Dreamland (6 page)

Yet if Terramycin was an unmitigated benefit to humankind, Valium was less so; or rather, any benefits were offset by significant risks. There was a little of nineteenth-century patent medicine in Valium’s DNA. It didn’t treat any root cause of stress. Instead, it treated vague symptoms and thus allowed doctors to avoid the complicated work of understanding the causes of that stress. Like patent medicines, Valium was a name-brand drug, promoted together with the idea that a pill could solve any ailment. Four decades later, and well after Arthur Sackler was gone, his company, Purdue, would produce and promote through his ad firm, William Douglas McAdams, a painkiller with similar characteristics.

Valium became the pharmaceutical industry’s first hundred-million-dollar drug, and then its first billion-dollar drug. By the midseventies Valium was found indeed to be addictive and a street trade grew up around it. Hoffman-La Roche was accused of not warning of the drug’s addictive potential.

Sackler, meanwhile, kept combining remarkable energy with great intellectual curiosity. He founded the
Medical Tribune
, a biweekly newspaper full of ads from the now-burgeoning pharmaceutical industry. In the newspaper, he wrote a column, One Man and Medicine. He became a world-class collector of Chinese art, and at parties at his house, guests hobnobbed with Luciano Pavarotti and Isaac Stern. As doctors raced to keep up with rapidly changing medicine, Sackler saw another marketing opportunity. He pushed his drug-company clients to fund CME—continuing medical education—seminars that were increasingly required for doctors to keep their licenses. By funding
cme
seminars, he saw, drug companies could grab the ears of physicians.

Arthur Sackler never retired. In 1987, at age seventy-three, he had a heart attack and died. He left behind a wife and two ex-wives, a spectacular fortune, and an industry so indebted that it referred to him by his first name. Today, his name is on galleries or wings of the Smithsonian Institution, the Metropolitan Museum of Art in New York City, the Royal Academy in London, as well as at Princeton, Harvard, and Beijing universities. Medical facilities bear his name at Tel Aviv, Tufts, and New York Universities. In 1996, he was one of the five first inductees into the Medical Advertising Hall of Fame.

But Arthur Sackler is important to this story because he founded modern pharmaceutical advertising and, in the words of John Kallir, showed the industry “that amazing things can be achieved with direct selling and intensive direct advertising.”

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

Enrique Begins

A Rancho in Nayarit, Mexico

Enrique’s mother hated rain. It dripped through the corrugated-tin roof of their cardboard shack, keeping them damp for weeks. She placed pans and buckets around the shack to catch the new streams of water finding their way through the roof. As a toddler, Enrique ran about in the rain, splashed in puddles, and chased after the town’s stray dogs. But to his mother, cold and relentless rain embodied their poverty and reminded her of her husband.

Enrique’s parents lived at the bottom of a rancho with no paved streets or electricity, in the Mexican state of Nayarit. His parents had married young and without land. They eked a living from selling charcoal and wood. Enrique was their second child. The family was wedged into a four-room house with two other families. A few years later, they found land in a barrio known as the Toad, near a bog at the village bottoms. They crafted that two-room shack from cardboard, tarp, and plywood that could be scavenged from garbage dumps. They had more children. Enrique remembers nothing from those years but yelling, and his father beating his mother, and his mother having no idea where each day’s food was coming from.

Then, a miracle. Enrique’s father inherited all fifty acres owned by his parents, who had decided not to share any of it with their other children. With that, Enrique’s father became a landowner and grew sugarcane, which, this being Mexico’s populist 1970s, enjoyed new government price supports. With savings, he bought an old sugarcane truck. Property didn’t soften Enrique’s father. It inflated him with arrogance. Coming home drunk at night, he yelled at his kids and beat his wife more often. He spoke no words that weren’t orders. When Enrique’s mother asked her husband for money to run the household, he gave it with insults. His truck roared like a beast, and he rode around the village high in the seat, as if it were a fine mare.

