Getting Patients Hooked On An Opioid Overdose Antidote, Then Raising The Price

First came Martin Shkreli, the brash young pharmaceutical entrepreneur who raised the price for an AIDS treatment by 5,000 percent. Then, Heather Bresch, the CEO of Mylan, who oversaw the price hike for its signature Epi-Pen to more than $600 for a twin-pack, though its active ingredient costs pennies by comparison.

Now a small Virginia company called Kaleo is joining their ranks. It makes an injector device that is suddenly in demand because of the nation’s epidemic use of opioids, a class of drugs that includes heavy painkillers and heroin.

Called Evzio, it is used to deliver naloxone, a life-saving antidote to overdoses of opioids. More than 33,000 people are believed to have died from such overdoses in 2015. And as demand for Kaleo’s product has grown, the privately held firm has raised its twin-pack price to $4,500, from $690 in 2014.

Founded by twin brothers Eric and Evan Edwards, 36, the company first sought to develop an Epi-Pen competitor, thanks to their own food allergies.

Now, they’ve taken that model and marketed it for a major public health crisis. It’s another auto-injector that delivers an inexpensive medicine.

One difference, though, is that Evzio talks users through the process as they inject naloxone. The company says the talking device is worth the price because it can guide anyone to jab an overdose victim correctly, leave the needle in for the right amount of time and potentially save his or her life.

According to Food and Drug Administration estimates, the Kaleo product, which won federal approval in 2014, accounted for nearly 20 percent of the naloxone dispensed through retail outlets between 2015 and 2016, and for nearly half of all naloxone products prescribed to patients between ages 40 and 64 — the group that comprises the bulk of naloxone users.

And the cost of generic, injectable naloxone — which has been on the market since 1971 — has been climbing. A 10-mililiter vial sold by one of the dominant vendors costs close to $150, more than double its price from even a few years ago, and far beyond the production costs of the naloxone chemical, researchers say. The other common injectable, which comes in a smaller but more potent dose, costs closer to $40, still about double its 2009 cost.

Still, experts say the device’s price surge is way out of step with production costs, and a needless drain on health-care resources.

“There’s absolutely nothing that warrants them charging what they’re charging,” said Leo Beletsky, an associate professor of law and health sciences at Northeastern University in Boston.

Kaleo, which is trying to blunt the pricing backlash and turn Evzio into the trusted brand, is dispensing its device for free — to cities, first responders and drug treatment programs. Such donations were also essential to the Epi-Pen’s business strategy.

The device has been invaluable to patients, said Eliza Wheeler of San Francisco’s Harm Reduction Coalition, a nonprofit that works to combat overdoses and has received donations of Evzio. But at $4,500 a package?

“I might have $10,000 to spend on naloxone for a year, to supply a whole city,” Wheeler said. “If I have 10 grand to spend, I certainly can’t buy two Evzios.”

Mark Herzog, Kaleo’s vice president of corporate affairs, said in an email that most earlier naloxone devices were “developed, designed and intended” for use in medically-supervised settings.

Prior kits contained a pre-filled syringe. The Evzio was the first to help laypeople dispense the drug. And competition is limited: One of the few consumer-friendly alternatives to Evzio is a nasal spray device for naloxone.

A growing market

The opioid crisis has led more experts to call for expanded access to naloxone — for people navigating addiction and for those around them. The idea is that if someone nearby could overdose, dispensing the drug should be as easy as pulling the fire alarm.

Federal and state governments have spent millions of dollars equipping police officers and other first responders with naloxone. In communities particularly hard-hit by drug overdoses, places such as schools, libraries and coffee shops are keeping the antidote on hand. Physicians are prescribing it to patients who are taking prescription painkillers in an effort to make sure they — and their families and friends — are prepared.

The Evzio could be ideal, especially when medical professionals are not nearby, noted Traci Green, an associate professor at Boston University’s School of Medicine. But the price limits access.

“It’s a really good product,” she said. “It’s elegant. People do like it — but they can’t afford it.”

“There’s a lot of value to this formulation,” said Ravi Gupta, a medical student and lead author of a December op-ed on the pricing issue, published in the New England Journal of Medicine. “But it’s not justified. This pricing is not justified.”

