The Crime of the Century: Pharma and the US Opioid Crisis

The opioid crisis in the US has killed half a million people and created millions of addicts, all because the pharmaceutical companies pushed opioid medicines as not being prone to abuse or addictive.

In his latest HBO doc-series The Crime of the Century (2021), Oscar- and Emmy-winning filmmaker Alex Gibney provides the most comprehensive look to date at the opioid crisis in the US.

Alex joins us to discuss the making of the film, arguing that the opioid crisis has deeply criminal roots. The film finds fresh evidence that shows just how deep that criminality runs.

The Crime of the Century premiered on HBO and HBO Max on May 10th and May 11th. It comes to Sky Documentaries and streaming service NOW on Sunday, May 16th at 9pm.

It’s the little acts of corruption that get bigger and bigger, and over time you get a fully corrupted system. – Alex Gibney

Time Stamps:

00:12 - Trailer for The Crime of the Century.
03:00 - Introducing the director Alex Gibney.
04:14 - What The Crime of the Century is about.
05:50 - Why Alex is making this film now, and the new evidence he uncovered.
08:00 - How crimes by the pharma industry created the opioid crisis.
13:10 - How the opioid crisis has evolved and worsened during Covid.
14:23 - The reactions of federal and state governments to the crisis.
19:45 - The number of pharmaceutical industry executives that were prosecuted.
23:48 - How the problem with opioids can be solved.
28:10 - How Alex Gibney approached the subjects of the film.
34:40 - Pharma rap video in the film is a smoking gun.
36:40 - The perseverance with which Alex Gibney explores corruption.
39:12 - What The Crime of the Century tells us about human nature.
39:45 - Alex Gibney's next projects and the topics he would like to explore.
41:15 - What he hopes the legacy of the film will be.

Resources:

Empire of Pain: The Secret History of the Sackler Dynasty, a book by Patrick Radden Keefe
The Washington Post - The Opioid Files
Innersound Audio  
Alamo Pictures 

Connect with Alex Gibney:

Website
Twitter 

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Transcript for Factual America Episode 60 - The Crime of the Century: Pharma and the US Opioid Crisis

Alex Gibney 00:00
Hi, my name is Alex Gibney, and I'm the writer and director of The Crime of the Century, a new documentary about the opioid crisis in America.

00:10
I came out of the doctors, and there was a representative of Purdue; she said we have a drug called OxyContin. We pick up all the costs, just take as much as you need. I said it sounds like a deal.

Alex Gibney 00:23
Within the last 20 years, more than 500,000 Americans have been killed by overdoses. Controlled release OxyContin would be the drug that triggered the opioid crisis. But what if we discovered that the crisis started with a crime?

00:44
When we talk about drugs like oxycodone, you're talking about drugs that are essentially heroin pills. Opioid makers started to promote their opioids for common chronic pain conditions.

Alex Gibney 00:56
Purdue didn't have any evidence that the drug was safe. So, the company obtained the help of a medical officer at FDA.

01:03
This is the first time I've ever seen this. This isn't just unethical. I think this could be illegal.

01:08
Hundreds and hundreds of sales reps go out and meet with doctors and say, 'The FDA approved this'.

Alex Gibney 01:17
Big Pharma celebrated its marketing muscle, using parties to lure doctors to write scripts.

Matthew 01:23
This was a new drug cartel. They were drug dealers wearing suits and lab coats.

01:28
Basically, here's some money, write some scripts.

Speaker 4 01:30
Yes. I'm looking at this and I'm going, clearly we're breaking the law.

01:36
Purdue ends up getting pursued by the authorities. The company lied under oath.

Alex Gibney 01:41
Ethics did not play a role. The companies took out their checkbooks and paid to keep the evidence hidden.

01:46
You are basically telling pharmaceutical companies, 'You have a green light to do this'.

01:51
It explains how America got hooked on opioids.

Speaker 5 01:54
Doctors willing to be paid to prescribe the drug - those were the people that were going to get you promoted and eventually put you in prison.

Speaker 6 02:01
The abuse exploded, and spread like cancer.

Speaker 7 02:03
When you're in that much pain and you're addicted to such a high dose, you're a trapped rat.

Speaker 8 02:09
When the companies didn't like that they were being held accountable, they decided to change the statute.