One morning, when Enrique was eight, he was helping his father, who was hungover and working under the truck. His father called for his son to find him a tool. Enrique had no idea what the tool was. Under the truck, his father grew angry. Enrique spun about, searching without knowing what he was looking for. His father cursed him. Enrique began to cry in desperation. His father crawled out from under the truck. Enrique ran off. His father chased him down and beat him. Enrique had never beaten an animal the way he was beaten that day. He cried himself to sleep that night, angry that his mother hadn’t defended him, hating life and his father.

He heard people say they were happy in their poverty. But Enrique never knew anybody poor who was anything but miserable. An unbridgeable river seemed to separate the Toad from the world. In the Toad, poverty pitted villagers against each other in a vicious battle for an upper hand. Enrique milked cows for another farmer. He was paid two liters of milk a day and ten pesos a week, and with it endured the kicks and insults from the farmer’s son, who was his age. Once, when Enrique was sick, his mother took him to a hospital in Tepic. He stared at perfumed women, and men in new cars, and children with new clothes. The city was only a few miles from his rancho, but it seemed a distant land on the other side of that river.

Enrique grew older and went to school. There he learned to hate his teachers like his mother hated rain. They treated kids from the village’s upper barrio with respect, but spoke sharply to the ragged children who came up from the Toad without food for lunch. To the upper-barrio kids, the teachers awarded prizes of candy and toys that no one from the Toad had a chance of winning. Some teachers forbade the Toad kids from going to the bathroom until they wet themselves. A few teachers showed up drunk; others didn’t show up for weeks at a time. Enrique’s father mocked him for not knowing his multiplication tables, but how could he know them with teachers like these?

Life held one thrill: His mother’s brothers were up in Los Angeles working, which gave his family a connection that other kids envied. Villagers spoke of his uncles like far-off explorers and traded their latest news. Enrique didn’t let on to his friends that his father never got along with these uncles. There had been a fight years before, in which his father had been knifed and two people on his uncles’ side of the family died. His father married into the family but he and his brothers-in-law never liked each other.

Then one day news spread that an uncle was returning from the San Fernando Valley. Relatives thrilled at the gifts he would bring. That day, mothers washed their kids and lined them up in anticipation. The uncle, remembering the feud with Enrique’s father, had gifts for everyone but Enrique, his sisters, and his mother. The children went home in tears of incomprehension.

Life improved only slowly. Somehow his mother saved enough to buy a cow and finally they were ranchers of a sort, and worked harder because of it. Enrique went to bed dreaming of life as a respected ranchero. For a while, he thought he glimpsed a future as a cop. Highway patrolman looked like an exciting job. But his father had no political connections to get him into the academy.

Besides, said his father, “I need an agronomist, not a patrolman. Remember, one day, this land will be yours. Your sisters will get married and go live with their husbands. You’ll inherit the land and the house.”

Enrique’s father held that promise over him, and soon it seemed more like a threat. Enrique saw farmers like his father draining their lives into those fields. They remained the same ignorant, violent, cold men stuck in poverty, controlled by others. Escaping this fate became Enrique’s greatest concern.

His urgency intensified when he spotted a girl. She was twelve and beautiful. Her father was a butcher in town. That placed her in the upper classes of the rancho, well above Enrique’s station as the son of an alcoholic sugarcane farmer. She lived up the hill, which was more than just geographically above the Toad. The kids from that barrio had parents who owned stores, slightly better houses, and more land. They ruled the town playground and ran off kids from the Toad with rocks.

Enrique knew he could give this girl none of the life she, and her father, expected for her. But when he asked her to be his girlfriend, she accepted. Theirs was a chaste village romance, filled with kisses and hugs. For it to become more than that, Enrique knew he would have to get moving.