But consumers may not yet be pinched. In another Mylan parallel, Kaleo offers coupons to patients with private insurance, so they don’t have any co-pay when they pick up the device.

So Kaleo would say the price hikes are essentially moot. Herzog said they are necessary to subsidize programs that do not offer copayments. In a follow-up email, he added that the list price is “not a true gauge,” because insurance companies can sometimes negotiate rebates and discounts. And, he said, since the price increase, more patients have gotten Evzio prescriptions filled — so the cost doesn’t seem to be stopping them.

Mylan provides a similar Epi-Pen discount — a move that’s helped cement it as the dominant epinephrine provider. But even if consumers don’t directly pay for the price increases, they’re affected, analysts cautioned.

“When you have these kinds of programs, the cost is still borne by patients, because insurance premiums go up,” Beletsky said.

That, analysts say, undermines Kaleo’s argument that they’re somehow increasing access. After all, while some government agencies and private organizations get the drug for free or at a deep discount, that isn’t true across the board. For those who don’t get that deal, the list price matters.

Take Vermont. The state’s been particularly hard-hit by the epidemic — more than 70 people died of opioid overdose in 2015, and it’s been dubbed America’s “heroin capital.”

Its health department is trying to get naloxone into the hands of people using opioids, setting up distribution sites around the state. But because of its high cost, Evzio isn’t an option, said Chris Bell, who runs the state health department’s emergency preparedness and injury prevention division. So it is opting for the nasal spray that costs a fraction of the price.

That’s not true everywhere, though. The Veterans Health Administration, known for its especially high rate of patients taking opioid-based prescription painkillers, covers the auto-injector. It can do so, though, because of its bargaining power — the agency is legally authorized to negotiate with pharmaceutical companies.

As a result, the VA is paying “far, far less” than the Evzio list price, said Joseph Canzolino, deputy chief consultant for pharmaceutical benefits management at the VA. (He would not release the precise figure.)

The agency’s buying power is such, he added, that even when companies drive up prices, what the VA pays will stay more or less stable — far below a figure he called “pretty exorbitant.”

Thanks to an infusion of public funding to combat opioid overdoses, other institutional buyers may also be able to afford Evzios. Their budgets are larger right now, so they’re less price sensitive, said Nicholson Price, an assistant professor at the University of Michigan Law School.

But that money comes from somewhere — most likely taxpayers. And it’s hardly sustainable, Price noted, saying “at some point in time the rubber’s got to hit the road.”

Kaleo has given away more than 180,000 devices, Herzog said, distributed in 34 states among about 250 organizations such as police departments and nonprofit groups that distribute naloxone to people at risk of overdose.

Advocates and pharmacy groups have made videos touting the product. In neighborhoods where overdose is common, businesses — like fast-food restaurants, grocery stores and other retail establishments — are interested in keeping readily dispensable naloxone on hand.

But those who’ve accepted free Evzio devices and have come to rely on it may soon face withdrawal. Last year, Kaleo’s donation supply was exhausted by July. Herzog said the company has added to its donation supply and is taking applications from groups hoping for free devices.

Barring a meaningful expansion, the free device program could run out of supplies even sooner if the current opioid crisis keeps up.

The problem, law professor Price noted, is that policymakers haven’t found a solution to get people needed medication and keep pricing in line with value.

“Epi-Pen happened, and everyone was like, ‘Wow, this is terrible, we shouldn’t allow this to happen,’” he said. “And we haven’t done anything about that, and it’s not clear what the solution is. Now, shocker, it’s happening again.”

— source By Shefali Luthra

How Big Pharma’s Money is Affecting our Health and our Wallets

Pharmaceutical companies are the power brokers of the medical industry. The influence of pharmaceutical companies on prescription drugs has had a significant impact on the health of Americans, such as the release of defective drugs, which can end in lawsuits. Even more, a recent ProPublica report shows that between August 2013 and December 2014, pharmaceutical companies spent $3.49 billion in payments to various organizations.

Who received the money?

681,020 doctors received payments from pharmaceutical companies for their work
1,135 teaching hospitals received payments
1,565 companies received payments

Which individual doctors received payments?

