This book was so good I read the afterword. Empire of Pain by Patrick Radden chronicles the eccentricities and lives of the Sackler Family. I also really enjoyed how modern this issue is. Most of the nonfiction I read takes place before I was born, so this was amazing to read about the relationship with the Trump Administration so recently and to see, through my job, Orange County's settlements with big pharma for the opioid crisis. One of the more fun parts of reading this book was putting the timeline into perspective. The Sacklers lived through the Red Scare, which Robert Moses, of Power Broker, participated in. They eventually moved into a mansion on Long Island, which Moses probably built the road around. And the guy who they dealt with at the Met, Rorimer, worked under Moses. Additionally, they directly profited off of the widespread depression and anxiety of youth and rural people during the 1970s anti-union rhetoric described in Stayin' Alive through the innovative marketing of Valium.
As immigrants in New York, there was heavy pressure from their family to become doctors. Arthur, Raymond, and Mortimer Sackler obliged, all becoming psychiatrists and experimenting in the Creedmoor asylum. Arthur Sackler was pretty much the patriarch of his family, leading the biological experimentation and paying for his brothers' medical school.
At the end of World War II, chemical companies were mass producing drugs and Arthur Sackler had a model to follow. Arthur revolutionized drug advertising directly to doctors and produced studies which they cited. The Sacklers held a few fundamental beliefs which exonerated them, in their minds, of any wrongdoing: 1) doctors could do no harm 2) abuse of drugs was the abuser's fault.
Something kind of interesting about this family is the cognitive dissonance between giving and cruelty. Their socialistic roots ingrained a desire to give, but their gifts 1) included complex stipulations about how their names would be used and 2) the gifts were only available because of their greed. Similarly, I did not realize that most schools like Harvard and NYU had maximums for Jews and that many workplaces did not hire Jews. This further complicates the character of these individuals. They made a point to hire people who could not get hired elsewhere.
1960 is where Arthur really began the scheme of producing one drug at Purdue Frederick, advertising it through McAdams, and legitimizing it through the medical journal he owned, Medical Tribune. He created fake competition, in the advertising market as well as drugs (Librium vs. Valium). The Sacklers made their first fortune off of Valium, "the mostly widely consumed- and most widely abused- prescription drug in the world," (p.75).
Character-wise, Arthur Sackler and his brothers seem to have resembled many wealthy people who came before them. Like Addison Mizner from a previous book, Arthur collected art vociferously. "You put your name on something it is not charity, it's philanthropy. You get something for it. If you want your name on it, it's a business deal," - Michael Sonnenreich, Arthur's attorney (p.86). "What philanthropy really buys is immortality," (p.115). It was clear the Sacklers were in it for fame and celebrity on their terms.
Arthur Sackler set the stage for what was to come with OxyContin, developing the mechanisms and future of medicine advertising. Arthur died first, but his brothers, Raymond and Mortimer were taking care of the family business. Mortimer was a traveler who dealt with the international business, Mundipharma, and acquired a pharmaceutical company in London called Napp. Napp developed what would become MS Contin in the late 1970s. Once again, to put this into perspective for the mood in America, Stayin Alive highlighted the depression of this time, making it ripe for drug abuse. Mortimer brought MS Contin to America without applying for FDA permission, getting people illegally hooked. Even when the FDA did get involved, Purdue paid them off. The FDA allowed, for the first time, what were effectively advertising statements on drug warnings. Meanwhile, Purdue began the decades-long campaign of de-stigmatizing pain. They hired doctors to speak at symposiums, sent salespeople directly to doctor's offices, and obscured any traces of culpability.
The second generation of Sacklers were even more greedy. As the patent for MS Contin was running out, Purdue actually turned on itself and said MS Contin did not work, people must use OxyContin. They knew how powerful this drug is, but "confirmed that the intention was to expand the use of OxyContin...to chronic non-malignant pain" (p.208). The FDA was derelict in their duty to regulate these drugs; the Revolving Door was real. After the FDA approved OxyContin in nearly record time, the individual who facilitated this approval got a job at Purdue making $400,000 in his first year.
Their sales team targeted rural areas and areas where there was a higher number of worker's compensation claims. Knowing what they were in for, they hired Eric Holder, Rudy Giuliani, and Mary Jo White for their lawyer team, headed by Howard Udell. Jay McCloskey, the individual who first raised alarms about OxyContin, got hired at Purdue. Even James Comey was involved. Then-Senator Joe Biden raised the alarms on the opioid crisis. Mike Pence, as governor of Indiana in 2016, signed a law for mandatory minimums for any street level dealers. Mike Bloomberg was a family friend. It all runs so deep. In 2003, our own Orlando Sentinel's Doris Bloodsworth published an in-depth series about OxyContin. According to Purdue Staff, "83% of patients who were admitted to substance abuse treatment centers had started using opioids by swallowing them," (p.352).
"Between 1994 and 2015, the quota of oxycodone that the DEA permitted to be legally manufactured was raised thirty-six times," (p.413). Further, they were working with the Trump administration: "A decision had been made at high levels of the Trump administration that this matter would be resolved quickly and with a soft touch," (p.479). The evidence against the Sacklers is so damning, it's insane. This leads us to where we are today. Tomorrow, April 26, the Orange County Board of County Commissioners is accepting a settlement from TEVA, Allergan, and CVS for their role in the opioid crisis in Orange County.
Overall, this book really showed me how evil people can be. It read like a true crime novel and condemned the Sacklers for good. I think this might be one of the best books I'll read all year. Thank you, Jeremy!