influence, the Koch name means nothing, pollsters report, to more than half of the U.S. population. In fact, the brothers Koch largely stayed under the radar until recent years when their roles as polluters, campaigners against the environment, and funders of a new politics came into view. Thanks to Robert Greenwald’s film Koch Brothers Exposed and Jane Mayer’s book Dark Money: The Hidden History of the Billionaires Behind the Rise of the Radical Right, we now know a lot more about them, but not enough.

They’ve always been ready to profit off America’s wars. Despite their extreme neo-libertarian goal of demonizing and demolishing government, they reportedly didn’t hesitate to pocket about $170 million as contractors for George W. Bush’s wars.  They sold fuel (oil is their principal business) to the Defense Department, and after they bought Georgia Pacific, maker of paper products, they supplied that military essential: toilet paper.

But that was small potatoes compared to what happened when soldiers came home from the wars and fell victim to the profiteering of corporate America. Dig in to the scams exploiting veterans, and once again you’ll run into the Koch brothers.

Pain Relief: With Thanks from Big Pharma

It’s no secret that the VA wasn’t ready for the endless, explosive post-9/11 wars.  Its hospitals were already full of old vets from earlier wars when suddenly there arrived young men and women with wounds, both physical and mental, the doctors had never seen before.  The VA enlarged its hospitals, recruited new staff, and tried to catch up, but it’s been running behind ever since.

It’s no wonder veterans’ organizations keep after it (as well they should), demanding more funding and better service. But they have to be careful what they focus on. If they leave it at that and overlook what’s really going on — often in plain sight, however disguised in patriotic verbiage — they can wind up being marched down a road they didn’t choose that leads to a place they don’t want to be.

Even before the post-9/11 vets came home, a phalanx of drug-making corporations led by Purdue Pharma had already gone to work on the VA.  These Big Pharma corporations (many of which buy equipment from Koch Membrane Systems) had developed new pain medications — opioid narcotics like OxyContin (Purdue), Vicodin, Percocet, Opana (Endo Pharmaceuticals), Duragesic, and Nucynta (Janssen, a subsidiary of Johnson & Johnson) — and they spotted a prospective marketplace.  Early in 2001, Purdue developed a plan to spend hundreds of thousands of dollars targeting the VA.  By the end of that year, this country was at war, and Big Pharma was looking at a gold mine.

They recruited doctors, set them up in private “Pain Foundations,” and paid them handsomely to give lectures and interviews, write studies and textbooks, teach classes in medical schools, and testify before Congress on the importance of providing our veterans with powerful painkillers.  In 2002, the Food and Drug Administration considered restricting the use of opioids, fearing they might be addictive. They were talked out of it by experts like Dr. Rollin Gallagher of the American Academy of Pain Medicine and board member of the American Pain Foundation, both largely funded by the drug companies. He spoke against restricting OxyContin.

By 2008, congressional legislation had been written — the Veterans’ Mental Health and Other Care Improvement Act — directing the VA to develop a plan to evaluate all patients for pain. When the VA objected to Congress dictating its medical procedures, Big Pharma launched a “Freedom from Pain” media blitz, enlisting veterans’ organizations to campaign for the bill and get it passed.

Those painkillers were also dispatched to the war zones where our troops were physically breaking down under the weight of the equipment they carried. By 2010, a third of the Army’s soldiers were on prescription medications — and nearly half of them, 76,500, were on prescription opioids — which proved to be highly addictive, despite the assurance of experts like Rollin Gallagher. In 2007, for instance, “The American Veterans and Service Members Survival Guide,” distributed by the American Pain Foundation and edited by Gallagher, offered this assurance: “[W]hen used for medical purposes and under the guidance of a skilled health-care provider, the risk of addiction from opioid pain medication is very low.”

By that time, here at home, soldiers and vets were dying at astonishing rates from accidental or deliberate overdoses. Civilian doctors as well had been persuaded to overprescribe these drugs, so that by 2011 the CDC announced a national epidemic, affecting more than 12 million Americans.  In May 2012, the Senate Finance Committee finally initiated an investigation into the perhaps “improper relation” between Big Pharma and the pain foundations. That investigation is still “ongoing,” which means that no information about it can yet be revealed to the public.

