In the large and prosperous Indian community of Atlanta (pop. 472,522), Dr. R. K. Smile was known as “the Little King.” A few of the oldsters remembered Otto Soglow’s fun-loving cartoon character by that name, a small hemispherical monarch dressed in a fur-collared red garment with a pointy golden crown and a flamboyant black handlebar mustache. He liked innocent pleasures and pretty women. If you took off the yellow crown, that was a good description of the Smile Pharma billionaire too. He loved to play the games of Indian childhoods, was a whiz on the carrom board at his Colonial Revival home on Peachtree Battle Avenue, sponsored a team in the “hard tennis ball” Atlanta Cricket League (“We play casual cricket but we wear professional outfit!”), and from time to time organized informal kabaddi competitions in Centennial Park. He was happily married to his wife, Happy, the biryani expert, but could not resist flirting with every attractive woman who crossed his path, so his other nickname, used only behind his back and primarily by the younger women of the community, was Little Big Hands.
In spite of these grabby tendencies, he was highly regarded, a benefactor of the best Atlanta Indian newspaper and website, named Rajdhani, “Capital,” as if to assert that Atlanta was the capital of Indian America, and a donor to most of the proliferating community associations in the city, groupings of people by their state of origin back home, but also by language (Bengali, Gujarati, Hindi, Tamil, Telugu), caste, subcaste, religion, and preferred house deities (Devi, Mahadeo, Narayan, and even small groups dedicated to Lohasur the iron god, Khodiyal the horse god, and Hardul the god of cholera). He gave as generously to Hindu groups as to Muslim ones, even though he disapproved of the widespread local admiration for the Indian leader Narendra Modi, his Bharatiya Janata Party, or BJP, and its ideological parent body, the Rashtriya Swayamsevak Sangh, or RSS. The only community gatherings in which he politely declined to participate were those at which money was raised to send back to India to support those organizations. In spite of this he was popular across the whole spectrum of Atlanta Indians, and even spoke of himself as a unifying force, able to bring the seventy-five thousand South Asian Muslims in the area closer to their one hundred thousand Hindu brothers and sisters. He was not a deeply religious man himself, and had never set foot in any of the three dozen mosques in the city, not even the large Al-Farooq Masjid on Fourteenth Street. “To tell the truth,” he confided to his closest friends, “I (a) am not the praying type and I (b) in fact like the look of the Swaminarayan temple better.” This was the large Krishna temple in the suburb of Lilburn. “But don’t tangle me up in any of that, yaar,” he added. “I’m a pharmacist. I make pills.”
On the subject of prescription medication he was outspoken, severe, and, as events would reveal, utterly dishonest. “Back home in the old days,” he said when he spoke at one of the community’s many gala evenings, “there was always a street corner dispensary that would hand out drugs without a doctor’s chit. Cross-legged in his raised booth, the vendor would wave a forgiving hand. ‘Come back and give me later,’ he might say, but when you came back for more he never asked where the last chit was. And if you asked for twenty painkillers he would say, ‘Why so few? Take the box only. Save yourself trouble. Why come back every week?’ It was bad for his customers’ health, but good for health of business.” There was nostalgic laughter when he said this, but he wagged a finger at the assembled worthies and went tsk-tsk-tsk. “Ladies and gents, it is not a laughing matter.”
Afterwards, when his house came tumbling down, people would say, “It’s like he was confessing to us openly. Standing there in front of us and challenging us. Putting on a straight face even while he was telling us he was crooked, and where he got the idea.”
“Many of us have done well in America,” he went on. “I, also, by the grace of God. Our life here today is a good life. But so many of us still believe our roots are in the past. This is not true. Our old places are gone, our old customs are not the American ways, our old languages are not spoken. Only we carry these things within us. Our roots are in ourselves and in each other. In our bodies and minds we preserve our identity. Because of this we can move, we can go out and conquer the world.”
Afterwards, when his enterprises lay in ruins, people would say, “He was too greedy. He wanted to conquer the world. He told us this also, standing right in front of us, he confessed everything. But we were too stupid to see.”