Then his mother went to California for a few months. She returned with gifts but also with the news that one of her brothers had been killed—by a police officer overstepping his authority, she said. People in the village accepted that story. His remaining uncles up north, whose anger at Enrique’s mother for having married his father had subsided, sent Enrique his first clothes from America. Villagers viewed these men as heroes; some asked his uncles for help getting north. Enrique imagined his uncles were grand men in a place called Canoga Park.

His mother found work overseeing the village school’s lunch program, so Enrique no longer went hungry at school. His father was elected treasurer of the local sugarcane farmers’ cooperative. He oversaw the installation of the first village streetlights. It surprised Enrique to see his father so diligent about putting in village light poles while he brought so much darkness home.

Then junior high ended. Enrique attempted high school in Tepic. He spent two weeks there, each day without anything to eat for lunch, before he ran out of bus money and withdrew. The threat of a life in the fields now seemed frighteningly real. Toiling in the cane would never allow him to give his girl what she and her father expected for her. In the village, girls married young; though she was only thirteen, Enrique had no time to lose.

Plumbing was at last coming to the village. Now townsfolk could get drinking water from the faucet instead of from distant wells. Toilets would replace the hills. But Enrique thought only of his uncles in Canoga Park. So he made plans and he kept them to himself. He’d get to Tijuana, find a coyote to take him to Canoga Park. He had no address or phone number for his uncles, but surely they were so well-known that they’d be easy to find.

One day he walked through the village, greeted his friends, spent time with his girlfriend, and said farewell to no one. The next, he took a birth certificate and put on his best black jacket, one that his uncles had sent to him, a white collared shirt and blue pants, kissed his mother, and said he’d be back later that day. He went to Tepic and boarded Tres Estrellas de Oro, the low-cost bus line that over the years took north hundreds of thousands of Mexicans intending to cross.

He paid for the ticket with two hundred pesos he had swiped from his parents. He considered the money a loan so he wouldn’t feel bad for taking it. He sat by the window for twenty-eight hours so he could see all the things he had never seen before.

It was 1989 and he was fourteen.

The Molecule

Andy Coop very nearly spent his career watching paint dry.

The son of a machinist and school cafeteria worker, Coop hailed from Halifax in Northern England. He finished his undergraduate work in chemistry at Oxford University in 1991. He was given a choice of where to continue his studies. At Cardiff University was a professor whose specialty was the chemistry of paint. Industry at the time was aiming to find a new paint that dried at a certain temperature. At the University of Bristol was John Lewis, who studied the chemistry of drugs and addiction. In the 1960s, Lewis had discovered buprenorphine, an opiate that he later helped develop into a treatment for heroin addicts.

Coop didn’t remember giving the choice much thought. Drugs sounded more interesting than paint was all, so off to Bristol and John Lewis he went. It was there, in 1991, in a lab at Bristol that Andy Coop encountered the morphine molecule—the essential element in all opiates. In time, Andy Coop got hooked on the morphine molecule—figuratively, of course, for he only once took a drug that contained it, and that following surgery.

I looked up Andy Coop because I wanted to understand the molecule behind the story that consumed me.

Like no other particle on earth, the morphine molecule seemed to possess heaven and hell. It allowed for modern surgery, saving and improving too many lives to count. It stunted and ended too many lives to count with addiction and overdose. Discussing it, you could invoke some of humankind’s greatest cultural creations and deepest questions: Faust, Dr. Jekyll and Mr. Hyde, discussions on the fundamental nature of man and human behavior, of free will and slavery, of God and evolution. Studying the molecule you naturally wandered into questions like, Can mankind achieve happiness without pain? Would that happiness even be worth it? Can we have it all?

“I might have loved paint,” Coop told me. “But the conversation over evolution, heaven and hell, psychology—none of that matters when you’re [studying paint].”

In heroin addicts, I had seen the debasement that comes from the loss of free will and enslavement to what amounts to an idea: permanent pleasure, numbness, and the avoidance of pain. But man’s decay has always begun as soon as he has it all, and is free of friction, pain, and the deprivation that temper his behavior.