The latest book: Dreamland

Latest book that I’m reading: Dreamland by Sam Quinones.

The book is about the rise of prescription opiates, such as OxyContin (1996), based on a flawed interpretation of the literature:

One day twenty years earlier, in 1979, a doctor at Boston University School of Medicine named Hershel Jick sat in his office pondering the question of how often patients in a hospital, given narcotic painkillers, grew addicted to these drugs. … Hershel Jick was in a better position than most to gather findings on the topic. At Boston University, he had built a database of records of hospitalized patients. The database charted the effects of drugs of all kinds on these patients while they were in the hospital. … Of almost twelve thousand patients treated with opiates while in a hospital before 1979, and whose records were in the Boston database, only four had grown addicted. There was no data about how often, how long, or at what dose these patients were given opiates, nor the ailments the drugs treated. The paragraph simply cited the numbers and made no claim beyond that. … A graduate student named Jane Porter helped with his calculations in some way that Dr. Jick could not remember years later. As is the practice in medical research papers, she received top byline, though Dr. Jick said he wrote the thing. The secretary put the letter in an envelope and sent it off to the prestigious New England Journal of Medicine, which, in due course, in its edition of January 10, 1980, published Dr. Jick’s paragraph on page 123 alongside myriad letters from researchers and physicians from around the country. It bore the title “Addiction Rare in Patients Treated with Narcotics.”

People couldn’t get opiates easily after they left the hospital back in those days so of course only about 1 percent became addicted. These data were cited in support of the idea that you could send Americans home with pills and no supervision and they wouldn’t get addicted to opiates.

The book is also about the genius of an American marketeer and friend to the lover of Asian art:

In 1951, an adman named Arthur Sackler from a little-known marketing firm met with the sales director of a small hundred-year-old chemical concern named Charles Pfizer and Company in New York City. Arthur Mitchell Sackler was thirty-nine and already had a career of achievement as a psychiatrist behind him. … Sackler became a psychiatrist at Creedmoor, a New York mental hospital. There, he wrote more than 150 papers on psychiatry and experimental medicine, and identified some of the chemical causes in schizophrenia and manic depression. He was an antismoking crusader long before it was popular, and prohibited smoking at the companies he would later own.

He switched careers in the 1940s and hired on at William Douglas McAdams, a small, rather staid medical advertising firm. Before long one of his clients was Charles Pfizer and Company, then the world’s largest manufacturer of vitamin C. The company’s newly formed pharmaceutical research department had developed a synthetic antibiotic, first derived from soil bacteria, that it called Terramycin and that had proven effective on more than fifty diseases, including pneumonia. The company was moving from chemical manufacturing to pharmaceuticals. Instead of licensing it to a drug company, Pfizer wanted to sell the antibiotic itself. In the office that day, Sackler told the company’s sales director, Thomas Winn, that with a large enough advertising budget for Terramycin, he could turn Charles Pfizer and Company into a household name among doctors.

Meanwhile, Sackler’s ad writers in New York wrote thousands of postcards meant to appear as if they were from Egypt, Australia, Malta, and elsewhere. They mailed these cards, addressed individually to thousands of U.S. family doctors, pediatricians, and surgeons, describing how Terramycin was combating diseases in these exotic locales—“milk fever” in Malta, “Q fever” in Australia. The cards were signed “Sincerely, Pfizer.” Doctors already known to prescribe a lot of drugs got extra direct mail.

All that combined with the drug’s efficacy to make Terramycin a blockbuster—with forty-five million dollars in sales in 1952. Based on its Terramycin success, Charles Pfizer and Company expanded to thirteen countries, and eventually changed its name to Pfizer.