Speaker 9 02:14
They should be changing their behaviors, not the rules.

Speaker 10 02:18
People were dying by the 10s of 1000s, and their own representatives are basically selling them down the river.

02:28
If you talk to people whose lives have been touched, what does matter to a lot of these people is truth.

Matthew 02:40
That is a trailer from the HBO documentary series Crime of the Century. And this is Factual America. We're brought to you by Alamo Pictures, an Austin and London based production company making documentaries about America for international audiences. I'm your host Matthew Sherwood, and today it is an honor and privilege to welcome documentary film legend Alex Gibney to the podcast. The Oscar and Emmy winning filmmaker joins us to discuss his latest documentary, Crime of the Century, which premiered on HBO this week. The film provides the most comprehensive look to date of the opioid epidemic in the US. Alex, welcome to Factual America.

Alex Gibney 03:18
Thanks. Glad to be here.

Matthew 03:19
Well, it's great to have you. Thank you so much. The film is, again, Crime of the Century. It's a two part docu-series. I know it's premiered May 10, and 11 on HBO - this is for our viewers and listeners, this is the 10th but by the time this gets released on Wednesday, it will have made a big splash in the US. And then in the UK, it's going to show on Sky Documentaries, and be streaming on Now TV from Saturday, May 15 at 9pm British Standard Time. So again, welcome to Factual America. Thanks so much; it's a real honor to have you on, and thanks so much for making this docu-series. Alex, I think maybe the best way to - if you don't mind, for our listeners who probably haven't had a chance to see this yet - is to: can you tell us what Crime of the Century is about?

Alex Gibney 04:16
Sure. I mean, broadly speaking, it's about the opioid crisis. But what was interesting about this was after sitting down with a group of reporters from the investigative unit of The Washington Post, I came away convinced that we weren't seeing this crisis properly. I mean, in America, we tended to regard it as something we ran our hands over, but treat as if it were some kind of natural disaster like a flood or hurricane. What this is about is how the crisis was manufactured, and in a way that I argue is criminal. So, and that's not just my opinion; I mean, a number of companies have plead guilty to to crimes. But that the crisis was manufactured in the sense that 500,000 people have died, millions have become addicted, all because of the fact that these opioid medicines were advertised as not being either prone to abuse or addictive.

Matthew 05:25
And I think you raise a good point because I was gonna ask you what - I mean, there's been loads of docs about the opioid crisis. I've seen many of them. I've even had a tangential relationship with one of them. But why make this film now? But it's because you and the investigative reporters in Washington Post have essentially have an uncovered a crime, haven't you?

Alex Gibney 05:48
That's right. It's re-inventing the narrative as a murder mystery, in effect, that it's seeing the intentionality behind this happening. So, there's been a lot of hand wringing, there have been a lot of films about the victims of the crisis. This series, I would say, focuses more on the perps, rather than the victims. So, certainly, victims are represented. Because it's a crime story. It's a true crime story, is what this is. And we worked in conjunction with The Washington Post. And also, you know, were generously aided at times from a couple of other authors who've done great work on this. One is Patrick Radden Keefe, writer for The New Yorker, who's just written a book called Empire of Pain about the Sackler family, which owns Purdue Pharma. And also Barry Meier, who was really the first investigative reporter to kind of dig out the first signs of malfeasance. So, anyway, I wanted to give credit where credit is due but the purpose of this and what makes this new and fresh, is our discovery of evidence that shows how deep the criminality goes, and actually how the pharmaceutical sales of opioids lead to other criminal acts relating to illicit opioids like heroin, and also illicitly produced and distributed fentanyl, which, of course, is a drug that is really taking a terrible toll on Americans. So, this time, it's 50 times more powerful than heroin 100 times more powerful than morphine.

Matthew 07:30
Maybe you could say a little bit more about that. Can you explain to me - maybe go a little bit deeper into that: how did this happen? Because I think - without, you know, no, spoiler alerts or anything - obviously, I highly recommend people watch the film. But you know, it's quite, I'll say something more after you answer because of how for me personally, having seen a lot of these other docs, what I think is so, one of the most powerful things about this doc is, but, you know, what was it? I mean: how did they go about creating this crisis or this crime, really?

