Gerald Posner, Pharma: Greed, Lies, and the Poisoning of America (2020) — a short book review

© 2020 Peter Free


02 November 2020



Caveat — bias?


I write what follows as a medically knowledgeable lawyer.


For two years, I was peripherally involved in pharmaceutical and medical device litigation on the side of cooperating groups of (US) state attorney generals.


Big Pharma — as I first recognized in medical school and later affirmed in law practice — is arguably the United States' most parasitically focused big business.



Pharma — misleadingly titled, but outstanding anyway


Pharma: Greed, Lies, and the Poisoning of America (Avid Reader Press, 2020) predominantly revolves around the Sackler family's comparatively small pharmaceutical holdings, including those enterprises' primary contribution to the OxyContin addiction plague.


Author Gerald Posner does not as deeply address Big Pharma's dominant major corporations. Those remain as named, but only superficially dissected, villains in the shadows for most, but not all of the book.


Posner's debatably overpromising title does not detract from the enormity of his investigative accomplishment. Pharma is, surprisingly, an addictive and insight-prompting page-turner.


Gerald Posner demonstrates the worth of "real" journalism, even when that occupation's characteristically rambling communication style irritates better-honed minds.



Let's get some of the book's annoyances out of the way, first


I go into these because I have yet to see a review that addresses the volume's stylistic weaknesses in adequate fashion.


The following aspects of Pharma may annoy some readers:



An irritating tendency to disregard providing reasonably precise dates for events.


Constantly traipsing back and forth in time — in unnecessarily disordered and sometimes confusing fashion — within chapters and across the whole book.


An inability to coherently stay on topic; for instance, the OxyContin story reappeared at least three to four times after having been (apparently) killed off.


Inexplicably long and topically irrelevant, asides on the progress of Arthur Sackler's interest in art acquisition and his battle to be recognized as a "somebody".


Similarly traipsing forays into Arthur Sackler's Jewishness and his sensitivity about it.


Peripherally related, equally off topic, aspects of New York City's snobby social elite.


Go-nowhere, topically irrelevant (but nevertheless interesting) expeditions into Arthur Sackler's leftist political leanings and the admirable ways in which he tried to help similarly minded people.


Unnecessarily extended and hopelessly vague references to the Sackler Family's penchant for creating an impenetrable web of secretly related corporations, so as to hide their tracks and avoid taxes.


Repetitively addressing (across scattered chapters) Big Pharma's abuse of Congress's "orphan drug" legislation — instead of less sporadically condensing that subject into just one connected section of the book.



In sum


This is not a well-organized or concisely delivered work.


Yet . . .



Posner's writing, presentation and rigorous documentation are captivating


I had expected the book's 534 pages (not including endnotes) to be a slog. They weren't. I cannot recall recently reading another non-fiction book of similar length that flew by so quickly.


Posner's story-telling genius — combined with his meticulous documentation (via voluminous citations to sources) — reduces my stylistic criticisms to absolute meaninglessness.



A sample of Gerald Posner's writing style


From a chapter dealing with Big Pharma's (over-the-top profitable) gaming of an "orphan drug" system, Posner wrote that:



Those doctors were prescribing it to more patients and with greater frequency even though there were comparable generics that cost thousands of dollars less per treatment.


"I was shocked by my profession," said Dr. Dennis Bourdette, on of the study's authors and chairman of neurology at Oregon Health and Science School of Medicine. Since some of Acthar's competitors cost one fiftieth as much, Bourdette said, "It's a mystery to me why someone would be prescribing the drug."


One reason is that the U.S. rights to an almost identical Canadian drug, Synacthen, which sells for $33 for a comparable dose, were bought by Mallinckrodt [Acthar's manufacturer] and killed.


© 2020 Pharma: Greed, Lies, and the Poisoning of America (Avid Reader Press, 2020) (at page 514) (paragraph split)



The book's genuinely Big Pharma-oriented chapters are . . .


49 — Gaming the System (page 492)


50 — Billion Dollar Orphans (page 502)


51 — The Coming Pandemic (page 517)



If you read just those sections, you will gain substantive insight into what makes Big Pharma tick.



The moral? — Pharma is a splendid introduction into more than just Big Pharma's often ethically repulsive behavior


If you want a strong argument against Unconstrained Capitalism and Bribed Government, this book is it.


If I were a law or economics professor, Pharma could competently begin a discussion about potentially more humane ways to construct just social orders.


In that vein, one irony — which Posner does not explicitly point out — is the (apparently untroubling) conflict between Arthur Sackler's hard left political orientation and his repeatedly demonstrated genius for becoming an avariciously grasping, arguably people-harming, parasitic capitalist in spite of it.


There is a human truth buried in that example. For almost all of us, arguing the common good is fine — insofar as its societal attainment does not (even mildly) inconvenience our personal pursuits of highly piled, grossly over-the-top, wealth.


Hypocrisy may be humanity's most characteristic condition.