Empire of Pain

 Empire of Pain: The Secret History of the Sackler Dynasty

Patrick Radden Keefe (2021, Doubleday)

    Isaac and Sophie Sackler, hard-working eastern European immigrants to Brooklyn, achieved a version of the American dream: they had three sons who grew up to be doctors. Arthur, Mortimer, and Raymond would also leave lasting marks on the pharmaceutical industry, and, through their extravagant philanthropy, on museums and educational institutions across the world. There is, however, a movement afoot to take their names off of some of those edifices, because their name has finally been associated with the dangerous drugs they sold, to the detriment of millions.

  The eldest Sackler brother, Arthur, had a truly remarkable degree of entrepreneurial energy. Even in high school, he edited publications and hustled for advertising sales, delivered flowers, and had a paper route; when his plate was full, he enlisted his brothers to step into his old jobs. One of his most profitable sidelines, by the time he got to medical school, was copywriting for a drug company. In 1942, he joined the William Douglas McAdams agency, which specialized in pharmaceutical advertising; within five years, he bought the founder out, and was running the show. His clients were among the first to send out dozens, then hundreds, of sales reps, bringing free lunches and official-looking medical literature into doctors' offices, in the interest of persuading them to prescribe a particular drug by brand name.

   Always in search of synergy, Arthur also started a weekly newspaper called the Medical Tribune. "The whole purpose was to reach physicians and to influence them ('educate' them, Arthur would insist), so the Medical Tribune was subsidized by pharma ads and distributed for free." In his capacity as advertising guru for companies like Pfizer (Terramycin) and Hoffman-La Roche (Librium and Valium), he was his own best customer. He was also a secret partner in an ostensibly competitive ad agency, run by a friend who had once worked for him; it was a simpler way to handle competing products without a visible conflict of interest. And he bought a small drug company, Purdue Frederick, naming his brothers as equal partners.

    He needed Mortimer and Raymond to run that business as his own interest strayed into collecting Asian art, becoming a large force in the market; he had a special arrangement with the Metropolitan Museum to store as well as to display parts of his collection, and he gave them a wing to put an Egyptian temple in. Meanwhile, Purdue plodded along selling Betadine antiseptic and Senakot laxative. It was considered a minor part of Arthur's estate when he died in 1987, and his heirs were happy to sell their share to the younger brothers.

    By then Mortimer's daughter Kathe and Raymond's son Richard had found places in the company, and were moving it into the pain relief business. An English subsidiary had invented a way to coat tablets so that morphine could be dispensed by mouth, because the coating released the drug over time. Purdue released MS Contin in the United States, and it did very well, but it still had the scary reputation of morphine, considered a last resort drug. Richard Sackler pushed the R&D department for a new formulation that could both renew the patent exclusivity of the Contin coating, and gain acceptance for the wider world of pain sufferers. OxyContin was the time-release form of oxycodone, a chemical cousin of morphine and heroin, and it met those criteria very well. Though stronger than morphine, it was perceived as an ordinary painkiller, familiar from Percocet and Percodan pills. OxyContin came in much larger doses, however, marketed to last twelve hours.

   Real life was not so tidy. In many patients, the pills wore off in eight or ten hours; and the protective coating could be readily defeated by cutting or crushing the pills, leading to an immediate rush. In either case, withdrawal symptoms were miserable, and constantly on the verge of returning. An epidemic was born, as the Sacklers could very well have seen from their own sales figures, had they been willing to. As with Arthur Sackler and Valium, they tended to blame addicts for some character flaw, rather than considering the drugs themselves addictive. They probably didn't see themselves as addicted to the billions in profits, either.

   Patrick Radden Keefe has done a beautiful job of telling this harrowing story. He's got citations for every detail and anecdote, and they're stitched together very naturally. A friend I mentioned it to said the book sounded depressing, and I couldn't quite explain why it isn't. Maddening, maybe, and horrifying, but the misery of the victims is not the focus of the story. No, this book is about the shamelessness of the Sacklers: "They could produce a rehearsed simulacrum of human empathy, but they seemed incapable of comprehending their own role in the story, and impervious to any genuine moral epiphany." Lord have mercy.

 

 

Any Good Books, February 2022 by emair 2/1/22

 

Behind the Magic Curtain

Behind the Magic Curtain: Secrets, Spies, and Unsung White Allies of Birmingham's Civil Rights Days

T. K. Thorne (NewSouth Books, 2021)

There was no chance I wouldn't want to read Behind the Magic Curtain: Birmingham's history has always held a fascination for me, particularly the story of the years when I lived there but was too young to follow the world-changing events. In addition to familiar mayors, bishops, and department store owners, the book is full of people I knew growing up there, including friends of my parents or the parents of my friends.

