Stephen May (2:58)

Oh, I use that quite frequently. Yeah. Start with and stay with. So basically the idea is this. You've got a physician that is prescribing a lot of Lortab or Vicin, and those are the combination opiates with hydrocodone or Percocet or Oxycodone that the patient is taking every four to six hours. Well, doctor, if you recognize early on that they're going to have to take an opiate, why not just go ahead and start them on 10 milligrams of oxycontin twice a day instead of getting into that habit forming four or six times a day. So you could start with a low dose, 10 milligrams. If you, if you think about it, 10 milligrams delivered over a period of 12 hours is the same or even less than if a patient took 5 milligrams of hydrocodone or percocet every four or six hours. And at the same time, you're not getting that peak and then that trough and then that peak and then that trough. It's basically a much smoother delayed absorption of the product over a period of 12 hours.

Patrick Radden Keefe (3:59)

So that's so fascinating. So actually, part of the sale for you guys was that OxyContin might be less prone to addiction and abuse than other drugs?

Stephen May (4:10)

Yeah, I think the word that was used more often would be habit forming in that case.

Patrick Radden Keefe (4:14)

I see.

Stephen May (4:15)

You know, it's habit forming to use something every four hours as opposed to 12 hours.

Patrick Radden Keefe (4:19)

Yeah, though, I mean, you can use something every 12 hours and have it be a habit as well.

Stephen May (4:24)

Exactly.

Patrick Radden Keefe (4:26)

But when you were talking to those physicians, did you get the sense that some, some of them might be prescribing the drug more frequently, like on a more frequent dosing schedule to their patients?

Stephen May (4:38)

Yeah, I mean, you would have doctors tell you that they were doing that. And what was absolutely crucial as a sales rep to protect your own job? Well, you have to promote the product according to the label. I mean, we're talking about class two medications here. You can get in a lot of trouble. So it was always trying to get the doctor back to, hey, listen, this is a 12 hour drug. I know you said that your patients need to take it three times a day, every eight hours, but it's a 12 hour drug. That's the way it's supposed to be prescribed.

Patrick Radden Keefe (5:15)

And when they told you that in some instances maybe the patients needed it three times a day and they would be prescribing it as that. Did it strike you at all that if that was what was happening, then the whole kind of marketing thrust that you only needed it twice a day might not actually be true?

Stephen May (5:37)

It's possible, yes. At the same time, we would also instruct the doctor, if they're having to take it every eight hours versus every 12 hours, perhaps the patient needs to be titrated upwards on the, on the drug to a higher dose.

Patrick Radden Keefe (5:50)

I see. And so they would take it just twice a day but with a higher dose each time.

Stephen May (5:54)

Exactly, exactly. That would be the appropriate thing to do.

Patrick Radden Keefe (5:59)

Gotcha. I mean, it's interesting. So you're going in there, you're meeting with doctors, you're showing them literature to support the drug, but you're not a doctor. Right. You're not a clinician. How comfortable were you with the science of it? I mean, did you have to kind of prepare in advance for questions that you might get from the doctors and know what types of answers you would give them?

Stephen May (6:21)

Well, that's part of the training that we go to. I mean, we spend three weeks literally, not only learning about the product itself, but you learn about the background of the product. In this case, it was pain management. We learn about the history of pain management. And then you spend a lot of time going through common objections that the doctors would give you.

Patrick Radden Keefe (6:43)

What kinds of common objections?

Stephen May (6:46)

Well, I mean, I guess the most common objection that I heard after joining the company was, well, it's just too addictive. I mean, we've got too many problems in our community with overdose deaths. And so basically a lot of time was spent trying to overcome the doctor's objections on that and trying to refocus them and saying, yes, there's going to be people out there that are going to abuse or divert the drug. But basically, we were trained. Let's focus on treating the legitimate pain patients, you know, and if we can focus our, you know, focus on treating those patients, then we'll have the outcomes and the doctors will prescribe the products.

