Reviews with content warning for Gaslighting - Empire of Pain: The Secret History of the Sackler Dynasty

Reviews tagging 'Gaslighting'

Empire of Pain: The Secret History of the Sackler Dynasty by Patrick Radden Keefe

22 reviews

stephaniezd's review against another edition

dark informative reflective tense medium-paced

5.0

Impeccably researched and compelling in it's telling. Easily the best non-fiction I have read this year. I have already recommended to several people. Jaw-dropping at times in the unabashed ridiculousness that the focuses of the tale engaged in. Just an incredible story.

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kdsmoove's review against another edition

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dark informative sad slow-paced

5.0

*insert annie screaming gif”

the amount of times i screamed at the radio or texted someone “just when i thought these people couldn’t get any worse, they fucking do!” throughout reading this is not a low number. when i tell you i was HOOKED from the beginning and somehow not intimidated by the length.

i knew some about the opioid crisis, even enough to associate the sackler name with it but i had *no idea* just how deep the rot went. i didn’t realize that arthur sackler was the mastermind behind the way the entire pharmaceutical marketing schemes work now. that he basically invented sales and created his own fucking sources and oh my GOD. it was a solid five or six hours in before we even got to Reagan and i did the whole *leo pointing at the tv gif* thing to the stereo.

and of course today to tidy it up it HAD to be the fucking trump administration willing to let them off with a slap on the wrist. i am so mad, i will be staying mad. you should read this. but beware, there’s a lot of trigger warnings to check and it will make you very mad. One of the lines he used was “rip shit pissed” which sounds a lot funnier out loud than it does written down but i will be using it moving forward.

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samarakroeger's review against another edition

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challenging dark informative slow-paced

4.25

fascinating and extensive look at the villain origin story behind the opioid epidemic. as addicting to read as oxy (although this is certainly a slow release).

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emilybaum's review against another edition

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dark informative reflective sad medium-paced

5.0

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just_one_more_paige's review against another edition

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challenging informative reflective medium-paced

5.0

Alright. I did it. In one of the most overwhelming #bookstagrammademedoit reading choices I've ever made, with particular shout outs to @thestackspod and @irisbooklist, I decided to give this one a go. I've never really seen a nonfiction book talked about like this one was, with so much hype. I hesitated to read it though, because I worked in youth substance youth prevention for years, in a state (NC) and county (Orange) that were part of the suits brought against Purdue Pharma, and it was in the depth of argument while I worked there. I was really enmeshed in the world of prevention and harm reduction related to opioid use (pushing patient education materials and new tracking software on prescribers and pharmacists, among other things) and I wasn't sure I wanted or was ready to jump back into that world. Also, for a few years my partner worked as a pharma rep (for a small, now bankrupt/nonexistent company, that did not, in fact, have an opioid in their repertoire) and he truly hated the role. So, for that reason as well, I was concerned about revisiting some of that, mentally. However, I am nothing if not a sucker for book hype, especially from certain readers/reviewers, so in the end, I decided to give it a go.

After that intro, this nonfiction chunk is, obviously, about the opioid crisis/epidemic in the United States. There have been many other books, both fiction and nonfiction, that address this topic from a variety of perspectives. This expose in particular focuses on the Sackler family, the family who owns Purdue Pharma, and their history and rise to financial and social prestige, and the way their marketing and business decisions were pivotal in the way the opioid crisis played out. As the author addresses in the afterward, this book touches on but doesn't delve as deeply into the affected people/communities, the consideration of prevention and treatment availability moving forwards, etc. - as other books have done that well already and otherwise this book would be too wieldy to pick up. This particular book delves into the Sackler family itself, and their internal development/issues, as well as how they managed (for so long) to keep their name disconnected from this unfolding epidemic, despite how deeply involved they actually were, in an attempt to call them to account, to responsibility, in a way that hadn't yet been done.

We begin with the "original three" Sackler brothers Arthur, Mortimer and Raymond in the early 20th century and their general rise through medical school, the first investment in the company that became (expanded into), Purdue Pharma and what was, essentially, the creation of the field of medical/pharmaceutical marketing. In addition, this beginning part chronicles the way the family put an emphasis on philanthropic giving, to arts and sciences foundations, widely and generously, but always was an obvious attachment of their name to the giving. On the other hand, we see how, from the beginning the family chose to disassociate their name from their business interests, in a dichotomy that is fascinating and does cause one to question, even before things got really shady. Anyways, we then follow the next generation, Richard Sackler in particular, as Purdue Pharma created and aggressively marketed the opioid OxyContin without real scientific evidence of its safety, and even against all (increasing) evidence that it was deeply addictive. Keefe uses court documents, company communications, employee/family friend interviews, and many other primary sources to detail the way the Sackler's ignored the actual needs of patients with a view solely on creating their "empire of pain." There are no words of the Sackler's own, at least in interviews or in response to Keefe's writing here, because they have steadfastly refused public commentary. However, even without that, this is an incredibly robust and intricately researched work of nonfiction, really bringing this family and their history to life on the page.

