EMPIRE OF PAIN by Patrick Radden Keefe

A thoroughly depressing book about what money can buy. It tells the story of the Sackler family. They are personally and primarily responsible for the opiod crisis, and have faced no significant penalty for it.

The story begins with Arthur Sackler, born early 1900s, the only one of them who could be said to have earned his money. He was smart, inventive, and pathologically hard-working. He basically invented modern pharmaceutical advertising. He generated the idea of marketing directly to doctors; of data management, so they knew who was prescribing what (for better advertising); and of advertorial. He got very rich off Valium and Lithium.

One of his many business ventures was a small pharmaceutical firm. They produced a kind of covering that allowed a slower release of medicine. They used this covering on a very strong opiod, twice the power of regular morphine, called Oxycodene. As everyone has known for centuries that opiods are extremely addictive, the demand for this drug was naturally limited. Once Arthur was dead, Richard took over and directed his team to a) claim, without any proof whatsoever, that <1% of patients would become addicted to it; b) incentivize reps to always push doctors to prescribe the absolute highest dose for as long as possile and c) ignore the data systems of his uncle which clearly showed exactly what doctors were massively over-subscribing because they were selling direct to the street

More people died from opiods in America last year than from guns or traffic accidents. Despite clear and extensive evidence of criminality, the Sacklers have managed to pay <1% of their fortune in reparations. I won’t go into it, it’s a long story, but basically it’s a lesson for all of us: you can do whatever you want, as long as you have the right lawyers

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