👑 The "Great Man" Theory (Of Healthcare)

A follow-up to my AmerisourceBergen story on Medium

Last week I published on Medium a lengthy piece about my experience at US Acute Care Solutions, and specifically that company’s decision to replace a retiring physician CEO with a non-clinician, Harvard MBA whose previous job had been as a president at AmerisourceBergen.

I wrote about AmerisourceBergen’s role in the opioid crisis and also about the moral hazards of doing work for companies with negative impacts on society. In the case of AmerisourceBergen, one of the country’s largest drug distributors, the company had recently settled a case with two Ohio counties for its role in fueling the opioid crisis.

And last year, AmerisourceBergen was ordered to pay $625 million to state and federal governments for its role in a cancer drug “repackaging scheme” that allowed the company to bill multiple providers for the same (and once repackaged, non-FDA approved) vial of drug.

I chose as a headline for my piece, My boss’ boss’ boss’ was a drug dealer, and though I chose the pejorative term “drug dealer” where I could instead have substituted “president of multinational company with culpability in the opioid epidemic,” ultimately I stand by the title, and the pejorative.

Still, my piece was read, by some, as a personal attack on the new CEO of USACS. It wasn’t.

📜 Theories of history

In College, I was a history major and enamored with a view of the past known as “The Great Man” theory of history. This theory has largely fallen out favor in today’s data-driven, sociology-dominated cultural conversation. But it’s worth remembering for a moment, for its significance in current debates about healthcare.

It should really be called “The Great Person” theory of history, because as any student of history knows there were plenty of women in positions of power also making the decisions. (Just ask my mom, a history PhD specializing in the Elizabethan era). The theory says that history is driven largely by the decisions of individuals. That human events are a series of turning points, and those turning points are determined by the particular characters of people in positions of power at the time. This is as opposed to other theories of history, which point to factors like geography, or cultural movements, or perhaps, as Karl Marx would say, the class struggle.

What does this have to do with healthcare? In the U.S., we talk about healthcare as a systemic problem, and I have always, and largely still do, think of it that way. The problems we face in building a civilized system to care for this country’s sick are systemic in nature. We talk about things like misaligned incentives, or regulatory hurdles, or faulty business models.

In contrast, we rarely talk about the impact of individuals.

👸 The Great Person theory of healthcare

Healthcare’s problems are largely systemic, but recent news has provided us with a rare example of a case in which it’s useful to think about the people involved, and their individual decision-making in the face of systemic forces. I am speaking of course of the case of the Sackler family, founders of Purdue Pharma, the company that introduced OxyContin in 1996.

In 2018, at least eight members of the Sackler family were named as defendants in opioid-related lawsuits. The details of the suits are sickening as expected. Here’s the NY Times describing the filings in an April story:

The filings cite numerous records, emails and other documents showing that members of the family continued to push aggressively to expand the market for OxyContin and other opioids for years after the company admitted in a 2007 plea deal that it had misrepresented the drug’s addictive qualities and potential for abuse.

And later:

The suits are not only an effort to get at the Sacklers’ personal fortunes — estimated by Forbes to be $13 billion — but to expose the extent to which the Sacklers themselves have been calling the shots.

The lawsuits and resulting negative press attention have made Sackler charitable donations toxic. No foundation, museum, or research institute, wants to take the profits of a family whose fortune was made by those who lied to the medical community and purposely obscured science in the pursuit of profit and at the cost of tens of thousands of lives.

So, there are two theories of what happened here: