Pharma: Greed, Lies, and the Poisoning of America
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- Author：Gerald Posner
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Summary
Award-winning journalist and New York Times bestselling author Gerald Posner reveals the heroes and villains of the trillion-dollar-a-year pharmaceutical industry and delivers “a withering and encyclopedic indictment of a drug industry that often seems to prioritize profits over patients （The New York Times Book Review）。
Pharmaceutical breakthroughs such as antibiotics and vaccines rank among some of the greatest advancements in human history。 Yet exorbitant prices for life-saving drugs， safety recalls affecting tens of millions of Americans， and soaring rates of addiction and overdose on prescription opioids have caused many to lose faith in drug companies。 Now， Americans are demanding a national reckoning with a monolithic industry。
“Gerald’s dogged reporting， sets Pharma apart from all books on this subject” （The Washington Standard） as we are introduced to brilliant scientists， incorruptible government regulators， and brave whistleblowers facing off against company executives often blinded by greed。 A business that profits from treating ills can create far deadlier problems than it cures。 Addictive products are part of the industry’s DNA， from the days when corner drugstores sold morphine， heroin， and cocaine， to the past two decades of dangerously overprescribed opioids。
Pharma also uncovers the real story of the Sacklers， the family that became one of America’s wealthiest from the success of OxyContin， their blockbuster narcotic painkiller at the center of the opioid crisis。 Relying on thousands of pages of government and corporate archives， dozens of hours of interviews with insiders， and previously classified FBI files， Posner exposes the secrets of the Sacklers’ rise to power—revelations that have long been buried under a byzantine web of interlocking companies with ever-changing names and hidden owners。 The unexpected twists and turns of the Sackler family saga are told against the startling chronicle of a powerful industry that sits at the intersection of public health and profits。 “Explosively， even addictively， readable” （Booklist， starred review）， Pharma reveals how and why American drug companies have put earnings ahead of patients。
Pharmaceutical breakthroughs such as antibiotics and vaccines rank among some of the greatest advancements in human history。 Yet exorbitant prices for life-saving drugs， safety recalls affecting tens of millions of Americans， and soaring rates of addiction and overdose on prescription opioids have caused many to lose faith in drug companies。 Now， Americans are demanding a national reckoning with a monolithic industry。
“Gerald’s dogged reporting， sets Pharma apart from all books on this subject” （The Washington Standard） as we are introduced to brilliant scientists， incorruptible government regulators， and brave whistleblowers facing off against company executives often blinded by greed。 A business that profits from treating ills can create far deadlier problems than it cures。 Addictive products are part of the industry’s DNA， from the days when corner drugstores sold morphine， heroin， and cocaine， to the past two decades of dangerously overprescribed opioids。
Pharma also uncovers the real story of the Sacklers， the family that became one of America’s wealthiest from the success of OxyContin， their blockbuster narcotic painkiller at the center of the opioid crisis。 Relying on thousands of pages of government and corporate archives， dozens of hours of interviews with insiders， and previously classified FBI files， Posner exposes the secrets of the Sacklers’ rise to power—revelations that have long been buried under a byzantine web of interlocking companies with ever-changing names and hidden owners。 The unexpected twists and turns of the Sackler family saga are told against the startling chronicle of a powerful industry that sits at the intersection of public health and profits。 “Explosively， even addictively， readable” （Booklist， starred review）， Pharma reveals how and why American drug companies have put earnings ahead of patients。
Reviews
Jessica
，
I picked this up looking for another book that was checked out and couldn't put it down。 In-depth look at the pharmaceutical industry from the beginning to modern day。 Eye-opening and a lot of hard stuff but definitely helped change the way I think about medication， prescriptions， and the industry as a whole。 I picked this up looking for another book that was checked out and couldn't put it down。 In-depth look at the pharmaceutical industry from the beginning to modern day。 Eye-opening and a lot of hard stuff but definitely helped change the way I think about medication， prescriptions， and the industry as a whole。 。。。more
Walt
，
This massive book is really three separate books spliced into one-another。 It starts out with a historical focus on the American pharmaceutical industry。 Then it begins the story of Arthur Sackler。 Later on， it discusses the opioid epidemic in the United States。 Along the way， all three stories interrupt the three running narratives making daunting read even more difficult to follow。 The rise of big pharma is a little dull。 Chemical companies selling narcotics after the Civil War slowly morphed This massive book is really three separate books spliced into one-another。 It starts out with a historical focus on the American pharmaceutical industry。 Then it begins the story of Arthur Sackler。 Later on， it discusses the opioid epidemic in the United States。 Along the way， all three stories interrupt the three running narratives making daunting read even more difficult to follow。 The rise of big pharma is a little dull。 Chemical companies selling narcotics after the Civil War slowly morphed into a cartel that fixed prices and engineered an illegal monopoly。 Along the way， government regulation stepped in （against intense industry pressure） to impose modest oversight。 It has always been an uphill battle。 Arthur Sackler was the little Jewish kid from Brooklyn who is the anti-hero of the story。 Posner found multiple references to people who described him as shady and shifty， if not illegal。 The founder of the Sackler Empire， he was an accomplished psychologist who shepherded his younger brothers through medical school。 Every step of the way through the lives， Arthur was the dominant personality pushing them to do more and more。 Arthur himself appears to have had boundless energy and a fascination with byzantine business arrangements。 His genius was in creating a market for medical advertising。 Big advertising agencies did not think there was enough money in medical advertising。 Drug makers were not allowed to market directly to consumers （patients）。 Sackler devoted his life to subverting that FDA requirement。 In the 1940s he began creating companies， what future investigators would call shell companies。 No one could unwrap the network of companies。 He began with an small advertising agency。 Next he developed a research service that paid doctors monthly for subscription data。 That service allowed Sackler's advertising agency to market directly to high proscribers。 Then， they began influencing or publishing their own scholarly journals hyping the drugs being sold by the advertising agency。 They were soon involved in running clinical trials that corroborated their advertising。 It was not long before they purchased small pharmaceutical companies。 He did not live to see the FDA relax its rules on advertising directly to consumers in 1997。One of their first forays was L-Glutavite。 They made the substance， they marketed it， and verified it with their own studies published in their own journals。 Among the advertising were testimonials from doctors。 It took some determination to determine that 8 of the doctors were fictional。 In another instance， the firm used real doctors， who wrote to the company demanding them not to use them in their advertising。 In both cases， Sackler blamed over-eager young employees。 It would be years before rigorous studies determined that L-Glutavite was harmful。 Posner offers various examples of Arthur's playbook。Sackler died in 1987 almost ten years before one of his companies unleashed Oxycontin。 Posner offers evidence to argue both ways as to whether Arthur would have supported it。 His own research from the 1960s stated that narcotics are addictive and should be used sparingly。 Family members argue that he would not have endorsed the sale of opiates。 However， his shady advertising practices （which were wildly successful） indicate a willingness to do many questionable things as long as they are legal。 Posner also found among Sackler's papers an underlined notation in an report that read 'No drug is moral or immoral; that the exclusive monopoly of the consumer。" His descendants certainly did everything possible to make money from opioids。 The opioid crisis had its genesis in seeking to allow terminally ill patients to die with dignity and not in pain。 This led to the creation of pain management as a profession in the 1980s with Russell Portenoy publishing a dubious study in 1986 arguing that opioids， if taken according to prescription， are not addictive。 Then in in 1989 some researchers coined the idea of pseudo-addiction - all the symptoms of addiction， but something else。 Surprise！ Some of the researchers who coined the term were funded by the drug companies， like Sackler's Purdue。 It would not be until 2015 that rigorous analysis of the pseudo-addiction studies flagged major methodological problems proving that the entire concept was a sham。 One aspect of the opioid epidemic that is not clearly described in Pharma is the proportional role of larger pharmaceutical companies in the epidemic。 Other opioids， like Vioxx， Fentayl， and the Atiq Lollipop were available。 Posner wrote that Purdue only occupied 10% of the opioid market。 Considerable space is devoted to the greed of the Sacklers。 Busted in 2002 in Florida， Virginia in 2007， and 2018 by the feds， the Sacklers negotiated their way out; but they apparently did not adhere to the stipulations in their bargains; and even increased all of the activities that got them in trouble in the first place。 The Sackler companies were able to negotiate deals with their shell companies allowing other shells to continue their bad activities。 Their aggressive sales force was seemingly much more aggressive than big pharma salesmen - amounting to thousands of dollars in simple one-on-one visits with prescribing physicians。 They did not alert authorities to pill mills or drug diversions， even though the frequency increased。 They hushed sales staff who flagged pill mills。 All the while， the directors doubled down on rewarding sales staff for more and more sales。 When the feds filed charges in 2018， they made an offer to settle with bankruptcy threatening a smaller settlement。 In-between the stories on opioids and Arthur Sackler， were gems of knowledge on how Pharma rigs the system。 As far back as the 1950s， Congress observed that the US was the only advanced nation not regulating drug prices and drug patents。 In 1968 the FDA determined that nearly half of all drugs sold in the United States before 1942 were ineffective or possibly ineffective。 One industry insider testified that half of all drugs were useless。 Along the way， Pharma learned that they can pay the FDA for accelerated approval or priority preview。 Pharma encourages proscribing physicians to proscribe off-label （treating a symptom other than what the FDA approved the drug to treat）。 Lyrica， Rogaine， Viagra， and Botox all enjoyed phenomenal sales due to off-label sales。 The Orphan Drug Act （1983） gives Pharma major advantages。 The law was intended to encourage Pharma to develop drugs to treat diseases with 200，000 patients or less， the law provides great incentives to orphan drugs （ignoring the off-label possibilities）。 The feds offer $500，000 / year for 4 years; there is a 50% tax credit for R&D。 The remaining 50% can be written off as a business expense。 The drugs can be fast-tracked their FDA approval。 Posner summed it up by saying that the feds can pay 70% of the cost of bringing an orphan drug to market。 Posner illustrated the case of Truvada。 Developed in 2004 to slow the progression of AIDS， the manufacturer shared it with the CDC and academic researchers。 After several years and $50 million from the feds， a new version / delivery was developed that reduced infections。 It costs $6 to produce。 Pharma sells it for $1，600 - $2，000 / month - that is a 25，000% markup。 This pales in comparison to the outrage when Martin Shkreli， a hedge fund manager purchased the rights to Daraprim and raised the price 5，000%。 He went to prison for fraud on unrelated charges。 His company still charges the same price （$35，000/month， prior to Shkreli it sold for $608/month）。 Finally， there is a 7-year exclusive monopoly。 Pharma quickly abused the system by fragmenting populations to under 200，000 and using the slightest variations。 Each tweak resulted in an extended exclusive seven years。 Purdue has had 13 patent extensions giving it exclusive sales until 2030。 Throughout the book， the FDA usually appears to be the good guys。 Posner did find an example of a good Pharma - Merck donated the drug to developing countries to eradicate river blindness。 Yes， the FDA struggled against overwhelming odds to control and regulate Pharma and the advertisers like Arthur Sackler。 But they also are partly to blame。 The constant patent extensions， the orphan drug status， the pay to accelerate reviews， the fragmented diseases eligible for orphan status all fall to the FDA。 Posner did identify several agency employees who sold their services to Pharma。 It is unwritten， how many other employees hope to follow suit。 In 2001， the agency allowed Oxycontin to remove a warning label that said 'addiction is rare。' That subtle change radically boosted their sales。 Overall， this book is full of good information。 The three stories are fascinating。 The way they crisscross is distracting。 The vast amount of jargon makes it difficult to follow， much less remember。 Posner relies heavily on magazine stories。 His 200+ pages of endnotes demonstrate a reliance on these sources， although his preface declares he uses interviews， secret correspondence， and government documents。 I gathered a list of academic citations to consult for use in my classes to demonstrate topics like conflict of interest and weak methodologies。 I fondly remember Arthur Sackler violently shaking rats to simulate riding on a subway， so he could claim subways are bad for humans。 But， reader beware， the depths of this book will overwhelm you。 。。。more
Jayme
，
A great read， but a bit all over the place。 I’ll be interested to compare it to Empire of Pain。 Side note: I got this title from a Wired article （which also included Blood & Oil）。 I’ll definitely be paying attention to Wired book recommendations going forward。
Chase Thomas
，
I was expecting a book about the pharmaceutical industry。 And while the book is framed around big pharma， the obvious focus is on Purdue and the Sackler family。 Don’t get me wrong， this family and their contribution to the opioid crisis is unmistakable and one of the biggest tales of corruption and greed in the healthcare system， and their story is well-written， which is why I still give it four stars。 The stated subject versus the actual subject just felt like a bait and switch to me。
Dustless Walnut
，
The core of the book was somewhat interesting if not particularly groundbreaking-- an industry skirts the law and makes lots of money doing so。 Ultimately I feel like the author couldn't just fully commit on which book he wanted to write so he wrote one about the history of drug advertisement， one about commercial drug development， one about the Sackler family， one about the opioid epidemic， and then he jumbled them all together， tacked on a quickly written chapter on pandemics， and called it P The core of the book was somewhat interesting if not particularly groundbreaking-- an industry skirts the law and makes lots of money doing so。 Ultimately I feel like the author couldn't just fully commit on which book he wanted to write so he wrote one about the history of drug advertisement， one about commercial drug development， one about the Sackler family， one about the opioid epidemic， and then he jumbled them all together， tacked on a quickly written chapter on pandemics， and called it Pharma。It was very difficult to keep the myriad Sacklers apart in his narrative， with backwards and forwards time jumps happening rather quickly。 Rudy Giuliani makes a brief appearance。 The "vaccines cause autism" scandal dips in but is not explored in any depth。 I originally rated this 3/5 but as I wrote this review I dropped another in remembering how haphazardly assembled it is。 Why was there a big diversion into one of the original Sackler's Jewish faith？ It had literally nothing to do with the Pharma business。 I've seen ad copy for this book mentioning Sackler's "radical left wing politics" and I have to be honest-- the only evidence the author provides of that is that Sackler campaigned against segregated blood supplies in the US， and a brief mention of some McCarthyism/red scare stuff。 That's radical？ Several times in reading I stopped to look up Gerald Posner's history to see if he's considered a right wing author/journalist and it seems as though he's not considered to be。 Ultimately， there are portions of the book that show some aspects of the pharma industry to be just as self-serving and greedy as every other industry。 There was a brief section about actual poisoning （per the title） that was interesting but ultimately it felt like an investigators raw notes were published without editing。 。。。more
Cheryl
，