Patrick Radden Keefe (7:29)

Well, that's. I mean, this is another thing I wanted to ask you about is. So you go out there and the first and biggest objection that you're encountering is, well, geez, you know, aren't these things really addictive? Did you, like, did you believe that they weren't? Was the company telling you that they weren't? Were there studies or was there data that you could give to doctors to say, no, actually, you've got it wrong, this isn't addictive?

Stephen May (8:00)

Well, I mean, early on, one of the biggest things that I would use, I mean, I memorized the. The specific line in the package insert that was later changed by the FDA, and that was the delayed absorption of the OxyContin was believed to reduce the abuse liability of the drug. That was one of the things that we're trying to express to physicians now. I think that worked for a while, but it wasn't very long into my experience with the company that, well, if they crush up the medication, then that kind of destroys the long acting delivery system. So.

Patrick Radden Keefe (8:38)

Well, because people were crushing the pills and snorting them or injecting them, melting them.

Stephen May (8:46)

Exactly, exactly. So there was ways to get around that. And eventually I think the FDA changed the labeling of that. And at some point we were told that we could no longer use that particular language.

Patrick Radden Keefe (8:57)

So let me understand this. So you get recruited to go work at Purdue Pharma, which has this super elite salesforce. It's got this blockbuster product. They're paying better than a lot of other pharmaceutical companies are.

Patrick Radden Keefe (9:14)

And then you actually get down there on the ground and it sounds like.

Patrick Radden Keefe (9:16)

Already there's blowback because in the communities, people realize that there's abuse and addiction. So, I mean, that must have been kind of disillusioning for you. I would think.

Stephen May (9:28)

It was. I mean, I started seeing it early on. One of my experiences was I had, I think at the time it was a representative who was either the previous national sales rep of the year or they were on track to becoming the national sales representative of the year. So they would come in to help train us, to watch them handle objections from physicians. So we went into a doctor's office in West Virginia and, you know, we were pulled aside and advised that a family member of that particular doctor had died over as a result of an overdose of OxyContin. So that was a pretty significant blow that we both had. So I call that the day that it really hit really close to home for me.

Patrick Radden Keefe (10:16)

And what year was that roughly?

Stephen May (10:19)

Oh, that was within a month or two after me joining with the company in 2000. In 2000, yeah.

Patrick Radden Keefe (10:26)

And you stayed on for another five years?

Stephen May (10:30)

Yes.

Patrick Radden Keefe (10:31)

So what did you tell yourself? I mean, did you think these were just isolated incidents or.

Stephen May (10:40)

You know, quite frankly, I mean, what do you tell yourself? I mean, you really believe that you're doing something, you're doing a righteous duty by trying to treat pain, you know, and you're trying to focus, trying to get physicians on using the product for legitimacy, legitimate paying patients who use the product the right way. I mean, that was my personal focus. And at the same time, it was still a good company to work for. There was more and more challenges. I think we really as a company first started seeing the challenges in West Virginia and southern West Virginia and parts of what anybody calls Appalachia. But you really feel like you're doing something good and at the same time you're recognizing that, hey, look, this is a company that I could work for for a long time. They're going to have other products down the road. So you stay with it for that reason because there's an opportunity for personal growth.

Patrick Radden Keefe (11:36)

I see. And were you feeling pressure from the company to keep growing the territory?

Stephen May (11:43)

Oh, absolutely. I mean, it was, you know, how do we turn the doctors minds away from the bad news of what was happening in the community and get them focused on treating the legitimate chronic pain patients? So, yeah, there was a constant push on that.

Patrick Radden Keefe (12:02)

And you eventually were part of a whistleblower lawsuit against Purdue, is that right?

Stephen May (12:07)

That's correct.

Patrick Radden Keefe (12:09)

But it got dismissed.

Stephen May (12:11)

Yeah, it was dismissed. I mean, it had been in the court system for many years. It's not hard for anybody to look up any information about it. It's Radcliffe May v. Perdue. We had specific allegations that the company had committed fraud and eventually it was dismissed on a technicality.