So, after all that background, let me just start by saying that everyone was right. This was truly a spell-binding piece of nonfiction. I listened to the audiobook (which Keefe himself reads) and it was unputdownable. The 18 hours went by so fast. I couldn't believe it. And, as a few people messaged when I posted about having started reading this, I was both astounded and infuriated, in alternating reactions, over the course of the book. I mean, with my personal/partner background in what this epidemic turned into (sales and prevention), I shouldn't have been surprised by as much as I was, but seeing the narrative unfold "in order" like this, I honestly sometimes was. To start, the amount of conflicting interest in the Sacklers' rise to fortune through monopolistic drug production/testing/medical journals/advertising, etc. is unbelievable. So many legitimate efforts to move treatment and medicine forwards were co-opted for prestige and money with no regard for anything else (like patient safety or sales/marketing regulations) and it's sickening. Also, like I knew the FDA has not always been above reproach (re: lobbying and bribing and sub-par investigation), but honestly reading about the corruption here was sickening, making one question (more than before) and lose trust in all FDA approvals and now here we sit with the shit end of that stick mid opioid crisis and COVID with no end in sight...

Anyways, this whole book was an astounding primer on willful ignorance, detachment from reality and lack of cognitive dissonance. The outmanned/over-gunned smear campaigns against individuals bringing attention to red flags, and the efforts to cast all naysayers as “addicts”/unstable. The systematic undermining, through lobbying/bribing, of Congress, the DEA, the CDC, state legislatures, federal prosecutors, and more. Basically, the way that rich white people can get away with stuff, in this case legitimate mob and drug dealing type shit is unreal to see this clearly displayed; what money can get you as far as leverage is frightening. This kind of elitist bullshit is the baseline of so many social issues now.

The Sacklers were just so blind to their own immorality, to an unbelievable degree, with an addiction to money and prestige and the lengths they went to (what they ignored and willingly misunderstood) to get and maintain it. Keefe highlights so many really fascinating insights into this family's rise and the way they were hyper-focused on philanthropy (being known for "good"), but ignored how much harm they were causing the world; the way they started out so diversified and ended so single-minded. Plus, the internal family drama was kinda unbelievable and entertaining in the way that messy families and rich people behaving badly can be. Honestly, I have no idea how Keefe made this long of a book, on such an intense, heavy topic, such a parge-turner. But damn, he sure did.

“The doctor is feted and courted by drug companies with the ardor of a spring love affair [...] The industry covets his soul and his prescription pad because he is in a unique economic position; he tells the consumer what to buy.”

“...a classic Arthur Sackler play: innovative, showy, a little bit shady...”

“…Arthur liked limbo. He thrived on it. He'd built a life around fuzzy boundaries, overlapping identities, conflicts of interest. Limbo was his element.”

“It is a peculiar hallmark of the American economy that you can produce a dangerous product and effectively off-load any legal liability for whatever destruction that product may cause by pointing to the individual responsibility of the consumer.” (With guns, underage access to/overuse of substances like tobacco and alcohol, addiction, and more - it’s freaking infuriating.)

“He had a hubris, a blindness to consequences, and unshakable certainty in his own convictions. If there was one attribute that Richard shared with his uncle Arthur - apart from a common name, a genius at marketing, and a sense of unquenchable ambition - it was the stubborn refusal to admit doubt, even in the face of contrary evidence, and a corresponding ability to delude himself into a blinkered faith in his own virtue.” (And let me add a disgustingly nonexistent ability to accept responsibility for his own choices and actions.)

“I wondered if, for some of these people, it was just too demoralizing to take a sober measure of their own complicity, if it was simply too much for the human conscience to bear.”

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sapphire's review against another edition

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dark emotional informative reflective sad

5.0

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maarsargo's review against another edition

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challenging dark emotional informative reflective sad tense medium-paced

5.0

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allisonwonderlandreads's review against another edition

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challenging dark informative reflective slow-paced

5.0

This meticulous, damning work of non-fiction is worth all the hype. The opioid epidemic was a topic completely outside my sphere of understanding before picking this book up. I was unaware of all the legal battles raging to bring a particular company and its scions to account for a public health disaster of epic proportions. I was horrified by the influence of one powerful family over an entire industry, and through that, the country at large. The Sacklers' inability to empathize, to accept any level of responsibility for the opioid crisis through the aggressive marketing of their drugs, is more astounding than it ought to be given our society, fueled by capitalistic fever dreams and cold ambition. Here, we have a family ostensibly offering a compassionate product, a drug that can help many suffering from pain of all sorts. However, the tactics revealed in this book tell a different story, the calculating minds of a family willing to do anything to increase their net worth with no concept that there could be negative, lasting consequences to answer for. That misleading the medical establishment could lead to dangerous prescription practices. That data indicating where pill mills are located could necessitate corrective action rather than representing a welcome source of income. That influencing government agencies and public perception is anything less than their right as the ultra-wealthy. That willful ignorance is somehow less harmful than intentional malice when the result is the same: over a million dead and many more affected in the US alone.

I'm not really sure how to review such an impactful work. I think everyone can benefit from a closer look at how the pharmaceutical industry works and how wealth is accrued and kept more broadly. It leaves me with a lot to ponder and with a lot more information at my disposal to see things clearly. Highly recommend.

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laurenkimoto's review against another edition

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dark emotional informative mysterious reflective sad medium-paced

4.0

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horizonous's review

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informative medium-paced

5.0

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