This is an incredibly eye-opening book。 The pharmaceutical industry develops some amazing drugs which help many people。 But it also acts as a legal drug pusher to keep people on drugs， some of which are dangerous and some are not very effective， as it earns billions of dollars in profits。 This book is about the history of the pharmaceutical industry and it’s not a pretty story。 From the development of antibiotics and antibiotic resistance， birth control pills， hormone replacement therapy after m This is an incredibly eye-opening book。 The pharmaceutical industry develops some amazing drugs which help many people。 But it also acts as a legal drug pusher to keep people on drugs， some of which are dangerous and some are not very effective， as it earns billions of dollars in profits。 This book is about the history of the pharmaceutical industry and it’s not a pretty story。 From the development of antibiotics and antibiotic resistance， birth control pills， hormone replacement therapy after menopause， the marketing of happy pills like Valium and Xanax， to the recent marketing of OxyContin which resulted in thousands of deaths by overdose， this book makes it very clear that the pharmaceutical industry needs to be reined in。 The book covers the period of time from about 1900 to 2020。 It is a fascinating read。 。。。more
Lucy
，
If the events of the past 15 months haven’t caused you to lose all faith in humanity， this book may just succeed in doing so。 I had to read it in small doses。 Sad passage: The prediction of a coming pandemic， unstoppable because the pharmaceutical industry has put profits over its duty to develop drugs for the public good， is no wild-eyed conspiracy theory heavy on drama and light on evidence。 “It is not a question of if，” warns Professor Bush， “it is a question of when。”
Daniel Middleton
，
Very good history
Arevik Heboyan
，
An incredibly insightful work on the trillion-dollar scheme and such an important and pivotal branch of science: pharmacology， especially its account in the United States， where it is exploited， corrupted， and morphed to a population control tool at its worst！ This is such an important topic， where unique scientific discoveries for the good of the human population are morphed into the unrecognizable tool of control， disgusting population manipulation tool。 The use of drugs and medicine is so muc An incredibly insightful work on the trillion-dollar scheme and such an important and pivotal branch of science: pharmacology， especially its account in the United States， where it is exploited， corrupted， and morphed to a population control tool at its worst！ This is such an important topic， where unique scientific discoveries for the good of the human population are morphed into the unrecognizable tool of control， disgusting population manipulation tool。 The use of drugs and medicine is so much included and considered normal， that people without thinking take pills， on top of pills， to minimize the negative of another pill and so on in an unending cycle。。。Governments are informal beneficiaries of populations hooked on drugs， both financially and more psychologically and mentally。。。 Do yourself a favor， read the book and afterward decide for yourself whether such a scheme-like use of medicine， its exploitation， and corruption is acceptable for you and your family and how to recognize when it is really needed and when it is used simply against us。 。。。more
Elizabeth Gayton
，
Really eye-opening look at our prescription medicine system， how it's developed， and how incestuous it all is！！ Listened to it on CD。 Really eye-opening look at our prescription medicine system， how it's developed， and how incestuous it all is！！ Listened to it on CD。 。。。more
Kathryn in FL
，
I resoundingly endorse this historical account of the pharmaceutical industry。 Posner is extremely factual and connects dots few have provided in the past exposes。 Since he is a lawyer， he is careful to present only the facts being careful not overstate the issues or conflicts of interest - and woo hoo there are many conflicts of interest！ This is one of the most thorough accounts of the pharmaceutical industry history that I've heard or read。 I have no doubt that I know more than most medical p I resoundingly endorse this historical account of the pharmaceutical industry。 Posner is extremely factual and connects dots few have provided in the past exposes。 Since he is a lawyer， he is careful to present only the facts being careful not overstate the issues or conflicts of interest - and woo hoo there are many conflicts of interest！ This is one of the most thorough accounts of the pharmaceutical industry history that I've heard or read。 I have no doubt that I know more than most medical professionals in this area of concern。 I am not bragging or trying to elevate my position！ I say this to highlight my grave concern at how little consideration many medical personnel demonstrate， when I queried them about side effects， other drug interactions， effectiveness， etc。 For example， when one drug caused me to lactate， my prescribing doctor didn't realize it was a side effect of my antidepressant。 I did the research and immediately discontinued。 Upon advising the doctor of what happened， he laughed。 That was my last appointment with this careless "professional"。 Additionally， I've done some significant research into this field including turning down a lucrative job as a pharma rep one year out of college （an usual event）。 After doing my senior paper on the industry with a focus on Pfizer， I got the highest grade provided by that professor for that term （he even told me he rarely assigned A's）。 This got my foot in the door with several different companies and when I fully understood that rewards for the doctors and myself for writing prescriptions， I turned the offer down because I knew my conscience could not operate in the realm of putting profits before people to benefit the doctors， pharmacy's and the manufacturer。 In that vain， I always do due diligence on anything prescribed for myself or others and I urge you to do the same。 I believe if I hadn't， I would have been seriously damaged by more than one drug and possibly dead （several among these were removed from sale and at least four had class action suits due to death）。 Consider this， pharmaceutical companies are among the most profitable in the United States， they have many lobbyist on their payroll。 The CEO's are some of the most well paid in the medical sector （which is one of the most successful across all industries）。 