BEFORE WE GO ANY further we must take issue with the good—or, as it turned out, not so good—Dr. Smile, and insist on the significance of his historical roots, or at least, the roots he claimed on those occasions when he wanted to claim roots. We have previously mentioned (see this page) his supposed ancestor who was denied American citizenship at the dawn of the twentieth century on the grounds that he was not a free white man. We now whisk the veil of anonymity off this individual, as if removing the cover from a gilded birdcage, and the caged bird begins to sing. His name, as far as we can establish, was Duleep Smile, and he first bubbled up into history as a chef in London, first at the Savoy, then at the Cecil, which back in 1896 was the largest hotel in Europe. The owner of Sherry’s, then one of the best restaurants in New York, brought this proto-Smile and his English wife to Forty-Fourth Street and Fifth Avenue to introduce the American palate to Indian flavors. (An English wife, by the by! An unforeseen element to hurl into the racial mix! But we proceed.) It’s a strange name, Duleep Smile, for if, as Dr. Smile insisted, the “Smile” derived from Ismail, then “Duleep” might perhaps be an abbreviation of Duleepsinhji (like the great cricketer), and that was a Hindu Rajput name; whereas this Original Smile came, in all probability, from Karachi. When asked about the curious contradictions of his putative ancestor’s name, Dr. R. K. Smile would shrug. “Go back a few generations in any Indian Muslim family,” he would say, “and you’ll find a convert.” Beyond that he did not care to explain or discuss.
What was important to him was that Duleep Smile became a star, a celebrity chef avant la lettre, beloved by women in particular, especially as he stated publicly that his food improved the looks and attractiveness of the women who ate it, even suggesting that curries had aphrodisiac qualities. The opinion of the English wife regarding his womanizing ways is not recorded. However, at an unspecified date, she decamped, which may serve as the clearest expression of her feelings; whereupon Chef Smile married and left a succession of ever more youthful American ladies. He also began to call himself a prince. Prince Duleep Smile, the Emir of Balochistan’s fourth son. (He wasn’t.) He claimed to have a degree from Cambridge University (he didn’t), and said he was a friend of King Edward VII. (Amazingly, this part of his fantasy of himself had some truth to it; the king agreed to be his patron for a brief time, at least until he discovered that Duleep Smile’s other claims were phony.) But the chef’s golden era—only a few years long—was ending. His troubles with the law were just getting started.
After his citizenship application was rejected he returned to England and then came back to America accompanied by a mysteriously large entourage. There was a law in America making it a crime carrying a thousand-dollar penalty to give anyone a pretext for immigrating by offering them a job. Duleep Smile had made such offers to twenty-six people. He claimed he hadn’t. His large entourage was composed of mere tourists, he said; tourists and friends. The authorities didn’t buy it. Sherry’s restaurant, facing a fine of twenty-six thousand dollars (seven hundred thousand dollars in today’s money), ended its association with Chef Smile, who entered a long decline and eventually left for India with his last American wife and disappeared from history. If he left children behind in America, their names are not recorded.
This story was not known to the Indians of Atlanta for a long time. The version they were given by Dr. Smile, and which everyone accepted unquestioningly, was heavily doctored. The culinary triumphs were described; the lies, deceptions, and hustles were left undescribed. Only after everything that happened had happened did an enterprising researcher exhume the true story of Duleep Smile, and establish that no line of descent from the famous chef to the pharma billionaire could satisfactorily be established. Once again, his fellow Atlantan Indians were left to shake their heads at their own willingness to be deceived. “Not only did he choose to claim descent from a con man, but that claim itself was a con,” the Indian newspaper wrote. “This was the level of the man’s audacity: he showed himself to us openly, but blinded us with his charm. So he rose high high. But he has fallen now.”