Alex Gibney 08:06
Well, I think it does start with Purdue Pharma, and the Sackler family, in the sense that, you know, having had some success with a drug, morphine based drug, called MS Contin, which is a time release form of morphine. They then produced a drug called OxyContin, which uses oxy codone, again in a time release capsule. And what they tried to do with OxyContin, was to say that because of its time release mechanism, it was not prone to abuse, even though we now know it was, and also that it was really not addictive. And that was within the context also of a new fashion and trend to view pain as the fifth vital sign, and to expand the definition of pain and to note that addiction was not really as much of a problem for people as, you know, as pain itself. Now, before I get into the problem with that, you know, I should say that oxycodone, or opiates in general, like morphine, can be extremely effective as pain relievers, let's say immediately after a major operation, morphine or oxycodone can be very valuable for end of life cancer patients experiencing excruciating pain. It doesn't matter if you become addicted because you need a pain medicine and it's not going to, you're not going to be taking it for that long, sadly. So, there's good reasons why this pain medicine is still valuable, but the notion that it would be widely disseminated, which, of course, is much more valuable economically. That's where you have the problem. It's taking this drug that was meant for one thing and saying, no, it's good for everything.

Matthew 09:59
So, what I was alluding to earlier, because I have seen quite a few of these opioid docs and have had the directors on. And I must say, in the early days, I was always a bit skeptical, this big conspiracy theory, but because it always struck me that it was like you had to have this wave of corrupt doctors in order to this work. But I think what yours does so powerfully, and I think for the first time, if I may say, is that it's really criminal pharma, or criminal activities, plus, yeah, there's a few bad apples in there who've obviously, you know, as many of your films have shown, all walks of life have their bad apples. But that's what leads to this epidemic, this crisis that the US faces right now is that I never quite had a feel for how they could have gotten away with it or how they could have perpetrated it. As you say, you focused on the perps until having seen - Well, there's some incredible bombshells in there. And we won't go into details of those. But until seeing your film, I think it really for the first time really lays it out how we got into this situation.

Alex Gibney 11:11
Well, thank you. I mean, I think that, look, a lot of the pharmaceuticals like to say, look, you know, we companies who produce products like OxyContin, and others, you know, these properly prescribed opioids, you can't hold us to account for heroin addiction, or fentanyl addiction. But one of the things that we did was to kind of look at this problem in terms of supply and demand, okay, through the broad dissemination and false marketing of prescription opioids, effectively, what the pharmaceutical companies did was to create an enormous demand for opioids. And then when patients started developing a tolerance or either were not economically able to afford these drugs, they would turn to heroin. And when heroin became too expensive, they would then turn to illegally produce fentanyl, we have one character in the film, a kind of Walter White like character, who goes exactly through that process and ultimately ends up being a fentanyl dealer. And fentanyl I mean, sadly, is, you know, is so powerful that improperly mixed or or applied can lead to instant death. You know, we talked to a number of DEA officials who show - who talked to us about DOA scenes where the, you know, the fentanyl pipe is still in the person's hand because it hit that fast. And that's the way in which the, you know, the licit and illicit, you know, are complicit in a way and also, you know, in some ways, the two industries, both illicit and licit opioid industries, actually share a good amount of business oriented DNA, shall we say?

Matthew 13:02
Yes. And so, the crisis continues to rage now, does it? And has it changed at all?

Alex Gibney 13:10
Oh, it's gotten worse. I mean, particularly during COVID, you know, opioid overdoses increased. So, sadly, you know, particularly with this problem with fentanyl, things have not abated, they've gotten worse. Now, one of the things that's happened is there has been a reluctance over time, in part because of new guidelines from the CDC, in part because other doctors have become reluctant to prescribe opiates as much as they had been prescribing them in the late '90s and early 2000s. And so there's been a dramatic cutback. And I think there's been a certain amount of supervision of that. And some people are pushing back saying 'Too much', you know, 'Now, I'm a legitimate pain patient, it's too difficult for me to get drugs'. Okay, so the pendulum has swung to some extent in that regard. But in the meantime, what has happened is that there's a tremendous demand has been created that is now being satisfied by illicit fentanyl. And that is hugely a problem. And what is the government doing about it? Not enough. I mean, and I suppose you'd have to separate the federal government, from state governments. Now, a number of state governments are suing pharmaceutical companies. And there is a massive MDL - so called multi district litigation - taking place in Cleveland, where communities and states from all over the United States are suing to try to get some compensation for the damage that has been done either through opioids, either through - sorry, overdoses through, you know, community treatment centers of addiction, you know, all sorts of things and to try to get money paid to compensate the states for the damage done. And those efforts are ongoing. So, in that sense government is pushing back. The federal government, sadly, has not only not really addressed this properly, but in one instance, which we chronicle in the film, there was a law passed by unanimous consent, that means every senator and every representative went along with it, that was basically a talking point for the pharmaceutical industry that was indeed written, in effect by a representative of the pharmaceutical industry, and passed in a way that dramatically undercut the efforts of the DEA to prevent what we call diversion, which is taking properly prescribed opioids and diverting it to the black market. So, that was a terrible thing. And the reason this happens, though, is because of the corruption, unfortunately, that's built in to the American political system in the form of campaign contributions.

