The opioid epidemic has ravaged the nation and claimed the lives of thousands. How did we, as a nation, get to this point? How did the medical practice of “pain management” become a for-profit scheme conducted by pharmaceutical companies seeking to keep addicts as repeat customers?
Charlotte Bismuth’s Bad Medicine: Catching New York’s Deadliest Pill Pusher provides detailed insight into how America’s opioid problem can be pinned not to a single moment or person but to the negligence of systems intended to improve vulnerable people's lives, and to the indifference of people in positions of power within that system. Rather than placing the blame on a definitive cause, this knowledgeable account emphasizes overarching systemic failures, rooted in the greed of those who are meant to “do no harm.”
Bismuth, a graduate of Columbia Law School and a former prosecutor, describes the case of Dr. Stan Xuhui Li, the first doctor in New York state charged for and convicted of homicide based on the overdose deaths of his patients. Bismuth joined the New York County District Attorney’s Office in 2008 as an appellate attorney, and in 2010 she transferred to the Office of the Special Narcotics Prosecutor. In December of that year, the office received a tip from an NYPD detective about a physician who was “prescribing medication to young kids who don’t need it.” Bismuth was asked to dig into the complaint, which kicked off her yearslong journey of bringing Li to justice.
The doctor, who was based in New Jersey and employed as an anesthesiologist at a teaching hospital, had opened a basement clinic in Flushing, Queens, that soon became a popular pill mill. Li was found to have written prescriptions for patients even after concerned family members begged him to stop. And though he didn't physically force patients to abuse their medications, Li’s actions, or rather lack of actions, contributed to the overdose deaths of 16 patients, “some within a few days, some within a month or a few months; others within a year” of their last meeting with Li at his office.
Bismuth writes in the author’s note that her book “does not purport to be a journalistic overview” but “a memoir from the trenches.” Told in nonchronological order, Bad Medicine isn't a stuffy, detached reenactment of the trial. Bismuth provides the necessary background to contextualize the opioid crisis, the evolution of related laws and the requirements of legal procedures, but she also shares the personal chaos that influenced her courtroom battle, including the breakdown of her marriage and contentious divorce, the demands of parenting and the crushing dread of depression and anxiety.
Some readers may wonder why the narrative switches focus from chapter to chapter, hopping from the nitty-gritty aspects of building a case to reflections on the author's inability to live up to her own expectations in her personal life, but the overall result shows Bismuth’s commitment to a higher calling. Bismuth came to know the victims’ surviving relatives as well as the deceased themselves. She portrays Li not as a doctor who cared too much or trusted his patients to a fault but as someone who had all the right educational training and chose to keep endangering his patients anyway—whose apathy and need for financial gain overruled his sacred duty as a doctor.
The greatest strength of the book is the author’s ability to break down the legal jargon of the court system and the prosecution’s evidentiary path to conviction. The text links each piece of evidence in a clear path to confirm Li’s self-serving motivations, despite the jumps in the timeline. Bismuth humanizes Li’s patients and does not pass judgment on their substance abuse problems.
For readers who prefer more of a straightforward nonfiction account that centers on the scientific data rather than the messiness of the human condition, Bismuth’s work may be too close to the bone. However, Bismuth does not claim to offer the final authoritative take on the opioid epidemic but instead provides one important piece of the puzzle.