I'm sorry I can't report better of it as a reading experience. It's clearly the product of extensive research, but the notes and quotes don't necessarily add up to a satisfying narrative, any more than a stack of boards make a house. There may actually be too many characters, some of whom are brought in for a single anecdote, then forgotten. Given that, a better final editorial pass would have been a big improvement, as would a more sedulous indexing job. (How do you quote Bear Bryant in the text, and omit him in the index?)

There is a central character, however, and I didn't know about him before. Tom Lankford was the police beat reporter for the Birmingham News, reporting to Vincent Townsend, Sr., the general manager and assistant to the publisher. Townsend assigned Lankford, just a couple of years out of journalism school, to shadow Eugene "Bull" Connor and the Birmingham Police Department. This put him in a position to exchange favors with City Hall staff and police officers at all levels, and T. K. Thorne is not loath to admit that some of what he did fell outside the bounds of journalistic ethics. His first loyalty was to Townsend, but information flowed in nonstandard ways; he used hidden microphones and taping systems to find out about both the Ku Klux Klan and the civil rights leaders, often to the benefit of the police or Bull Connor. Lankford was on the spot when the Freedom Riders arrived at Birmingham's Trailways bus station, avoiding a Klan beating only because one of their number (who was an FBI spy, to boot) recognized him as "Bull's boy."

The whole story features strange bedfellows, and people who could have been allies but weren't. On the Black side, the Reverend Fred Shuttlesworth had lawsuits and protests going before Martin Luther King ever came to town, only to have King getting the lion's share of attention in 1963. Thorne reprints the Birmingham Ministers' Letters of January and April of 1963, to which King's Letter from the Birmingham Jail was a response; she assumes the reader knows or can look up King's letter. In the climate of violence caused by White supremacists, the pastors, bishops, and one rabbi were offering utterly insufficient solutions for their Black neighbors: "When rights are consistently denied, a cause should be pressed in the courts and in negotiations among local leaders, and not in the streets." Even this was enough to stir up protests from their white parishioners, and they were utterly wounded when King said he needed much more, much sooner.

The other development in the spring of 1963 was an electoral impasse. The preceding November, voters had narrowly endorsed a change of governance from a system with three commissioners – Bull Connor was one of these – to a mayor and city council system. The mayoral election of March fifth resulted in a runoff between Bull Connor and Albert Boutwell; on April second, Connor lost, and refused to accept the results. The next day, Black students from Miles College began a program of sit-ins and boycotts directly challenging segregation. It was to be a long and raucous summer of marches, to the consternation of White moderates. David Vann, a lawyer who would later be mayor, said, "This is the most cruel and vicious thing that has ever happened in Birmingham." Well, no, sir, there were beatings, bullets, and bombs you could put up against it, if you really wanted to talk about cruelty.

The inconvenient timing of the protests was part of the point, not least because the Black leadership reckoned correctly that Bull Connor would not respond with moderation. Police dogs and fire hoses wielded on national television against schoolchildren would have more impact in Washington, D.C., than all the lawsuits and committee meetings of the preceding years. The September bombing of the 16th Street Baptist Church, which notoriously killed four young girls, would make more of a difference to the consciences of White Birmingham. There was still a very long way to go.

Other books that I liked better:

https://anygoodbooks-mixedreviews.blogspot.com/search/label/Diane%20McWhorter

https://anygoodbooks-mixedreviews.blogspot.com/search/label/Hank%20Klibanoff

 

Any Good Books, January 2022

published by email 1/1/22

 

The Premonition: a Pandemic Story

Michael Lewis (W.W. Norton, 2021)

 

   In 2003, a man named Bob Glass was working at Sandia Labs, playing with computer models, when his daughter Laura asked for his help using them to consider infectious disease. Her eighth grade project modeled the Black Plague; the next year, she introduced social networks to the model. She posited, for example, that children were something like twice as likely as adults to pass along a virus, because they spent more time in close contact with others. Her father coached and challenged Laura, and he did some of his own research, especially on the 1918 influenza pandemic.

 

    The Glasses are just the first of the self-taught plague experts Michael Lewis will introduce to us. They range from White House officials to county health officers; most are doctors or nurses, others are laymen like Bob and Laura Glass. They are experts because they're so interested in the problem, including what could actually be done to slow or stop the spread of dangerous illnesses. That's not exactly easy, but, in the context of this story, there's a larger problem: will they be allowed to do it?

 

   Charity Dean, as the chief health office of Santa Barbara county, has seen more than enough of this problem. She does her own research, including seeing patients in county clinics and homeless shelters; that's where hepatitis C and tuberculosis are likely to present themselves, and she wants to be the first to know when they do. Lewis describes the time in 2014 that Dean closed a clinic on suspicion that it was passing hepatitis from patient to patient. The Centers for Disease Control in Atlanta reacted with consternation: such a use of local authority struck them as radical and rash. "She'd grown used to the lack of material support. But...the total absence of moral and practical support from the state and federal government mystified her."

