📚 Finished listening to Empire of Pain by Patrick Radden Keefe.

This is the story of the Sackler family, starting with Arthur Sackler. He owned an advertising industry that rather revolutionised the marketing of medicines to doctors. And not for the better, even in the context of an industry that probably shouldn’t exist in the first place. His agency pushed Valium to medical professionals, perfectly happy to make misleading or untruthful claims about the often-times dependency instigating drug all in the name of more sales sales sales.

He shrunk away from the limelight in this context, becoming something of a shadowy figure in terms of his involvement in the business. He much preferred to appear in public as a generous philanthropist and benefactor. Albeit a name-obsessed one, leading to the instigation of many “Sackler wings” of museums, universities and so on, with little acknowledgement of where all this supposedly philanthropic money came from. But the scandal of what came next was enough such that an array of institutions are now trying to rename themselves to something less symbolic of the ongoing opioid crisis.

Because Arthur’s foray into extremely effective pill-pushing was almost small-fry compared to what came next for the family’s business dealings. Arthur’s brothers, and latterly their children, set themselves up to be the chief marketers for OxyContin. This is an opiate developed in 1995 that’s substantially more powerful as a painkiller than morphine, which at the time was mainly used to treat the most severe pain of cancer and terminal patients as it was known to have potentially dangerous side effects including addiction .

But the Sacklers had different plans for OxyContin. They marketing it to doctors as something suitable for everyone who suffers from any even moderate level of pain. With no evidence, and soon enough plenty of counter-evidence, they claimed it wasn’t addictive - with a latterly galling slogan of it being a drug to “to start with and to stay with”. They had their sales people just repeat fake facts, such as that fewer than 1% of patients could become addicted to OxyContin.

When people addicted to Oxy started to turn up, the company was always careful to indulge in victim blaming, arguing something along the lines of “because we decided that the drug isn’t addictive then this means anyone who seems to be addicted by definition must be of inferior moral character”.

Within their pharmaceuticals company, Purdue Pharma, they created and seemingly reveled in an atmosphere of willful ignorance and deliberate falsehoods, pushing doctors to purchase and prescribe more and higher doses of Oxycontin, no matter how appropriate the treatment was for the condition. There was also seemingly a fairly astonishing amount of corruption in the supposed regulators, the US FDA, who went ahead and approved the drug and some of its promo materials based on claims that they were fully aware had never been tested.

Fast forward to now, and mass Oxy usage is heavily associated with opiate “abuse”, both directly, and also as a pipeline that ends up with black market substitutes. The opiate epidemic has killed hundreds of thousands of people and created millions of addicts in the US alone. The CDC currently reports that up to 1 in 4 people receiving long-term opioid therapy in a primary care setting may struggle with addiction.

The Oxy business is thus an example of one of those big conspiracies that turn out to be true. It’s not that producing opiates is a problem. They’re an important class of drugs that are very useful for specific medical conditions in specific contexts. It’s the lying and cheating involved in mass-marketing them, as entirely safe and problematic-side-effect free solutions to any form of pain, in full knowledge of the human cost of doing so that is truly horrific.

The Sacklers’s pharma marketing business is easily up there with, say, the tobacco industry and the oil industry in terms of companies that knowingly inflict harm on the world whilst actively lying about it. Purdue is a privately held company, owned by some of an extremely wealthy family who so loved to show off their extraordinarily hypocritical philanthropy - so it doesn’t even have the always-invalid excuse of “shareholder interest”.

Although it’s in some ways a tedious conspiracy, contra to the wilder accusations that fly around the world these days - just another example of appalling outcomes emanating from the actions and intention of people who just seem to want to become richer and richer, no matter how wealthy they become, no matter the human cost or obvious ethical breaches. They do what they do, largely unconstrained by the wholly inadequate systems we supposedly put in place to limit the social harms that we allow to be done in the name of profit.

The book’s author wrote a piece for the New Yorker a while back on the same topic which is well worth a read if you don’t feel like tackling the whole book.