Wu Xinyue
In 2016, small drug dealer Darnell Washington sold a pack of fentanyl, causing one of its users to die of an overdose, and he was also arrested for drug trafficking and sentenced to fifteen years in prison. This humble news was published in the New York Times by award-winning author and journalist Patrick Radden Keefe – because the opioid abuse crisis is intensifying, the death of illegal opioid overdose has been prosecuted as a crime, and many street drug dealers have been arrested, however, since the 1990s, Purdue Pharmaceuticals, controlled by the Sackler family, has packaged the strong opioid Oxycontin as a "non-addictive drug". Sold to tens of millions of Americans, it has resulted in more than half a million deaths from drug overdoses and millions of families dying. Small drug dealers have been arrested and imprisoned, while the "big drug lords" Sackler family still sits on tens of billions of dollars and is at large.
Empire of Pain
In his 2021 book, Empire of Pain, Kiefer begins with a Family of Eastern European Jewish immigrants taking root in the United States, combing through how three generations of the Sackler family have gradually developed a bankrupt family convenience pharmacy into a one-handed empire of painkillers, and have taken the phrase "basing one's happiness on the pain of others" to the extreme.
As a contributing writer for The New Yorker, Kiefer is an interdisciplinary and versatile writer: in addition to his undergraduate degree from Columbia University, he also has three degrees: a Doctor of Laws degree from Yale Law School, a Master of International Relations from Cambridge University, and a Master of Communication from the London School of Economics and Political Science. Kiefer has worked on a wide range of subjects and won awards, from "Snakehead" about a gangster in New York's Chinatown to "Say Nothing", which tells the story of the Northern Ireland Revolutionary War with a murder case.
Based on Kiefer's 2017 special report in The New Yorker, "The Family That Built the Empire of Pain," he joked in an interview that the book had been written on his bedroom bed in the past two years because his only study had been occupied by his wife who worked from home during the pandemic, but it was also because of the pandemic that his phone interviews were particularly efficient, probably because there was nowhere to go and the people in isolation at home were very talkative. The book combs through a large number of interviews and public letter copy, and the switch between the macro narrative and the perspective of the parties makes the reader feel as if he is in the private hall of the Metropolitan Museum of Art Sackler, immersed in how the Sackler family has carefully laid out a "pain movement" to change the United States, and how anxious to face the investigation, trying to calm things down. The greed of the Sackler family and the corruption of the medical regulatory system are shocking to read.
The Sacklers claimed they could get any member of Congress to answer the phone within seventy-two hours, and they did do what they said, using all their connections to pressure investigators. Kiefer himself, along with many other journalists, prosecutors, and civil society protesters against OxyContin, received snowflake intimidating letters from the Sackler family and Purdue pharmaceutical lawyers, and even indirectly led to personnel changes in Washington.
In this book's narrative of three generations of the Sackler family spanning nearly a century, it is not only drugs that are addictive, addictive, and ultimately addictive, not only drugs, but also money, power, and ambition. Countless addictions and desires form a crumbling pyramid: the addiction of millions of Americans to opioids, the addiction of doctors to the sugar-coated shellwashing and targeted marketing of pharmaceutical companies, the addiction of drug regulatory bureau chiefs to money bribes, the addiction of Purdue Pharmaceuticals to pursue performance regardless of provenance and consequences, the addiction of the Sackler family to unlimited greed... Inflated desires colluded heavily into dominoes that eventually ignited the scandal of the century.
Founder of the Empire
The story begins at the beginning of the twentieth century. Isaac and Sophie, a Jewish couple who immigrated to the United States from Eastern Europe, opened a convenience store in Brooklyn, and the business was good and bad, and it was not always a climate, but the elder Isaac was convinced that there was no money to be earned, and fame to come again. The couple grew up with three sons: Arthur, Mortimer, and Raymond.
The eldest son, Arthur, has been the eldest of the three brothers since childhood. Because the family convenience store's income was not enough to train three doctors, Arthur worked part-time from his student days, taking a doctorate in medicine at New York University School of Medicine and writing for a pharmaceutical advertising agency, not only earning his own tuition in his spare time, but also providing for his two younger brothers to attend medical school in Scotland.
