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Pain Relief Foundation Essay 2015 Movies

The winner will receive a prize for an essay on an aspect of chronic pain, of not more than 3000 words. The winning entry MUST be presented at the Pain Relief Foundation.

CLOSING DATE 31st August 2017

Click here for announcement

2017 entry forms can be downloaded here.

For further information contact

Brenda Hall Pain Relief Foundation.

Tel: 0151 529 5822 Fax: 0151 529 5821

email: b.hall@painrelieffoundation.org.uk

See the 2016 winning entry here.

Or download the presentation

Rules:

1. The essay should be 3000 words or less. Essays of more than 3000 words will be disqualified. The judges are looking for a well written, original and interesting essay, rather than a scientific paper.

2. The essay topic must be about an aspect of Chronic Pain.

3. The entry must be word processed and well presented.

4. Please provide a separate title page showing the essay title, your name, your medical school and the word count. On all pages of the essay please put the essay title as a header, and the page number as a footer. Your name, medical school or other identifiers should not appear on any page other than the title page, otherwise we will return the essay to you for modification.

5. Entries must be accompanied by a signed entry form sent by post. Essays received without a signed entry form will be disqualified. We cannot accept entry forms or essays sent by fax.

6. Essays may be submitted as a hard copy by post, or as an Microsoft Word document email attachment sent to secretary@painrelieffoundation.org.uk Please specify on the entry form by ticking the correct box.

7. Both the entry form and the essay must reach the Pain Relief Foundation by 31st August 2017 – late entries cannot be accepted. No allowance will be made for postage or email failure etc. We will notify you when we receive your entry.

8. The competition is only open to medical students studying at a UK Medical School. Only single author entries can be accepted.

9. You must be available to present your essay to the Foundation in November/ December 2017. If the winner is not available to present their essay, then the prize will pass to the next best entrant who is available to present. Reasonable travel and accommodation (one night) expenses, up to a maximum of £150 will be reimbursed by the Foundation, subject to receipts being presented.

10. Members or relatives of staff or associates of the Pain Relief Foundation are not eligible for the competition.

11. Any suspicion of plagiarism will result in disqualification.

12. The judges’ decision is final for all aspects of the competition.

The north wing of the Metropolitan Museum of Art is a vast, airy enclosure featuring a banked wall of glass and the Temple of Dendur, a sandstone monument that was constructed beside the Nile two millennia ago and transported to the Met, brick by brick, as a gift from the Egyptian government. The space, which opened in 1978 and is known as the Sackler Wing, is also itself a monument, to one of America’s great philanthropic dynasties. The Brooklyn-born brothers Arthur, Mortimer, and Raymond Sackler, all physicians, donated lavishly during their lifetimes to an astounding range of institutions, many of which today bear the family name: the Sackler Gallery, in Washington; the Sackler Museum, at Harvard; the Sackler Center for Arts Education, at the Guggenheim; the Sackler Wing at the Louvre; and Sackler institutes and facilities at Columbia, Oxford, and a dozen other universities. The Sacklers have endowed professorships and underwritten medical research. The art scholar Thomas Lawton once likened the eldest brother, Arthur, to “a modern Medici.” Before Arthur’s death, in 1987, he advised his children, “Leave the world a better place than when you entered it.”

Mortimer died in 2010, and Raymond died earlier this year. The brothers bequeathed to their heirs a laudable tradition of benevolence, and an immense fortune with which to indulge it. Arthur’s daughter Elizabeth is on the board of the Brooklyn Museum, where she endowed the Elizabeth A. Sackler Center for Feminist Art. Raymond’s sons, Richard and Jonathan, established a professorship at Yale Cancer Center. “My father raised Jon and me to believe that philanthropy is an important part of how we should fill our lives,” Richard has said. Marissa Sackler, the thirty-six-year-old daughter of Mortimer and his third wife, Theresa Rowling, founded Beespace, a nonprofit “incubator” that supports organizations like the Malala Fund. Sackler recently told W that she finds the word “philanthropy” old-fashioned. She considers herself a “social entrepreneur.”