Matthew 16:04
Yeah, so I think, I mean, like any great docs, it sheds light on many different subjects, I think. And what I kept thinking is, as you duly note, in your film, I think both political parties have blood on their hands when it comes to this. And I kept thinking of the William Greider book, Who Will Tell The People that came out in the early '90s. I mean, it's this whole - the way the federal power structures built in.

Alex Gibney 16:31
I look at them a little bit, I think of it a little bit like the famous Agatha Christie novel Murder on the Orient Express, you know, throughout the story, we keep thinking, well, there's got to be one culprit? Well, it turns out, there were many culprits. They were all, you know, plunging the knife into the victim. And so in this case, The Crime of the Century, one of the reasons we called it that is because there were so many culprits, from bad doctors to pharmacies looking the other way, to distributors looking the other way, to the manufacturers, who know exactly where the pills are going, and that were being diverted. But they're looking the other way, to Congress, to the Department of Justice. There are many bad apples. And so you have to say there are so many, that it's really the barrel that is rotten, not the apple that we must select.

Matthew 17:19
And as you found out, so well documented, I mean, you know, these spreadsheets - there's so many smoking guns.

Alex Gibney 17:26
Oh, my God, I mean, you know, Purdue started this kind of business model of giving blandishments to doctors to be sort of spokespeople, and speakers for opioid treatment. And when you get paid money to advance a drug, by and large, there's an incentive to keep using that drug, right? Well, by the time you get much later to another company called Insys that we profile, which had a, you know, had a fentanyl based under the tongue spray for breakthrough cancer pain. Well, they now have a spreadsheet, a return on investment spreadsheet, where, you know, the bribes that they were giving doctors, they would quantify, whether it was taking them out to dinner or giving them cash payments for so-called speaking engagements that would never take place. If they gave a doctor $10,000, they would look on the chart to see if that doctor prescribed at least double that amount in Subsys, which was the drug that was being applied. So, it was literally, I had it on a balance sheet on an Excel spreadsheet in terms of return on investment. So, it was the money that corrupted everything.

Matthew 18:41
And I think, meanwhile, the little guy is still suffering, you know, isn't it? I mean, I think you will document that - one thing that struck me because you talk about, you know, some people have gone to jail. But you look at the different even the differences in, like, jail sentences and fines, you know, relative to, you know, sort of slaps in the hands for people like Purdue or, you know, the guy Dr. John Kapoor, Insys goes to, I think it's even five years but even - yeah, I forget the guy's name, but the one you mentioned at the - who the fentanyl guy at the end of the film who...

Alex Gibney 19:14
Alec Burlakoff?

Matthew 19:14
Ah, no, no, the - sorry, the guy from Lubbock, Texas...

Alex Gibney 19:19
Oh, the guy from Lubbock, Texas; he goes down for quite a number...

Matthew 19:22
For 10 years. Yeah, and he's happy. I mean, oddly enough, because he sees it as a new lease on life. But yet, some of these other people are getting year, two years, you know, this kind of thing.

