Last month we talked about the New York Times Critics List of 100 best books in the 21st century. Our book, Far From the Tree by Andrew Solomon was on that list. We talked about his book in episode 54. Now, let’s talk about the New York Times READERS list of 100 best books in the 21st century. We have ten of our books on that list. I’m going to start with an easy true/false question. Nancy asks Linny whether she thinks our book this month, Empire of Pain by Patrick Radden Keefe, appears on the list. Linny wisely guesses that since she asked, it probably is, and she is correct! Empire of Pain appeared as number 99 on the list. Linny then decides she will guess the other nine books. She does pretty well correctly guessing: Where the Crawdads Sing (#59), Lessons in Chemistry (#47), The Nightengale (#52), and A Man Called Ove (#100). She guessed, incorrectly, that three books were on the list: The Invisible Life of Addie LaRue, I Am a Man, and Hello Beautiful The other books we’ve read that were on the list were: (Coming up in November, so sort of fudged!) Tom Lake (#82), The Lincoln Highway (#75), and The Song of Achilles (#46). Nancy incorrectly thought we’d read Hamet (#22), so we actually had nine on the list! Linda introduces our book this month, Empire of Pain, saying last month we talked about cozy murder and this month we’re talking about mass murder. Empire of Pain: The Secret History of the Sackler Dynasty is a non-fiction book written by investigative journalist Patrick Radden Keefe. Keefe has written three New York Times bestsellers: Empire of Pain, Rogues, and Say Nothing. He’s received the National Magazine Award for Feature Writing, the National Book Critics Circle Award for Nonfiction, the Orwell Prize for Political Writing. He is also the writer and host of Wind Of Change, an 8-part podcast, which investigates the strange convergence of espionage and heavy metal music during the Cold War, and was named the #1 podcast of 2020 by The Guardian. Patrick received master’s degrees from Cambridge University and the London School of Economics, and a law degree from Yale. He is the recipient of a Guggenheim fellowship, and fellowships from the New America Foundation, the Woodrow Wilson International Center for Scholars, and the Cullman Center for Scholars and Writers at the New York Public Library. He writes for the New Yorker and Nancy has enjoyed his pieces, long before she knew he wrote this book. Linny quotes a 2021 article by the Centers for Disease Control and Prevention: “ A staggering loss of life has resulted from the ongoing epidemic: nearly 500 000 people have died from opioid overdoses during the past 20 years. Because many die prematurely, their surviving family members and communities lose out on benefits from an individual’s lifetime earnings. Opioid use disorder also results in costs associated with added health care expenses, criminal justice, lost productivity, and reduced quality of life. In 2017, these costs totaled an estimated $1.02 trillion—54% was attributed to overdose deaths and 46% to opioid use disorder, according to one analysis.” Nancy thinks Keefe does an excellent job describing what amounts to three waves of overdose deaths: the first wave beginning in the 1990s with increases in deaths involving prescription opioids; the second wave beginning in 2010 with increases in deaths involving heroin; and the third wave beginning in 2013 with increases in deaths involving synthetic opioids such as fentanyl. It’s important to note that this epidemic continues. In 2023 US reached an all-time high of overdose deaths at 111,401 deaths. Linny notes that overdose deaths also are concentrated in specific occupational groups. According to a study by the Brookings Institute six occupational groups accounted for a disproportionate share of unintentional and undetermined overdose deaths: construction, extraction (e.g., mining), food preparation and serving, health care practitioners, health care support, and personal care and service. It’s notable that these are generally jobs with high occupational injury rates and low access to paid sick leave. The Brookings article also mentioned other studies that: “found that regions with higher exposure to opioid prescriptions experienced significant declines in labor force participation. In a 2016 survey of men aged 25-54 who were not in the labor force, nearly half of respondents reported taking pain medications on a daily basis, two-thirds of whom were taking prescription pain medications. In a follow-up survey of women in the same age group who were not in the labor force, 54% of respondents reported taking pain medications daily, half of whom were taking prescription medications.” Nancy mentions there’s a geographic story, too. According to a CDC article, among states, Nebraska has the lowest opioid overdose deaths per 100,000, coming in at 3.1 per 100,000. The highest is West Virginia at 47.3 deaths per 100,000 (that’s over 15 times more death). In general, the per capita economic cost vary pretty dramatically across areas of the United States, too. A Brookings Institute report found the hardest hit economically has been the Ohio Valley and New England. Nancy remembers when this epidemic was first starting that here in Nebraska we couldn’t believe we were missing the worst of it. But that’s not the story in Pennsylvania. Linny talks about how normalized Meth clinics are and the widespread knowledge about opioid addiction. She recently was trained to administer Naloxone. Linny says Pennsylvania declared the opioid crisis a statewide disaster in 2018 amid rising overdoses. From 2018-24 in PA, 96,337doses of Naloxone used by EMS, 58,065 ER visits for opioid overdoses. Nancy was surprised that book starts in 1913 with the birth of Arthur Sackler, the uncle of Richard, who basically took Oxycontin to the masses. She and Linny both liked how Keefe weaves Arthur’s story into how the family got to the place where they were wanting a blockbuster drug and then allowed their arrogance or greed to blind them to the consequences. Linny liked how the book helped her understand the decisions the Sacklers made. Nancy said she still couldn’t understand how greedy they were! She notes their willingness to sacrifice everyone who worked for them in order to not be blamed and to not have to acknowledge their culpability. Richard was willing to even sacrifice his own son, David, to take the blame for his actions, in front of a Congressional committee. She was surprised by the way they used marketing to convince skeptical doctors that the drug was not addictive. The Sacklers deliberately lied to doctors that OxyContin was stronger than morphine, in fact it was twice as strong as morphine. They twisted medical research, managed to get the FDA to allow them to insert unfounded promotional language in their literature, they had an army of drug reps who gave out free samples, they lied about the length of time the drug lasted, they lied about the addictiveness, they lied that they weren’t aware that the drug was addictive and that users would experience withdrawal, they blamed people who became addictive and claimed the company was being victimized by addicts, they set up shell advocacy organizations that touted the company line about the drug being beneficial to people experiencing chronic pain. All the while they were obsessed with having their names splashed all over museums and universities (the Sackler Wing of the Metropolitan Museum of Art, the Sackler Gallery in DC, the Sackler Museum at Harvard, the Sackler Center for Arts Education at the Guggenheim, the Sackler Wing at the Louvre, Sackler Institutes at Columbia, Oxford, and a dozen other universities). The book describes how some of these places are now chiseling the Sackler name off their buildings. Though this is a great big book, over 500 pages, Nancy feels like everyone in the US should read it, but that probably isn’t possible. I have two suggestions for people who just don’t see themselves reading a great big book: • Patrick Radden Keefe’s 2017 article in the New Yorker about the Sackler family: The Family That Built An Empire of Pain (October 23, 2017) • Painkiller – Netflix series starring Matthew Broderick. He plays Richard Sackler and it parallels Empire of Pain very well.