Patrick Radden Keefe (12:29)

It was a procedural basis for dismissing it.

Stephen May (12:32)

That's my understanding, Kurt.

Patrick Radden Keefe (12:34)

Looking back now, a lot of observers feel that while there are obviously a bunch of companies that make prescription painkillers which are abused, that Purdue Pharma played kind of an instrumental, special role in precipitating the opioid crisis because the company pushed really aggressively to destigmatize the long term use of strong opioids. How do you feel looking back? I mean, do you feel as though Purdue has any culpability in getting us to where we are today in the opioid crisis?

Stephen May (13:14)

I believe they were absolutely instrumental in it. The culpability is you can't turn a blind eye to the problems that you're creating in the community. And that's one of the things I want to say to the Sackler family. Stand up, be responsible, be proud of your company. Okay, you built a great company. But also take some responsibility for the problems that has been caused by the way that your products are being promoted and how your products are being abused. And at the same time, you're still pushing the promotion of that product that's destroying communities today. I mean, I can't say it any other way. Be accountable.

Patrick Radden Keefe (13:56)

And is there I mean, is there any sense in which you, on a personal level, look back and feel any guilt or feel any as though you personally have any culpability.

Stephen May (14:14)

Left? I think as an individual, you're doing your job. You believe that you're doing it righteously. You don't want to do wrong. You want to help people. At the same time, looking back, you go, wow, perhaps I probably should have resigned from the company early on and just walked away from a situation that was growing bad. But at the same time, you look, what was the information that I had at the time? Was there a way to turn this thing around? At the time, I believe there was. But looking back, it saddens me that I was a part of it. I'll say it that way.

David Remnick (15:08)

That was Stephen May, a former sales rep for Purdue Pharma, talking with the New Yorker's Patrick Radden Keefe. Patrick's piece about the selling of OxyContin called Empire of Pain, was published in the New Yorker in 2017. And I spoke with him then. Now, Patrick, we just heard Stephen May lay blame for the consequences of opioid addictions on the Sackler family. The fact that Purdue is privately held by the descendants of two brothers. How has that affected how it does business now?

Patrick Radden Keefe (15:43)

Well, it's a very secret company.

Patrick Radden Keefe (15:45)

It always has been. If this was a publicly traded pharmaceutical company, you'd have shareholders, you'd have earnings calls, you'd have quarterly reports, and there would be a check, a kind of an outside check. But really, this company is the kind of private realm of this one family, and they own it, they control it, they're on the board. The profits all flow to the family. And what this means is when you get into some of these dicey questions about selling a very addictive substance to lots and lots of people, what may be complicated ethical questions that normally you would be able to subject to a larger review in a publicly traded company. Really, they're just decided by the family, and we don't know what goes into that decision making.

David Remnick (16:33)

What do you think their defense will be, David?

Patrick Radden Keefe (16:35)

I've wondered about that, and I thought to myself, you know, there might be a kind of libertarian case that could be made, which is essentially in the same way that if you own a firearms company, right. We put a product out there in the world, it's dangerous if used incorrectly. But ultimately, this is a question of individual responsibility.

David Remnick (16:54)

Libertarian argument. In the world of pharmaceuticals, can you imagine, we're seeing a staggering, tragic number of deaths from overdoses because of this epidemic, especially from heroin, which is deadly and very cheap on the street. OxyContin is legal and it's regulated. So why is it such a problem?

Patrick Radden Keefe (17:13)

Well, here's the answer. For thousands of years, people have cultivated poppies, and we've known about the therapeutic benefits of opium related narcotics. We've also known for thousands of years that they're really addictive. And this has always been the two sides of the coin. When Purdue pharma and the Sackler family set out to sell oxycontin, what they wanted to do was destigmatize strong opioids. The whole idea was, we've got doctors out there who are reluctant to prescribe these. How do we change their minds? And they set out to change their minds, and they were incredibly effective. So the real issue with the heroin is that once the country is flooded with these opioids, you get a lot of people getting addicted. And once that genie is out of the bottle, it gets very hard to put it back.

