Snag Empire Of Pain: The Secret History Of The Sackler Dynasty Produced By Patrick Radden Keefe Accessible In Publication

of Pain will easily make my list of the best books I read in, My guess is if you read it, it will end up on yours too,

Journalist Patrick Radden Keefe chronicles three generations of the Sackler family, the people behind Purdue Pharma, also known as the makers of OxyContin, better known as the creators of the current opioid epidemic.
Their story is one of philanthropy and philandering, of pioneering and pilfering, and of grandeur and greed.
It begins back inwhen Isaac Sackler immigrated to America, had three sons, and encouraged them to dream big and become doctors.
Though the Great Depression hit him hard, he told his sons, “What I have given you is the most important thing a father can give a good name.
”

Two generations later, that good name is being removed from museums and educational institutions, Thest century Sacklers pushed their wonder drug OxyContin so hard and so recklessly that millions have become addicted and died.
I personally know at least three people who have died from opioid overdoses, and I bet you do too.


The marvel of PRKs reportage though is that a book that could be so dry is utterly fascinating.
While I sadly lost interest in his prior work, Say Nothing, about The Troubles in Northern Ireland, I flew through Empire of Pain in two days.


For those with HBO, the twopart documentary series “The Crime of the Century” makes an excellent companion piece for this book, as does the fictional drama “Succession.
” Both further showcase how greed is so intoxicating that right is indistinguishable from wrong, The pull of power and money can be so strong that the most important thing a good name becomes collateral damage.
In the case

of the Sacklers, unfortunately that collateral damage includes millions of lives lost to a crisis they helped to create by recklessly pushing sales of their pain medication.


The Sacklers continue to try to hide behind the Purdue Pharma corporate name, but thanks to journalism like Empire of Pain theyre becoming increasingly exposed.
Kudos to Patrick Radden Keefe for bringing this story to light,

Blog: sitelink confettibookshelf. com/ “It felt as if the skin had been peeled right off”

Thats how opioid withdrawal felt to Nan Goldin, a photographer who developed an addiction after being prescribed OxyContin.


This is the story of how Purdue Pharma aggressively marketed OxyContin, claiming that its “controlled release” feature makes addiction very rare.
Its the story of how for millions, an OxyContin prescription began a path of addiction with devastating consequences.
The stories of people who moved to heroin after their OxyContin ran out were particularly devastating,

The story is focused on the Sackler family the owners of Purdue Pharma and its responsibility for the opioid epidemic.
The book at times seems written with the goal to make you as angry and disgusted with the Sacklers as possible.
Sometimes that means going beyond the scope of the opioid epidemic and into their personal scandals, Its a pretty juicy read,

The Sackler familys involvement is a story worth telling, but I came away more curious about the bigger picture.
What were the structural incentives that made it profitable to recklessly market and sell opioids that are so addictive Why didnt regulatory bodies, doctors, or distributors push back more

The CDC estimates thatmillion Americans suffer from chronic pain.
There were enormous profits waiting to whoever could figure out a way to market opioids as an effective way to address this.
While the Sacklers were pioneers in this area, they werent the only ones, Even if they never existed, it seems like it wouldnt have been long until someone else figured this out and took the lead.


The FDA didnt do their due diligence, partly because they just didnt bother, and partly because the pressure from Purdue was enormous including letting it be known they could help regulators move to higher paid jobs in the private market.


Doctors massively overprescribed, They were wooed by sales pitches and found OxyContin a convenient way to make their patients happy and end appointments quickly.
Some doctors engaged in outright fraud, prescribing high amounts to dealers in exchange for kickbacks,

Distributors recklessly sent the pills all over the place, not thinking twice if a pharmacy in a small town got enough orders to literally give everyone in town hundreds of pills.


What are the lessons for how to prevent the next time we get inundated with an exciting new product that turns out to be destructive I suppose an obvious candidate is to beef up our regulatory bodies, but Im not sure how much benefit there would be.
Industry is always going to be more knowledgeable and more resourceful than regulators, They also have much more incentive on the outcome of regulatory decisions than any individual regulator,

Then there is the danger of regulatory bodies swinging too far in the direction of preventing lifesaving products from reaching the market.
A lot of smart people believe we are already there, like Alex Tabarrok, Look at how the FDA dragged its feet on COVID tests and vaccines, Look at how they are still dragging their feet on approving cheap athome COVID tests,

Am I being contradictory by saying regulation is not going to catch bad behavior, but will also overregulate safe products Thats a fair question, but I think regulatory bodies can bothprovide too little oversight on issues that are not highly publicized like OxyContin when it started, andoverweight “drug risk” relative to “disease risk” on issues that are highly publicized like COVID vaccines and tests as they are deathly afraid of being blamed for the side effects of a drug they approved.


What about lawsuits Ideally the potential for lawsuits would be a disincentive for reckless behavior, but that didn't seem to happen here.
I think if the money is rolling in people tend to think they are invincible, The book describes the lawsuits in some detail, and it is quite messy and hard to follow.
Much of the billions of dollars recovered is supposed to go toward public health programs, I hope that really happens and it helps people,

I know some people will use this case as evidence that we should just scrap Capitalism completely.
I dont agree, but I have to admit I dont know a way to prevent these situations from happening in the future.


Finally, even if we figure out how to get OxyContin prescribed more responsibly and reduce opioid addictions, that's no solution to the people out there suffering from chronic pain.
I hope better solutions are developed for them,

Alex Tabarrok summarizes research and concludes the FDA is too conservative on approvals
sitelink com/margin

Scott Alexander also concludes the FDA is too conservative on approvals, and describes COVID tests and vaccines as examples
sitelink substack. com/p
Key quote: “By March, China was testing millions of people a week, South Korea had tested,people, and the USA had done a grand total ofcoronavirus tests.
The pandemic in these three countries went pretty much how you would expect based on those numbers.
”

Propublica article on the FDA delays in approving cheap athome COVID tests
sitelink propublica. org/article/he .