IN RECENT TIMES HIS WIFE had raised his profile higher than ever. His sons had left home and gone to college to study useful things, money and machines, but their mother, Mrs. Happy Smile, was a lover of the arts, and now that she had an empty nest she insisted to her husband that they should become involved in that world, even though he thought of the arts as useless and the people involved in the arts as useless people. At first he rebuffed her desire to set up a family arts sponsorship foundation, but she persisted, and when she found out about the extensive involvement of the OxyContin family in this kind of work she saw her opening, correctly guessing that her husband’s competitive spirit would be aroused. In the garden of the Peachtree Battle Avenue house, by the rhododendron bush, and over a mint julep at the end of the working day, she confronted him. “We must give back, isn’t it,” she began. “That is the right thing to do.” He frowned, which showed her this was not going to be easy. But she set her jaw firmly and frowned back.
“Give back what?” he asked. “What have we taken that we must return?”
“Not that way,” she said, in her most cajoling voice. “I mean only, give back out of our generosity to society in thanks for the so so many blessings we have received.”
“Society gave me no blessings,” he said. “What I have received, I have earned by the sweat of my brow.”
“OxyContin khandaan, they give back plenty,” she said, playing her ace. “Their family name is so so respected. You don’t want your name to be so so respected also?”
“What are you talking about?” he said, sounding interested now.
“So so many wings they have,” she said. “Metropolitan Museum wing named after them, Louvre wing also, London Royal Academy wing also. A bird with so so many wings can fly so so high.”
“But we are not birds. We have no need of wings.”
“At the Tate Modern they have an escalator with their name. At the Jewish Museum in Berlin they have a staircase. They have a rose also, pink, bearing their name. They have a star in the sky. So so many things they have.”
“Why must I care about asteroids and escalators?”
She knew what to say. “Branding,” she cried. “You buy naming rights, your name becomes loved. It will be so so loved. And love is good for business, no? So so good.”
“Yes,” he said. “Love is good for business.”
“So then. We must give back, isn’t it.”
“You’ve been looking into this,” he guessed, correctly. She blushed and beamed.
“Opera, art gallery, university, hospital,” she said, clapping her hands. “All will be so so happy and your name will be so so big. Collecting art also is good. Indian art is hot just now, like Chinese, but we must support our own people, isn’t it. Prices are rocketing, so investment potential is good. We have so much wall space. Also we can put pictures on permanent loan in best museums, and your name will be so so loved. Let me do this for you. Also,” she said, clinching the argument, “art world ladies are so so beautiful. This is all I’m saying.”
He loved his wife. “Okay,” he said. “Smile wing, Smile extension, Smile gallery, Smile balcony, Smile ward, Smile elevator, Smile toilet, Smile star in the sky.”
She broke into song. “When you’re smiling,” she sang. It was their song. “When you’re smiling.”
“The whole world smiles with you,” he said.
VERY WELL. IT IS TIME to reveal certain secrets closely guarded by Dr. R. K. Smile and the upper-echelon executives of Smile Pharmaceuticals Inc. (SPI, everyone pronounced it “Spy”). These secrets have to do primarily with the hidden life of the enterprise’s premier product, InSmile™, the sublingual fentanyl spray that made the company’s fortune; although they also involve the rest of the opioid products manufactured at the main SPI facility in Alpharetta, Georgia (pop. 63,038). It will not be a pretty story. After all, here was a man at the very peak of his career, a generous man, widely respected and even beginning to be loved. It is never pleasant to tear down such a personage, to reveal the feet of clay. Such exposés tarnish the whole community, and are regarded by many as washing the community’s dirty linen in public. But when a façade begins to crumble, it is only a matter of time before the unwashed linens tumble into public view anyway. By the time Dr. R. K. Smile visited his relative Quichotte to terminate their official relationship, SPI had already begun to attract the curiosity of the authorities, even though Dr. Smile was dismissive of their suspicions. Meanwhile, Mrs. Happy Smile had entered the arts donor sphere with high energy, and her donation offers had initiated positive discussions regarding naming rights to a potential new Smile Wing of the High Museum and a much-anticipated second-stage Smile Extension of the Cobb Energy Performing Arts Center; and it even, for a time, seemed possible that the city might agree to the renaming of Pemberton Place, the urban hub where the World of Coca-Cola and the Georgia Aquarium were located. “Give me five years,” she told her husband, “and I’ll make our name bigger in Atlanta than Coke.” And yet, and yet. Lightning can strike out of a clear sky. Dr. R. K. Smile would not have five years to give.