When the Met was originally built, in 1880, one of its trustees, the lawyer Joseph Choate, gave a speech to Gilded Age industrialists who had gathered to celebrate its dedication, and, in a bid for their support, offered the sly observation that what philanthropy really buys is immortality: “Think of it, ye millionaires of many markets, what glory may yet be yours, if you only listen to our advice, to convert pork into porcelain, grain and produce into priceless pottery, the rude ores of commerce into sculptured marble.” Through such transubstantiation, many fortunes have passed into enduring civic institutions. Over time, the origins of a clan’s largesse are largely forgotten, and we recall only the philanthropic legacy, prompted by the name on the building. According to Forbes, the Sacklers are now one of America’s richest families, with a collective net worth of thirteen billion dollars—more than the Rockefellers or the Mellons. The bulk of the Sacklers’ fortune has been accumulated only in recent decades, yet the source of their wealth is to most people as obscure as that of the robber barons. While the Sacklers are interviewed regularly on the subject of their generosity, they almost never speak publicly about the family business, Purdue Pharma—a privately held company, based in Stamford, Connecticut, that developed the prescription painkiller OxyContin. Upon its release, in 1995, OxyContin was hailed as a medical breakthrough, a long-lasting narcotic that could help patients suffering from moderate to severe pain. The drug became a blockbuster, and has reportedly generated some thirty-five billion dollars in revenue for Purdue.

But OxyContin is a controversial drug. Its sole active ingredient is oxycodone, a chemical cousin of heroin which is up to twice as powerful as morphine. In the past, doctors had been reluctant to prescribe strong opioids—as synthetic drugs derived from opium are known—except for acute cancer pain and end-of-life palliative care, because of a long-standing, and well-founded, fear about the addictive properties of these drugs. “Few drugs are as dangerous as the opioids,” David Kessler, the former commissioner of the Food and Drug Administration, told me.

Purdue launched OxyContin with a marketing campaign that attempted to counter this attitude and change the prescribing habits of doctors. The company funded research and paid doctors to make the case that concerns about opioid addiction were overblown, and that OxyContin could safely treat an ever-wider range of maladies. Sales representatives marketed OxyContin as a product “to start with and to stay with.” Millions of patients found the drug to be a vital salve for excruciating pain. But many others grew so hooked on it that, between doses, they experienced debilitating withdrawal.

Since 1999, two hundred thousand Americans have died from overdoses related to OxyContin and other prescription opioids. Many addicts, finding prescription painkillers too expensive or too difficult to obtain, have turned to heroin. According to the American Society of Addiction Medicine, four out of five people who try heroin today started with prescription painkillers. The most recent figures from the Centers for Disease Control and Prevention suggest that a hundred and forty-five Americans now die every day from opioid overdoses.

Andrew Kolodny, the co-director of the Opioid Policy Research Collaborative, at Brandeis University, has worked with hundreds of patients addicted to opioids. He told me that, 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. “If you look at the prescribing trends for all the different opioids, it’s in 1996 that prescribing really takes off,” Kolodny said. “It’s not a coincidence. That was the year Purdue launched a multifaceted campaign that misinformed the medical community about the risks.” When I asked Kolodny how much of the blame Purdue bears for the current public-health crisis, he responded, “The lion’s share.”

Although the Sackler name can be found on dozens of buildings, Purdue’s Web site scarcely mentions the family, and a list of the company’s board of directors fails to include eight family members, from three generations, who serve in that capacity. “I don’t know how many rooms in different parts of the world I’ve given talks in that were named after the Sacklers,” Allen Frances, the former chair of psychiatry at Duke University School of Medicine, told me. “Their name has been pushed forward as the epitome of good works and of the fruits of the capitalist system. But, when it comes down to it, they’ve earned this fortune at the expense of millions of people who are addicted. It’s shocking how they have gotten away with it.”

“Dr. Sackler considered himself and was considered to be the patriarch of the Sackler family,” a lawyer representing Arthur Sackler’s children once observed. Arthur was a gap-toothed, commanding polymath who trained under the Dutch psychoanalyst Johan H. W. van Ophuijsen, whom Sackler proudly described as “Freud’s favorite disciple.” Arthur and his brothers, the children of Jewish immigrants from Galicia and Poland, grew up in Brooklyn during the Depression. All three attended medical school, and worked together at the Creedmoor Psychiatric Center, in Queens, collectively publishing some hundred and fifty scholarly papers. Arthur became fascinated, he later explained, by the ways that “nature and disease can reveal their secrets.” The Sacklers were especially interested in the biological aspects of psychiatric disorders, and in pharmaceutical alternatives to mid-century methods such as electroshock therapy and psychoanalysis.