 

   It's a mystery, if you imagine that the CDC is intended to be working on controlling disease. Rather, Lewis says, "The CDC did many things. It published learned papers on health crises, after the fact. It managed, very carefully, public perception of itself. But when the shooting started, it leapt into the nearest hole, while others took fire." Charity Dean was a battlefield commander. She was General Grant, knee-deep in mud and blood, to the CDC's fastidious General McClellan. In that position, she had to make decisions on pitifully incomplete information; tests that would help will come back too late. Such decisions often involved asymmetrical risks: "Sins of commission got you fired. Sins of omission you could get away with, but they left people dead."

 

Carter Mecher is another real-life character who's acutely sensitive to that sort of problem. He found his sweet spot in the Veteran's Administration, as an expert in medical error. That is, he studied decisions made and delayed, and taught other doctors to make better ones. In 2005, he was invited to the White House to work on pandemic planning in a newly created interagency group. The official report the group produced went through the normal government bad-writing-ification process, but at least Mecher and the others had permission to think about the real problem, of what to do in an epidemic before vaccines can be produced.

 

Because weird things that happen sometimes happen for good, Bob Glass got his and Laura's research about disease transmission to Carter Mecher, who passed it to Richard Hatchett, a colleague who'd been looking for just such a model. Mecher and Hatchett put Glass to work testing ideas about how to slow disease transmission; the insight that children go to school in petri dishes felt like a big breakthrough.

 

 Later in the book, when a new coronavirus appears in China, we are equipped for premonitions of our own: The CDC collects information and never gives it back; decision-makers make things worse by waiting on data that will be ancient history by the time they get it; the people who do see what could be done have to work in unofficial networks and constantly buck the system. Michael Lewis, as always, tells a gripping story, and it may be as important a story as he's ever told.

 

 

 Published by email,

Any Good Books, December 1, 2021

 

Counterpoint: A memoir of Bach and mourning

Counterpoint: A Memoir of Bach and Mourning

Philip Kennicott (W. W. Norton and Company, 2020)

 

       In Counterpoint, Philip Kennicott gives us an extended disquisition on a project that can never be finished: mastering J. S. Bach's 'Goldberg' variations on the piano. It's an epic, Mount-Everest-sized project, to be able to play it competently, in the first place, and further, to memorize it. He decided to tackle the work after his mother died, when he was in his forties. He'd been a pianist from the age of four, but never a very good student. His mother, a frustrated violinist, started him on lessons, and music complicated their relationship throughout his childhood. "This wasn't about resurrecting the long-discarded fantasy of being a great pianist. Rather it seemed a way to test life again, to press upon it and see what was still vital."

 

         The Goldberg Variations comprise thirty-two linked pieces, beginning and ending with the same aria. The thirty pieces in the middle fall into groups of three, every third one a fugue, with successively more distance between the voices. They are linked by a common thirty-two bar bass line. (That's unusually long - eight bars is more usual, and four is not uncommon.) This is only to scratch the surface of what could be known and studied, of course: with Bach there are always wheels within wheels, and smaller wheels still. 

 

        Then there are the performance options: Bach specified the harpsichord, giving directions for one or two manuals; the piano is certainly more common for today's performance spaces, and living rooms, but it can make fingering exceptionally challenging. Classical guitarists play a version, giving back the plucked quality the piano takes away. There are string ensemble versions, as well; my favorite version, by Bernard Labadie, adds a string orchestra to a harpsichord and a theorbo. (I highly commend Emmanuel Music's performance, as long as it's available -  

https://www.youtube.com/watch?v=onbc0XNcMgI )

 

       It's certainly something you could study for a lifetime, but Kennicott is really talking about remaking himself into someone who could do this. He's fighting a lifetime of bad practice habits and unsound techniques. He procrastinates, or he rushes, or he gets distracted. Hours on the piano bench, as it turns out, don't actually matter as much as the engagement between the hands and the mind. "I have spent decades returning to the piano, struggling to find the concentration and peace of mind necessary to move a piece forward, and never, in all those many attempts, scattered through every chapter of my life, have I managed to find more than a few quarters of an hour when I was actually in control of the music."

 

       The more his early teachers tried to make him slow down and concentrate, the less he was able to. His mother's unpredictable violence was certainly no help; he took up music with her support, but it doesn't bring them any closer to a warm, loving relationship; she saw it as something she has lost to him. He found himself bound to use music, her only gift to him, as the vehicle for escaping her orbit. "Had she been merely cruel and capricious, I might have hated her. But all along I saw also the woundedness of her life."

