Pharma

February 1, 2020
Of nightmare germs, sleazy dealings, and the big money that fuels the (legal) drug trade. Investigative journalist Posner writes that big pharma "resides at the intersection of public health and free enterprise," sometimes capable of lifesaving acts but often an agent of unbridled greed. The industry emerged in the 19th century with the need to care for wounded soldiers and new strains of epidemic diseases such as yellow fever and cholera. In the early days, firms had a lock on certain broadly applied medicaments--morphine, in the case of Pfizer. A century later, when physician Arthur Sackler came onboard, Pfizer had just a handful of salespeople; Sackler forged an army of thousands of them, fanning out to sell drugs he had developed, such as Valium, to a waiting audience. In time, Sackler came under federal scrutiny, a bête noire of crusading Sen. Estes Kefauver, who "was bothered by an industry where only a few firms dominated sales and had unfettered discretion to set prices." Moving on to the family-owned Purdue Pharma, Sackler and kin refined techniques of secrecy and underreporting. As Posner notes, it was a firing offense for a salesperson to make notes on visits to doctors in writing, and what went on behind closed doors were all sorts of spoken inducements and rewards for prescribing and overprescribing the firm's products, including OxyContin. Even in Kefauver's time, the U.S. pharmaceutical industry was making many multiples more profit than other sectors of the economy, charging far more to American consumers and insurers than to those in other parts of the world. This was true of the AIDS-battling AZT, "the highest priced drug on the planet." This remains true today, even as Purdue, heavily fined for its role in an epidemic of opioid-overdose deaths, tiptoes into bankruptcy, one ploy in the "complex corporate chess game in which Arthur Sackler excelled." A shocking, rousing condemnation of an industry clearly in need of better policing.

COPYRIGHT(2020) Kirkus Reviews, ALL RIGHTS RESERVED.

March 16, 2020
Journalist Posner (God’s Bankers) chronicles the historical abuses of the American pharmaceutical industry in this sprawling jeremiad. Beginning in the mid-19th century, when the Mexican-American and Civil Wars caused “an unprecedented surge for antiseptics and painkillers,” Posner explains how the addictive nature of opiate-based remedies and lack of government oversight benefitted pharmaceutical pioneers. The race to develop and manufacture penicillin during WWII and the granting of the first antibiotic patent in 1948 launched an era of “wonder drugs” that produced huge profits and drove changes in the way drugs were sold and marketed. Posner places Arthur Sackler, a psychiatrist and medical advertising executive, at the forefront of those developments, documenting his contributions to the groundbreaking rollout of Pfizer’s Terramycin antibiotic in 1951; his purchase of drugmaker Purdue Frederick Company; and his tangles with the FBI (for alleged links to Soviet spies) and Congress (for deceptive advertising practices) in the 1960s. Under the leadership of Arthur’s nephew, Richard Sackler, Purdue developed and aggressively promoted the painkiller OxyContin in the 1990s, and its rampant overprescription, high dosage recommendations, and easily bypassed “extended release shell” significantly contributed to the opioid crisis. Posner’s research impresses, but the blizzard of details often proves more disorienting than enlightening. This door stopper yields damning revelations but would benefit from a sharper focus.

April 1, 2020

Investigative journalist Posner (Hitler's Children) employs extensive, meticulous research in this exploration of the U.S. pharmaceutical industry, tracing its evolution from 19th century nostrums to 21st century billion-dollar drugs. Through it all, he notes the tension between the desire to help humanity and the greed that casts a shadow over the industry. The push to develop antibiotics with the onset of World War II marked the beginnings of the modern industry. After the war, companies focused on searching for new drugs and extending patents on existing ones by making small changes in their composition. Posner also describes the rise of orphan drugs, which are used to treat rare medical conditions, and how they allowed companies to squeeze new money out of drugs previously considered unprofitable. Telling the story of generics, direct-to-consumer advertising, swine flu, Ebola, HIV/AIDS, ineffective government oversight, and the current opioid epidemic, Posner leaves no stone unturned. Threaded through this history of modern pharmaceuticals is the story of the Sackler family of Purdue Pharma fame. Posner uses one family's unscrupulous greed as symbolic of the corruption in big pharma. VERDICT A lengthy, yet fast-paced read that should interest anyone who is watching the rising cost of medicine with dismay.--Caren Nichter, Univ. of Tennessee at Martin

Copyright 2020 Library Journal, LLC Used with permission.

Starred review from February 15, 2020
A more apt subtitle might be Everything anyone wanted to know about the drug industry but was afraid to ask. Emphasis on the afraid. Fraud, incompetence, conspiracy, avarice: it's all here, and to read best-selling, award-winning Posner's (God's Bankers, 2015) encyclopedic expos� of the pharmaceutical industry and the government's role in its development and regulation is to peer into a Pandora's box of malfeasance, perfidy, and corruption. Explosively, even addictively, readable, Posner's meticulously documented investigation of the historical roots and contemporary state of Big Pharma examines everything from aspirin to Zantac, beginning with the naive use of heroin and cocaine in the 1800s and moving into the opioid epidemic of the 2000s, as government regulatory involvement waxed and waned while the pharmaceutical industry morphed into a monolith that emphasized investor wealth over patient health. Making Posner's corporate history even more topical is its through line following the notoriously headline-grabbing Sackler family as they created and manipulated a medical juggernaut that revolutionized the way pharmaceuticals are developed, manufactured, and marketed. Their role in the current drug catastrophe is unmistakable and byzantine. As this and other drug-related stories continue to dominate the news, who better than a determined and prolific investigative journalist to provide the context necessary to understand and correct the crisis.(Reprinted with permission of Booklist, copyright 2020, American Library Association.)

February 1, 2020
Of nightmare germs, sleazy dealings, and the big money that fuels the (legal) drug trade. Investigative journalist Posner writes that big pharma "resides at the intersection of public health and free enterprise," sometimes capable of lifesaving acts but often an agent of unbridled greed. The industry emerged in the 19th century with the need to care for wounded soldiers and new strains of epidemic diseases such as yellow fever and cholera. In the early days, firms had a lock on certain broadly applied medicaments--morphine, in the case of Pfizer. A century later, when physician Arthur Sackler came onboard, Pfizer had just a handful of salespeople; Sackler forged an army of thousands of them, fanning out to sell drugs he had developed, such as Valium, to a waiting audience. In time, Sackler came under federal scrutiny, a b�te noire of crusading Sen. Estes Kefauver, who "was bothered by an industry where only a few firms dominated sales and had unfettered discretion to set prices." Moving on to the family-owned Purdue Pharma, Sackler and kin refined techniques of secrecy and underreporting. As Posner notes, it was a firing offense for a salesperson to make notes on visits to doctors in writing, and what went on behind closed doors were all sorts of spoken inducements and rewards for prescribing and overprescribing the firm's products, including OxyContin. Even in Kefauver's time, the U.S. pharmaceutical industry was making many multiples more profit than other sectors of the economy, charging far more to American consumers and insurers than to those in other parts of the world. This was true of the AIDS-battling AZT, "the highest priced drug on the planet." This remains true today, even as Purdue, heavily fined for its role in an epidemic of opioid-overdose deaths, tiptoes into bankruptcy, one ploy in the "complex corporate chess game in which Arthur Sackler excelled." A shocking, rousing condemnation of an industry clearly in need of better policing.

COPYRIGHT(2020) Kirkus Reviews, ALL RIGHTS RESERVED.