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What OxyContin Reveals About Structural Sin

Jan 11, 2022

In the last few years, Christians have engaged in heated discussion and debate about the existence of “systemic” or “structural” sin, especially as applied to racism. Is it possible for sin to be “baked in” the structures of society, or is it primarily (or only) an individual offense?

Some say, yes, systemic racism has existed in the past, with slavery and segregation as the preeminent examples of such injustice. But now that those days are over and our laws have changed, they argue, talk about “systemic racism” is wrongheaded. To combat racial prejudice, we’ve got to focus on the individual heart.

What’s more, some say, any talk about systemic injustice is code for liberation theology or revolutionary Marxist thought. Once you begin down the path of “social justice,” they warn, you’re in danger of redefining sin in such a way that an individual’s disobedience to God’s Word gets lost in all the talk about sin’s structural manifestations. The system overcomes the individual to the point that the “oppressed” (the minority) are cast as the “righteous” because of their oppression while the “oppressors” (the majority) are cast as the guilty because of their privilege.

Standing in (rightful) opposition to the reductionist theories of Marxism and liberation theology, some Christians today go so far as to argue against the idea of anything other than sin and repentance as individual. There is no such thing as national guilt, or systemic sin, or corporate repentance. Sins are always and only individual, not communal.

In thinking through issues like this, I find it helpful to test the validity of certain principles by considering other examples. Let’s set aside the debate over “systemic racism” for a moment and see if the principle of structural sinfulness might apply in another domain.

“Systemic Injustice” Debate: A Different Example

For an example of how sin can infect an organization, including its structure, culture, incentives, and atmosphere, you need look no further than Empire of Pain: The Secret History of the Sackler Dynasty by Patrick Radden Keefe. This book helps readers understand how and why more Americans have died from opioid overdoses than in all the wars the United States has fought since WWII.

Where do we begin the attempt to assign responsibility for the opioid epidemic? Empire of Pain describes how brothers Arthur, Mortimer, and Raymond Sackler entered the ranks of New York high society and then came to own Purdue, America’s leading supplier of opioids.

Over the years, the Sackler family created an ecosystem for clinically testing their own drugs before finding ways to “secure favorable reports from the doctors and hospitals with which they had connections, devise an advertising campaign in their agency, publish the clinical articles and the advertisements in their own medical journals, and use their public relations muscle to place articles in newspapers and magazines.”

Righteous Cause  

The stated motivation for pushing the opioid OxyContin was compassion and mercy—to desire to deliver drugs that would alleviate any pain, not just for cancer patients. “There was a sense, in the industry, that Purdue was doing right and doing well—providing an innovative product that was helping people and making money hand over fist,” Keefe writes.

As one employee said, “We felt like we were doing a righteous thing. There’s millions of people in pain, and we have the solution.”

By cajoling the FDA, and by providing free samples designed to “acquaint” patients with OxyContin, the family ensured their opioids would be top of mind with new patients. They dominated the market.

Fallout

The result has been catastrophic. Keefe writes:

Some communities began to resemble a zombie movie, as the phenomenon claimed one citizen after another, sending previously well-adjusted, functioning adults into a spiral of dependence and addiction. . . .

When it became clear that people were abusing Oxy­Contin, Purdue’s leaders responded by blaming the victims. The opioid addicts were the criminals and victimizers, misusing a perfectly good product and giving the company a bad name. “We are losing sales because physicians have become scared or intimidated from press reports!” they said.

For years, the Sacklers denied the addictiveness of the drug. Eventually, the company conceded that OxyContin could be dangerous, just in time to secure an exclusive patent for a new “abuse-resistant” version. Then, in an audacious reversal, Purdue asked the FDA to refuse to accept generic versions of the original OxyContin because the product they’d been selling all those years should now be deemed “unsafe.”

No Single Actor  

Empire of Pain is maddening to read. Anyone with a sense of justice will be simultaneously grieved and angry at how this company skirted the law, relied on personal connections, and built a culture on a foundation of falsehood about its primary products. Purdue sent sales reps to call on prescribers the company knew were giving out unnecessary prescriptions, even going so far as to give kickbacks to the doctors of these pill mills.

But you can’t blame a single person for the opioid crisis. What we see here is a case of sinfulness and selfishness pervading several reinforcing institutions designed to increase sales, at any cost. People inside and outside the company were involved—corrupt doctors handing out prescriptions, salespeople and secretaries facilitating the flood of opioids into ravaged communities, and government officials who turned a blind eye to the mounting legal problems. You can describe this as conspiracy or collusion by individuals at the highest levels of a business, but the institutional structures (including the governmental approvals and the relational dynamics between multiple organizations) and the institutional incentives were all tilted toward injustice.

Everyone involved was culpable, though not equally so. We wouldn’t hold a secretary doing paperwork for Purdue to the same degree of guilt as one of the Sackler family members, but surely some culpability remains.

Pervasiveness of Sin

Empire of Pain is a good example of structural sin—the corruption of an institution given over to perverse incentives, bad habits, and false beliefs. More than just a conspiracy of individual bad actors, the situation with Purdue demonstrates how a business itself, or a system, program, or law, can be set up in such a way that even good-willed individuals become enmeshed in carrying out evil beyond their intentions.

Sin is pervasive. All of us are involved, at some level or another, in injustice, simply by participating in a global economy where wrongs (small and large) take place on a regular basis. It’s impossible to fully extricate ourselves from every potential entanglement with evil.

It’s no wonder that on occasion the apostle Paul talked about sin not merely as individual transgression but as a power, giving a personification to “Sin” as something more than the sum of what sinners do. How else do we explain how civilized German Lutherans fell prey to Hitler’s corrupted call for national greatness? Or how Christians in Rwanda committed shocking atrocities of ethnic violence against one another?

Overly individualized visions of sin diminish the pervasiveness of sin’s effects on society. Likewise, the problem with liberation theology and Marxist views of structural sinfulness is not that they go too far in their diagnosis; it’s that they don’t go far enough. Structural manifestations of sin are part, not all, of the problem. The human heart should remain foregrounded, not diminished, because the heart remains desperately wicked whether on the side of the “oppressor” or “victim.”

Because we hunger and thirst for righteousness and pray to see the Lord’s will done on earth as in heaven, we do whatever we can to expunge “systemic injustice” from our society, even as we recognize such attempts will always be provisional and that even our reforms will be susceptible to sin’s effects, causing unintended consequences that will form the basis for future reformers.

Thankfully, we have a Savior who both covers and conquers sins. We are justified by faith in his atoning blood, to cover all our sins of omission and commission. And we are ambassadors of reconciliation who testify of One who conquered the power of Sin and promises to bring about a new heaven and new earth, where righteousness dwells. The gospel is the answer to both individual and institutional sin.

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