Several doctors throughout the country received multimillion dollar payments from pharmaceutical firms. The highest earning doctor was Dr. Sujata Naraya, a specialist in family medicine, who received $43.9 million. The second highest earning doctor according to the spending data was Dr. Karen Underwood, a specialist in pediatric critical care, who received $28.5 million.
Which companies spent the most?

The following companies were responsible for the vast majority of the expenditures:

Genentech, Inc. made $388 million in payments made to 1,888 doctors
DePuy Synthes Products (makers of the defective DePuy Pinnacle Hip Implant) made $94.7 million in payments made to 364 doctors
AstraZeneca Pharmaceuticals made $90.7 million in payments made to 128,461 doctors

Disparities between marketing and R&D spending

Many of the leading pharmaceutical companies spent more money on marketing than they did on the research and development of their own products. The highest spending company was Johnson & Johnson, makers of Risperdal and Xarelto, who spent $17.5 billion on marketing and only $8.2 billion on research and development

Read this infographic by for the complete details.

— source

One-percenters, pay your taxes

In recent years, business leaders at Davos, the World Economic Forum’s annual meeting, have ranked inequality as one of the greatest risks to the global economy. They have recognized that it is not just a moral issue but also an economic issue.

Of course, if ordinary citizens don’t have incomes with which to buy the products made by the world’s corporations, how can those corporations prosper? That’s consistent with the findings of the International Monetary Fund: that countries with less inequality perform better.

If a majority of citizens feel that they are not getting what they view as a fair share of the economic gains, they may turn against our economic and political system, or at least those parts of it that they blame. If a majority believes that globalization is hurting them, they may turn against globalization.

The outcomes of the election in the US and the result of the referendum on Britain’s membership in the European Union suggest that a rebellion may already be brewing. And this is understandable: in the US, the average income of the bottom 90% has stagnated for nearly a quarter of a century. According to the National Center for Health Statistics, average life expectancy declined last year for the first time in more than two decades.

In recent years, Oxfam has been keeping tabs on the growth in global inequality. In 2014, the anti-poverty organization painted a vivid image of a bus with the world’s 85 richest people — many of whom are in attendance at Davos, as it happens — who had as much wealth as the bottom half of the world’s population. Each year since, that bus has been shrinking. This year, Oxfam revealed that such a large form of transport was no longer needed: a minivan with just eight men (and they are all men) would do. They have as much wealth as the bottom 3.6 billion people.

Not surprisingly, the message has not been lost on these top executives meeting in Davos. For some, it is a moral issue; for all, it is an economic and political one. At stake is the future of the market economy as we know it. At session after session at Davos, executives have been grappling with the question: Is there anything that the world’s corporations can do about this scourge that threatens the political, social, and economic sustainability of our democratic market economies? The answer is yes.

It begins with a simple idea: pay your taxes. This is the first element of corporate responsibility. Don’t resort to shifting taxes to lower tax jurisdictions. Apple may feel that it has been unfairly singled out on this score; it only did a slightly better job at tax avoidance than others.

Don’t make use of the secrecy and tax havens, onshore or offshore, whether it’s Panama or the Cayman Islands in the Western hemisphere or Ireland or Luxembourg in Europe. Don’t encourage the countries in which you operate to engage in tax competition, a vicious race to the bottom where the real losers are the poor people and ordinary citizens around the world.

It’s shameful when the president-elect of a country appears to boast that he hasn’t paid certain taxes for nearly two decades — suggesting that smart people don’t — or when a company pays .005% of its profits in taxes, as Apple did. It’s not smart: it’s immoral.

Africa alone loses $14 billion in tax revenues due to the super-rich using tax havens, Oxfam has calculated, noting this would be enough to pay for health care that could save the lives of 4 million children and to employ enough teachers to get every African child into school.

A second idea is equally simple: Treat your workers decently. A full-time worker shouldn’t be living in poverty. In Scotland, 31% of households where one adult works full time are still in poverty.

Top executives in large US corporations now take home around 300 times what the same corporation’s median worker receives. That’s far more than in other countries or at other times — and the disparity can’t be explained simply by productivity differentials. In many cases, corporate CEOs take home so much simply because they can — doing so at the expense not only of their workers but of the long-term growth of the company. Henry Ford understood the idea about good pay, but his wisdom seems to have been lost on some of today’s corporate executives.

