The document discusses President Trump's appointments related to the opioid epidemic, particularly focusing on Scott Gottlieb's nomination as FDA commissioner. Gottlieb's extensive ties to the pharmaceutical industry raise concerns about conflicts of interest, while his commitment to combating opioid addiction has been emphasized. The document contrasts the potential influence of industry ties against Trump's promises to reform drug approval processes and address the opioid crisis.

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Big Pharma gets their men in Trump appointees
thesoberworld.com/2017/05/14/big-pharma-gets-men-trump-appointees
Presidential campaigns have a way of eliciting bold and sweeping commitments from its
candidates that don’t always translate into policy. It’s usually not until after cabinet and
key positions are filled that the tea leaves reveal what is in store. After all; personal is
policy. On the campaign trail, candidate Trump claimed that his supporters constantly
spoke to him about the opioid epidemic. In response, he pledged to end the epidemic at a
Columbus, Ohio town hall meeting last August; “we’re going to work with them (addicts),
we’re going to spend the money, we’re gonna get that habit broken.” This promise became
central to his campaign and reiterated in stump speeches throughout the remainder of the
election.
President Trump seems to be making good on his pledge. In March (2017) he appointed
New Jersey Governor Chris Christie to head a federal commission whose sole purpose is
to identify the status of the epidemic and make recommendations for the future. Christie
– who lost a close friend to an opioid overdose and has been outspoken about the need for
reform – has a personal interest in ending opioid abuse and overdoses which makes him
the perfect candidate for this position.
If there were a polar opposite of Governor Christie it might just be the President’s
nominee to head the Food and Drug Administration, Dr. Scott Gottlieb. Looking at his CV
you might think Gottlieb crafted his career – like an artist chisels a statue out of a block of

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stone – specifically for this appointment.
Dr. Gottlieb, 44, is very accomplished. According to his Wikipedia page, Gottlieb is a
physician, internist at Tisch Hospital, clinical assistant professor at New York University
School of Medicine, and conservative health policy analyst. He has held many positions in
the federal government including being a member of the White House Biodefense
Interagency Working Group, Deputy Commissioner for Medical and Scientific Affairs at
the U.S. Food and Drug Administration (FDA) during the Bush Administration, and has
testified as an expert witness before committees of the United States House of
Representatives and Senate on issues related to FDA regulation, healthcare reform, and
medical innovation. Gottlieb is also a cancer survivor who regularly writes healthcare
policy op-eds for many national newspapers and magazines, and is a frequent guest on
cable TV shows.
But there is another side to Dr. Gottlieb that not all have seen. Before he studied
medicine, Gottlieb worked as a healthcare analyst at the Baltimore office of Alex. Brown &
Sons, an investment bank. Since 2007 he has been a partner at New Enterprise
Associates, which he describes as “one of the world’s largest and most active venture
capital firms.” His focus at the firm has been on health care investments. In addition, he is
also a senior principal at the investment bank TR Winston, and partner at the hedge fund
Arcoda Capital Management; all health care–centric finance groups. He has served on five
pharmaceutical companies’ boards and is currently a member of GlaxoSmithKline’s
product investment board. Gottlieb is also a resident fellow at the American Enterprise
Institute where he researches the FDA and the Centers for Medicare & Medicaid Services.
Due to his nomination, Gottlieb was required to provide Health and Human Services
associate general counsel for ethics, Elizabeth Fischmann, disclosure statements revealing
any conflicts of interest or financial ties to companies in the health industry. In his report,
Gottlieb stated he has approximately two dozen healthcarerelated companies in which he
has a financial interest. Gottlieb also stated he would divest his interests in those
companies within 90 days of his confirmation.
Harvard professor Daniel Carpenter, an expert on the FDA, stated that; “These are not
relationships whose influence just disappears once he resigns from a corporate board. If
(Gottlieb) is confirmed, he would be the most interest-conflicted commissioner in
American history, by far.”
Upon news of Gottlieb’s nomination, The Pharmaceutical Research and Manufacturers of
America’s (Pharma) CEO Stephen J. Ubl sent out congratulations stating; “We look
forward to working with Dr. Gottlieb in his new role, as they seek to modernize the drug
discovery and review process and advance competition in the biopharmaceutical market.”
According to Market Watch, a Mizuho Securities USA survey found “72% of 53 drug
companies polled favored Gottlieb for the position.” Gottlieb’s disclosure statements
reveal a troubling relationship with opioid manufacturers and distributors. According to a
federal database, he received more than $400,000 in payments from pharmaceutical

