Empire of Pain: The secret history of the Sackler dynasty by 1. Do you see this narrative as a 'Rise and Fall' story of the Sackler family? Can you identify a specific point in the book’s timeline that the Sackler organization put profit over harm to patients and society?
2. A common refrain in the book is pain. Do you think there is a pain epidemic?
3. The book talks about very strong drugs. Some would say that the problem wasn’t the medications - they are effective - but the fact that they were used ‘off label’ or otherwise abused. What do you think about the strategy of convincing the medical community that the drugs could be used long term and without addiction?
4. Do you think that medical advertising would even be an industry if Sackler hadn’t invented it? It started with advertising, creating medical journals, but eventually led to an army of drug representatives paying doctors to promote their drugs. Do you think these dynamics have been too aggressive? Do they provide any benefits to the healthcare community and consumers?
5. One group that seemed to be consistently overlooked in the book is the patients. It seemed like no one was looking out for the patients - not the doctors, the pharmaceutical reps, the government, or the community. Also, there is a legacy of viewing addiction as a moral failing. Do you see progress in understanding addiction as a medical condition?
6. In the book, the author uses the phrase ‘philanthropy isn’t charity.’ This refers to the great sums that the Sacklers donated over time. How do you feel about organizations – such as museums and universities – that have accepted donations from the Sacklers?
7. It seems like there is a lot of blame to go around for the opioid crisis. Should the owners who pushed for more use and more money be the primary targets? What about the drug representatives - the army on the street - and relevant government agencies?
8. Accountability is at the root of this story. What do you think should be the consequences for those who should be held accountable? Can we ever know the costs to society of the opioid crisis?