A third idea is equally simple but seems increasingly radical: Invest in the future of the company, in your employees, in your technology and in capital. Without such investment, there won’t be jobs in the future and inequality will only grow. Yet today, rather than investing profits back into the company, an ever-greater proportion is siphoned off to shareholders. In the UK, for example, 10% of profits were returned to shareholders in 1970; this figure is now 70%.

Historically, banks (and the financial sector) performed the important function of raising money from the household sector, to be used by the corporate sector to build factories and create jobs. In the US, corporate borrowing now primarily funds dividend payouts. Last year, the British retail magnate Philip Green was grilled before a committee of parliamentarians for under-investing in his company. He extracted great wealth for himself but led the company into bankruptcy and left a pension deficit of hundreds of millions of pounds, for which he apologized.

Though knighted, praised and paraded by successive governments as a beacon of British business, the description a committee of parliamentarians chose for him may be more apt: the “unacceptable face of capitalism.”

Corporations realize that how well they are doing is not just a product of the laws of economics. It is the result of the laws written in the capital of each country. That’s why corporations spend so much money lobbying. In the US, the banking sector lobbied for deregulation: they got what they wanted, and taxpayers had to pick up the tab for the consequences.

Over the past quarter of a century, in many countries, the rules of the market economy have been rewritten in ways that have enhanced market power and increased inequality. Many corporations have done far better in “rent seeking”— getting a larger share of the national wealth through the exertion of monopoly power or extracting favors from government — than in anything else. But when profits come from such rent seeking, the wealth of the nation is diminished.

Around the world, there are many corporations, led by enlightened leaders, who have long understood these maxims. They have understood that it is in their enlightened self-interest for there to be shared prosperity.

Rather than lobbying for policies that increase rent seeking — with their corporate gains coming at the expense of others — they have realized that the only sustainable prosperity is shared prosperity, and that in those countries afflicted with ever growing inequality, the rules will have to be rewritten to encourage long-term investment, faster growth and shared prosperity.

— source By Joseph Stiglitz

Swiss voters soundly reject corporate tax overhaul

Swiss voters clearly rejected plans to overhaul the corporate tax system, sending the government back to the drawing board as it tries to abolish ultra-low tax rates for thousands of multinational companies without triggering a mass exodus.

Most Swiss recognized the country needs reform to avoid being blacklisted as a low-tax pariah. But new measures proposed to help companies offset the loss of their special status breaks had created deep divisions

Switzerland has been in the firing line of the European Union and OECD club of rich countries for years over the special tax status that cantons give foreign companies. Some pay virtually no tax above an effective federal tax of 7.8 percent.

Switzerland agreed with the OECD in 2014 to abolish by 2019 the special status, which has been an attractive perk for around 24,000 multinationals looking to lower their tax bills. That provision will now remain in place past the original deadline.

— source

Major Corporations You Never Knew Profited from Slavery

The enslavement of African people in the Americas by the nations and peoples of Western Europe, created the economic engine that funded modern capitalism. Therefore it comes as no surprise that most of the major corporations that were founded by Western European and American merchants prior to roughly 100 years ago, benefited directly from slavery.

Lehman Brothers, whose business empire started in the slave trade, recently admitted their part in the business of slavery.

According to the Sun Times, the financial services firm acknowledged recently that its founding partners owned not one, but several enslaved Africans during the Civil War era and that, “in all likelihood,” it “profited significantly” from slavery.

“This is a sad part of our heritage …We’re deeply apologetic … It was a terrible thing … There’s no one sitting in the United States in the year 2005, hopefully, who would ever, in a million years, defend the practice,” said Joe Polizzotto, general counsel of Lehman Brothers.

Aetna, Inc., the United States’ largest health insurer, apologized for selling policies in the 1850s that reimbursed slave owners for financial losses when the enslaved Africans they owned died.

“Aetna has long acknowledged that for several years shortly after its founding in 1853 that the company may have insured the lives of slaves,” said Aetna spokesman Fred Laberge in 2002. “We express our deep regret over any participation at all in this deplorable practice.”