Alex Gibney 19:34
Well, in the case of the Purdue executives, I mean, let's be clear. In 2007, Purdue as a company was convicted of felonies. Then again in 2020, Purdue once again pled guilty to felonies as a company, where very few executives are held to account. Three executives are held to account in 2007 in a plea agreement in which they plead guilty to misdemeanors of misbranding but on that basis, they would not, you know, spend a day in prison. The recommended charges were far more grievous. But the Department of Justice, you know, the higher ups in the Department of Justice, much against the advice of all their career prosecutors, decided to cut this deal. And one of the most damaging things about the deal that was cut was not only that it let executives off the hook, and also, you know, let Purdue get away with a fine, which encouraged other pharmaceutical companies to rush into this market. But it buried the evidence. That was part of the deal that this 120 page prosecution memo, which was one of the key documents we got our hands on, all the evidence in that charging document would be buried, and would never see the light of day. And so as a result, everyday people and journalists, you know, would be unaware of the corrupt activities that Purdue was engaging in in order to pull the fleece over people's eyes about the potential damage that would be done by opioids.

Matthew 21:09
I mean, that's a good point; you've got a few people in the film who talk about, they just want a public hearing. Even if they don't win it, they would like to have a public hearing. So all this stuff gets aired in the public. And it's just, you know, and each time the, well, whoever up, the higher ups that either DEA or DOJ just squash this, these things. I mean, what; is that...

Alex Gibney 21:35
It's also the problem, you know, with these civil lawsuits very often; often you see, you know, fines get paid. And you think, okay, justice is being done. But part of the justice that isn't being done is the truth isn't being told, because part of the deal is that we'll pay a fine, but bury the evidence. And, you know, Patrick Keefe says something rather poignant toward the end of Part Two, he says at the end of the day, families of victims want something more than money. Because after all, you can't quantify the value of a human life. What they want is the truth. And that's what Crime of the Century is attempting to give to people.

Matthew 21:44
Okay. I think that's a good point to take a break for our listeners, and we'll be right back with Alex Gibney, award winning director of Crime of the Century.

Factual America midroll 22:31
You're listening to Factual America. Subscribe to our mailing list or follow us on Facebook, Instagram or Twitter at Alamo Pictures to keep up to date with new releases or upcoming shows. Check out the show notes to learn more about the program, our guests and the team behind the production. Now back to Factual America.

Matthew 22:50
Welcome back to Factual America with award winning director Alex Gibney. The film is Crime of the Century, two part docu-series premiered May 10, and 11 on HBO in the US streaming - is it streaming on HBO Max? I imagine it is.

Alex Gibney 23:04
It is.

Matthew 23:06
And it's here in the UK on Sky Documentaries and streaming on Now TV from Saturday, May 15 at 9pm, British Summer Time. When we left off, you were talking about Patrick Keefe and a comment he made, and I think another comment he made, which I found very interesting was how everyone kind of - maybe one reason, not more has been done, or we all think we - so many of us have just seen this is just such a complex problem. But he actually says something to the effect that it's actually not all that complex, is it? You know, and with that in mind, I mean, now that we know that the system is broke, how do we fix it?

Alex Gibney 23:49
Well, I think one way of fixing it - and this is not so much of a problem in the UK, but in the United States, we have a health care system with some very bad financial incentives, particularly when, you know, comes to pharmaceutical companies where decisions often get made on the basis of profit, rather than health care for individuals. You know, I kind of liken it to what I call the MRI problem. So, let's say you're a group of doctors and you buy 10 MRI machines. Well, having spent that much money on the MRI machines, it probably isn't surprising to people to learn that the number of MRI prescriptions goes up. Why? Because there's a financial incentive to do so. Now, it may be something that you just internalize it may not be well, I'm going to do this against the, you know, well being of the patient; no, but in many cases, an X-Ray would be just as good at least for somebody who's just coming in with some kind of back pain, say; but the financial incentive is to use the MRI which, of course, drives up the cost of healthcare for everybody, unnecessarily. So, in the same way, you know, in the opioid system, you know, there's a financial incentive to get doctors to prescribe not only opioids more broadly for all sorts of pain treatment, but also to continue to titrate up to increase the doses. Why? Because it's financially beneficial to Purdue Pharma. And they spread that wealth around to doctors, etc. So that, I think is the big problem. I mean, if you want to really dig deep, you know, one of the ways, of course, there's, you know, we're in the process of various regulatory mechanisms, but it's, it's seeing - part of what I wanted to do with Crime of the Century was to show that it's a complex integrated problem. But really, you can sort that problem out by attacking it on the level of certain fundamentals and changing the incentive system. So the new incentive system is not for the profit of private corporations, but for the health benefit of patients who are not consumers.