But the brothers made their fortunes in commerce, rather than from medical practice. They shared an entrepreneurial bent. As a teen-ager, Mortimer became the advertising manager of his high-school newspaper, and after persuading Chesterfield to place a cigarette ad he got a five-dollar commission—a lot of money at a time when, he later said, “even doctors were selling apples in the streets.” In 1942, Arthur helped pay his medical-school tuition by taking a copywriting job at William Douglas McAdams, a small ad agency that specialized in the medical field. He proved so adept at this work that he eventually bought the agency—and revolutionized the industry. Until then, pharmaceutical companies had not availed themselves of Madison Avenue pizzazz and trickery. As both a doctor and an adman, Arthur displayed a Don Draper-style intuition for the alchemy of marketing. He recognized that selling new drugs requires a seduction of not just the patient but the doctor who writes the prescription.

Sackler saw doctors as unimpeachable stewards of public health. “I would rather place myself and my family at the judgment and mercy of a fellow-physician than that of the state,” he liked to say. So in selling new drugs he devised campaigns that appealed directly to clinicians, placing splashy ads in medical journals and distributing literature to doctors’ offices. Seeing that physicians were most heavily influenced by their own peers, he enlisted prominent ones to endorse his products, and cited scientific studies (which were often underwritten by the pharmaceutical companies themselves). John Kallir, who worked under Sackler for ten years at McAdams, recalled, “Sackler’s ads had a very serious, clinical look—a physician talking to a physician. But it was advertising.” In 1997, Arthur was posthumously inducted into the Medical Advertising Hall of Fame, and a citation praised his achievement in “bringing the full power of advertising and promotion to pharmaceutical marketing.” Allen Frances put it differently: “Most of the questionable practices that propelled the pharmaceutical industry into the scourge it is today can be attributed to Arthur Sackler.”

Advertising has always entailed some degree of persuasive license, and Arthur’s techniques were sometimes blatantly deceptive. In the nineteen-fifties, he produced an ad for a new Pfizer antibiotic, Sigmamycin: an array of doctors’ business cards, alongside the words “More and more physicians find Sigmamycin the antibiotic therapy of choice.” It was the medical equivalent of putting Mickey Mantle on a box of Wheaties. In 1959, an investigative reporter for The Saturday Review tried to contact some of the doctors whose names were on the cards. They did not exist.

During the sixties, Arthur got rich marketing the tranquillizers Librium and Valium. One Librium ad depicted a young woman carrying an armload of books, and suggested that even the quotidian anxiety a college freshman feels upon leaving home might be best handled with tranquillizers. Such students “may be afflicted by a sense of lost identity,” the copy read, adding that university life presented “a whole new world . . . of anxiety.” The ad ran in a medical journal. Sackler promoted Valium for such a wide range of uses that, in 1965, a physician writing in the journal Psychosomatics asked, “When do we not use this drug?” One campaign encouraged doctors to prescribe Valium to people with no psychiatric symptoms whatsoever: “For this kind of patient—with no demonstrable pathology—consider the usefulness of Valium.” Roche, the maker of Valium, had conducted no studies of its addictive potential. Win Gerson, who worked with Sackler at the agency, told the journalist Sam Quinones years later that the Valium campaign was a great success, in part because the drug was so effective. “It kind of made junkies of people, but that drug worked,” Gerson said. By 1973, American doctors were writing more than a hundred million tranquillizer prescriptions a year, and countless patients became hooked. The Senate held hearings on what Edward Kennedy called “a nightmare of dependence and addiction.”

While running his advertising company, Arthur Sackler became a publisher, starting a biweekly newspaper, the Medical Tribune, which eventually reached six hundred thousand physicians. He scoffed at suggestions that there was a conflict of interest between his roles as the head of a pharmaceutical-advertising company and the publisher of a periodical for doctors. But in 1959 it emerged that a company he owned, MD Publications, had paid the chief of the antibiotics division of the F.D.A., Henry Welch, nearly three hundred thousand dollars in exchange for Welch’s help in promoting certain drugs. Sometimes, when Welch was giving a speech, he inserted a drug’s advertising slogan into his remarks. (After the payments were discovered, he resigned.) When I asked John Kallir about the Welch scandal, he chuckled, and said, “He got co-opted by Artie.”