Arthur worked as a resident in a psychiatric hospital after graduation, and even though there was no financial pressure at this time, the workaholic Arthur still worked two or three jobs at the same time, using his medical training and marketing skills trained in advertising agencies to mediate between multiple companies, and also cultivated a hobby of collecting Asian art, becoming the world's number one collector of Chinese art. He had maintained such remarkable energy all his life that even when he was in his seventies, he had given himself a full schedule of plans, from short-term goals to long-term ambitions, that even his personal secretary said that Arthur would have to live three lifetimes to complete the things on his list.
Arthur Sackler, who is talented in advertising and marketing and ambitious in medicine, ushered in a new era of pharmaceutical marketing. He found that instead of preaching the miracle of drugs to the general public, it was better to target doctors, because patients themselves did not have the right to choose drugs. Since doctors are also human beings, they will also be affected by marketing. Therefore, if you want to make new drugs sell well, the first thing is to concentrate on publicizing doctors. Arthur's Medical Tribune was sent to clinics and hospitals in various states, containing the latest medical research information and, of course, a large number of soft and widespread. Under Arthur's brilliant pen, Diazepam and Limianine (which are similar in composition but packaged into two different drugs) that were supposed to be given short-term to anxiety sufferers were marketed as "all-encompassing diseases", and doctors even asked medical representatives "what are the diseases they cannot cure". Soon, Anda became the first drug to sell more than 100 million —by 1971, Anda and Lymian had brought in two billion dollars for Arthur's client Roche Pharmaceuticals.
The successful marketing of Anding and Limian made Arthur famous and profitable, and the Sackler Empire entered a golden age.
Pain is golden
After Arthur's death, his children rarely cared about the family business, and the Purdue Pharmaceutical Company, which he bought for his two younger brothers in his early years, is now in the hands of raymond and Mortimer, of which Raymond's son Richard and Mortimer's daughter Casey each have a battalion.
Richard is self-absorbed and ambitious, bent on matching Arthur's former glory, and eager to overpower Casey. Purdue's main business is some tepid laxatives and ear wax solutions that cannot be touched on the side of pharmaceutical giants. In 1995, Richard's opportunity came: because the patent for sustained-release morphine painkiller meschcontin was about to expire, Purdue Pharma introduced a new drug called Oxycontin, whose active ingredient was oxycodone hydrochloride, an opioid more potent than morphine.
OxyContin
Opioid use is not new, and there is no shortage of similar products on the market, but the highlight of OxyContin's sales is its "sustained-release technology" - releasing a part of the drug immediately after taking it can quickly relieve pain, and the rest is slowly released in the next twelve hours. Purdue Pharmaceuticals claims that through long-acting controlled release, the drug concentration in the patient's body will not experience huge fluctuations in a short period of time, and it will not become addictive - this is an unprecedented breakthrough for opioids, and it also allows the US Food and Drug Administration (FDA) to give AuschContin a green light, so that it directly into thousands of households.
Richard took the plunge, invested a lot of sales manpower, sent medical representatives to various rural clinics and hospitals to set fire to sell, distributed free samples in a big way, and spent a lot of money to secretly support various medical journals for pain treatment and celebrity doctor forums: the medical weekly was full of all kinds of "latest research" touting the efficacy of medicine, and the medical representatives without any medical training meticulously "helped" doctors to prescribe more medicines to more patients... All of this is to create momentum for the "pain movement" that has swept the United States - pain is also a disease, and any pain should be treated with medicine.
The R&D and marketing of OxyContin is a great integration of the successful strategies of the two generations of the Sackler family: packaging OxyContin as a universal painkiller that cures all diseases like the Stability and Limianning of the year, copying the "sustained release technology" that made Meschcontin a great success intact to demonstrate the safety of OxyContin, and adding exponentially expanded sales investment. For Richard, OxyContin meant not only the future billions of dollars in wealth, but also the fact that he himself, like his uncle Arthur, would make a name for himself in the history of modern medicine.