JPMorgan Chase recently admitted their company’s links to slavery.

“Today, we are reporting that this research found that, between 1831 and 1865, two of our predecessor banks—Citizens Bank and Canal Bank in Louisiana—accepted approximately 13,000 enslaved individuals as collateral on loans and took ownership of approximately 1,250 of them when the plantation owners defaulted on the loans,” the company wrote in a statement.

New York Life Insurance Company is the largest mutual life insurance company in the United States. They also took part in slavery by selling insurance policies on enslaved Africans.

According to USA Today, evidence of 10 more New York Life slave policies comes from an 1847 account book kept by the company’s Natchez, Miss. agent, W.A. Britton. The book, part of a collection at Louisiana State University, contains Britton’s notes on slave policies he wrote for amounts ranging from $375 to $600. A 1906 history of New York Life says 339 of the company’s first 1,000 policies were written on the lives of slaves.

USA Today reported that Wachovia Corporation (now owned by Wells Fargo) has apologized for its ties to slavery after disclosing that two of its historical predecessors owned enslaved Africans and accepted them as payment.

“On behalf of Wachovia Corporation, I apologize to all Americans, and especially to African-Americans and people of African descent,” said Ken Thompson, Wachovia chairman and chief executive officer, in the statement released late Wednesday. “We are deeply saddened by these findings.”

N M Rothschild & Sons Bank in London was linked to slavery. The company that was one of the biggest names in the City of London had previously undisclosed links to slavery in the British colonies. Documents seen by the Financial Times have revealed that Nathan Mayer Rothschild, the banking family’s 19th-century patriarch, made his first personal gains by using enslaved Africans as collateral in dealings with a slave owner.

Norfolk Southern also has a history in the slave trade. The Mobile & Girard company, which is now part of Norfolk Southern, offered slaveholders $180 ($3,379 today) apiece for enslaved Africans they would rent to the railroad for one year, according to the records. The Central of Georgia, another company aligned with Norfolk Southern Line today, valued its slaves at $31,303 ($663,033 today) on record.

USA Today has found that their own parent company, E.W. Scripps and Gannett, has had links to the slave trade.

According to reports, FleetBoston evolved from an earlier financial institution, Providence Bank, founded by John Brown who was a slave trader and owned ships used to transport enslaved Africans.

The bank financed Brown’s slave voyages and profited from them. Brown even reportedly helped charter what became Brown University.

CSX used slave labor to construct portions of some U.S. rail lines under the political and legal system that was in place more than a century ago.

Two enslaved Africans who the company rented were identified as John Henry and Reuben. The record states, “they were to be returned clothed when they arrived to work for the company.”

Individual enslaved Africans cost up to $200 – the equivalent of $3,800 today – to rent for a season and CSX took full advantage.

The Canadian National Railway Company is a Canadian Class I railway headquartered in Montreal, Quebec that serves Canada and the midwestern and southern United States. The company also has a history in which it benefited from slavery. The Mobile & Ohio, now part of Canadian National, valued their slaves lost to the war and emancipation at $199,691 on record. That amount is currently worth $2.2 million.

Brown Brothers Harriman is the oldest and largest private investment bank and securities firm in the United States, founded in 1818. USA Today found that the New York merchant bank of James and William Brown, currently known as Brown Bros. Harriman owned hundreds of enslaved Africans and financed the cotton economy by lending millions to southern planters, merchants and cotton brokers.

Brooks Brothers, the high-end suit retailer got their start selling slave clothing to various slave traders back in the 1800s. What a way to get rich in the immoral slave industry!

Barclays, the British multinational banking and financial services company headquartered in London, United Kingdom has now conceded that companies it bought over the years may have been involved in the slave trade.

USA Today reported that New York-based AIG completed the purchase of American General Financial Group, a Houston-based insurer that owns U.S. Life Insurance Company. A U.S. Life policy on an enslaved African living in Kentucky was reprinted in a 1935 article about slave insurance in The American Conservationist magazine.

AIG says it has “found documentation indicating” U.S. Life insured enslaved Africans.