Meanwhile, opioid addicts, both veterans and civilians, were discovering that heroin was a cheaper and no less effective way to go.  Because heroin is often cut with Fentanyl, a more powerful opioid, however, drug deaths rose dramatically.

This epidemic of death is in the news almost every day now as hard-hit cities and states sue the drug makers, but rarely is it traced to its launching pad: the Big Pharma conspiracy to make big bucks off our country’s wounded soldiers.

It took the VA far too long to extricate itself from medical policies marketed by Big Pharma and, in effect, prescribed by Congress. It had made the mistake of turning to the Pharma-funded pain foundations in 2004 to select its Deputy National Program Director of Pain Management: the ubiquitous Dr. Gallagher. But when the U.S. Drug Enforcement Agency finally laid down new restrictive rules on opioids in 2014, the VA had to comply. That’s been hard on the thousands of opioid-dependent vets it had unwittingly hooked, and it’s becoming harder as Republicans in Congress move to privatize the VA and send vets out with vouchers to find their own health care.

Cute Cards Courtesy of the Koch Brothers

To force the VA to use its drugs, Big Pharma set up dummy foundations and turned to existing veterans’ organizations for support. These days, however, the Big Money people have found a more efficient way to make their weight felt.  Now, when they need the political clout of a veterans’ organization, they help finance one of their own.

Consider Concerned Veterans for America (CVA). The group’s stated mission: “to preserve the freedom and prosperity we and our families fought and sacrificed to defend.”  What patriotic American wouldn’t want to get behind that?

The problem that concerns the group right now is the “divide” between civilians and soldiers, which exists, its leaders claim, because responsibility for veterans has been “pushed to the highest levels of government.” That has left veterans isolated from their own communities, which should be taking care of them.

Concerned Veterans for America proposes (though not quite in so many words) to close that gap by sacking the VA and giving vets the “freedom” to find their own health care. The 102-page proposal of CVA’s Task Force on “Fixing Veterans’ Health Care” would let VA hospitals treat veterans with “service-connected health needs” — let them, that is, sweat the hard stuff — while transforming most VA Health Care facilities into an “independent, non-profit corporation” to be “preserved,” if possible, in competition “with private providers.”

All other vets would have the “option to seek private health coverage,” using funds the VA might have spent on their care, had they chosen it. (How that would be calculated remains one of many mysteries.) The venerable VA operates America’s largest health care system, with 168 VA Medical Centers and 1,053 outpatient clinics, providing care to more than 8.9 million vets each year. Yet under this plan that lame, undernourished but extraordinary and, in a great many ways, remarkably successful version of single-payer lifelong socialized medicine for vets would be a goner, perhaps surviving only in bifurcated form: as an intensive care unit and an insurance office dispensing funds to free and choosy vets.

Such plans should have marked Concerned Veterans for America as a Koch brothers’ creation even before its front man gave the game away and lost his job. Like those pain foundation doctors who became self-anointed opioid experts, veteran Pete Hegseth had made himself an expert on veterans’ affairs, running Concerned Veterans for America and doubling as a talking head on Fox News.  The secretive veterans’ organization now carries on without him, still working to capture — or perhaps buy — the hearts and minds of Congress.

And here’s the scary part: they may succeed.  Remember that every U.S. administration, from the Continental Congress on, has regarded the care of veterans as a sacred trust of government. The notion of privatizing veterans’ care — by giving each veteran a voucher, like some underprivileged schoolboy — was first suggested only eight years ago by Arizona Senator John McCain, America’s most famous veteran-cum-politician. Most veterans’ organizations opposed the idea, citing McCain’s long record of voting against funding the VA.  Four years ago, Mitt Romney touted the same idea and got the same response.

That’s about the time that the Koch brothers, and their donor network, changed their strategy. They had invested an estimated $400 million in the 2012 elections and lost the presidency (though not Congress).  So they turned their attention to the states and localities.  Somewhere along the way, they quietly promoted Concerned Veterans for America and who knows what other similar organizations and think tanks to peddle their cutthroat capitalist ideology and enshrine it in the law of the land.