But to begin at the beginning: a long time ago, when he was just starting out in the pharma business, he had gone to India to visit family and friends and in a Bombay street an urchin was distributing business cards. He took one. “Are you alcoholic?” it read. “We can help. Call this number for liquor home delivery.”
Excellent business model, he thought.
He had kept that card with him ever since. SPI had followed the excellent business model with great success, sending its products in impressively large quantities even to very small towns. When the indictments were handed down, some startling facts would emerge. For example, in the years 2013–18, SPI shipped five million highly addictive opioid doses every twelve months to a pharmacy in Kermit, West Virginia (pop. 400). Six million opioid doses were sent to a pharmacy in Mount Gay, West Virginia (pop. 1,800.) Call this number for liquor home delivery, indeed. A great many doctors and pharmacists made the call.
It was a unique characteristic of SPI’s sales force—a characteristic that set it apart from the rest of the pharmaceutical industry—that you could join it even if you didn’t have a background in pharma sales or even a college diploma or degree in science. Only two qualities were required. You had to be the driven and aggressive type, and you had to be extremely beautiful.
SPI boasted the most supremely attractive sales force in America. (One of their major competitors, Merck, went down a similar route, but SPI did so with much greater commitment and enthusiasm.) As was later revealed, SPI’s Eastern Region sales chief, based in Atlanta itself, was a certain Dawn Ho, previously a dancer at Jennifer’s, a strip club in West Palm Beach, Florida (pop. 108,161). At SPI she was in charge of selling InSmile™ to the whole highly populous Eastern Seaboard, a drug so dangerous that it required its own special prescription protocol. Dr. R. K. Smile’s national sales chief expressed one hundred percent confidence in her abilities. The national sales chief was called Ivan Jewel and had a background in aquarium sales, sleep apnea testing devices, and an online ticket-resale agency in New Jersey, whose company registration was revoked after it failed to file an annual report for two consecutive years. He was also quite a looker himself, the Clint Eastwood type, as he liked to say. “Anything for a few dollars more.” He agreed with Dr. Smile that a Florida strip club was not the kind of place where Big Pharma traditionally recruited staff, but insisted that Dawn Ho was a major asset. “She’s the warm, sympathetic, good-listener type,” he said. “You gots to picture these pain management physicians. All day, all night, they live around extreme agony and cancer. Then comes this beautiful woman, it’s a pleasant distraction, one, and then she wants to listen to all your sadness, she wants you to let out all your stress, maybe a little shoulder rub, whatever, that’s more than pleasant, two, and so she wants to sell you something, you buy it, boom, three, deal closed. To me she’s a closer. I use her (a) after a first contact by another salesperson and (b) when there’s a client who’s undecided, who says yes yesterday, no today, we need him to say yes tomorrow. A beautiful lady who cares for you is the best thing in such cases. She’s like a super gorgeous no-commitment version of their wives.”
The Little King, a.k.a. Little Big Hands, liked this explanation. “If there are more like her out there,” he told his sales chief, “just get them all.”
But the beauty of the sales force—gorgeous women sent to visit male pain management physicians, Clint Eastwood hunks of men sent to visit the female ones—wasn’t enough, by itself, to explain the huge numbers of the sales. Beauty allied to drive and aggression: still not enough. When you wanted to pitch a restricted drug to board-certified oncologists, you needed to add a raft of additional techniques. Incentives: that was a better word than techniques. A group of additional incentives.
It was Dr. R. K. Smile himself who thought up the speakers’ bureau. Actually, one part of the idea wasn’t original. The idea of recruiting big-name doctors to recommend a particular medication to other doctors was an old one. Word of mouth was always recognized as the most effective marketing device. But if you wanted to go off-label, hmm. That was borderline. Maybe across-the-borderline, because going off-label meant getting doctors to prescribe a drug for conditions other than the ones stated on the label, for which the drug was intended. Or, of course, for no conditions at all, turning a blind eye to recreational use, or, more seriously, to addiction. Another, more colloquial term for going off-label might be becoming a drug dealer. Or even becoming a narco lord.