In 1952, the Sackler brothers bought a small patent-medicine company, Purdue Frederick, which was based in Greenwich Village and made such unglamorous staples as laxatives and earwax remover. According to court documents, each brother would control a third of the company, but Arthur, who was occupied with his publishing and advertising ventures, would play a passive role. The journalist Barry Meier, in his 2003 book, “Pain Killer: A ‘Wonder’ Drug’s Trail of Addiction and Death,” remarks that Arthur treated his brothers “not as siblings but more like his progeny and understudies.” Now Raymond and Mortimer, who became joint C.E.O.s, had a company of their own.

In the early sixties, Estes Kefauver, a Tennessee senator, chaired a subcommittee that looked into the pharmaceutical industry, which was growing rapidly. Kefauver, who had previously investigated the Mafia, was especially intrigued by the Sackler brothers. A memo prepared by Kefauver’s staff noted, “The Sackler empire is a completely integrated operation in that it can devise a new drug in its drug development enterprise, have the drug clinically tested and secure favorable reports on the drug from the various hospitals with which they have connections, conceive the advertising approach and prepare the actual advertising copy with which to promote the drug, have the clinical articles as well as advertising copy published in their own medical journals, [and] prepare and plant articles in newspapers and magazines.” In January, 1962, Arthur travelled to Washington to testify before Kefauver’s subcommittee. A panel of senators assailed him with pointed questions, but he was a formidable interlocutor—slippery, aloof, and impeccably prepared—and no senator landed a blow. At one point, Sackler caught Kefauver in an error and said, “If you personally had taken the training that a physician requires to get a degree, you would never have made that mistake.” Quizzed about his promotion of a cholesterol drug that had many side effects, including hair loss, Sackler deadpanned, “I would prefer to have thin hair to thick coronaries.”

As the Sacklers grew wealthy, they became patrons of the arts. In 1974, the brothers gave the Met three and a half million dollars, enabling the construction of the wing housing the Temple of Dendur. Mortimer used the space for a lavish birthday party. The cake was in the shape of the Great Sphinx, but its face had been replaced with Mortimer’s.

In April, 1987, when Arthur Sackler was seventy-three, he demanded that his third wife, Gillian, account for all their household expenditures. He dictated a terse memo: “I am determined to take command of all situations for which I personally and my estate bear the ultimate obligation.” A month later, he had a heart attack, and died. The family gathered for a fond memorial service at the Met, but Arthur’s children fought bitterly with Gillian, and sparred with Mortimer and Raymond, over the estate. They accused Gillian of trying to steal their inheritance, and of being “inspired variously by greed, malice, or vindictiveness toward her stepchildren.” According to the minutes of a family meeting, Arthur’s daughter Elizabeth suggested that he had hidden the true worth of some family investments, “because he didn’t want Morty and Ray to think they were more valuable.” A family lawyer told the children, “There were no absolutely white lilies here on either side.”

Arthur’s descendants still owned a third of Purdue Frederick, and Mortimer and Raymond were interested in buying the stake. The company, which had moved to Connecticut and would eventually change its name to Purdue Pharma, had made a great deal of money under their stewardship. But such riches were about to seem paltry. By the time the brothers made their bid, Purdue was already developing a new drug: OxyContin.

Humans have cultivated the opium poppy for five thousand years. The father of medicine, Hippocrates, recognized the therapeutic properties of the plant. But even in the ancient world people understood that the benevolent powers of this narcotic were offset by the perils of addiction. In his 1996 book, “Opium: A History,” Martin Booth notes that, for the Romans, the poppy was a symbol of both sleep and death. During the nineteen-eighties, Raymond and Mortimer Sackler had a great success at Purdue with an innovative painkiller called MS Contin, a morphine pill with a patented “controlled release” formula: the drug dissolved gradually into the bloodstream over several hours. (“Contin” was short for “continuous.”) MS Contin became the biggest seller in Purdue’s history. But, by the late eighties, its patent was about to expire, and Purdue executives started looking for a drug to replace it.

One executive who was centrally involved in this effort was Raymond’s son Richard, an enigmatic, slightly awkward man who, in the family tradition, had trained as a doctor. Richard had joined Purdue in 1971 as an assistant to his father, and worked his way up. His name appears on numerous medical patents. In the summer of 1990, a Purdue scientist sent a memo to Richard and several other colleagues, pointing out that MS Contin could “face such serious generic competition that other controlled-release opioids must be considered.” The memo described ongoing efforts to create a product containing oxycodone, an opioid that had been developed by German scientists in 1916.

