2021年经济学人 美国成瘾药物滥用成灾(1)（在线收听）

Books & arts

文艺板块

Book review

书评

Opioids in America

美国阿片类药物

Bitter pills

让人更痛苦的药物

Empire of Pain. By Patrick Radden Keefe.

《痛苦帝国》。作者：帕特里克·雷登·基夫

At 50,000 overdose deaths a year and rising, America’s opioid crisis has never been worse. What began in the late 1990s as an epidemic of prescription pain-pill abuse morphed into a worse one of illicit heroin and, later, fentanyl. Prosecutors and the public have zeroed in on Purdue Pharma, which introduced the blockbuster drug OxyContin in 1996. Of the colossal revenues it generated, some $13bn was paid to the company’s previously low-profile owners, members of the Sackler family, who have recently sunk from honoured arts patrons to society pariahs.

每年有5万人死于用药过量，而且死亡人数还在上升，美国的阿片危机从未像现在这样糟糕。阿片危机开始于20世纪90年代末，当时处方止痛药的滥用情况十分盛行，之后就演变成了更为严重的非法海洛因滥用，然后是芬太尼滥用。检察官和公众将矛头对准了普渡制药公司，该公司于1996年推出了轰动一时的药物奥施康定。普渡制药公司拿出了其创造的巨额收入中的约130亿美元支付给低调的前任公司所有者，即萨克勒家族的成员，他们最近从受人尊敬的艺术赞助人沦落为社会渣滓。

Patrick Radden Keefe’s excellent new book tells the story of this now-infamous clan. He traces the empire of the title to Brooklyn in 1920, and a trio of brothers born to Jewish immigrants: Arthur (the eldest and, in Mr Keefe’s telling, the “patriarch”), Raymond and Mortimer. Arthur Sackler’s business acumen and questionable ethical judgment proved lucrative. He in effect invented the field of medical advertising, creating the first family fortune after aggressively marketing the sedatives Librium and Valium to doctors, without a serious study of the addiction risks. A fascination with Chinese artefacts led him to bequeath huge sums to prestigious museums. For decades the Sackler name would primarily be associated with that largesse.

帕特里克·雷登·基夫在新书中讲述了这个如今臭名昭著的家族的故事。他把痛苦帝国追溯到了1920年的布鲁克林，以及犹太移民所生的三兄弟：亚瑟（长兄，基夫先生将其描述为“族长”）、雷蒙德和莫蒂默。事实证明，亚瑟·萨克勒的商业头脑和不正当的道德判断让他赚了大钱。事实上，亚瑟发明了医疗广告领域，他在没有认真研究成瘾风险的情况下，积极向医生推销镇定剂利眠宁和安定，并以此创造了第一笔家族财富。对中国艺术品的迷恋让他向享有盛誉的博物馆遗赠巨款。几十年来，萨克勒的名字基本与赠款绑定了。

Arthur died in 1987, almost a decade before Purdue, which the brothers had acquired in 1952, began selling OxyContin. By the time that happened, his branch of the family no longer held a stake—facts that its members hope will exonerate them from the taint of the “OxySacklers”. But after a gripping if lengthy account of the patriarch’s career in the first third of his book, Mr Keefe’s view is less forgiving. “So many of the antecedents of the saga of OxyContin could be found in the life of Arthur Sackler,” he concludes.

亚瑟于1987年去世，比普渡制药公司（萨克勒于1952年收购了普渡）开始销售奥施康定早了近10年。奥施康定销售之时，萨克勒家族成员已经不再持有普渡公司的股份，萨克勒家族成员希望凭借这一事实与“奥施萨克勒”的污点撇清干系。但基夫先是在《痛苦帝国》中以前三分之一的篇幅对亚瑟族长的职业生涯进行了引人入胜而又冗长的描述，然后他的观点就没有那么宽容了。基夫总结说：“我们在亚瑟·萨克勒的一生中能够发现许多奥施康定诞生的前因。”

For the other two brothers and their descendants, Purdue yielded money beyond even Arthur’s imaginings. “The prescription blizzard will be so deep, dense and white,” Richard Sackler, son of Raymond, promised at the launch party for OxyContin. His words proved all too prophetic. The plan for mass-market opioids was abetted by misleading advertising, which claimed that less than 1% of patients would become addicted, and a vast salesforce incentivised by lucrative commissions.

对于另外两兄弟和他们的后代来说，普渡制药所盈利的钱甚至超出了亚瑟的想象。雷蒙德的儿子理查德·萨克勒在奥施康定的发布会上承诺：“处方药将像深厚、稠密、雪白的暴风雪一样铺天盖地。”事实证明，他的话非常有预见性。大规模销售阿片类药物的计划受到误导性广告的推波助澜，这些广告声称只有不到1%的患者会上瘾，而利润丰厚的佣金刺激着庞大的销售队伍。