Purdue Pharma taps a Gilded Age history of pharmaceutical fraud

By Jonathan S. Jones

(We've invited Jonathan Jones, the first presenter of our 2019 Civil War Speakers series to blog for us this week. Jones will be speaking here at the museum Thursday April 4th at 7 pm. See the link at the bottom to read the full piece.)

Newly unsealed documents from a lawsuit by the state of Massachusetts allege that Purdue Pharma, maker of OxyContin and other addictive opioids, actively sniffed out new, sinister ways to cash in on the opioid crisis.

Despite years of negative press coverage, unwanted attention from regulators, multi-million dollar fines and several major lawsuits, Purdue staff and owners sought to expand the company’s sights beyond its usual array of opioid painkillers. Purdue planned to become an “end-to-end pain provider,” by branching into the market for opioid addiction and overdose medicines, looking to peddle these medicines even while the company continued to aggressively market its addictive opioids. Internal research materials coldly explained the rationale behind this plan: “Pain treatment and addiction are naturally linked.”

As thousands of Americans continue to overdose on opioids annually, Purdue’s secret  marketing research predicted that sales of naloxone, the overdose reversal drug, and buprenorphine, a medicine used to treat opioid addiction, would increase exponentially. Addiction to Purdue’s opioids would thus drive the sale of the company’s opioid addiction and overdose medicines. Purdue even planned to target as customers patients already taking the company’s opioids and doctors who prescribed opioids excessively, according to the Massachusetts lawsuit filing. To keep the plan quiet, Purdue staff dubbed the scheme “Project Tango.”

The audacity of Project Tango enraged many observers. But considered in historical context, the news that Purdue sought to peddle opioid addiction medicines while continuing to sell opioids seems less surprising. In fact, there is clear historical precedent for Purdue's business plan. Over a century ago, "patent medicine" sellers pioneered this strategy during the U.S.'s Gilded Age opiate addiction epidemic.

Collier’s ad, Dec., 1905, after the publication of articles on patent medicine fraud. Wikimedia Commons

Opiate addiction in the Gilded Age

Opiates were some of the most commonly prescribed medicines in American history until the 20th century. Pills containing opium, hypodermic morphine injections and laudanum, a drinkable liquid concoction of opium and alcohol, constituted half or more of all medicines prescribed in American hospitals during most of the 19th century, according to research by the historian John Harley Warner. Opiates were also present in countless “patent medicines,” over-the-counter panaceas made of secret ingredients, often sold under catchy brand names like Mrs. Winslow’s Soothing Syrup. Americans could choose from 5,000 brands of patent medicines marketed for all manner of ailments by the 1880s. In 1904, just before federal oversight began, patent medicines had matured into an astonishingly profitable industry, with estimated sales at US$74 million dollars annually – equivalent to about $2.1 billion dollars today.

Opiate-laced prescriptions and patent medicines often caused addiction. The historian David T. Courtwright estimates that opiate addiction rates in the U.S. skyrocketed to 4.59 per thousand Americans by the 1890s – a high rate, although lower than the rate of fatal opioid overdoses in recent years. Most individuals developed addictions through medicines, rather than the infamous smoking variety of opium. Victims of “the habit” cut across demographic lines, encompassing middle-class housewives suffering from menstrual pain, Civil War veterans reeling from amputations and many others in between.

To read his complete article published March 4, 2019 in The Conversation:

https://theconversation.com/purdue-pharma-taps-a-gilded-age-history-of-pharmaceutical-fraud-112363

Dr. Truman H. Squire: Civil War Surgeon

by Erin Doane, Curator

The Battle of Antietam took place on September 17, 1862. It is considered the bloodiest one-day battle of the Civil War with approximately 3,650 men killed and over 17,000 wounded. Around 9,550 of those wounded were Union soldiers. Those who were too badly wounded to make the trip to Frederick, Maryland were treated at two nearby Union field hospitals. Dr. Truman H. Squire of Elmira was in charge of one of those hospitals at John Greeting’s Farm near Keedysville, Maryland. The hospital was known as Crystal Springs or the Locust Spring hospital, and, with 24 tents, was the largest hospital on the Union left.

At the beginning of the Civil War, the Union army only had 98 medical officers. At first, the military did not think an official medical corps was needed because the war was not going to last very long. As the conflict dragged on, however, more medical personnel were recruited. Most men who became doctors in the mid-19th century did not attend medical schools. Rather, they would apprentice with established doctors. Those who did go to medical school were trained for two years or less and received practically no clinical experience. In general, little was known about keeping sanitary condition or the use of antiseptics to prevent infection at the time. “Surgical fevers” were a common cause of death for those wounded in battle. Only 1 in 7 wounded soldiers survived.

Surgical kit used by Dr. T.H. Squire during the Civil War

Conditions within the hospitals that treated the Union soldiers wounded at Antietam were notoriously bad. They were so bad, in fact, that the government performed inspections of the facilities that November because of all the complaints. While other hospitals won no praise during those inspections, the Locust Spring hospital was declared a model operation by Assistant Medical Inspector W.R. Mosely. Dr. Squire’s work at the hospital was specifically lauded by Jonathan Letterman, surgeon and medical director of the Army of the Potomac. He wrote in a letter to the Assistant Adjutant General of the Army of the Potomac that “great care and attention were shown to the wounded at the Locust Spring hospital by Surgeon Squire, Eighty-ninth New York Volunteers.”

Cases of gunshot fractured femurs at Battle of
Antietam treated at Locust Spring Hospital by
T.H. Squire – half of those treated died

Dr. Squire got his medical training at the Albany Medical College and the College of Physicians and Surgeons in New York City. He graduated from the latter in 1848 and moved to Elmira the next year. There he set up his private practice and married Grace Smith. The couple had three children and Squire spent the entirety of the rest of his life in Elmira except for the years he served during the Civil War.

University of the State of New York College of
Physicians and Surgeons Matriculation Ticket,
session of 1847-48 for Mr. Truman H. Squire

The 89th New York Volunteer Infantry was organized in Elmira starting on August 29, 1861. On December 7, the regiment mustered in under Col. Harrison S. Fairchild with 870 officers and men for a three-year enlistment. Squire had been commissioned as surgeon for the regiment on November 28. During the course of the war he became a division field surgeon and then the Director of Field Surgery under General Burnside with the Army of the Potomac.

List of sick to be sent to the rear from 1st
Brigade, 3rd Division, June 29, 1863, signed
by T.H. Squire, Surg.

Squire was also commander of several field hospitals including Locust Spring in Maryland and later on Folly Island in South Carolina. The island served as a major staging area for Union troops that were attacking Confederate forces around Charleston. The field hospital there helped in part to distribute medicines and medical equipment to other regiments. Joseph K. Barnes, Surgeon General of the United States Army, praised Squire for having “gained a high reputation for zeal, intelligence and fidelity,” during the war. “His service was in the field, and he was considered one of the most efficient and useful surgeons of the Army of the Potomac.”

List of medicines and hospital stores received
of T.H. Squire, Surgeon, 89th New York Volunteers
by surgeon of the 14th Pennsylvania Volunteers,
November 19, 1863

After the war, Squire returned to private practice in Elmira. He served as manager and a consulting physician at the Arnot-Ogden Memorial Hospital and was active in local and national medical organization. He continued to work as a surgeon until his death at age 65 in 1889. During his 40 years in medicine, he became known as a talented surgeon, a world-famous inventor of medical appliances, and one of the foremost medical writers of his time.