Matthew 26:05
Yes, I think that's a very good point. And, I mean, because this isn't, yeah, there are issues with this in other parts of the world, and we've seen some of it in the UK, but nothing like what we have in the US. I mean...

Alex Gibney 26:19
No.

Matthew 26:20
Is it sort of 21st century capitalism on steroids, is it...?

Alex Gibney 26:24
That's right.

Matthew 26:25
You know...

Alex Gibney 26:25
I think it is. And 21st century capitalism on steroids, mixed with healthcare. In other words, I'm not somebody who's like in favor of nationalizing Nike, you know, in the cases of sneakers, you know, markets and competition, that's a good thing, okay. But when it comes to healthcare, you know, there's nothing as I recall in the Hippocratic oath, it says, that speaks about market share or supply and demand, you know; no, it's about do no harm, and protecting the health and well being of the patient.

Matthew 27:04
I think, I mean, we could have a whole program on health systems and what needs to be done, but I think it's a - there's even added in, like, the examples you're giving about MRIs. I mean, there's also this whole litigious side of things as well. So, you know, do an MRI because that's better than, you know, you're covering your yourself...

Alex Gibney 27:26
You're protecting yourself against torts, yeah.

Matthew 27:28
Torts and things like that. But that's just - but specifically about opioids, I mean, I think, if you don't mind, because I know, we don't have that much time with you today. But if we talked about the - continuing talking about the film, but I mean, you - it's a very, I mean, like all your docs, but especially this one is, I found it extremely compelling, because it's so character led. And I imagine that that was very deliberate on your side. I mean, even the pictures of everyone's childhood, which I found very poignant in this case, it was - it kind of put a - it made these people real, it could be the neighbors next door, you know, in a lot of these cases. Was that something you were thinking of when you approached making this film?

Alex Gibney 28:18
Very much, so, you know, and you create this notion of people growing up in a system and also wanting the best for themselves and their families, you know, the American dream, and pursuing the American dream. And that these people are just like us, you know, so it's, we're all people. It's not like - one of the things that one of the other destructive things that the Purdue Pharma people would try to do, and to some extent, other opioid distribution and makers would say, there are good people, and there are bad people and the bad people are those addicts. They're the ones who are giving us all a bad name because they're addicts. Well, how do - you know, that's just such a wrongheaded way of thinking about addiction; you know, we're all potentially prone to addiction under certain circumstances: different levels of DNA, experience, so forth and so on. But you can't tell somebody who is an addict by the walk in their step, the shimmy and the shake of how they, you know, there's no such thing as that person's a bad person. And likewise, you know, even the perps in this film, you know, you can see them growing up in their childhood with a sense of striving, wanting to make their lives better, and pursuing the American dream, but they pursue it in a way where the dominant ethos is, as long as you're making money, it's good, right? And there's a tendency to rationalize - there's a saying, I can never remember who said it, but it's that economic actors aren't rational, they're rationalizers. So, as you're making money, you rationalize your behavior. Well, a little of this, it's okay to pay this doctor a speaker's fee, that's probably fine. Maybe we'll double it. Maybe I'll take him out to dinner in a strip club, and maybe we'll triple it, you know, because he's really writing or writing a lot of opioids, and they're probably pretty good for the patient. So, the idea of showing these people and you're speaking about somebody like Alec Burlakoff who was a salesperson for Insys. Sunrise Lee, who I find a very interesting, compelling character. She was an exotic dancer, when, when Alec Burlakoff shows up at the strip club, and then hires her to be what ultimately would be in charge of sales for a third of the country. She also, you know, you can see, she lived a life of extreme duress, you know, her parents were abusive, and so from there on, she just wanted something that was better for her and her family. Or, Mark Ross, a salesperson for Purdue, you know, again, grows up in Ohio and West Virginia. You know, right around the time when John Denver was writing that famous song, Country Roads, and you know, he comes out of college not meaning to get into the pharmaceutical business, falls into a job with Purdue Pharma, and the next thing he knows, he's, like, the key actor in a drama of horrible opioid abuse, and he's at the center of it selling these drugs.

Matthew 31:27
But with Alec Burlakoff, did you ever imagine you were gonna find a character like him?

