Title: Empire Of Pain
Rating: 5 Stars
It all starts with Isaac and Sophie Sackler, Jewish grocers living in New York before WWI. They had three sons: Arthur, Mortimer, and Raymond. The parents taught them a very strong work ethic. They must never quit working hard to succeed. Later in life, Isaac experienced financial difficulties and his sons had to pitch in to help. Isaac hated that, but even as he was dying, he told them that money can come and go, but all that really matters is that you keep your good name.
Over the ensuing decades, all three brothers got fantastically rich. They took their father’s words to heart. They were major philanthropists that made a point (with legally binding explicit contracts) of plastering their names all over their bequests. There were major wings in art museums, hospitals, research centers, and universities, all with the name of Sackler. Such named bequests appear all over the world.
They were lionized for their philanthropic works. They were awarded knighthoods. The elite of the elite fawned over them.
Here’s the thing. Even as all of this was happening, no one knew how they got their money. Many probably just assumed that they came from old New York money. Others probably assumed that they made their fortune in some obscure manufacturing industry. Most probably didn’t care. Don’t ask, don’t tell.
It turns out that they made their fortune by selling addictive drugs. Not only did they do so, but the sales innovations that they developed and that were subsequently imitated by others led directly to the opioid crisis that is currently killing over 100,000 Americans a year.
It started off so innocently. The eldest brother, Arthur, was a frenetic genius. His life reads like a Horatio Alger novel. Even as a young child, he worked multiple jobs while at the same time performing brilliantly at school. He was always hustling. He worked multiple jobs, including writing copy at an advertising agency. In the slipstream of his wake were his two brothers. Hard workers themselves, if not as brilliant as Arthur, the three of them were the epitome of the hard working immigrant family making good in the US.
All three of them became psychiatrists. They worked at mental hospitals during the time when the mentally ill were just warehoused. Thinking that there must be a more successful and more humane method to treat the mentally ill, they focused on the biology of mental illness with experimental medicine. At this point, all of their work seems admirable, if not noble.
At the same time that Arthur was working at a psychiatric hospital, he was also working full time at an ad agency. In the 1960s, a drug company came to him to help with marketing a new class of drugs. This class included drugs like Valium and Librium.
This is where the tone of the lives of the Sackler brothers begins to change. Working at the ad agency, Arthur, although not the inventor of the technique, dramatically expanded advertising to medical doctors. He fought all attempts to regulate physician advertising by claiming that doctors are so smart that they couldn’t possibly fall for deceptive advertising (cue rolling of eyes here).
This is where things start getting shady. These advertisements included physician testimonials from nonexistent doctors. Arthur started publishing a free medical journal (without mentioning his own involvement) to physicians that just happened to include glowing testimonials about the wonders of his drugs. In the medical advertising field, there were really only two major players. Arthur was secretly funding his competitor and the two collaborated in their efforts. Arthur and his company set out to seduce the FDA directors assigned to approve their drugs. Coincidentally enough, when these men left government service, they’d end up with jobs at Arthur’s companies.
Arthur and his brothers created / bought a complex spiderweb of companies with intermeshing interests. In all cases, the primary purpose was to obscure their own ownership in these companies. One company that was purchased was a small drug supplier named Purdue Pharma. Arthur gave it to his brothers to run.
This is when things really start to get ugly.
One of the drugs that Purdue developed was OxyContin. A problem with morphine is that, short of an IV drip, there was no way to regulate the usage. The key to OxyContin was that the pill had an outer shell that forced the opioid to be time released.
This was potentially a big breakthrough. The only problem was that doctors were scared of the addictive properties of opioids and were reluctant to prescribe them. The typical patient for such drugs were cancer patients or maybe hospice patients.
Well, that was simply not a big enough market for the Sackler family greed. Using techniques first promulgated by Arthur in the tranquilizer market, the Sacklers launched an immense advertising campaign blitz. They latched onto the valid medical field of pain management and blew it up to make it appear that pain was the number one problem in the US. They claimed that over one hundred million Americans suffered from unnecessary pain that could be relieved using OxyContin.
Using questionable studies, they claimed that opioids were only addictive to one percent of its users. They sold OxyContin as a medicine of first resort, not last. They sent out armies of sales reps to invade doctors’ offices with brochures and free swags. Copying the techniques of every drug dealer everywhere, they gave out free samples. To counter the problem of the buildup of tolerance, they encouraged ever larger sizes. At one point, they were making 160 mg pills. A single one could be deadly.
It worked. Prescriptions skyrocketed. Purdue (and just to be clear, Purdue was privately owned by the Sacklers) made tremendous sums of money.
There were just a couple of problems. One was that, although advertised as 12 hour relief, Purdue knew OxyContin only provided 8 hours of relief. The whole point of time released pill is to avoid the hill / valley feeling that addicts feel when taking opioids. By not being honest about the actual dosage, they built addictive behavior into the prescription.
The second big problem was that users quickly realized that they could ameliorate the time release nature of the pill simply by crushing it and snorting it. Purdue was already aware of this possibility and did nothing.
A really huge problem was that, pain management being somewhat arbitrary to diagnose, pill mills immediately sprung up. Unethical doctors running alleged pain clinics would have lines literally running out of the door of people wanting OxyContin. Small pain clinics in the middle of nowhere were selling many hundreds of thousands of pills. Purdue kept detailed data on sales. They knew who the bad actors were. As long as the money flowed in, they didn’t care.
Finally, they came up with another time release pill whose effects could not be removed by crushing it. The problem was that this was many years into the epidemic. There was no way that all of those millions of addicts would just shrug their shoulders and give up. Instead, they turned to illegal narcotics. OxyContin abuse led directly to our current heroin and fentanyl epidemic. It’s been estimated that eighty percent of heroin addicts started off by abusing OxyContin.
As the OxyContin patent expired, to maximize its profits, Purdue switched their advertising strategy to advocate higher doses for longer periods of time. When the patent expired and generics came on the scene, one of the biggest producers was a company called Rhodes. Yep, you guessed it. The Sacklers own that too.
During all of this, the Sackler family continued to claim innocence. They continued to hide their ownership. When pressed, much like gun manufacturers, they claim that their drugs don’t kill people but that it’s the addicts that kill themselves. They’ve aggressively fought every lawsuit that has come their way. They do not give an inch.
In all likelihood, none of the Sacklers will go to jail. Even after paying fines, they’ll still have billions. One minor act of justice that has happened is that, disgusted at the provenance of the bequests, many of the wings, centers, and galleries are stripping the Sackler name.
The Sackler family has accomplished the exact opposite of Isaac’s words. They are worth billions but their name is trash.
It’s safe to say that when the revolution comes, the Sackler family members will be the first against the wall.