 

        Late in the book, Kennicott visits his most important teacher, back in Schenectady. It's not a lesson, because the two are now friends, but he plays the first ten variations for the man, who is as respectful and careful in his response as ever. "Good teachers are necessarily interested in something that parents all too often find terrifying, the freedom of the younger person. Only after a student has left the teacher and lived for a time in freedom can the teacher judge the success of the relationship." By the same token, Kennicott now has a better sense of what the teacher was trying to free him to do: to trust himself, to forgive himself, and to move forward. That's a lifetime project, and a worthy one.

The Ninth Hour, What About the Baby?

What About the Baby? Some Thoughts on the Art of Fiction

Alice McDermott (2021, Farrar, Straus and Giroux)

The Ninth Hour

Alice McDermott (2017, Farrar, Straus and Giroux)

     Alice McDermott has taught fiction writing for decades, and written eight well-received novels. I read her book about writing fiction alongside her recent novel, to the benefit of both; What About the Baby shed considerable light on why The Ninth Hour worked so well.

      The novel is set in Irish-Catholic Brooklyn, mainly in the early twentieth century. The Little Nursing Sisters of the Sick Poor, Congregation of Mary Before the Cross wield a great influence because they show up for the sick and needy. They are, themselves, dependent on money collected pennies at a time, or raised from "idle Catholic women married to successful men." In the first scene of the book, Annie is widowed under awkward circumstances, and Sister St. Saviour is right on the spot. Her efforts to have Annie's husband buried in consecrated ground come to naught, but she's able to conjure up a job for Annie in the basement of the convent, helping with the laundry. Her daughter, Sally, grows up a little sister to the Little Sisters.

      Sister Lucy and Sister Jeanne cobble together a friendship for Annie with Elizabeth Tierney, who lives down the street, and the women stroll out together in the mornings. Sally will not grow up to be a nun, though she'll flirt with the idea, and she'll inherit her father's depressive streak. Instead, she'll grow up and marry one of the Tierney boys; their children provide the narrative voice in some chapters. Sister Jeanne will remain in all their lives, a friend for generations.

      One of McDermott's principles is that fiction "ought to contain, consistently, characters who, if they don't shine with the light of their uniquely individual souls, shimmer at least with that soul's unplumbed or as yet unillustrated possibilities." On this account, she's successful. Each of the nuns has her characteristic ways, including little disagreements with the other nuns, and episodes of irritation or envy. Mr. Costello, the milk-man, is tidy and dutiful, though his wife, an invalid, "was childish, sometimes churlish."

      The characters, she says, have to inhabit a specific place. Everything they eat or drink, sit on or wear, has to come to us in words, and they have to be the right words. Mr. Costello, for instance, "does as much dusting as a man could be expected to do: the top of a bureau, but not the legs; the base of a lamp, but not the shade." Mr. Tierney's Aunt Rose is remembered with "a velvet hat and a pale broadcloth suit, rose-colored perhaps, and maybe the smell of rosewater about her..." Knowing how things feel and smell brings the action to life, even more than a movie would.

      That scent of roses appears in other places, including the deathbed of Sister St. Saviour, though there's room for debate as to whether that was the odor of sanctity, or just an open window. McDermott commends to writers the habit of weaving in connections from one chapter to another. "I am not making a pitch for artifice, manipulation, or trickery, but rather for discovery." The extended description of the convent's laundry, early on, will resonate over and over through the story. Sister Illuminata keeps the nuns clean and starched, of course. She also washes the soiled linens generated by nursing. With Annie's help, she sorts, washes, and mends the neighborhood's castoff clothing, and we're not surprised to see little Sally wearing it.

      McDermott credits a rereading of Middlemarch with identifying a principle theme of her work. George Eliot describes Saint Theresa, whose "passionate, ideal nature demanded an epic life." But how many lives, especially women's, never reach that ideal? McDermott says, "I wanted to write about these women, these Saint Theresas who longed for but missed the epic life, who were foundresses of nothing. I wanted to say something about them."

        The Little Sisters of the Sick Poor are destined to die off faster than they are replaced, and the bishop will probably take back their fine house. They are woefully ineffective against certain cruelties of the world, especially those that arise from men. But the work they have done matters, nonetheless, down to the last cup of tea, and the crumbs swept up afterward. McDermott's work matters, too. The creative life of fits and starts being what it is, thirty-five years elapsed between that dip into Middlemarch and this novel, which, "...it might be said, is indeed about women 'whose loving heartbeats and sobs after an unattained goodness tremble off and are dispersed...' "

 

 

 

Any Good Books, by mail October 1, 2021