Alex Gibney 31:32
No, he is an incredible character. He's a character out of Glengarry Glen Ross. 'Always closing. Always be closing'. And he has this - he literally had a color coded system of how to describe doctors, because he didn't want to waste his time. And he likened that to, by the way, to Sunrise Lee's approach to, you know, picking out who do you want to potentially spend time with in a strip club, you know, you want the person who's going to pay. So, he color codes, the doctors, according to greens, they're the ecological ones, the blues, they're the analytical ones. You don't pay any attention to them, because they're not going to pay off. But the reds, those are the businessmen, those are the ones you want to focus on. Either the ones were brutally corrupt, because they don't care about creating pill mills, or because they just - they subscribe to what Alec calls the WIFM. And what is the WIFM? "What's In It For Me?" So, you know, if these guys, meaning the drug company Insys, is going to pay me $10 - $15,000 to pretend to speak about these drugs, great; it's more money for me. And if I write a few more scripts, fine, no problem. So, and they're so busy, they're not really even thinking about it. So, he's - so, we show the color coded, you know, Alec is incredible. And what I appreciated about Alec, by the way, this is a guy who pled guilty and ultimately cooperated with the government. In those cases, most often what you see is somebody says what I did was very bad. But they'll never take you back to the time when they were doing it to show you the tremendous enthusiasm with which they were pushing this stuff. And that's what Alec does so effectively; he takes you back and gives you what it must have been like to see him as a salesperson. And he must have been a wildly effective Salesperson! Right?

Matthew 31:37
Yes. Well, exactly.

Alex Gibney 33:22
And he shows that he was utterly corrupt and admits it now but does so with a sense of storytelling enthusiasm that it really does convey how it can work, right? Because you, you know, this stuff doesn't happen under dark of night where people agree, you know, using code names to meet at the corner of, you know, eighth and Vine. You know, it happens upfront, over dinner, you know, the regular meeting at the doctor's office, it's those little acts of corruption that get bigger and bigger and bigger and bigger and bigger over time until you have a full blown corrupt system.

Matthew 34:06
I mean, that's the thing. It's a two parter. And, well, you know, I've watched that first one, and you've got kind of the, in this respect, almost the anti-Alec Burlakoff; you've got the Mark Ross who ends with the poem that he's written about the crisis and his regret. And then my eyes just went big at the second part because you've just, you know, it's just - I never imagined the stuff that you're able to - that you document that was going on in terms of that, the sales conferences, everything that was going into the pushing...

Alex Gibney 34:39
How about the hip-hop video?!

Matthew 34:41
Oh! I mean...

Alex Gibney 34:43
The titration video where literally you have these two guys who were salespeople from the company Insys talking about titration, which is, you know, ratcheting up the dose, which means more money for Subsys, but the rap that goes along with that video is basically a step-by-step description of their criminal practices! It's like, what do you see that as like, 'Hey! let's do a dance to the crimes we're committing!', you know?

Matthew 35:17
Alec says it's like probably something they shouldn't have done. I mean, one of my favorite scenes in one of your more recent docs is in the Theranos doc with Elizabeth Holmes coming in with, you can't touch this, you know, and this trumps that; like, that is nothing compared to, you know, to what you've got here with that rap video.

Alex Gibney 35:36
Well, and it turns out like, this seems to be a trope for people; it's like, while you're corruptly making money, make a song, you know, a dance. Because we found some videos that had never been released before of some of the Purdue sales conferences. I think we showed excerpts from one in 1997. And, you know, they hired a rock band to sing songs about how aggressively they were pushing these drugs. [Sings] You got to sell OxyContin; sell MS Contin... And everybody's, like, pumping their fists and twirling and dancing. There was no song about how we're gonna do [Sings] good for the patient good for the patient. No, no, no, it's all about selling, commissions, payoffs. You know, it's all about the money.

Matthew 36:24
Well, speaking of which, I mean, in the most recent review, in The Guardian, they say Gibney's no stranger to prolific corruption, greed, and incompetence. Do you ever just want to throw your hands up sometimes; I mean, and this must have even shocked you - what you've found with this stuff.

