Empire of Pain

In his book "Empire of Pain," journalist Patrick Radden Keefe presents a comprehensive biography of the Sackler family, who were the founders of the pharmaceutical corporation Purdue Pharma. Purdue Pharma is responsible for producing the highly controversial prescription drug OxyContin. Keefe has compiled an exhaustive history of the beginnings, inner workings, and questionable activities of this prominent yet notoriously secretive corporation.

The first portion of the audiobook is devoted to providing a history of the Sackler brothers—Arthur, Mortimer, and Raymond—and describes how they came from modest beginnings before rising to prominence in the fields of medicine and philanthropy. Keefe outlines the process by which the Sackler family became owners of Purdue Frederick and expanded the business into a pharmaceutical conglomerate that generated enormous profits.

A sizeable chunk of the book is dedicated to discussing how Purdue developed and aggressively marketed the lucrative but addictive opioid painkiller OxyContin in the years after the product's introduction in 1996. In this chapter, Keefe discusses the advertising and marketing strategies that Purdue utilized to convince medical professionals to prescribe OxyContin for a variety of ailments.

Keefe reconstructs how Purdue executives and sales personnel routinely misrepresented OxyContin's hazards and advantages to physicians by using a variety of sources including as court statements, corporate papers, and interviews with former employees. Keefe does, however, include testimonials from medical professionals who believe they were led astray by Purdue's assertions that the risk of addiction to OxyContin was minimal.

Keefe accuses Purdue of intentionally hiding the possibility for abuse of OxyContin through selective marketing, misleading clinical trials, and bribing third-party medical experts to promote drug uses that are not backed by evidence. He does so in a journalistic manner that is measured and objective. However, he also shows how the larger medical community was involved in the problem by demonstrating how they overprescribed opioids based on inflated beliefs about the safety and effectiveness of these drugs.

The book details the meteoric rise in the number of prescriptions written for OxyContin as well as the escalating opioid crisis, both of which Keefe believes were likely caused by Purdue's aggressive marketing activities. He relays the heartbreaking accounts of patients who fell victim to addiction, as well as statistics on the rising number of fatal overdoses. The terrible effects of OxyContin abuse are given a human face through the portrayal of mourning families in portraits.

Keefe is following in the footsteps of prosecutors who have brought lawsuits saying that Purdue and the Sacklers share culpability for the opioid problem due to the reckless and purposeful deception of OxyContin marketing. The book discloses questionable internal records that raise doubt on the assertions made by Richard Sackler and other family members who deny knowing of the addictive characteristics of OxyContin.

Keefe details the multiple legal proceedings that have been taken against Purdue for false advertising, misbranding, and other claims that are related to unlawful OxyContin marketing. His writing is plain and journalistic in style. He examines the information that was produced in court without providing an excessive amount of editorialization, instead allowing the facts to speak for themselves.

In spite of the fact that Keefe has strong opinions regarding the Sacklers' morality, the tone of his exhaustively researched historical account is always objective and measured. This audiobook poses some thought-provoking concerns regarding the effect of commercial interests on medicine as well as the precarious balance that must be struck between alleviating suffering and reducing the likelihood of becoming addicted to drugs. Reporting from Keefe is really helpful in gaining a knowledge of an important public health concern.

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