Then, in 2014, President Obama signed into law the Veterans’ Access to Care Through Choice, Accountability, and Transparency Act. That bill singled out certain veterans who lived at least 40 miles from a VA hospital or had to wait 30 days for an appointment and gave them a “choice card,” entitling them to see a private doctor of their own choosing.  Though John McCain had originally designed the bill, it was by then a bipartisan effort, officially introduced by the Democratic senator who chaired the Senate Committee on Veterans’ Affairs: Bernie Sanders.

Sanders said that, while it was not the bill he would have written, he thought it was a step toward cutting wait times. With his sponsorship, the bill passed by a 93-3 vote. And so an idea unthinkable only two years earlier — the partial privatization of veteran’s health care — became law.

How could that have happened?  At the VA, there was certainly need for improvement.  Its health care system had been consistently underfunded and wait times for appointments were notoriously long.  Then, early in 2014, personnel at the Phoenix VA in McCain’s home state of Arizona were caught falsifying records to hide the wait-time problem.  When that scandal hit the news, Concerned Veterans for America was quick to exploit the situation and lead a mass protest.  Three weeks later, as heads rolled at the VA, Senator McCain called a town hall meeting to announce his new bill, with its “hallmark Choice Card.” His website notes that it “received praise… from veterans’ advocacy organizations such as Concerned Veterans for America.”

That bill also called for a “commission on care” to explore the possibilities of “transforming” veterans’ health care.  Most vets still haven’t heard of this commission and its charge to change their lives, but many of those who did learn of it were worried by the terminology.  After all, many vets already had a choice through Medicare or private insurance, and most chose the vet-centered treatment of the VA. They complained only that it took too long to get an appointment. They wanted more VA care, not less — and they wanted it faster.

In any case, those choice cards already handed out have reportedly only slowed down the process of getting treatment, while the freedom to search for a private doctor has turned out to be anything but popular.  Nevertheless, the commission on care — 15 people chosen by President Obama and the leaders of the House and Senate — worked for 10 months to produce a laundry list of “fixes” for the VA and one controversial recommendation. They called for the VA “across the United States” to establish “high-performing, integrated community health care networks, to be known as the VHA Care System.”

In other words, instead of funding added staff and speeded-up service, the commission recommended the creation of an entirely new, more expensive, and untried system. Then there was the fine print: as in the plan of Concerned Veterans of America, there would be tightened qualifications, out-of-pocket costs, and exclusions.  In other words, the commission was proposing a fragmented, complicated, and iffy system, funded in part on the backs of veterans, and “transformative” in ways ominously different from anything vets had been promised in the past.

Commissioner Michael Blecker, executive director of the San Francisco-based veterans’ service organization Swords to Plowshares, refused to sign off on the report.  Although he approved of the VA fixes, he saw in that recommendation for “community networks” the privatizer’s big boot in the door.  Yet while Blecker thought the recommendation would serve the private sector and not the vet, another non-signer took the opposite view. Darin Selnick, senior veterans’ affairs advisor for Concerned Veterans for America and executive director of CVA’s Fixing Veterans Health Care Taskforce, complained that the commission had focused too much on “fixing the existing VA” rather than “boldly transforming” veterans’ health care into a menu of “multiple private-sector choice options.”  The lines were clearly drawn.

Then, last April, Senator McCain made an end run around the commission, a dash that could only thrill the leaders of Concerned Veterans for America and their backers. Noting that his choice card legislation was due to expire, McCain, together with seven other Republican senators (including Ted Cruz), introduced new legislation: the Care Veterans Deserve Act of 2016.  It’s a bill designed to “enhance choice and flexibility in veterans’ health care” by making the problematic choice card “permanently and universally” available to all disabled and other unspecified veterans.  You can see where the notion came from and where it’s going. By May 2016, when Fox News featured a joint statement by Senator McCain and Pete Hegseth, late of Concerned Veterans for America, trumpeting the VA Choice Card Program as “the most significant VA reform in decades,” you could also see where this might end.

As real veterans’ organizations wise up to what’s going on, they will undoubtedly stand against the false “freedom” of a Koch brothers-style “transformation” of the VA system. The rest of us should stand with them. The plutocrats who corrupted veterans’ health care and now want to shut it down, and the plutocrats who profit from this country’s endless wars are one and the same. And they have bigger plans for us all.