The Sackler family themselves may not have imagined that Richard's gamble would actually win the jackpot: OxyContin really subverted the pharmaceutical community's view of prescription opioids, as they marketed, and strong opioids that were previously used primarily to alleviate the suffering of cancer patients are now available to doctors in public hospitals or township clinics to deal with ordinary bruises.
There is a delicate dialogue in the American drama "Addiction Dose": Richard insisted on going his own way to promote OxyContin in the very strictly regulated German market, which was opposed by the management of Purdue Pharmaceutical, believing that in German culture, enduring pain is a natural part of illness, and the German market does not have the obsession of "taking medicine immediately when it hurts". In fact, it is not so much that Germans have different perceptions of pain, but rather that "pain exercise" has become a conditioned reflex of the American public to pain, and as long as there is pain, it is necessary to take medicine immediately.
Generally speaking, the way to improve the performance of consumer goods can be divided into two categories, one is to expand the customer base, so that people who would not buy originally become customers, and the other is to upgrade the current customer base. Such an expansion model is basic common sense in the marketing of ordinary consumer goods. Take potato chips as an example: Developing healthy low-calorie products allows people who don't otherwise eat puffed foods to try potato chips, while selling home packs and promotional discounts can make customers who already like potato chips buy more — but when a pharmaceutical company sells strong opioids as potato chips and patients as consumers, it can cause serious social problems.
At first, for many patients who tossed and turned because of pain, OxyContin was a miracle drug that not only had an immediate effect, but also allowed them to finally get a good night's sleep for twelve hours. However, they soon found that the effect of the drug was getting shorter and shorter, and even after only six hours, it began to fail, and they had to double their dosage to barely maintain the previous effect. Purdue Pharmaceuticals also began to introduce more and more doses of pills, each of which brought performance to a new peak.
This is already a dangerous signal, if it is really not addictive, why can't you stop the drug, but also keep increasing the dose?
Worse things soon surfaced. "Not being addicted" is a well-made lie for obtaining FDA permission, and many patients develop symptoms of addiction. OxyContin's so-called sustained-release mechanism can be easily broken down in a variety of ways: scrape open the colored coating on the outside of the tablet, boil it in boiling water, or crush the tablet directly, and you can get a high concentration of opioids.
As a result, OxyContin quickly became popular in the United States and became the most popular street drug on the black market, known as "heroin that can be obtained from doctors." People go to different pain clinics every day to queue up, and after getting the medicine, they immediately sell it for ten times the price - OxyContin brings wealth to Purdue Pharmaceutical, but also leverages the flow of huge amounts of illegal funds.
Jumen and white bones
As OxyContin's sales climbed, abuse across the United States became more and more serious. Prosecutors in the states began to investigate and prosecute Purdue Pharmaceuticals, and the Sackler family, as the actual operators of the company, could not escape. This is not the first time that the Sackler family has faced such a lawsuit, they have long been prepared. Decades ago, Arthur was also indicted by prosecutors for the abuse of Limian and withdrew from the public and lost his reputation. Arthur's defense of Limiannin was paraphrased by the Sackler family to OxyContin: people who are addicted to OxyContin have their own record and tendency to abuse drugs, and even without OxyContin, they will become dependent on other addictive drugs, so the makers and sellers of OxyContin should not be responsible for people's abuse. Richard's favorite metaphor was: "I give you a stick of celery, and you eat it for lunch, but if you have to juice it and put it into your veins, it's not my problem." ”
Any addiction is the result of a combination of subject and object: some people are more likely to become dependent on drugs because of their own growth experiences and physiological reasons; some drugs are more addictive because they stimulate the reward mechanism of the brain. Separating the two and attributing addiction to either side alone is one-sided – OxyContin has more addictive properties than celery and has more dangerous consequences when overdose, which is why celery can be sold in supermarkets, while OxyContin cannot.
The logic of the Sackler family's defense of OxyContin reflects the elite's deep-seated prejudices against drug addicts and the social Darwinism in their core values. In her book Why We Are Addicted, Maya Sarawitz argues that addiction is a disorder of the brain's reward system, not a mere disease, but public opinion tends to blame drug addiction entirely on the addict's own flaws and bundles addiction problems with distorted personality traits such as criminal tendencies, laziness, lying, and stupidity.
