Empire of Pain: A Short Book Review

With a rating of 4.6 on goodreads, Patrick Radden Keefe’s Empire of Pain is the best and highest-rated book I have read this year! Written in language that makes it extremely accessible, the book chronicles the story of the family behind OxyContin and the opioid crisis in America. Keefe covers four generations of the Sacklers and documents the greed and denial they embody, keeping their company and the drug at the center of the story – a no small feat by any measure. The author punches above his weight and manages to shatter a name that adorns some of the biggest museums and schools in the world. Keefe is meticulous in his research, and the book itself is well-paced, effortlessly moving through a period of about 107 years.

Purdue Pharma, a company that Arthur Sackler purchased with his brothers in 1952, began marketing and selling opioids around 1984 in the form of an oxycodone pill called MS Contin. A next generation product, OxyContin, was launched in 1996, and with that a concerted effort to change the way doctors in America prescribed pain medication. Colluding with the FDA for approval to use deceptive claims around the addictive properties of the pill, Purdue went on to position OxyContin as an analgesic that could be used to treat non-malignant pain. It used misleading marketing collateral to ‘educate’ physicians who were ‘opioid naïve,’ sponsored ‘pain management’ events, paid doctors to speak at these events about the virtues of opioids, and generally led the way in changing the way opioids were viewed in the American medical fraternity. It relied on a system of uncapped bonuses and incentives that rewarded its salespeople to peddle the drug in regions that saw a lot of on-the-job injuries and disabilities. From using coupon cards to distribute free samples of the drug to hiring consultants from McKinsey to devise ways in which the company could sell more, Purdue did everything in its power to get a nation hooked. And then denied its role, and that of the Sacklers in the ensuing crisis of addiction.

Keefe manages to highlight the greed and insatiability that has come to define Big Pharma in particular and capitalism in general, and is convinced that the Sacklers, while not the only guilty party in the opioid crisis, have a disproportionate burden of the blame to bear. Their fortune is blood money made from peddling a drug they knew was addictive for as long as they could before the patent protections ran out.

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