• Kathleen Lees

Takeaway: "Empire of Pain"

Quick Trivia Question: What are the only two countries in the world that permit direct-to-consumer pharmaceutical advertising?


Answer: The United States and New Zealand




I want to preface this review by saying that I used to work in the pharmaceutical industry as a regulatory labeling specialist and affairs specialist, so I’ve had a bit of a behind the curtain look into the world of pharmaceutical advertising. (I won’t go into the specifics of what drugs I’ve worked on.) However, I will say that some of those experiences (and of course, all the horror stories from this book), have dramatically changed my perspective of direct-to-consumer drug advertising.


Another experience that has changed my perspective is having a chronic illness. I have Crohn’s disease. Though in remission, I’ve been on a number of different medications–some I felt were unnecessary. For instance, has anyone heard of biologic drugs? These are medications given through shots or infusions in the hospital (typically) and often used to treat certain types of cancers or certain autoimmune diseases. Unfortunately, they can carry a lot of side effects (and some of them have black box warnings.)


Have you seen any commercials for Humira? I was on that initially, but it caused a lot of skin problems. (I remember initially thinking that an itchy sweater caused this horrendous rash on my chest and stomach, but then these red, bumpy patches spread to my entire body.) So then, I was put on Remicade, and things got better, but they also got a lot worse in other unexpected ways.


Without insurance, these drugs can be up to $10,000 per infusion. And with the insurance I had through my company at the time, it was $1,000 per infusion and several infusions are typically involved in one treatment process. (I am still paying off three infusions I had from 2019.)


With all that said, I used to think it was so great that Americans had choices. I didn’t think there was any harm in turning on the television and asking your doctor about a new drug you saw in a commercial. Sometimes there isn't, but sometimes it’s not so simple.


Quick Review

American writer and investigative journalist Patrick Radden Keefe begins "Empire of Pain: The Secret History of the Sackler Dynasty" book by discussing the history of the Sackler family, starting out with Arthur Sackler, the eldest of three brothers. He’s one of the pioneers of pharmaceutical advertising, initially selling things like earwax remover and laxatives to later Valium, and of course, OxyContin (which is argued to be “invented” by Kathy or Richard Sackler.)


A huge portion of the book, and my favorite perhaps, is the first half. It primarily focuses on Arthur’s life and those that weave in and out of his orbit. There’s his wives (there are three), his children (four children), all the people he worked with, and all the people he killed (indirectly.) He was this bombastic sociopath that spent nearly a century stealing from people and obsessed with Asian art. More than just for entertainment purposes, I loved how Keefe showed what an imposter he was. All the art and money in the world couldn’t give this family class. (And that’s what the Sacklers were trying to do. Pathetic.)


The second half of the book was less interesting to me, which segments off into different family members and more of what’s going on today. (We hear more on Raymond and Mortimer, the brothers of Arthur; I believe all of them are dead now. We also learn a great deal more about Richard Sackler, the son of Raymond Sackler.)


Here are some main points I want to focus on from the second half:


  • Oxycontin is still around: However, it’s no longer marketed to doctors and not used for “as needed” pain. The pill itself is also different, according to the book. Where patients could easily crush the pill and it would turn into a powder, the consistency of the pill is more of a gum drop if crushed. This allegedly makes it less difficult to abuse.


  • The Sacklers had their Name Removed from a Lot of Buildings: This includes the Louvre in Paris from the wing of Oriental antiquities, New York’s Dia Art Foundation, New York University’s Langone Medical Center, Edinburg University, the University of Glasgow, Tufts University in Boston, Solomon R. Guggenheim Museum.


  • No One Went to Jail: They had to pay roughly $4.3 billion.


  • Where are They Now? Richard Sackler allegedly lives in Austin, Tex.


One More Thing…

I would highly recommend that you watch the show “Dopesick,” in addition to reading this book. I watched the show once and then decided to read the book (and watched the show again!). As strange as it is to say, and particularly if morbid medical stuff fascinates you along with some soap opera content mixed in (that’s actually true), this is a great read. It’s a long book, but it goes super fast.


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