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companies between 2013 and 2015. From 2016 to the present Gottlieb has accepted
almost $45,000 in speaking fees from firms involved in the manufacture and distribution
of opioids.
Public Citizen’s Health Research Group director, Dr. Michael Carrome, had this to say
about Gottlieb; “He is someone who has been an industry shill and has spent most of his
career dedicated to promoting the financial interests of pharmaceutical corporations.”
“He is entangled in an unprecedented web of close financial and business ties to the
pharmaceutical industry and was no doubt chosen because he is well-suited to carry out
the President’s reckless, ill-informed vision for deregulating the FDA’s review and
approval process for prescription medications, including opioids.”
On April 5, 2017, Gottlieb appeared before a Senate panel for a confirmation hearing.
Gottlieb was quoted as saying that “the opioid addiction is the biggest crisis facing the
agency and will ’require dramatic action,’ including finding ways to spur development of
nonaddictive alternative painkillers as well as addiction treatments.” He said tackling the
crisis would be his first priority.
At the conclusion of the meeting, the ranking Democrat on the Health, Education, Labor,
and Pensions Committee, Senator Patty Murray (Wash.), said she believed the panel
needed to slow down the vetting process, to give time to review Gottlieb’s “unprecedented
financial entanglements in the industries he would regulate as commissioner.”
The most important question still unanswered is which Dr. Scott Gottlieb will we get? Will
it be cancer surviving internist with compassion for others suffering from disease, a man
who is determined to quickly expedite the approval of generic and orphan drugs? Or will
we get the Washington insider venture capitalist hell-bent on getting more drugs
approved at a faster pace with ambivalence towards drug efficacy and public safety? This
almost feels like election season all over again – a lot of talk and promises made by people
who will never be held accountable for their statements once their appointment is
approved by congress. If there is one thing that I’ve learned watching our political
process, it is that person is policy. The President is going to fill key positions with the
people who will carry out his vision.
That being said, perhaps a look into the President’s recent activities will give us better
insight to the new direction of the FDA. One of the first groups Trump met with after
becoming president in January was the pharmaceutical industry. Trump, who stressed on
the campaign trail that “pharmaceutical companies are getting away with murder,” threw
caution into the wind by telling big pharma execs that he plans to cut the FDA’s regulatory
playbook. “Instead of it being 9,000 pages, it’ll be 100 pages. We’re also going to be
streamlining the process so that from your standpoint so that when you have a drug, you
can actually get it approved — if it works — instead of waiting for many, many years.”
In early April (2017) insiders reported that Trump intends to tap former lawyer and
current Rep. Tom Marino for the position of U.S. Drug Czar (Office of National Drug
Control Policy – ONDCP). Marino, who is currently serving his third term as the U.S.
Representative for Pennsylvania’s 10th congressional district, is not without controversy.

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In 2016, Marino authored and supported the Ensuring Patient Access and Effective Drug
Enforcement Act. The bill’s supporters claim it struck the right balance between the needs
of patients, the pharmaceutical industry, and law enforcement. However, detractors of the
bill claim the legislation undercuts the DEA’s ability to hold pharmaceutical drug
distributors accountable for the diversion of large amounts of opioid pain relievers. More
specifically, Joseph Rannazzisi, JD, RPh, head of the DEA Office of Diversion Control,
cautioned the bill, backed by a pharmaceutical industry lobbying campaign, would protect
corporations engaged in criminal activity. “This bill passes the way it’s written we won’t be
able to get immediate suspension orders, we won’t be able to stop the hemorrhaging of
these drugs out of these bad pharmacies and these bad corporations. What you’re doing is
filing a bill that will protect defendants in our cases.”
If you look at Christie, Gottlieb, and Marino’s appointments independently, you might not
think much about any one of them. However, when you take into consideration that
Christie’s job ends in November and Gottlieb and Marino serve at the President’s
pleasure, the tea leaves begin to reveal their secrets.
The FDA is the most important government agency to our economy in that it regulates
industries that account for nearly 25 percent of consumer spending in the U.S. That
represents a lot of jobs and prosperity, something else former businessman and current
President Trump promised on the stump. He can only keep one of his promises, end the
opioid epidemic or open the flood gates at the FDA. Which promise he intends to keep
will be reflected by the actions Gottlieb takes as head of the FDA.
I have not given up hope because we still have a voice in this discussion. Make your
thoughts known by calling your congressmen and senator. Phone calls matter. There is a
new app called 5calls.org that makes it easy to find your representative and their contact
information. Exercise your rights and give it a try.
John Giordano, Doctor of Humane Letters, MAC, CAP, is the
founder of ‘Life Enhancement Recovery Center,’ an Addiction
Treatment Consultant, President, and Founder of the National
Institute for Holistic Addiction Studies, Chaplain of the North Miami
Police Department and is the Second Vice President of the Greater
North Miami Chamber of Commerce. He is on the editorial board
of the highly respected scientific Journal of Reward Deficiency
Syndrome (JRDS) and has contributed to over 65 papers published
in peer-reviewed scientific and medical journals. For the latest
development in cutting-edge addiction treatment check out his
website: www.holisticaddictioninfo.com