There are a large number of Congress people， who are very friendly toward these companies write and pass legislation that is highly favorable to their activities including the banning of competing of similar drugs for a specific illness。 These Congress people are rewarding handsomely via free trips， "speaker fees" to attend pharma's conferences， dinners at resorts。 It isn't just congress that benefits。 Many people， who regulate the industry have previously been top executives from the pharm companies。 There have been some notiable changes once they regulate the industry that they worked for， additionally other people are married to a pharma executive or otherwise related。 Doctors are also involved in the act。One doctor told me of his trip on a riverboat cruise along the Potomac River with free eats and drinks。 His joy was resounding as he told me how he and his buddies were allowed to order as many drinks as they wanted and how a high ranking chef prepared exquisite food for them。 This man with a PhD was telling me how nice his pharm rep was to do this， I sat thinking how much I pay for drugs （after my drug plan covers some of the cost） to the tune of $800。 a month。 All I could think of is while I live on noodles to pay for these meds， he was thinking the drug company paid for that "free" five day conference！ Supposedly， pharma isn't allowed to provide lunch for the entire staff at a doctor's office or other gifts but I've personally observed that this legislation passed several years ago is being ignored as I've seen huge lunches being delivered after the law was passed。 So， there truly is a "free lunch" for certain people。 Oh and did you know that doctors get rewarded by some companies for writing that brand name prescription？Certainly those covering respiratory know this first hand， as no Medicare drug plan unless it is an HMO or PPO， offers coverage for most respiratory inhalers。 This has been the case since 2006 when Plan D went into effect。 So， all those who desire to breathe and under the "straight" Medicare get to pay $300/mn just to breathe。 Now I don't know about you but covering erectile dysfunction drugs while ignoring breathing medications seems very at odds to me。Very recently I heard that less than 5% of all drug side effects are ever reported！ That means doctors and pharmacies are dropping the ball 95% of the time！ Still think that those profiting have your best interest at heart？ "Drug makers typically file the vast majority of reports of a serious or fatal outcome to the FDA。" In the same article， "The analysis found that in 2014， the FDA received 528，192 new reports of a serious or fatal side effect， of which 4。7 percent were filed with the agency directly by doctors and consumers。" See the complete article here https://www。statnews。com/pharmalot/20。。。Consider this， even some class action awards are paid to the states to allocate as the state desires， rather than the individuals harmed by these chemicals。 Additionally， the number of years， that a patent for a new drug to have no competition from other companies has been extended to 20（twenty！） years here in the U。S。 according to the FDA website， it used to be much lower。 Compare that to the European Union at 5 years。Frankly， anyone who requires drug intervention would do well to educate themselves to the operation of the drug industry and how their interests may override the safety of a pill or injection presented to the individual as positive benefit to what ails them。 In light of the current pandemic， I highly encourage people to use this information before they roll up their sleeve to "protect" themselves。 As for me， I've done enough research and I will not be participate in being jabbed especially because of what I know and what I've seen， never has our military knocked on our front doors to our benefit since Bostonians were warned that "The British are coming"， something to ponder。 。。。more
Melinda
，
Wow - a great read。 So much history， so many stories， so much bak room intrigue。 Makes you really thing about how well Big Pharma has protected itself and how much good work they are really doing for the average person。 Probably worth a re-read to absorb more facts。 There was a lot to take in。
Anthony
，
A look at a multi generational family that became the biggest crime family who built their empire through the business of legal drug manufacturing， and selling its biggest money making drug， OxyContin， as a pain medication， but kept hidden the truth that is was addicting， habit forming and an indiscriminating killer。 An eye opening revelation of what led to this issue and why it was ignored until it became an epidemic throughout America is covered in the chapters of this book。
Nienke
，
Who needs thrillers and spy novels when you can read Pharma。 A page turning investigation into the origin of American pharmaceutical business with a specific focus on the despicable business practices of the Sackler family， Pharma was - albeit often shocking - a super interesting read。 Amazing how the author - and his wife！ - manage to include all the research while still keeping the pace of the book; not a stifling account of facts and figures at all。 On the contrary， especially the description Who needs thrillers and spy novels when you can read Pharma。 A page turning investigation into the origin of American pharmaceutical business with a specific focus on the despicable business practices of the Sackler family， Pharma was - albeit often shocking - a super interesting read。 Amazing how the author - and his wife！ - manage to include all the research while still keeping the pace of the book; not a stifling account of facts and figures at all。 On the contrary， especially the descriptions of Arthur Sackler show a real man of flesh and blood and highly questionable ethics。Working in pharma myself I was in shock on how this business started in the US and am happy it has evolved and that other cultures lead to other ways of doing business。Good to read to remind myself on what the purpose should be and to ensure all who work on pharma stay focused in what matters; adding value to patients lives。 Mandatory read when starting in any role in pharma。 。。。more
