Emily Beswick reviews Patrick Keefe's Empire of Pain, an insight into the controversy surrounding Purdue Pharma and its supposed medical breakthrough narcotic, OxyContin.
The key takeaway from this book...is the power of data
Keefe presents a meticulous investigation into the rise and fall of the Sackler family, whose ownership of Purdue Pharma, during the creation of the pain-relieving drug OxyContin, contributed to the opioid crisis currently affecting America. Patrick Radden Keefe is a staff writer at the New York Times, whose role as an investigative journalist is evident in his diligent approach to authorship. The book itself expands upon Keefe’s 2017 article, ‘The Family That Built an Empire of Pain’, in the New Yorker that is widely cited as one of the first exposés about the Sackler family. Â
OxyContin is, at its core, an opioid, a type of drug that is effective in relieving pain but is highly addictive, and only previously prescribed to patients who were terminally ill. Purdue Pharma marketed OxyContin as ‘different’ to other pain medications due to its slow-release coating that released the opioid gradually which, in turn, reduced the risk of addiction. The problem was…that was not the case.Â
As Keefe details, the material used to market OxyContin as ‘non-addictive’ was an inaccurate representation of the real data collected, and the slow-release coating was nowhere near as effective as Purdue Pharma posited. More and more people across America were becoming addicted to opioids, with legally prescribed opioids starring in the beginning of many stories of addiction.Â
TV shows such as ‘Dopesick’ and ‘Pain Killers’ have highlighted the role of OxyContin prescribing in the opioid crisis, and the recent Netflix film ‘Pain Hustlers’ focused on the tactics used by pharmaceutical sales representatives responsible for ensuring the drug was prescribed. Whilst these series and films have been essential to draw public attention to this issue, Keefe’s book Empire of Pain goes into a greater level of detail about who should be held accountable for the opioid crisis.Â
The key takeaway from this book, and there are so many to choose from, is the power of data. To convince regulators to provide approvals, doctors to prescribe, and sales representatives to sell, Purdue misused data to convince others of the efficacy and safety of OxyContin. The data itself was usually accurate, but its representation was deliberately misleading. A clear example is the graph (Figure 1) used to indicate the release of opium into the bloodstream, which employed a logarithmic scale, rather than a traditional linear scale. This created the false image that OxyContin remained in the bloodstream for longer, without the sharp drop in opium levels that typically gives rise to addiction.
Figure 1. A graph to represent the changing levels of Oxycodone in the bloodstream, as used by Purdue Pharmaceuticals in the package insert approved by the Food and Drug Administration (FDA), for inclusion with OxyContin.Â
Image sourced from digitised citizen petition sent to the FDA at the Department of Health and Human Services, on behalf of the citizens of Mississippi attorney Philip W. Thomas. This petition (available at https://www.reuters.com/investigates/special-report/assets/usa-courts-secrecy-judges/thomas-motion-4.pdf) involves a request that the FDA remove, or amend, the graph from Oxycontin prescription packaging and outlines why it is misleading.Â
...wealth and power were generated through capitalising on people’s pain.
Empire of Pain is an incredible exposé of the Sackler family, Purdue Pharma, and all those involved in the provision of OxyContin. Keefe is a reporter; he presents the facts and evidence of the case, whilst also telling an engaging story of how wealth and power were generated through capitalising on people’s pain. The book is also a reminder that we, as scientists, have a social responsibility. Research on health must be conducted to the highest ethical standards as, unfortunately, the OxyContin scandal shows we have learnt little since the Tuskegee experiment (an overview of this scandal is available at https://www.cdc.gov/tuskegee/timeline.htm).Â
This book is a must-read for anyone interested in the process of drug development, pain management, or just some next-level family drama.
This article was written by Emily Beswick and edited by Rebecca Pope. Interested in writing for WiNUK yourself? Contact us through the blog page and the editors will be in touch!