Sackler’s campaign marked the emergence of modern pharmaceutical advertising, a field that up to then, in the words of one executive, “existed but it didn’t.” Seeing the future, Sackler bought the firm he worked for, William Douglas McAdams. As an aside, he and his brothers also purchased an unknown drug company: Purdue Frederick, formed in the 1890s, during the days of patent medicines, by John Purdue Gray and George Frederick Bingham. The company had limped along since then, and until our story begins to unfold in the 1980s, it was still known mainly for selling antiseptics, a laxative, and an earwax remover. Arthur Sackler, meanwhile, continued to transform drug marketing. In 1963, he licensed from Hoffman-La Roche the right to import and sell a new tranquilizer called Valium. Sackler again emphasized direct doctor contact to promote the drug. “Detail men”—salesmen—frequently visited doctors’ offices bearing free samples of Valium.

Part of the campaign aimed to convince doctors to prescribe Valium, which the public saw as dangerous. Ads urged doctors to view a patient’s physical pain as connected to stress—with Valium the destresser. If a child was sick, maybe her mother was tense. Valium was marketed above all to women, pitched as way of bearing the stress of lives as wives and mothers. Before the feminist movement, women were presumed to need that kind of help for the rest of their lives, thus there was no worry then about its addictiveness.

Years later, Purdue would put those strategies to use marketing its new opiate painkiller OxyContin.

The book is topical because it covers black tar heroin sold by illegal immigrants from a forgotten corner of Mexico:

The system operates on certain principles, the informant said, and the Nayarit traffickers don’t violate them. The cells compete with each other, but competing drivers know each other from back home, so they’re never violent. They never carry guns. They work hard at blending in. They don’t party where they live. They drive sedans that are several years old. None of the workers use the drug. Drivers spend a few months in a city and then the bosses send them home or to a cell in another town. The cells switch cars about as often as they switch drivers. New drivers are coming up all the time, usually farm boys from Xalisco County. The cell owners like young drivers because they’re less likely to steal from them; the more experienced a driver becomes, the more likely he knows how to steal from the boss.

Cell profits were based on the markup inherent in retail. Their customers were strung-out, desperate junkies who couldn’t afford a half a kilo of heroin. Anyone looking for a large amount of heroin was probably a cop aiming for a case that would land the dealer in prison for years. Ask to buy a large quantity of dope, the informant said, and they’ll shut down their phones. You’ll never hear from them again. That really startled the informant. He knew of no other Mexican trafficking group that preferred to sell tiny quantities

Moreover, the Xalisco cells never deal with African Americans. They don’t sell to black people; nor do they buy from blacks, who they fear will rob them. They sell almost exclusively to whites

The Xalisco traffickers’ innovation was literally a delivery mechanism as well. Guys from Xalisco had figured out that what white people—especially middle-class white kids—want most is service, convenience. They didn’t want to go to skid row or some seedy dope house to buy their drugs. Now they didn’t need to. The guys from Xalisco would deliver it to them.

As I listened to Chavez, it seemed to me that the guys from Xalisco were fired by the impulse that, in fact, moved so many Mexican immigrants. Most Mexican immigrants spent years in the United States not melting in but imagining instead the day when they would go home for good. This was their American Dream: to return to Mexico better off than they had left it and show everyone back home that that’s how it was. They called home and sent money constantly. They were usually far more involved in, say, the digging of a new well in the rancho than in the workings of the school their children attended in the United States. They returned home for the village’s annual fiesta and spent money they couldn’t afford on barbecues, weddings, and quinceañeras. To that end, as they worked the toughest jobs in America, they assiduously built houses in the rancho back home that stood as monuments to their desire to return for good one day. These houses took a decade to finish. Immigrants added to their houses each time they returned. They invariably extended rebar from the top of the houses’ first floors. Rebar was a promise that as soon as he got the money together, the owner was adding a second story. Rods of rebar, standing at attention, became part of the skyline of literally thousands of Mexican immigrant villages and ranchos.