Kirsten
，
While it meanders at times and spends more time than I wanted on one particular family/pharmaceutical company， the focused sections are outstanding。。。and alarming。
Laura Nolte
，
This is a gripping book covering the history of the pharmaceutical industry， the history of the FDA， the life and works of Arthur Sackler， and the sordid creation and protection of OxyContin。 I had a hard time putting it down。 Yet the ever-shifting focus made it something of an exhausting read at the same time。Some other reviewers said they didn’t care to hear so much detail about Sackler’s family and personal life。 I was happy to read about it， but then it began to feel like a biography， and th This is a gripping book covering the history of the pharmaceutical industry， the history of the FDA， the life and works of Arthur Sackler， and the sordid creation and protection of OxyContin。 I had a hard time putting it down。 Yet the ever-shifting focus made it something of an exhausting read at the same time。Some other reviewers said they didn’t care to hear so much detail about Sackler’s family and personal life。 I was happy to read about it， but then it began to feel like a biography， and then suddenly the scope would broaden back out to the new developments at the FDA， and it felt like I was reading a different book。 Also jarring were quite a few typos and even some grammatically questionable phrases （“abusive use of power”）。 Just from the standpoint of style and cohesiveness， I found myself thinking a few times， “it’s too bad Michael Lewis didn’t write this book。”Yet it was a fascinating story， and I learned a great deal from this book。 With a little more focus and flair， I’d have given it five stars。 。。。more
Sherrie
，
DISCLAIMER: I recently retired after 40 years of practicing pharmacy in both the hospital and the retail areas。2。5 starsNo one who read the title should be expecting an unbiased look at the world of pharmacology， and Posner come through。 Let me be clear--the industry deserves almost all of what's coming their way， and I shed no tears for them。 But this book is another in a long line of hit jobs， because that's fashionable right now。 "Pharma" is purportedly the history of pharmacy， and the best c DISCLAIMER: I recently retired after 40 years of practicing pharmacy in both the hospital and the retail areas。2。5 starsNo one who read the title should be expecting an unbiased look at the world of pharmacology， and Posner come through。 Let me be clear--the industry deserves almost all of what's coming their way， and I shed no tears for them。 But this book is another in a long line of hit jobs， because that's fashionable right now。 "Pharma" is purportedly the history of pharmacy， and the best chapters in the book are exactly that。 （Penicillin， the rise of the biotech industry， and a couple of others）。 Probably not coincidentally， these are the chapters in the book that don't mention the Sackler family。 Anyone from outside the field reading this would assume the Sacklers were the Devil Incarnate， and were connected with or caused every single bad thing that ever happened in pharmacy。 The Sacklers have--rightfully--earned a great deal of contempt because of the ways that they marketed and sold OxyContin。 And there's no question that they've affected the ways drugs are sold and advertised。 But almost half of this book concerns them and the various Purdue companies they own， which is ridiculous， not to mention that a lot of THAT involves the Sackler art collection， their wives， their wills， etc。， which really has nothing to do with the history of pharmacy， and everything to do with making the Sacklers look bad （which is pretty easy to do）。"Pharma" is a collection of chapters on various subjects， and a lot of important things get shorted because of the Sackler fixation。 The growing antibiotic resistance problem gets 4 pages。 HIV/AIDS and the blood supply get 10。 Etc。 Posner also has a habit of selectively presenting facts and opinions that support his case。 One that jumped out at me was on page 416， concerning （surprise） the marketing of OxyContin。 "This era introduced what old-timers disparaged as Pharma Ken and。。。Barbie， attractive young reps whose pharmaceutical know-how was not as important as their ability to sell。" I laughed out loud when I read this。 It's certainly true。 What the "old-timers" are forgetting is that they were hired FOR EXACTLY THE SAME REASON （And going back a few more years， their ability to be good old boys who liked to back-slap and carouse）。 In Posner's case， it's more like willfully ignoring。If you wish to read a better book on the pharmaceutical industry or the Sacklers， there are some out there， although most of the ones on pharmacy suffer from the same flaws as this one。 The pharmaceutical industry is a very easy punching bad， and again， I emphasize that I have little sympathy。 But just once in my life， I'd like to read an unbiased and un-sensationalized book about it。 。。。more
Antonio Nunez
，
Posner’s book is ambitious， and these ambitions are achieved。 He tells the story of pharmaceutical companies in the US from the days of patent medicines and snake oil traveling salesmen to current biotechnology。 Because this story is so big， he uses the story of the Sackler family who， Zelig-like， managed to embody all the key shifts from a scientist-driven public good concern （the antibiotic revolution）， to a business driven by marketers （anxiety medications from the 1960s） and by the manipulat Posner’s book is ambitious， and these ambitions are achieved。 He tells the story of pharmaceutical companies in the US from the days of patent medicines and snake oil traveling salesmen to current biotechnology。 