Books & Literature

Book Review: Empire of Pain, by Patrick Radden Keefe

NON-FICTION: The highly-anticipated portrait of three generations of the Sackler family, by the prize-winning, bestselling author of Say Nothing.

Great research uncovering the appalling behaviour of the Sackler family

Empire of Pain is a superb analysis by Patrick Radden Keefe of the history, secrecy, greed and utter selfishness of the Sackler family. The rags-to-riches story of an immigrant family to America is a familiar one with the medical profession being the route to respectability and wealth. Less so is the utter disregard shown by so many members of the family for the ethical and honourable behaviour usually associated with that profession. Like many immigrant families, the Sacklers sought both respectability and a kind of immortality through philanthropic works. Galleries and universities around the world have benefitted—the Louvre, the Metropolitan Museum of Art, Oxford, and Harvard—from Sackler donations, which almost always bear their name. Many are now seeking to remove the Sackler name from their institution.

Although the eldest son, Arthur, was a psychiatrist, much of the family’s early money came from a marketing agency he ran with his two brothers. Dealing mostly with doctors and drug companies, the secretive nature of the family covered up the fact that the free medical newspapers promoting drugs were actually published by the Sackler family. Valium became so popular that The Rolling Stones wrote a song about Mother’s Little Helper and these sales were the basis of the family fortune.

While uncovering the despicable lies and behaviour used by the Sackler family to promote their new “wonder drug”, the author also lays bare the uncomfortably close links between doctors, Big Pharma and the inadequacy of government regulators. Even though the company knew OxyContin was more powerful than morphine, they worked hard to maintain the medical profession’s belief that the opposite was the case and even began selling the drug before it had been approved. When regulators did check out the drug, they accepted the claim OxyContin posed little risk of addiction despite the fact there were no tests or evidence to support this. At least one regulator from the FDA, who was involved in the drug’s approval, left his position and went to work for Purdue Pharma at around four times his former salary.

Through the sales of OxyContin, the family was responsible for hundreds of thousands becoming addicted to opioids, leading in turn to almost 500,000 deaths between 1999 and 2019. Lax regulation and poor record keeping were further exploited by the company to actually target doctors who were over prescribing the drug, most often in poorer communities. What is so unconscionable is the way the Sackler family’s behaviour was supported by an almost useless regulatory environment which seemed to just rubber stamp whatever they asked for. In 2010 the patent on the drug was extended when they claimed a new formulation was uncrushable and thus could not be mixed into an injectable solution. Not until 10 years later did the FDA admit there was no strong evidence the new formulation had reduced the overall use of OxyContin.

Lawsuits are ongoing against the drug company and family members with a multi-billion settlement currently being finalised. However, the declared bankruptcy of Purdue Pharma and with family members moving most of their assets overseas, it seems unlikely they will ever be held personally liable. It may be cynical of me but given the close interactions, plus the revolving door of regulators, politicians, and lobbyists going to work for companies like Purdue Pharma, it is almost certain that none of the family members will ever face criminal charges.

What Keefe’s narrative shows is that the relationships between medicine, drug companies, health care systems, regulators and politicians in the US is far too close for comfort. He clearly demonstrates that it would have been possible to intervene in the opioid crisis much sooner and save many lives given the political will.

Reviewed by Jan Kershaw

Distributed by: Pan Macmillan Australia
Released: April 2021
RRP: $34.99

This review is the opinion of the reviewer and not Glam Adelaide.

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