Oxycodone, which was inexpensive to produce, was already used in other drugs, such as Percodan (in which it is blended with aspirin) and Percocet (in which it is blended with Tylenol). Purdue developed a pill of pure oxycodone, with a time-release formula similar to that of MS Contin. The company decided to produce doses as low as ten milligrams, but also jumbo pills—eighty milligrams and a hundred and sixty milligrams—whose potency far exceeded that of any prescription opioid on the market. As Barry Meier writes, in “Pain Killer,” “In terms of narcotic firepower, OxyContin was a nuclear weapon.”

Before releasing OxyContin, Purdue conducted focus groups with doctors and learned that the “biggest negative” that might prevent widespread use of the drug was ingrained concern regarding the “abuse potential” of opioids. But, fortuitously, while the company was developing OxyContin, some physicians began arguing that American medicine should reëxamine this bias. Highly regarded doctors, like Russell Portenoy, then a pain specialist at Memorial Sloan Kettering Cancer Center, in New York, spoke out about the problem of untreated chronic pain—and the wisdom of using opioids to treat it. “There is a growing literature showing that these drugs can be used for a long time, with few side effects,” Portenoy told the Times, in 1993. Describing opioids as a “gift from nature,” he said that they needed to be destigmatized. Portenoy, who received funding from Purdue, decried the reticence among clinicians to administer such narcotics for chronic pain, claiming that it was indicative of “opiophobia,” and suggesting that concerns about addiction and abuse amounted to a “medical myth.” In 1997, the American Academy of Pain Medicine and the American Pain Society published a statement regarding the use of opioids to treat chronic pain. The statement was written by a committee chaired by Dr. J. David Haddox, a paid speaker for Purdue.

Richard Sackler worked tirelessly to make OxyContin a blockbuster, telling colleagues how devoted he was to the drug’s success. The F.D.A. approved OxyContin in 1995, for use in treating moderate to severe pain. Purdue had conducted no clinical studies on how addictive or prone to abuse the drug might be. But the F.D.A., in an unusual step, approved a package insert for OxyContin which announced that the drug was safer than rival painkillers, because the patented delayed-absorption mechanism “is believed to reduce the abuse liability.” David Kessler, who ran the F.D.A. at the time, told me that he was “not involved in the approval.” The F.D.A. examiner who oversaw the process, Dr. Curtis Wright, left the agency shortly afterward. Within two years, he had taken a job at Purdue.

Mortimer, Raymond, and Richard Sackler launched OxyContin with one of the biggest pharmaceutical marketing campaigns in history, deploying many persuasive techniques pioneered by Arthur. Steven May, who joined Purdue as an OxyContin sales representative in 1999, recalled, “At the time, we felt like we were doing a righteous thing.” He used to tell himself, “There’s millions of people in pain, and we have the solution.” (May is no longer working for Purdue.) The company assembled a sales force of as many as a thousand representatives and armed them with charts showing OxyContin’s benefits. May attended a three-week training session at Purdue’s headquarters. At a celebratory dinner following the training, he was seated at a table with Richard Sackler. “I was blown away,” he recalled. “My first impression of him was ‘This is the dude that made it happen. He has a company that his family owns. I want to be him one day.’ ”

A major thrust of the sales campaign was that OxyContin should be prescribed not merely for the kind of severe short-term pain associated with surgery or cancer but also for less acute, longer-lasting pain: arthritis, back pain, sports injuries, fibromyalgia. The number of conditions that OxyContin could treat seemed almost unlimited. According to internal documents, Purdue officials discovered that many doctors wrongly assumed that oxycodone was less potent than morphine—a misconception that the company exploited.

A 1995 memo sent to the launch team emphasized that the company did “not want to niche” OxyContin just for cancer pain. A primary objective in Purdue’s 2002 budget plan was to “broaden” the use of OxyContin for pain management. As May put it, “What Purdue did really well was target physicians, like general practitioners, who were not pain specialists.” In its internal literature, Purdue similarly spoke of reaching patients who were “opioid naïve.” Because OxyContin was so powerful and potentially addictive, David Kessler told me, from a public-health standpoint “the goal should have been to sell the least dose of the drug to the smallest number of patients.” But this approach was at odds with the competitive imperatives of a pharmaceutical company, he continued. So Purdue set out to do exactly the opposite.