Because this story is so big， he uses the story of the Sackler family who， Zelig-like， managed to embody all the key shifts from a scientist-driven public good concern （the antibiotic revolution）， to a business driven by marketers （anxiety medications from the 1960s） and by the manipulation of intellectual property to perpetuate monopoly patent advantages without any return to the public （the orphan drug mishandling， starting during the AIDS crisis）， to “lifestyle drugs” meant to address the consequences of unhealthy living （diabetes， hypertension， obesity， coronary disease， collectively known as metabolic syndrome）， and finally to the heartless peddling of addictive opiates that collectively have decimated Appalachia and singlehanded brought down life expectancy in what Nobel economist Angus Deaton has called deaths of despair （the OxyContin debacle， which is ongoing）。 These trends were exemplified in the lives of the brilliant Sackler brothers （notably Arthur， who seems to have invented nearly all ghastly marketing trends in pharma marketing） and their offspring。 If none of them go to jail or at the very least end up bankrupt， the world is a very unfair place。 The failure of regulation and supervision in this industry， as well as its links with other industries （like intensive ranching which depends on feeding livestock huge amounts of antibiotics， so they don’t die prematurely from overcrowding and mistreatment， thus driving the proliferation of antibiotic resistant superbugs that one day could do all of us in） shows the rot at the core of the economic system。 Or perhaps this is a universal feature， a consequence of inescapable entropy， one that is more visible in the US because there everything is bigger。 The book makes clear that patients and ordinary people can’t really trust drug manufacturers （whose concern is not to improve the lives of patients through drugs that save or improve lives but to line the pockets of management， sales personnel and investors）， medical reviews （which are often influenced by publicity and hidden “sweeteners” from big pharma- often they are just knavish when they publish unsubstantiated “research”， like the Lancet did in an infamous 1998 paper that argued that vaccination caused autism）， authorities （who often are unable to address big pharma abuses due to understaffing- across the board budget cuts by successive administration after Reagan’s appear demented， like cutting one’s budget for gasoline prior to a cross-country journey-， or because they are in hock to big pharma， which has a revolving door for officials that leave public service） or doctors （many of whom have been influenced to prescribe particular drugs and brands by receiving gifts and sometimes money from pharma companies）。 Some big pharma companies have infringed judicial rulings when complying would have hurt their bottom line。 Others have continued to sell abroad drugs that were forbidden in their home markets （Talidomide- never approved in the US- continued to be sold by its European manufacturer in the third world much after it was proven that it produced birth defects when used by expectant mothers）。 All- or so it seems- thrive on price discrimination and sophisticated marketing designed to wring out down to the last penny of consumer surplus。 Their business is not to produce drugs that cure people of something， but drugs that will be part of a treatment， that hopefully will last to the end of the patient’s life。 For these drugs doctors are part of the sales structure and need to be kept on board。 Drug companies （as exemplified by the Sackler firms） thrive on opaque corporate structures where off-shore special purpose vehicles are dominant for tax optimization and protection from corporate liability and criminal prosecution。 Some companies specialize in buying smaller companies， shutting down their research pipelines and raising prices on orphan drugs without competing generics， sometimes 10- or 100-fold。 Such market power abuse should not be tolerated。 We all know investors in pharma ought to be remunerated in proportion to the risk they run， or else there would not exist research for new drugs。 But this book shows that some companies make money mainly by manipulating current patents to make then pay ever more returns， even if no incremental therapeutic value exists。It is amazing that in the US the government is not allowed to negotiate the price of the drugs it buys。 This， in a context of continually expanding intellectual property protection， is a system apparently designed to enhance already substantial monopoly pricing powers of patent holders。 This explains how price drugs in the US are usually the highest， and how the largest cost component of medical spending in that country are the drugs。 The system is broken， several administrations， including the outgoing Trump one， have tried to fix it， so far without any luck。 But this book is a useful resource to understand the system and protect oneself as much as possible。 。。。more
Trish
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This book is mostly about the opioid pandemic， which is not the only type of drug pharmaceutical companies produce。 There are hundreds of thousands drugs presently approved by the FDA。 It's an interesting read on the opioid problem， but you can't paint all drugs with the same brush。 A big part of the book is about the minutiae of Arthur Sackler's life and lifestyle。 Rich people behaving badly is hardly news， but I guess it makes for titillating filler。There's a reason why the cost of pharmaceuti This book is mostly about the opioid pandemic， which is not the only type of drug pharmaceutical companies produce。 There are hundreds of thousands drugs presently approved by the FDA。 It's an interesting read on the opioid problem， but you can't paint all drugs with the same brush。 A big part of the book is about the minutiae of Arthur Sackler's life and lifestyle。 Rich people behaving badly is hardly news， but I guess it makes for titillating filler。There's a reason why the cost of pharmaceutical drugs and healthcare in general is presently a hot topic。 Boomers have finally aged into needing them regularly。 Well， Boomers， you had decades of political influence you could have used to fix this， （the Clinton presidency's health care reform attempt comes to mind） but you didn't care about healthcare and its costs because it wasn't "your problem"。 Now you need to recruit Millennials and younger people to change healthcare， but they don't care because it's not "their problem"！ They learned this attitude from YOU。 How ironic is that？ I don't believe there's any way to "fix it" because the US isn't going to destroy patent protections for anyone。 。。。more
