EMPIRE OF PAIN by Patrick Radden Keefe
OR HOW TO BE A LEGAL DRUG DEALER
By armen pandola
Did you know that the prescription drug, oxycontin, has almost twice the power of morphine?
Did you know that the Food and Drug Administration’s official who approved Purdue Pharma’s Oxycontin was hired by Pharma only a couple of years after he approved it? For a lot of money?
Patrick Radden Keefe’s Empire of Pain is, at times, painful to read - or listen to, as I did. Keefe does his own narration on the audiobook and does a very good job for a non-professional. He traces the origins of the Sackler family which owns the drug company that manufactured Oxicontin, Purdue Pharma.
The Sackler family story starts out as a typical one of immigrants who make good in the New World. The Sacklers had three sons, Arthur, Raymond and Mortimer; each became a doctor of medicine. Arthur turned out to be a genius of sorts. According to Keefe, it was Arthur Sackler who pioneered the use of drugs to treat mental health problems. Before his work in this area of medicine, mental illness was treated with ‘talk therapy’, medical procedures such as lobotomies and electro-shock therapy or other bizarre means of inducing a change in a patient’s behavior.
From the very beginning of his storied career, Arthur had dueling duel interests, medicine and advertising. At legendary Erasmus High School in Brooklyn, NY, Arthur was an exceptional student. Among his many interests, he sold ads in the school paper and made an agreement that his salary would be strictly commission - the more he sold, the more money he made with no limits. Decades later, this same compensation formula would be offered to drug reps, thereby encouraging them to get doctors to prescribe as much oxycontin as they could. As a result, the most successful salespersons were those whose doctors ran ‘pill mills’ dispensing thousands of prescriptions for oxycontin each month.
As Deep Throat once advised a young Bob Woodward about Watergate, ‘follow the money.’ Reede takes this advice and shows how the Sacklers were blinded by the money to be made in selling a highly addictive drug. Their privately-owned drug company refused to diversify into other types of drugs and, effectively, doubled - down on Oxycontin because no other drug could make for the Sacklers the profits that an opioid like oxycontin could. Revenues for oxycontin exceeded a billion dollars a year for many, many years.
But this was a path to riches that the Sacklers took more than once. Arthur Sackler may have been a pioneer in psychotropic medicines, but he made his fortune in his other calling, advertising. Sackler was a genius at marketing medicines, usually by getting doctors to prescribe it for many more conditions than the drug was originally made for. By the time valium came along, he was able to make a deal with its manufacturer to get a percentage of the total gross sales of valium as his company's fee for marketing it. Valium was the first billion dollar drug and it had a commanding 70% of the market share and was the most prescribed drug in the USA. Sackler made a fortune, a small part of which he, and his brothers, gave to various art institutions in the US and throughout the world.
Arthur was so successful that he bought a small drug company for his brothers to run in the 1950s - that company became Purdue Pharma. In order to avoid conflict of interest charges with the ad agency Arthur ran, he kept his partnership with his brothers in Purdue a secret and formed with them and a fourth partner, a “tontine” which is an agreement by several people that a business would pass at the death of any partner to the other remaining partners until only one partner survived. Since Arthur died in the 1980s, before oxycontin was formulated, his heirs settled on receiving ‘only’ $22 million dollars since, under the tontine agreement, they were legally entitled to nothing. Meanwhile, the heirs of the two remaining brothers have been dividing up billions of dollars for over twenty years.
Ultimately, the story of the Sacklers and the opioid addiction is a story of incredible greed in an era of greed. None of the Sacklers have ever apologized for the part their family paid in getting hundreds of thousands if not millions addicted to painkillers. They point to the millions who were helped by opioids, like the terminal cancer patients who could die in peace with the comfort offered by opiods. Like the gun industry, they can see no blame attached to a product’s manufacturer just because the product is abused by some people.
A perfect example of the Sackler family’s clueless reaction to the opioid crisis is one family member’s reaction to the media blitz of 2018 when the Sacklers were being roasted on every comedy show, including John Oliver’s Last Week Tonight. This Sackler mother was disturbed because her teenage son and all of his friends were fans of the show and watched it together every week. What will they think?, she worried and how will my son get into high school?!