The finished houses of migrant Mexico often had wrought-iron gates, modern plumbing, and marble floors. These towns slowly improved as they emptied of people whose dream was to build their houses, too. Over the years, the towns became dreamlands, as empty as movie sets, where immigrants went briefly to relax at Christmas or during the annual fiesta, and imagine their lives as wealthy retirees back home again one day. The great irony was that work, mortgages, and U.S.-born children kept most migrants from ever returning to Mexico to live permanently in those houses they built with such sacrifice.

But the Xalisco heroin traffickers did it all the time. Their story was about immigration and what moves a poor Mexican to migrate as much as it was a tale of drug trafficking. Those Xalisco traffickers who didn’t end up in prison went back to live in those houses. They put down no roots in this country; they spent as little money in America as they could, in fact. Jamaicans, Russians, Italians, even other Mexican traffickers, all bought property and broadcasted their wealth in the United States. The Xalisco traffickers were the only immigrant narcotics mafia Chavez knew of that aimed to just go home, and with nary a shot fired.

Illegal immigration was (and remains?) critical to the effort because the Xalisco footsoldiers seldom had enough heroin with them to be worth imprisoning. If a footsoldier were caught, the U.S. taxpayer would buy him a plane ticket back to the sugarcane fields from which he’d come. He’d be replaced with a fellow ranchero within a few days.

I’m partway through Dreamland, but it is fascinating material. It sounds pretty easy to become addicted.


10 thoughts on “The latest book: Dreamland

  1. “It sounds pretty easy to become addicted.”

    I think it depends if you have an addictive personality or not. I’ve taken narcotic pain relievers after breaking my arm, etc. and they made me constipated and I couldn’t wait to get off of them. I never had any cravings for them. It’s the same thing for alcohol – I enjoy a glass of wine or a beer many nights but if for some reason they were no longer available, I would miss them the same way that I would miss milk if you could no longer get that, but it wouldn’t be the end of the world for me. When I was young I tried various forms of tobacco but they did nothing for me, just made me nauseous. I just don’t have an addictive personality, but some people do.

  2. I don’t have an addictive personality either. I can stop going to Dunkin’ Donuts any day that I choose. As it happens, I always choose tomorrow.

  3. Opiate addict here.

    @Jackie it’s not that simple. I’ve experimented with every other class of drug and addictive behaviour (I.e. gambling) with zero problems.

    Like the rest of human behaviour, it seems to have both a genetic and an environmental component.

    This is a good follow up to the classic rat & cocaine experiment:

  4. Around NC, middle class young adults are dropping dead left and right from overdose. The rumor is always the same thing–heroin laced with fentanyl. I’ve never seen anything like it.

    For anyone who thinks they are not a candidate for addiction, try going without caffeine for a week.

  5. @philg Hilarious that the video you linked to is a comedy bit on the economics of marriage.

    At this point I think you need a separate site dedicated to the topic.

  6. I visited Mexico (mostly around San Miguel de Allende in Guanauato) in 2012 and was struck by all of the buildings with rebar sticking out of the tops. I asked about it and I was told that it had to do with taxes: as long as a building isn’t “finished”, you don’t pay as much property tax.

  7. I’m addicted to philg’s blog, but that’s probably because of my environment: 1) the fact that I live in Europe and don’t know any Americans to discuss politics with 2) I don’t know any interesting people in my small town or workplace who would want to talk about tech/politics/absurdity 3) can’t really express myself freely without offending 95% of my facebook friends who are super-liberal or my european socialist colleagues. Or most people for that matter 🙂

  8. > I asked about it and I was told that it had to do with taxes: as long as a building isn’t “finished”, you don’t pay as much property tax.

    You see this all over the mid-east and south asia. It’s not some tax trick. It’s a standard approach by semi-rural people with regard to concrete house construction.

    The animal studies on drug addiction are definitely interesting. The basic take-away is that animals only wind up hooked on drugs when their otherwise stressed. Lacking stress they find narcotic unappealing. But as far as modern contexts go the Chinese and Malays found it necessary to summarily execute anyone with opium in order to save their civilizations. Parts of China were literally depopulating because of the opium problem.

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