On Feb. 9, 2019, protesters gathered at the Guggenheim Museum in New York City to lead a march down Fifth Avenue to the Metropolitan Museum of Art.1
As a general rule, news from the world of art is not a topic discussed in these pages, but if you indulge me for just a little bit longer, I promise this will start to make sense.
The protest was organized in secret by Nan Goldin, an American photographer whose work has been featured in London by the Tate.2 The protestors entered the museum during the day, along with art patrons and tourists. Then, at 6:30 p.m., they announced their purpose. The protestors unfurled a large red banner embossed with black letters that proclaimed “200 dead each day.”3
A shower of fake prescriptions then fell on the heads of the unsuspecting patrons of the Guggenheim. The prescriptions were ostensibly signed by Richard Sackler of Purdue Pharma for a patient named Solomon R. Guggenheim.
The prescriptions were for OxyContin.
In place of instructions appeared a quotation from Mr. Sackler, the co-chair of Purdue Pharma: “If OxyContin is uncontrolled, it is highly likely that it will eventually be abused. … How substantially would it improve our sales?”3
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Merriam-Webster defines compassion as a “sympathetic consciousness of others’ distress together with a desire to alleviate it.”4 It is an essential part of the human condition, and the prime reason many of us went to medical school.
William Osler, of course, said it best: “The practice of medicine … is a life of … countless opportunities to comfort and help the weak hearted, and to raise up those that fall.”5
Compassion fatigue is what happens to us in the weeks following a tsunami in Southeast Asia, or at the end of a particularly bad clinic day. Compassion is not a limitless resource. Charles R. Figley, who developed the concept, described it thus:
We have not been directly exposed to the trauma scene, but we hear the story told with such intensity, or we hear similar stories so often, or we have the gift and curse of extreme empathy and we suffer. We feel the feelings of our clients. We experience their fears. We dream their dreams. Eventually, we lose a certain spark of optimism, humor, and hope. We tire.6
For those of us engaged in patient care, compassion fatigue is an occupational hazard. That said, we also experience it more broadly in our daily lives. In this era of the 24-hour news cycle, the drumbeat of depressing news is pervasive. It is no wonder that, on occasion, to certain stories, we become numb.
I think it’s even more surprising, therefore, that the story of opiate addiction in the U.S. still has the power to shock. In 1999, opiate overdose caused 16,849 deaths; in 2017, the number of deaths attributed opiate overdose was 70,237.7 Opiate overdose is now the leading cause of death of Americans under 50 years old.8 Opiate addiction has led to a decrease in the average life expectancy in the U.S.9 The odds of dying of an opiate overdose in the U.S. are now higher than the odds of dying in a car accident.10 In 2016, one in 65 deaths was related to opiates, higher than the number of deaths caused by hypertension or HIV/AIDS. Among adults between 25 and 34 years old, opiates are responsible for 1 in 5 deaths.11
It is also surprising how a single drug, OxyContin, became a major cause of opiate addiction in the U.S. Surprising, but not accidental. The manufacturer started with an unproved and unfounded claim that “delayed absorption as provided by OxyContin tablets is believed to reduce the abuse liability of a drug.”12 On the strength of that single claim, Purdue Pharma built an empire. In 2000, the U.S. Food and Drug Administration forced Purdue Pharma to remove that statement from its label, and in 2003, started to add multiple black box warnings about the risks associated with OxyContin’s use, but by then, the damage was done. Deaths due to narcotics had already started to surge.13