<p><span style="color: #000000;">Patrick Radden Keefe is an award-winning staff writer at The New Yorker and the bestselling author of <em>Empire of Pain: The Secret History of the Sackler Dynasty</em>. In this episode, Patrick tells the story of the Sackler family and Purdue Pharma - makers of the pain management drug OxyContin, providing the backdrop for the ensuing opioid epidemic and public health crisis. He reveals the implicit and sometimes explicit corruption of all parties involved in the development, approval, and marketing of OxyContin, leading to a cascade of unintended consequences including addiction and death. He explains the unfortunate lack of accountability for the current crisis, as well as what it all means for those with legitimate pain management needs. Finally, he examines the difficult path ahead towards finding a solution.</span><span style="color: #333333;"><br /> <br /></span><span style="color: #000000;">We discuss:</span><span style="color: #333333;"><br /></span></p> <ul> <li><span style="color: #000000;">Patrick's investigation into distribution and use of drugs in our society [3:55];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">The scale of the opioid crisis [9:15];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">The Sackler brothers: family life, career in the pharmaceutical industry, and role in the current crisis [11:45];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Purdue Pharma: origins, early years, and move towards pain management drugs [17:30];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">The development of OxyContin: its conception, marketing, and the controversy around the FDA approval process [25:30];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Early reports of OxyContin addiction and unintended consequences and how Purdue Pharma sidestepped responsibility [40:45];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">The many paths to addiction and abuse of OxyContin and the ensuing downfall of Purdue Pharma [47:15];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Peter's personal experience with OxyContin [57:00];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Pain—the "fifth vital sign," how doctors are trained in pain management, and the influence of money [1:08:00];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Other players that helped facilitate the eventual opioid crisis [1:16:15];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Lack of accountability following the investigation and prosecution of Purdue and the Sackler family [1:23:30];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Legacy of the Sackler family and their disconnect from reality [1:34:45];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Patrick's views on the regulation and use of pain management drugs [1:42:15];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">The difficult path forward [1:44:45]; and</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">More.</span></li> </ul> <div>Learn more: <a href="https://peterattiamd.com/">https://peterattiamd.com/</a><br /> Show notes page for this episode: <a href="https://peterattiamd.com/PatrickRaddenKeefe">https://peterattiamd.com/PatrickRaddenKeefe</a> <br /> Subscribe to receive exclusive subscriber-only content: <a href="https://peterattiamd.com/subscribe/">https://peterattiamd.com/subscribe/</a><br /> Sign up to receive Peter's email newsletter: <a href="https://peterattiamd.com/newsletter/">https://peterattiamd.com/newsletter/</a><br /> Connect with Peter on Facebook | Twitter | Instagram.</div>
Actionable Insights
1. Guard Against Power Delusion
Individuals in positions of immense power and wealth, surrounded by agreeable advisors, are highly susceptible to delusion and losing touch with reality. Actively seek diverse perspectives and critical feedback to avoid self-deception and acknowledge potential wrongdoing.
2. Recognize Soft Corruption
Be aware of ‘soft corruption’ where government officials may be subtly influenced by the prospect of lucrative private sector jobs, even without explicit quid pro quos. This systemic issue can compromise regulatory integrity and requires vigilance.
3. Scrutinize Industry-Backed Innovations
Exercise critical scrutiny when evaluating medical guidelines or ‘innovations’ that are heavily promoted or underwritten by industry, such as the ‘fifth vital sign’ for pain. Industry backing can influence medical discourse and prescribing habits.
4. Question Revolving Door Lobbyists
Maintain skepticism and apply scrutiny when former government regulators transition to lobbying for the industries they once oversaw. This ‘revolving door’ phenomenon can compromise public interest by leveraging insider knowledge for commercial gain.
5. Seek Expert Opioid Tapering
If physiologically dependent on opioids, never attempt cold turkey cessation due to severe withdrawal risks. Always seek professional medical guidance for a safe and managed tapering protocol, potentially involving other medications.
6. Prioritize Comprehensive Pain Care
For chronic or post-operative pain, advocate for a multi-modal, expert-guided approach that includes non-opioid medications, injections, and physical therapy. This strategy can break the cycle of pain and reduce reliance on addictive substances.
7. Beware Rapid Opioid Escalation
Be extremely cautious of rapid opioid dose escalation, as tolerance and dependence can develop quickly, even with legitimate prescriptions. Understand the potent nature of these drugs and question increasing dosages.
8. Differentiate Pain, Grief
Recognize when medication is being used to blunt psychological pain or grief, rather than solely physical discomfort. Addressing emotional and psychological components of suffering separately from physical pain is crucial for recovery.
9. Build Strong Recovery Support
Cultivate a knowledgeable and supportive network, including medical experts and personal connections, to navigate health crises and addiction recovery. A robust support system is vital for overcoming challenges and preventing relapse.
10. Document Business Risks
In business, thoroughly document all known risks and problems, even if uncomfortable, as attempts to hide information can lead to severe future repercussions. Executives were advised against discussing issues via email, yet sales reports revealed early problems.
11. Incentivize Sales Growth
Design compensation schemes with escalating, uncapped bonuses based on sales volume to drive product adoption and market dominance. This business strategy can lead to massive commercial success.
12. Exploit Market Misconceptions
Identify and strategically leverage customer or professional misconceptions about a product to expand its market without correcting the erroneous beliefs. Purdue executives noted doctors mistakenly thought oxycodone was weaker and chose not to correct it.
13. Embrace Diverse Skills, Hustle
Combine diverse skills and an entrepreneurial spirit early in your career, like Arthur Sackler who managed advertising in high school alongside medical training. This approach can lead to unique opportunities and significant financial success.
14. Pursue Education, Meritocracy
Prioritize education and believe in meritocracy as foundational values for personal and professional growth. The Sackler brothers were raised with these beliefs, which guided their path to building an empire.
15. Analyze Sales for Abuse
Utilize sales data, especially after product changes, to identify and understand the extent of illicit use or abuse of a product. A 25% drop in 80mg OxyContin sales after reformulation indicated significant prior abuse.
Influence medical education and prescribing habits by sponsoring academic and medical conferences on relevant topics. This strategy allows for aligning with and promoting specific viewpoints within the professional community.