Patrick Radden Keefe (17:58)

So Purdue Pharma, other companies, have tried.

Patrick Radden Keefe (18:02)

To prevent their pills in more recent years from going to the black market, from getting crushed, from being abused, but it's kind of too late. And in an awful paradox, the harder it gets for somebody who's already addicted to opioids to get access through their doctor to opioids, the more likely it is that they're going to be buying them on the street. It may be too expensive, and they end up buying heroin, which is cheaper. And this is where we get spike in heroin.

David Remnick (18:25)

Did the Sackler family make any efforts to right or wrong?

Patrick Radden Keefe (18:30)

Well, they would tell you that they did in that Purdue Pharma reformulated OxyContin in 2010, making it harder to crush and snort.

Patrick Radden Keefe (18:40)

But I talked to people who said you really have to look at the timing of this because they reformulated OxyContin in 2010, but the patent on the.

Patrick Radden Keefe (18:48)

Drug was set to expire in 2013.

Patrick Radden Keefe (18:51)

This is something you actually typically find.

Patrick Radden Keefe (18:53)

In the life cycle of a branded.

Patrick Radden Keefe (18:55)

Narcotic, is just as the exclusive patent is about to expire, you tweak the formula in some way so as to make it seem that much different. And then what happens is you reset.

Patrick Radden Keefe (19:06)

The clock on your exclusive right to produce it, so they would tell you they had. What's interesting is if you look at their philanthropy, this is a family that gives to cancer research, they give to medical schools, they give to art museums, universities. There's nothing for the opioid crisis, nothing for addict treatment. If there is any sense in that family that they bear any moral culpability for where we are today. They're not acting on it.

David Remnick (19:33)

Patrick, it's an astonishing piece of journalism. I really appreciate it. Thank you.

Patrick Radden Keefe (19:36)

Thank you.

David Remnick (19:42)

Patrick. Raden Keefe's article about Purdue Pharma from 2017 is called Empire of Pain, and you can find it@newyorker.com the company is now facing dozens of lawsuits from states and municipalities, and there's even been talk that it may declare bankruptcy. This is the New Yorker Radio Hour. More to come. This is the New Yorker Radio Hour. I'm David Remnick. The list of cartoonists who are household names is a very short list, but Roz Chast is certainly at the top of it. She's been publishing in the New Yorker since she was 24, and her book Can't We Talk About Something More Pleasant? Was a finalist for the national book Award in 2014. Her cartoons stand out for how personal they are. They're about marital tensions and the stress of dealing with your crazy parents and your even crazier children. In her drawings, everyone looks completely frazzled, even the animals.

Liana Fink (21:05)

Hi, I'm Liana Fink. We are outside Roz Chast's house in Connecticut and I brought her some flowers that might be a bit too romantic. I made it. Oh, my God, you're beautiful.

Roz Chast (21:17)

Thank you so much. Come on in.

David Remnick (21:19)

Liana Fink grew up studying Roz's cartoons and she started contributing her own cartoons to the New Yorker a few years ago when she was 27. They share a certain stressed out line and a love of birds.

Roz Chast (21:32)

This is Jackie. She is a kaik. She's very un shy.

Liana Fink (21:38)

She looks like a Disney character. She has these big eyes.

Roz Chast (21:41)

She's a little bit of a cartoon bird.

Liana Fink (21:43)

I've been falling in love with Jackie. She's trembling while I pet her. I was a really shy kid and I've always felt really comfortable with animals because they don't do the things that I feel like I have to pretend to do, like hold conversations that are really hard for me. I always feel connected to pigeons. I feel like there are these wild creatures in the city and I'm like that too. He's a very good bird.

Roz Chast (22:14)

This is my very neurotic and very sweet African great. And she says many, many things. As you can see, she plucks.

Liana Fink (22:22)

She looks like a lion because she has this plucked body and this regal head.

