Pharma’s almanac

Thanks in part to its heft, Pharma is really two books in one. Half or more of its length is dedicated to an academic history of the pharmaceutical industry, offering a thorough and compelling overview of the past 120 years. As far as such histories go, it is a solid, perhaps even exceptional, effort — although it suffers from the flaws from which such works tend to suffer. At times, the level of detail can be exhausting. This is not a fault of the book per se, but caveat emptor: The casual reader would perhaps like something breezier. That said, if what you are looking for is a comprehensive history of the pharmaceutical industry in one place, you could do much worse than Pharma.

If that were all that Posner got up to in the book, this review could end here. It is impossible to say for certain, but one can speculate from the working title of Posner’s original proposal, A History of the American Pharmaceutical Industry, that this was all he really wanted to write. Unfortunately, such histories do not generally do well on the mass market, and so, perhaps out of a desire to sell more books or a genuine sense that such a contribution was needed, Posner gave over a large chunk of his book to a frankly ill-advised exploration of America’s most infamous pharmaceutical family, the Sacklers.

The Sacklers, who trace their success to now-deceased patriarchs Arthur, Mortimer, and Raymond, are the family behind Purdue Pharmaceuticals, the makers of the high-potency opioid OxyContin, which is often blamed for America’s current drug crisis. Consequently, the family has become more or less public enemy No. 1: High society has shunned them, artists have led mass protests against galleries endowed by them, and state attorneys general have sought to bankrupt them.

Pharma dedicates countless pages to the family’s history, from its earliest days up through and past a 2007 guilty plea in a federal prosecution of its marketing practices. The level of detail verges on the absurd: Whole chapters are given over to detailing the Sacklers’ many contributions to New York’s Metropolitan Museum of Art — as though the exact negotiations around the gifting of the Temple of Dendur are central to the history of the pharmaceutical industry.

Bluntly, the world does not need another book about the Sacklers, certainly not one of this length. The family has been treated not only in numerous magazine features but in (to cite just a few examples) Barry Meier’s Pain Killer, Beth Macy’s Dopesick, and Sam Quinones’s Dreamland, the definitive work on the early opioid crisis. The problem with Pharma’s fixation on the Sacklers, however, is not so much that there are too many books on the family already. Rather, the problem lies in what this focus tries to communicate.

Consider the book’s subtitle: Greed, Lies, and the Poisoning of America. There is a kind of syllogism implied here: Pharma’s greed led to lies, which in turn led to mass death and destruction in the form of an opioid crisis. Call it the “Michael Moore” fallacy — greed is the source of evil, so identifying greed is adequate when explaining why evil things happen.

This helps explain why Posner is happy to argue, with little consideration, that the Sacklers, along with the heads of other pharmaceutical firms, are behind the drug crisis. In the book’s last chapter, for example, Posner blithely asserts that in 2015, “Oxy[Contin] … had killed more people than had fatal car crashes and guns combined (52,000),” adding that “statisticians blamed OxyContin for the first decline in more than twenty years in the life expectancy of Americans.”

That’s just false. In 2015, prescription opioids were involved in 12,727 deaths, fewer than heroin (12,989), and just ahead of synthetic opioids (9,580). In fact, of those prescription opioid deaths, 16% involved synthetics, and the rate of death involving prescription opioids alone has been falling, in line with prescriptions per capita, since 2012. The 2015 decline in mortality was a product of increases in heart disease, Alzheimer’s, and self-injury, including suicide and abuse of not only prescription opioids but also all other major classes of drugs and alcohol. (The “statisticians” Posner cites are from a Vox article.) As of 2018, heroin, fentanyl, cocaine, and even methamphetamine are all deadlier than prescription opioids.

This may seem like nitpicking, but there is a deeper point: Where it veers beyond academic history, Pharma works to repeat a story about the drug crisis that is categorically out-of-date. To be clear, there is strong evidence that OxyContin helped ignite the crisis two decades ago. But today’s drug crisis is driven not by irresponsibly prescribing high-potency opioids but by the wanton distribution of powerful synthetic substances by Chinese and Mexican traffickers. While the realities of drug markets have moved on, however, the media and the public have not. They continue to understand the deaths of nearly 70,000 people a year as being largely or exclusively the fault of big business and greed.

In reality, Pharma’s concern with the Sacklers is akin to its more historically minded parts: purely academic. Certainly, greed is a part of the story of America’s current crisis. But it’s only a part, and telling it over and over again as if it were the whole does little service to anyone.

The fixation on the Sacklers is a shame because it limits what would otherwise be a commendable piece of historical research. Perhaps readers, armed with this knowledge, can still find something useful in Pharma. To do so, however, they will need to disregard the book’s retread of an old morality tale and embrace the much bigger and more interesting picture of which it provides a partial sketch.

Charles Fain Lehman is a staff writer for the Washington Free Beacon, where he covers social issues and policy.