Sales reps, May told me, received training in “overcoming objections” from clinicians. If a doctor inquired about addiction, May had a talking point ready. “ ‘The delivery system is believed to reduce the abuse liability of the drug,’ ” he recited to me, with a rueful laugh. “Those were the specific words. I can still remember, all these years later.” He went on, “I found out pretty fast that it wasn’t true.” In 2002, a sales manager from the company, William Gergely, told a state investigator in Florida that Purdue executives “told us to say things like it is ‘virtually’ non-addicting.”

May didn’t ask doctors simply to take his word on OxyContin; he presented them with studies and literature provided by other physicians. Purdue had a speakers’ bureau, and it paid several thousand clinicians to attend medical conferences and deliver presentations about the merits of the drug. Doctors were offered all-expenses-paid trips to pain-management seminars in places like Boca Raton. Such spending was worth the investment: internal Purdue records indicate that doctors who attended these seminars in 1996 wrote OxyContin prescriptions more than twice as often as those who didn’t. The company advertised in medical journals, sponsored Web sites about chronic pain, and distributed a dizzying variety of OxyContin swag: fishing hats, plush toys, luggage tags. Purdue also produced promotional videos featuring satisfied patients—like a construction worker who talked about how OxyContin had eased his chronic back pain, allowing him to return to work. The videos, which also included testimonials from pain specialists, were sent to tens of thousands of doctors. The marketing of OxyContin relied on an empirical circularity: the company convinced doctors of the drug’s safety with literature that had been produced by doctors who were paid, or funded, by the company.

David Juurlink, who runs the division of clinical pharmacology and toxicology at the University of Toronto, told me that OxyContin’s success can be attributed partly to the fact that so many doctors wanted to believe in the therapeutic benefits of opioids. “The primary goal of medical practice is the relief of suffering, and one of the most common types that doctors see is pain,” he said. “You’ve got a patient in pain, you’ve got a doctor who genuinely wants to help, and now suddenly you have an intervention that—we are told—is safe and effective.”

Watch “The Backstory”: Philip Montgomery on his portfolio about the American opioid crisis.

Keith Humphreys, a professor of psychiatry at Stanford, who served as a drug-policy adviser to the Obama Administration, said, “That’s the real Greek tragedy of this—that so many well-meaning doctors got co-opted. The level of influence is just mind-boggling. Purdue gave money to continuing medical education, to state medical boards, to faux grassroots organizations.” According to training materials, Purdue instructed sales representatives to assure doctors—repeatedly and without evidence—that “fewer than one per cent” of patients who took OxyContin became addicted. (In 1999, a Purdue-funded study of patients who used OxyContin for headaches found that the addiction rate was thirteen per cent.)

Within five years of its introduction, OxyContin was generating a billion dollars a year. “There is no sign of it slowing down,” Richard Sackler told a team of company representatives in 2000. The sales force was heavily incentivized to push the drug. In a memo, a sales manager in Tennessee wrote, “$$$$$$$$$$$$$ It’s Bonus Time in the Neighborhood!” May, who was assigned to the Virginia area, was astonished to learn that especially skillful colleagues were earning hundreds of thousands of dollars in commissions. One year, May’s own sales were so brisk that Purdue rewarded him with a trip to Hawaii. As prescriptions multiplied, Purdue executives—and the Sackler family members on the company’s board—appeared happy to fund such blandishments. Internal budget plans described the company’s sales force as its “most valuable resource.” In 2001, Purdue Pharma paid forty million dollars in bonuses.

One day, May drove with a colleague to Lewisburg, a small city in West Virginia. They were there to visit a doctor who had been one of May’s top prescribers. When they arrived, the doctor was ashen. A relative had just died, she explained. The girl had overdosed on OxyContin.

Arthur and Mortimer Sackler each married three times, and Raymond married once. There are fifteen Sackler children in the second generation, most of whom have children of their own. The Sackler clan has pursued a variety of causes and interests. In 2011, Mortimer’s widow, Theresa, who sits on the board of Purdue, was awarded the Prince of Wales Medal for Art Philanthropy. When the medal was conferred, Ian Dejardin, the Sackler Director of the Dulwich Picture Gallery, remarked, “It’s going to be difficult not to make her sound utterly saintly.” Theresa’s daughter, Sophie, is married to the English cricket player Jamie Dalrymple, and lives in a forty-million-dollar house in London. Raymond’s thirty-seven-year-old grandson, David Sackler, runs a family investment

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