Roz Chast (22:27)

Hey, Eli, what's this?

Stephen May (22:31)

That's water.

Roz Chast (22:33)

That's right. That's right. What a smart bird. What a smart Smart bird. This is a list of the things that she says, by the way. She says chirp, she says chirp, chirp, chirp. Who cares? When she gets scared, sometimes she'll say to herself, it's okay, it's okay, it's okay. Which is, you know, self soothing kind of thing. Yeah, she knows. Yeah, I do. Yeah, I do too. I mean. Yeah, me too. Yeah, it's okay.

Liana Fink (23:02)

I say fearless.

Roz Chast (23:04)

I sometimes I say, like, people do this, you know, like when I'm driving, especially because driving and I are not good friends.

Liana Fink (23:14)

You had a cartoon about driving where you just tell the story of driving, but you call it sailing instead of driving.

Roz Chast (23:20)

Yeah, it is, it is. I thought maybe if I did a cartoon where I was comfortable with it, like, somehow, like I would actually become more comfortable and, you know, gradually I'm more. It's better than it was when I started. But, I mean, it worked. The cartoon worked, but I still getting lost is. I mean, the GPS is good, but then I worry about the GPS going out.

Liana Fink (23:45)

I read your work most deeply when I was in high school and college. I think that's why I love the New Yorker. I mean, I know it. I think I was 14 when I found your work. And we had just moved to this suburban, kind of Fancy, kind of WASPy town in New Jersey. And I related so much as this kind of outsider and as a person who drew and as a shy kid and as a Jew, like, it just. It just completely summarized my world. And you got a lot. You got a lot of zeitgeisty stuff in there too. Like, it was much more intense than rereading an old diary or looking at photographs or something. I feel like you really cut that era and cut my life. And how do you feel when you reread your work?

Roz Chast (24:39)

Hmm, Sometimes it does bring me back because I guess a lot of my work is kind of personal.

Liana Fink (24:46)

So do you feel like. What do you feel about your cartoons being the most autobiographical ones in the New Yorker?

Roz Chast (24:56)

Definitely. There's a part of me that is that voice of, sorry, sorry, sorry, sorry, sorry, sorry, sorry, sorry, sorry, sorry. You know, I mean, sometimes I wish that I did a whole different kind of work, you know, but I always think there's that Yiddish, you know, if my grandmother had wheels, she'd be a wagon. You know, I mean, if I were a very different person, then I would do different cartoons.

Liana Fink (25:24)

Are you terrified of people?

Roz Chast (25:26)

Oh, yeah, it's. And I know that everything that I say this afternoon, I'm going to rewind in my Head and regret. Oh, no. And that is just what I mean. I'm just almost. I wouldn't quite say used to it, but I just know that that's.

Liana Fink (25:43)

I still regret some things that I've said to you, like a year ago. And I probably won't think about it all the time.

Roz Chast (25:50)

It's just like a regretters festival.

Liana Fink (25:52)

Yeah.

Roz Chast (25:52)

Well, I'm a very big fan of your work in magazine, too. Thank you. I love seeing it and I love God. Finding all the prayers of mankind in his spam folder, I think is just sensational.

Liana Fink (26:04)

Thanks. I mean, I didn't care about them. I love working. I don't care if they're good. If I cared, I would be paralyzed.

Roz Chast (26:14)

Well, do you have ways that you sort of trick yourself of kind of getting out of that?

Liana Fink (26:21)

I think it might have been easier for me if I were a guy and encouraged to be assertive.

Roz Chast (26:26)

Do you feel that, like, making jokes sometimes, like, comedy is a way of being assertive and expressing anger that, like, you can be, like, very indirect about it?

Liana Fink (26:39)

Yeah. Yeah. I don't. I never even thought of myself as funny, and I still don't. I think of myself as really needing to express myself. And I think for some people, that's. I kind of think for you it's the same thing.

Roz Chast (26:54)

For me, it doesn't seem to work to, like, deliberately, like, try to be funny. I mean, I might make something that. Then I think, well, that's really a pretty good joke. That's pretty funny, but it's not funny.

