On Pain and Painkilling
This week: a conversation with Patrick Radden Keefe and Kathleen Frydl about the opioid epidemic and the family behind OxyContin. Listen today at 2 pm, or anytime at our website.
You’ve seen the Sackler name on museums, on university buildings, but you might not have always known how that name attached itself to the kind of money that supports museums and universities. These days, though, a source of the fortune is well known: OxyContin (among other drugs from the Sackler family’s company, Purdue Pharma) which helped get Americans on opioids in the last few decades.
Patrick Radden Keefe’s Empire of Pain tells the story of the Sacklers—the philanthropy, the family history, the medical thinking, and above all, the marketing tactics by which Arthur Sackler, first, changed the way medicine was done.
There are people who worked in medical advertising, these old men who I’ve interviewed, who were in the business in the 50s—somebody said he invented the wheel when it came to the way in which that business is done. There were a bunch of things that Arthur did. To me the most significant was that because of his veneration of physicians, he really recognized that actually . . . it’s nice to reach the consumer if you can. Any of us who turn on the television at night know that we’re inundated with with ads for pharmaceuticals now in a way that actually consumers weren’t in the 50s and 60s.
The rules were different back then. But Arthur Sackler realized that what you really need is the physician, that the physician writing the prescription is the person you want to target. And so, on the one hand, he would he would say, “Oh, physicians, you know, they would never be influenced by something as simple as advertising.” On the other hand, he owned and ran an advertising agency geared at persuading physicians to prescribe differently. So I think that was that was one of his huge innovations.
And you see, decades later, when OxyContin is introduced, a very concerted effort by Purdue and the Sacklers. There was a kind of status quo in the American medical establishment when it came to the prescribing of strong opioids and they decided, “We are going to upend that status quo. We are going to take an army of of sales reps who aren’t doctors and send them out with their persuasive skills and a bunch of [what, in retrospect, was pretty, pretty dubious] medical literature and a bunch of claims about how these drugs aren’t addictive and try and cause a sea change in prescribing.” And they were fantastically successful.
The Sackler marketing of opioids is now viewed in light of the eventual rise of heroin and fentanyl addictions. But the pain movement associated with Sackler medications lives on, in a way, through patients committed to particular drug regimens. Says Keefe on our show:
What’s so unsettling for me is that I get emails from the pain patients who often will tell me about their own conditions, which sound harrowing, but will then say, “I’m responsible, I take my medicine responsibly. Why are these other people ruining it for me?” And I think that that underestimates the role that the drugs themselves can have in causing addiction.
Joining us this hour is Kathleen Frydl, historian of America’s drug crises. She cautions listeners against over-emphasizing the Sackler family’s role in the crisis, because there are plenty of other contributors. Says Frydl:
I actually don’t consider them, you know, by necessity more evil than others. They had many fellow travelers, many enablers. Johnson and Johnson is a pharmaceutical giant without whom we would not have the opioid crisis because they made possible the raw materials that the Sacklers and others use to manufacture their drugs. So I think of them as one in a group and they might be distinguished, but I think the characteristics which distinguish them are that they’re just particularly skilled and they’re skilled at one thing, which is the direct-to-physician marketing. The pharmaceutical industry spends more money on marketing than it does on research and development. This is an industry that spends more on its sales force than any other US industry. So this is an industry that’s very aware that the missions that they’re sending out to the individual doctor’s office, what they call detailing, is a highly, highly effective mechanism to drive their sales.
Read: Junky
William S. Burroughs’s classic novel of heroin addiction is part autobiography, part ‘50s noir, part cultural study. From Will Self:
Burroughs wrote Junky on the very brink of a transformation in western culture. His junkies were creatures of the depression, many of whose addictions predated even the Harrison Act of 1922, which outlawed the sale of heroin and cocaine in the US. Burroughs viewed the postwar era as a Götterdämmerung and a convulsive re-evaluation of values. With his anomic inclinations and his Mandarin intellect, he was in a paradoxical position vis a vis the coming cultural revolution of the 1960s.
Listen: Wind of Change
If you want to hear more Patrick Radden Keefe, there’s always his hit podcast from last year, about the CIA, the Scorpions, and the Cold War.
Listen: Lost Hills
The New Yorker’s Dana Goodyear tries her hand at a podcasting with a true crime series about a murder in a Malibu, California state park. In Goodyear’s and Puskin Industries’ capable hands, this is a great example of how this medium, for this story anyway, surpasses a long-form magazine article.
This week’s ephemeral library
The Brontë’s Secret. Remembering Paul Mooney. A new word in Washington for the Israel-Palestine conflict. The US Nuclear War That Almost Happened. Watch David Hockney Page Through His Sketchbook. Big Tech’s Favorite Nobel Prize-Winning Economist Changes Sides.
That’s all for this week, folks! Thanks for listening and think about tossing some spare change into the OS tip jar.
The OS Gang