— source

Insurance Policies on Slaves: New York Life’s Complicated Past

New York Life, the nation’s third-largest life insurance company, opened in Manhattan’s financial district in the spring of 1845. The firm possessed a prime address — 58 Wall Street — and a board of trustees populated by some of the city’s wealthiest merchants, bankers and railroad magnates.

Sales were sluggish that year. So the company looked south.

There, in Richmond, Va., an enterprising New York Life agent sold more than 30 policies in a single day in February 1846. Soon, advertisements began appearing in newspapers from Wilmington, N.C., to Louisville as the New York-based company encouraged Southerners to buy insurance to protect their most precious commodity: their slaves.

Alive, slaves were among a white man’s most prized assets. Dead, they were considered virtually worthless. Life insurance changed that calculus, allowing slave owners to recoup three-quarters of a slave’s value in the event of an untimely death.

An ad taken out by Nautilus Mutual Life Insurance in 1847 in the Daily Democrat newspaper in Louisville, K.Y. offering slave policies. Nautilus was renamed New York Life Insurance in 1849.

James De Peyster Ogden, New York Life’s first president, would later describe the American system of human bondage as “evil.” But by 1847, insurance policies on slaves accounted for a third of the policies in a firm that would become one of the nation’s Fortune 100 companies.

Georgetown, Harvard and other universities have drawn national attention to the legacy of slavery this year as they have acknowledged benefiting from the slave trade and grappled with how to make amends. But slavery also generated business for some of the most prominent modern-day corporations, underscoring the ties that many contemporary institutions have to this painful period of history.

Banks absorbed by JPMorgan Chase and Wells Fargo allowed Southerners seeking loans to use their slaves as collateral and took possession of some of them when their owners defaulted.

Like New York Life, Aetna and US Life also sold insurance policies to slave owners, particularly those whose laborers engaged in hazardous work in mines, lumber mills, turpentine factories and steamboats in the industrializing sectors of the South. US Life, a subsidiary of AIG, declined to comment on its slave policy sales. Wachovia, one of Wells Fargo’s predecessor companies, has apologized for its historic ties to slavery as have JPMorgan Chase and Aetna.

More than 40 other firms, mostly based in the South, sold such policies, too, though documentation is scarce and most closed their doors generations ago.

New York Life survived. Its foray into the slave insurance business did not prove to be lucrative: The company ended up paying out nearly as much in death claims — about $232,000 in today’s dollars — as it received in annual payments. But in the span of about three years, it sold 508 policies, more than Aetna and US Life combined, according to available records.

Now, the descendants of one of those slaves — who were recently identified by The New York Times — are coming to terms with the realization that one of the nation’s biggest insurance companies sold policies on their ancestors and hundreds of other enslaved laborers.

A ledger entry for policy No. 1055 taken out in 1847 by Nicholas Mills on the life of “Nathan York, Slave.” Mr. York had been insured under a previous policy, No. 447. Credit Hilary Swift for The New York Times

Policy No. 447 covered Nathan York, a slave who toiled in the Virginia coal mines where the earth often collapsed on its subterranean work force. Policy No. 1141 insured a slave known as Warwick, who fed the fiery furnaces on a Kentucky steamboat. Policy No. 1150 covered Anthony, who labored amid the whirling blades of a sawmill in North Carolina.

The handwritten record of sales, insurance premiums and expenditures, many described here for the first time, illuminate the inner workings of a company born before the Civil War. That history has stirred anxiety among some New York Life executives, who take pride in their multiracial work force and customer base. They worry that news coverage about the company’s ties to slavery may overshadow their efforts to provide philanthropic support to the black community.

New York Life hired one of the insurance industry’s first black agents in 1957. African-Americans currently account for 13 percent of the firm’s employees, including its senior vice president for governmental relations, George Nichols III, who reports directly to the chief executive.

The company donates millions of dollars annually to causes and groups that benefit African-Americans, the executives said, pointing to a $10 million endowment to the Colin Powell Center for Policy Studies at the City College of New York, sponsorship of the National Museum of African American History & Culture and other initiatives. (The company was known as Nautilus Mutual Life Insurance; the name was changed to New York Life in 1849.)

“We profoundly regret that in the 1840s our predecessor company, Nautilus Insurance Company, insured the lives of slaves for a brief period of time,” Kevin Heine, a spokesman for the company, said in a written statement. “While we cannot change our history, our longstanding recognition of it has helped shape our commitment to the African-American community.”