Cover of Why We Are Addicted
The regions with the highest sales and substance abuse of OxyContin are highly overlapping with the most economically backward regions in the United States. Many of the people who suffered from OxyContin were low-educated manual workers who worked long hours, working in harsh conditions, and injuries and strains were common. These workers were prescribed OxyContin by doctors for various ailments. After their initial symptoms of addiction, the doctors not only did not cut the dosage, but instead increased the dose step by step under the advocacy of Purdue Pharmaceutical, resulting in them being trapped in it, and many people died of drug addiction and poor families. In the eyes of the elite represented by the Sackler family, this is all caused by the defects of the people at the bottom and has nothing to do with OxyContin. It wasn't until more and more OxyContin abuses occurred among highly educated, well-off middle-class "atypical addicts" that the severity of the opioid crisis was not taken seriously enough.
Kiefer mentioned in the interview that one of the things that shocked him most during the writing of "Empire of Pain" was that the core members of the Sackler family, even in court, did not express the slightest remorse for the harm caused to society by OxyContin's abuse. At the hearing, Kathy bluntly stated that he had done nothing wrong. Richard even blamed the victims for dragging Purdue Pharmaceuticals back: "They are all criminals, and they do not deserve our sympathy at all." Even though the two factions within the Sackler family were sharply divided, they never disagreed on the indifference and disdain for addicts.
The unspeakable "addiction"
OxyContin addicts need to constantly increase their doses to get pleasure, medical representatives need to constantly look for indiscriminate prescription doctors to expand their business, and the Sackler family tirelessly hunts the institutions and museums that symbolize the highest achievements of human intelligence and beauty, engraving their names on them and piling up the names of the ages with money.
The addiction that has made the Sackler family more and more obsessed is their desire to conquer. Arthur's fanaticism with Chinese art was the beginning of the Sackler family's high-profile funding of art, but it was not the cause. The Sackler family did use loopholes in the tax code to save themselves a lot of taxes through philanthropy, but their underlying motivations were not just financial gains.
One of the questions That Pain Empire tries to answer is, why are the Sackler family so obsessed with philanthropy? The Sackler family was a master of marketing, marketing OxyContin into a cure for all ills, and marketing themselves with ill-gotten gains into a "contemporary Medici" of charity. If you want to use the metaphor of "money laundering", then the most persistent thing of the Sackler family is to "wash the name" - let the Purdue Pharmacy, which sells laxatives, become a giant that reforms modern medicine, let the three brothers from the convenience store become the father of charity, and let the upstart be reborn into old money with cultural capital.
Because of the anti-Semitic discrimination during the war, two of the three Sackler brothers could not enter the medical school in the United States and had to go to Scotland for further study, and after half a century, this Jewish family named its surname the top medical school in the United States, Harvard University, Oxford University, Columbia University, as well as the Metropolitan Museum of Art in New York, the Guggenheim Museum, the Louvre... Mortimer Sackler was awarded the French Legion of Honor by the French government, and both Mortimer and Raymond were knights by the Queen of England (even a new variety of roses was named after Mortimer Sackler).
Interestingly, the Sackler family, obsessed with naming their names among the world's top universities and museums in the highest profile, has been careful to avoid OxyContin and Purdue Pharmaceuticals. They want their fame and charity to be closely linked, but they don't want to be recognized as the source behind the money.
For the Sackler family, who have enough money, they crave all the fame and influence that can and cannot be bought. Within the theoretical framework of the sociologist Bourdieu, the Sackler family gradually completed the transformation of social capital and economic capital under the accumulation of a large amount of economic capital.
The heirs of the third generation of the Sackler family are mostly engaged in literary and artistic work, and rarely involve the operation of the family business - these rich three generations grew up in the mansions of New York's Upper East Side, went to Oxford and Harvard with their family's named library, and engaged in film art and social activities after graduation, becoming the typical "old money" children. Raymond's granddaughter Madeleine became a professional filmmaker after graduating from Duke University, made many documentaries about social issues, and won several Emmy Award nominations; in contrast to the simple and low-key Madeleine is Richard's daughter-in-law José, who started her own fashion brand, each of which is listed for thousands of dollars, although the design is lackluster, and the celebrity club linked to the brand is the focus - although the two styles are very different, they both say that their careers have nothing to do with Purdue Pharmaceuticals. Society should not judge a person's career by his origins.