Amy （literatiloves）
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This is an excellent history of the Pharma industry。。。 will gather my thoughts and write some thoughts on it soon。
Nancy Lilly
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Very interesting and extremely well researched。 I look forward to more from this author！
Emily Borst
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very informative and， as evidenced by the 200-page bibliography， very well-researched。 however， as others have said， this book couuld have used some editorial help。 at times it felt like multiple books combined into one （a bio of arthur sackler， a history of the opioid epidemic， a history of the overall pharmaceutical industry， and a primer about the weird facets of the system （such as the misplaced chapter about PBMs））。 ultimately i learned a lot from this and probably could have finished it fa very informative and， as evidenced by the 200-page bibliography， very well-researched。 however， as others have said， this book couuld have used some editorial help。 at times it felt like multiple books combined into one （a bio of arthur sackler， a history of the opioid epidemic， a history of the overall pharmaceutical industry， and a primer about the weird facets of the system （such as the misplaced chapter about PBMs））。 ultimately i learned a lot from this and probably could have finished it faster if i didnt need to take a break because several of the chapters were so infuriating。 。。。more
Scott Mcauley
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This could have been interesting， it was just written with too many facts and was too dry。
Emma Z
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Took a long time to finish。 It was a very interesting non-fiction read but I found it to be too bogged down with unimportant details。 I really could care less about Arthur Sackler’s extra marital affairs and his vast art collection。 It was interesting to see the dawn of big pharma in America。 It’s crazy to me how the FDA only began regulating drugs recently; drugs used to be sold with false advertising and little to none tests on its effectiveness or harms。 It’s also crazy how much big pharma is Took a long time to finish。 It was a very interesting non-fiction read but I found it to be too bogged down with unimportant details。 I really could care less about Arthur Sackler’s extra marital affairs and his vast art collection。 It was interesting to see the dawn of big pharma in America。 It’s crazy to me how the FDA only began regulating drugs recently; drugs used to be sold with false advertising and little to none tests on its effectiveness or harms。 It’s also crazy how much big pharma is still a problem today， claiming outrageous profits by taking advantage of the well meaning Orphan Drug Act。 :（ Anyway， I would have rather had this book focus on those important pillars instead of the life of Arthur Sackler。 It’s fine for even a chapter to give context but it felt like half of the book 。。。 。。。more
George Yang
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mind-blowing insight into modern pharma industry development， particularly the story of the sacklers family， which is still unfolding in 2020。 it may be never easy to strike thr perfect balance between public health and profit making in the thriving industry but one lesson we can surely learn from is nothing is 100% safe and risk-free
Caleb
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I feel a new low for Rudy Giuliani after reading this book。 I had no idea he was getting paid from both sides！！！ The Sackler family will never ring the bells of dignity it once did and I’m glad Tufts made the honorable decision。 The citizens must hold elected officials accountable and not stand by idle while the pharmaceutical lures regulators with lucrative job offers that are obvious quid pro quo arrangements。 Let’s hold pharmaceutical companies accountable “prescription” drug peddlers。
Ginger Young
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I was so appalled at what really happens behind the scenes of drug creation and manufacturing！
Hannah
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a long but incredibly interesting read
Lynn
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A huge overview of pharmaceutical companies from the 19th century when Bayer and the Sackett family who made aspirin and other drugs。 Many didn’t really cure people and are like dietary supplements are today。 Three were increasing concerns with opioids and cocaine and demands to control addictive substances。 Food quality was also a concern so the FDA was created。 With penicillin after WWII in which the government needed help making the drug， the modern drug industry was born。 A need for broader A huge overview of pharmaceutical companies from the 19th century when Bayer and the Sackett family who made aspirin and other drugs。 Many didn’t really cure people and are like dietary supplements are today。 Three were increasing concerns with opioids and cocaine and demands to control addictive substances。 Food quality was also a concern so the FDA was created。 With penicillin after WWII in which the government needed help making the drug， the modern drug industry was born。 A need for broader antibiotics and other drugs grew。 Vaccines， birth control， cancer， Ebola AIDS and finally OxyContin are covered。 A problem with the companies and government has always been a balance in the roles each should play has always been a concern。 A current problem is promoting drugs and hiding problems。 Another is the huge profits they’re making and the costs to government and consumers。 。。。more
Elizabeth Chadsey
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