The company’s connections to slavery drew attention in the early 2000s as California and more than a dozen localities, among them Chicago, Philadelphia and San Francisco, began to require companies to disclose their slavery-era activities. The disclosure laws emerged in response to black activists and lawyers who pressed for reparations and a public reckoning with history. (A lawsuit filed against New York Life and other companies tied to slavery was dismissed in 2004 after a judge ruled that the African-American plaintiffs had established no clear link to the businesses they sued and that the statute of limitations had run out more than a century ago.)

New York Life executives found the old records in a storage room that served as an informal archive on the 16th floor of their headquarters, a trove of fraying ledgers and yellowing documents. They turned over the names of slaves and slaveholders as required by law and donated several of the accounting books to the Schomburg Center for Research in Black Culture, where they are available to the public. The company stored the rest in a private corporate archive.

Company officials allowed The Times to review several ledgers from its archive, but declined to allow a reporter to interview its archivist to determine whether additional records related to the slave policies still exist. The executives said that slave policies generated only about 5 percent of total revenues during the three fiscal years in which the policies were sold. They said the policies proved to be unprofitable and did not drive the company’s growth.

But historians say the slave policies had an impact on the company’s development. The company had two years to invest or spend much of the revenues from the slave policies before death claims exceeded annual premium payments, according to Dan Bouk, a historian at Colgate University who has studied 19th- and 20th-century insurance companies, and reviewed the company’s figures at the request of The Times.

The policies helped New York Life establish an early foothold in the South, which distinguished it from its larger competitors, said Sharon Ann Murphy, a historian at Providence College. Its agents continued to insure white lives in the region after the slave policies were discontinued.

“Slave policies were an opportunity for them to break into the industry and they actively promoted these policies in the early years,” said Ms. Murphy, who is the author of a book about the emergence of the insurance industry before the Civil War.

“We can be disturbed by this, but we shouldn’t be surprised by it,” she said. “It wasn’t just Southern companies that benefited from slavery; many Northern institutions also benefited directly or indirectly.”

The advertisement appeared in the Richmond Enquirer on Jan. 29, 1846. It described a new firm offering life insurance for slaves employed in any “occupation where there may be danger or risque.”

New York Life — known as the Nautilus Mutual Life Insurance Company in the mid-1840s — placed an ad in the Richmond Enquirer in 1846, offering insurance of slaves employed in a variety of occupations.

Within four days, the customers started streaming into the office of the insurance agent for New York Life. They owned laborers who worked in the coal mines in nearby Chesterfield County and they all knew something about risk.

Their slaves dug for black ore in underground shafts that oozed deadly gases and shuddered with explosions. Dozens of enslaved African-Americans had died in a blast just seven years earlier, mining records show, a catastrophic financial loss for their white owners.

Nicholas Mills, who owned shares in the Midlothian Coal Mining Company, was determined to protect himself from such a calamity. So he purchased policies on more than 20 of his enslaved laborers, including Mr. York, a 40-year-old coal miner and the father of a baby boy.

The premiums Mr. Mills paid in the spring of 1846 — about $7,000 in today’s dollars — flowed into the New York Life office on Wall Street, where employees began recording the names, ages, policy numbers and occupations of the slaves who were insured.

Slavery was finally abolished in New York in 1827. But the plantations in the South continued to generate business in the city in the decades before the Civil War, according to Eric Foner, a historian at Columbia University.

New York City’s merchants helped to finance the nation’s premier export crop, cotton, and the purchase of the land and slaves needed to grow it. They controlled the boat companies that shipped the cotton to Europe, leading one Southern editor to describe New York City as “almost as dependent upon Southern slavery as Charleston.” And some of these businessmen assumed prominent positions at New York Life.

Mr. De Peyster Ogden, the company’s first president, was a cotton merchant who grew up in a home tended by slaves. He would become a prominent defender of slavery, describing it as an unfortunate, but inextricable part of the nation’s economy.

A depiction of James De Peyster Ogden, the first president of the Nautilus Mutual Life Insurance Company. He became a prominent defender of slavery, but would later describe it as “evil.”