Empire Twilight
As the opioid crisis intensified and more state prosecutors began to investigate OxyContin, Purdue pharmaceuticals were pushed to the forefront and became the target of public criticism. Even under pressure, Purdue Pharmaceuticals still did not give up the sale of OxyContin, they re-improved OxyContin, and set up overseas branches, ready to vigorously develop the market of developing countries such as China and India in the face of setbacks in the local market.
The improved OxyContin finally has what it originally claimed as a "slow-release anti-addiction mechanism", and the new tablets are as difficult to scratch open as gummy, and they can't be smashed, which can be described as a resounding copper pea, and its sales have plummeted. But Pandora's box has been opened, OxyContin's supply on the black market has decreased, and millions of people who are already addicted to drugs have switched to its alternative: heroin.
Purdue Pharmaceuticals has not tried to develop other drugs, but the Sackler family, which holds the company's power, is not interested in any new drug that cannot replace OxyContin in performance, and the new drug plan is constantly rejected, because no other drug can surpass opioids in terms of profitability.
Between 2007 and 2019, Purdue Pharmaceuticals has been mired in thousands of lawsuits, facing fines of up to billions of dollars, three executives pleaded guilty to criminal charges, and filed for bankruptcy in 2019. Talk show host John Oliver described Purdue Pharmaceuticals' bankruptcy as "if you're going to do something bad, it's better to hide it with something boring." Purdue Pharmaceutical's bankruptcy settlement agreement is clearly the opioid crisis is temporarily over, but in fact it is a strategy for the golden cicada to break out of the shell, at this time, Purdue Pharmaceutical's strategic role is to make the Sackler family retreat at all costs. In order to be able to squeeze the last drop of oil and water out of Purdue, the Sackler family manipulated the board of directors, drastically reduced the cost of scientific research, and transferred a large amount of money from Purdue to the family's overseas account. Purdue Pharma is a watermelon that has been hollowed out and is about to be abandoned.
Purdue's settlement was overturned in December 2021 after one of the federal judges questioned the agreement's immunity from future civil lawsuits for the Sackler family. Without a new bankruptcy agreement, the lawsuit could be years long and would be a historic bankruptcy lawsuit.
The Sackler family has the legal protection that money power can get, from the huge legal department to the backing of Washington, and also co-opted the former Mayor of New York Giuliani, which can be said to be armed to the teeth. Every move played by the Sackler family was the best position, but it still lost every game.
The families of the victims, the doctors with a troubled conscience, the prosecutors of the states, the public interest groups protesting in museums ... These unknown people were insignificant pawns in front of the power and wealth of the Sackler family, but these little pawns spent twenty years pushing forward little by little, and finally the spark burned and pushed the Sackler family off the throne of the pharmaceutical empire.
However, in this intricate game of chess, there is no victory, only desires that can never be satisfied. The old Isaac Sackler's motto ,"Money is gone, fame is gone, fame can't come again" takes a dramatic turn —now, the Sackler family is forever tied to the notoriety of the opioid crisis, they still have a lot of money, but there are no museums and universities that want to accept their gifts. Although no member of the Sackler family was punished for their role in the Opioid crisis, the absence of the "contemporary Medici" name became the biggest blow to them.
The Louvre was the first museum to take down the Sackler title, and on March 25 this year, the British Museum also announced that it would remove the title of the Sackler family from the exhibition halls and other spaces it sponsored. More and more universities refused to accept gifts from the Sackler family and removed their titles. For medical students who aspire to cure diseases and save lives, becoming a doctor in a school named after Sackler is a betrayal of hippocratic oath: "I shall not give harmful drugs to others, nor shall I give instructions for them, even if anyone asks for them." ”
Editor-in-Charge: Zheng Shiliang
Proofreader: Yijia Xu