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

challenging informative reflective sad fast-paced

5.0

From the ages of 8-11, I would hang out at my dad’s office during the summer, doing menial tasks and earning around $5 a day. I remember the most exciting days,  not just for me, but for much of the office staff, were those days when someone brought free lunch.  I would later understand that these were sales representatives from drug companies buying lunch in order to persuade physicians like my dad to prescribe their medicine. It was shocking to learn that buying lunches such as these in medical offices was a result of an aggressive advertising campaign created by Arthur Sackler, a campaign in which profits for drug companies were prioritized over patient outcomes. My dad is a pain management physician, who  prescribes narcotics, so learning about the role that physicians played in peddling false information and overprescribing OxyContin was difficult to read, since I greatly respect him and the patients he has been able to help. Through my conversations with him, I was comforted to hear the perspective of doctors who resisted the seduction of companies like Purdue. My dad had listened to Portenoy (one of the most prominent pain physicians on Purdue’s payroll) advertise OxyContin at  conferences and even had a drug rep try to persuade him to prescribe a fentanyl lollipop, supposedly to treat headaches. Yet, despite all these external influences, my dad maintained his skepticism and didn’t prescribe these more potent drugs. As someone entering medical school in a month, this book initially shook my confidence in the medical establishment. If the medication we prescribe is being approved by an FDA funded by drug companies, supported by studies also funded by drug companies, then how can I be certain that I am improving patient outcomes by prescribing certain medications? This is something that I don’t have an answer to, but I believe that learning about the inside of the medical establishment will enable me to engage more critically with it. Greed can chip away at a person’s better judgment, as was the case with the Sacklers and many of the people who supported them in their wrongdoings, but even in the face of great financial incentive, there were many physicians, lawyers, and activists who refused to be swayed and that’s what gives me hope.