Several wealthy members of the company’s board also opposed efforts to end slavery, including William H. Aspinwall, a builder of the trans-Panama railroad; Schuyler Livingston, the New York representative of Lloyd’s of London; and James Brown, a banker whose firm, Brown Brothers, controlled several plantations in the South. (A board member, Henry W. Hicks, on the other hand, came from a family of abolitionists.)

It was no surprise then that New York Life tried to tap into the flood of money pouring into the city from the South. In the beginning, the payments from slaveholders and other customers helped the company generate interest and cover the rent of its Wall Street office ($500 for the first year), the salary of its first president ($500), commissions for agents (roughly 5 to 10 percent of premiums), the fees for the medical doctors who examined the slaves ($2 per exam) and office upkeep like painting, carpeting and postage.

The clothbound ledgers, which describe New York Life’s revenues and expenses in spidery script, also document how the company institutionalized the nation’s racial hierarchy.

Officials typically insured the lives of white customers for $1,000 to $5,000 in the early years. Slaves, on the other hand, were considered property under the law and were typically insured for about $400, the records show, and some for as little as $200.

Payouts from death claims usually went to the grieving relatives of white customers. In the case of slaves, however, it was the slave owners — who insured their laborers and paid the annual premiums — who collected.

Abraham S. Wooldridge, a mining magnate and business partner of Mr. Mills, praised the company’s swift response after two of his slaves perished on the job.

“The insurance was promptly paid,” Mr. Wooldridge said in an advertisement published by the Richmond Whig newspaper in 1847. “I have entire confidence in the solvency and fair dealing of the company.”

An 1847 ad in the Richmond Whig newspaper contains a testimonial from Abraham S. Wooldridge, who expressed satisfaction that the insurer had paid out on two slaves who died.

As the death claims mounted, New York Life’s board voted on April 19, 1848, to discontinue the sale of slave policies. It would take about six years for the last slave policies to lapse.

But the names of the slaves remained inscribed in accounting books that moved from one office to the next as the company grew, handwritten clues that would link the past to the present.

Policy No. 447 led to a red brick church in Midlothian, Va., and to Audrey Mozelle Ross, an amateur historian who has spent years researching the origins of the First Baptist Church. Enslaved miners founded the congregation in 1846, gathering to pray amid the dust and dangers of the coal pits.

Ms. Ross, a retired public health scientist, prayed at First Baptist just as her parents, grandparents and great-grandparents did before her. She knew the names of the founding members by heart.

She never imagined that she was connected to any of them, though, until she received an unexpected email earlier this year. That’s when she learned that The Times, with the help of Crista Cowan, a genealogist at Ancestry, had unearthed a missing piece of her family tree.

Ms. Ross’s great-great-grandfather was Mr. York, a founding member of her church and one of the hundreds of slaves whose lives were insured by New York Life.

“I can’t believe it,” said Ms. Ross, who is 66 and had researched the family histories of several church members, but not her own. “You have just opened my eyes.”

Ms. Ross worked in New York City in the mid-1970s and never dreamed that one of the city’s insurance companies had tried to profit from her ancestor’s enslavement. “I think it was pathetic that they used the labor, the hard work, blood, sweat and tears of the slaves” to help their business, she said.

Even so, she considers herself lucky. Her great-great grandfather survived his time as an enslaved miner. After the Civil War, Mr. York continued digging for coal and earned enough money to buy land and cattle. He helped to establish a school for newly freed slaves and became the patriarch of a sprawling family.

Others were less fortunate. The stone ruins of the Grove Shaft building, the remains of the Midlothian Coal Mining Company, are only a short drive from Ms. Ross’s home. Whenever she visits, she prays for the enslaved miners who never made it home.

Godfrey, a 50-year-old slave who was also insured by New York Life, died in a fire in Midlothian on Nov. 20, 1847.

“Burned to death,” reads the entry in the company’s accounting of the dead.

The insurance clerks on Wall Street did not record Godfrey’s last name or the location of his burial place. But they described what happened next: Mr. Mills, Godfrey’s owner, filed a claim with New York Life for the loss of his human property.

Within three months, the company delivered, paying him $337.