Alex Gibney 36:39
It did shock me. I mean, honestly, like, as I said, at the beginning, like many people, I viewed the opioid crisis as something that was terrible, but something that just happened as if there was no cause and effect. And it turned my head around to realize that, no, it's actually a crime. And look, this is part of what we do. That's why, you know, Justice Brandeis famously said, sunlight is the ultimate disinfectant, right? So, that's why we tell these stories, and that's why I continue to do it. It's not like most of us - well, there's the famous Cherokee saying, you know, it goes something like this, which is that, you know, inside of us live two wolves. You know, one is good, and one is evil. And the next question is, well, how do you know which one takes hold? And the saying goes depends on the one you feed, right? So, I think that like looking at people, and dividing them into categories of good or bad people, misses the point; we're all a little bit gray. And depending on the circumstances, we could go one way or the other: which wolf are we going to feed, right? And that's the purpose of telling these stories, because I think if I thought that it didn't make any difference, I wouldn't do it. But at the end of the day, you know, you got to be prepared. It's like phishing attacks, right, on your computer. If you know they're coming, and you know, if you get Hi Alex, name is Ed from, you know, Ukraine, please click on the link so I can give you happy prize. Right? You know, and if you're not conditioned to say, Sorry, I'm not I'm probably not going to click on that link, then you're going to get burned. Right? So, by letting people know I, because my view of human nature is not that we're all bad or that we're all good, but that we're potentially a little bit of both and over time, we either feed the good wolf or we feed the bad.

Matthew 39:00
Yes. And I will - thank you for saying it because that was one of the last questions I going to ask you about what your film say about human nature. And I think that it's very, very well put; obviously, I think we're all capable of great things. we're all capable of horrible things. Me, personally. And so, I'm aware we're actually coming to the end of our time. So, can I ask what's what's next for you after this? I mean, I don't know how you do it, you generate so many high quality docs. You had three that dropped just in 2020 alone. I mean, it's absolutely amazing. What's next on the cards for 2021

Alex Gibney 39:44
There's some stuff coming out. I think I generally don't talk about them too much in advance because I like them to, you know, drop when they do and it takes the energy out of it if I do. But, you know, look, this one I worked on three years. Another one, Agents of Chaos, I worked on, I think, for four. It was a little bit anomalous this year, I helped with two other people to rush through a documentary called Totally Under Control, which was all about the COVID pandemic. But, you know, the thing about doing what I do, and I feel lucky to be able to do it, is that I've reached a point where I can spend a good bit of time on these things. And so really dig deep and think through them from all different angles. And so, you know, some of course, there's stuff I'm working on, and it's - and thankfully, it's a mixture of the dark and the light, and some investigative stuff along with some stuff about music and sports, which I really dig and like to do more on.

Matthew 40:51
Well, we look forward to seeing those - all of them. And if we haven't scared you off, we'd love to have you back on again sometime. It's been a joy having you on and to discuss Crime of the Century. One last question, if I may: what do you think Crime of the Century's legacy will be? Or what do you hope it will be?

Alex Gibney 41:13
I hope that the legacy will be to destigmatize those who are addicted to these drugs, and also cause a complete re-evaluation of the bad economic incentives in healthcare. If it would do that, I would be very, very proud and happy.

Matthew 41:34
And I think we would all benefit if that is indeed what happens. So, thank you so much for coming on to Factual America. Good luck with the release. I know it will do well. And yes, I look forward to hopefully having the chance to talk to you again sometime. So, thank you again.

Alex Gibney 41:52
Thank you, Matthew. A great pleasure.

Matthew 41:55
So, I just want to say thank you again to Alex Gibney. The film is Crime of the Century, premiered on May 10, and 11. on HBO. It's also streaming on HBO Max, and will drop on Sky Documentaries and stream on Now TV from Saturday, May 15 at 9pm here in the UK. If you have any questions regarding how you can become a documentary director like Alex Gibney, or other roles in the industry, I recommend you check out careersinfilm to learn more about careers in the film industry. I want to give a shout out to Innersound Audio just outside of York - well, actually in Escrick, England. Big thanks to Nevena Paunovic our podcast manager at Alamo Pictures who ensures we continue getting such great guests like Alex Gibney on to the show. And finally, a big thanks to our listeners. As always, we'd love to hear from you. So please send us your feedback and episode ideas. And whether it is on YouTube, social media, or directly by email, we'd love to hear from you. And please remember to like us and share us with your friends and family wherever you happen to listen or watch podcasts. This is Factual America, signing off.

Factual America Outro 43:02
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