Liana Fink (27:04)

Yeah.

Roz Chast (27:05)

I remember drawing things that made me laugh when I was really little.

Liana Fink (27:09)

Yeah.

Roz Chast (27:09)

And that I liked that. I mean, I think when I got to be a certain age, it was like things came out funny, and I didn't really want them necessarily to come out funny, but they came out funny like, you know, drawing horses. And I could not draw horses. I don't. I'm not a horse. I did not like horses.

Liana Fink (27:26)

When. When I wrote you some fan mail when I was 15. A lot of it was praising your horses. And then your magnificent letter that you wrote back to me contained some drawings of horses.

Roz Chast (27:39)

Well, it's.

Liana Fink (27:39)

With their big teeth.

Roz Chast (27:41)

Yes. They just. I just actually was drawing some horses the other day just for fun, and actually, I'll show them to you right here. I was just trying, you know, just kind of. I was trying to explain to somebody the horse drawings that I did when I was a kid.

Liana Fink (27:59)

So it's a page of watercolor paper with 20 horses on it, and all of them have Kind of hair that was cool in the 90s, like, sticking straight up. And also this very game grin on their faces. Kind of like bros, you know, highlights for children. Oh, yes.

Roz Chast (28:19)

Quasi educational magazine for children. It was often in dentists offices, waiting rooms. And, yeah, they had this thing, our own page. And I wanted to get a drawing onto our own page when I was around 10. And I noticed that most of the drawings that were accepted by little girls, rough horses, or quite a number of them were. And so one day I decided I was gonna. God damn it, I was gonna learn to draw horses. I was gonna make myself draw horse after horse until I got it right. And I filled up this sketchbook with drawings of horses. And then I looked at them and I laughed so hard that I nearly, like, lost control of bodily functions. They were just so terrible, but they were so funny and. Hello.

Liana Fink (29:12)

We hear you. What's it like when you get letters from young women? Do you feel this huge responsibility? People like me probably send you very personal letters in which they maybe think that you're their mom or something. Is it. What's it like?

Roz Chast (29:30)

Well, I feel like women relate to each other differently from the way men relate to each other. And I don't know, I mean, when I give talks and stuff, it's mostly women in the audience. Different ages, but mostly women, but guys, too.

Liana Fink (29:47)

I do think there's something different in how we're made. But I also wonder whether there's so many more obstacles for a woman to become something like a cartoonist that maybe the women who. And the obstacles are very insidious and invisible, such as, I don't see anyone like me doing this, so I'm not even going to try. So I wonder if the women who do make it are people who. Who are really, really honest. And I wonder if, like, the way your cartoons are different is you happen to be a really honest person and you're not going to fall into a form that doesn't come from inside of you.

Roz Chast (30:28)

I don't know. I don't know. I don't know how this relates to that exactly, but I think I felt like, well, you probably won't like me anyway, so I might as well do what I want to do.

David Remnick (30:41)

Roz Chass is the author of countless great cartoons, and she's got a new book out next month, a collaboration with Patricia Marks. It's called. And you might want to write this down. Why don't you write my eulogy now so I can correct it? A Mother's Suggestions. Leanna Fink's latest book is called Passing for Human and I'm David Remnick. That's the show for today. I want to thank you for listening and I hope you'll join us next time.

David Remnick (31:15)

The New Yorker Radio Hour is a co production of WNYC Studios and the New Yorker. Our theme music was composed and performed by Meryl Garbus of Toon Yards, with additional music by Alexis Quadrado. Our team includes Alex Barron, Emily Botin, Ave Carrillo, Rhiannon Corby, Jill Duboff, Karen Frillman, Kalalea, David Krasnow, Caroline Lester, Louis Mitchell, Sarah Nix and Steven Valentino, with help from Emily Mann and Jessica Henderson. The New Yorker Radio Hour is supported in part by the Cherina Endowment Fund.