“I’ve spent my life crossing borders,” said Dr. R. K. Smile, at the opening of the first session of SPEIK (Smile Pharmaceuticals Expanding Information and Knowledge) in Eureka, Montana (pop. 1,037), a smallish gathering which took place in the historic Community Hall, a single-story log building in the rustic style. “I read it in a book once: if you fly above the Earth and look down, you see no frontiers. That’s my attitude. I’m a no-frontier guy in favor of flying high.” That was the secret ethos of SPI. They were all high-flying no-frontier guys.
After the Eureka meeting Dr. Smile allocated a budget of three million dollars toward the speakers’ bureau project. Over time the project became even more sophisticated in its methods. Doctors were identified and booked, fees were paid, and then, more often than not, the events unfortunately could not take place owing to unforeseeable circumstances, but the terms of the agreements with the doctors stated that the speaking fees were nonreturnable. A budget of three million dollars a year, handed out in substantial dollops of, for example, $56,000 p.a., or $45,000 p.a., or $33,000 p.a., or $43,000 p.a., or even $67,000 p.a., in return for performing speaking engagements which did not actually have to be performed! Such a budget offered opportunities that were attractive to a lot of doctors. Such a budget bought—or to use a more polite term, booked—some very senior doctors. And these were tough doctors, ready to receive these substantial sums in return for prescribing InSmile™ off-label, willing to recommend doing so to other doctors, and able to take any heat that followed.
Yes, unfortunately, some of them got investigated by their state medical boards, but they just handled it! They paid the fines and carried on. Yes, unfortunately, in the worst cases there was disciplinary action when, unfortunately, some of the tough doctors went too far! When unfortunately they allegedly handed out multiple pre-signed prescriptions to patients and some of said patients died of drug overdoses from the drugs so prescribed! When unfortunately they allegedly prescribed InSmile™ to persons with zero cancer pain! When unfortunately they allegedly defrauded Medicare of multiple millions of dollars! When unfortunately they allegedly billed insurance companies for procedures they never performed! A pain management specialist from Rhode Island who was also a SPEIK speaker was reprimanded! A neurologist who was a SPEIK speaker was arrested! These matters were shocking to Dr. Smile and all the SPI team. They moved swiftly to rectify or terminate their relationships with such medical practitioners. They were a reputable company. They were running a speakers’ bureau on the side, that was all. They were not and could not be held responsible for what their speakers might be doing on their own time. SPEIK was a reputable and highly regarded program and if its speakers believed in InSmile™, that was because of the inherent quality of the product. It was ridiculous and even slanderous to impugn the ethics of SPI staff. Yes, it was true, some of the adult children of SPEIK speakers were employed by SPI as part of the sales force, but that was on account of their high levels of beauty, not their parentage. These were grown independent men and women and it would be insulting both to their level of beauty and to SPI to allege that their employment was a ruse to give SPI leverage over their parents. SPI had no need to twist people’s arms. The profession liked buying what SPI had to sell.
One of Dr. R. K. Smile’s favorite doctors, Dr. Arthur Steiger, an experienced pain specialist from Bisbee, Arizona (pop. 5,200), was ordered to stop prescribing painkillers completely while serious allegations against him were investigated. At that time he had received more speakers’ fees from SPEIK than any other medical practitioner, even though unfortunately all the much-anticipated events at which he had been billed to speak had had to be canceled owing to unforeseeable factors. Dr. Steiger fought back when he was indicted. “There is a vendetta against doctors who prescribe opioids regularly,” he said. “But me, I’m the aggressive type. I aggressively help my patients. I’m the caring type also. I care aggressively. That’s just who I am.”
“I couldn’t have said it better myself,” Dr. R. K. Smile said to Happy when he read this statement.
She nodded lovingly. “You also are a fighter like this Dr. Arizona,” she said. “Look how you have fought for your family. So so many achievements, so so much success. And when I have done my work and your name is everywhere, museums, concert halls, fish tanks, parks, then you will be too too respected by so so many people and all this noise will go. It is the Age of Anything-Can-Happen,” she explained. “This I heard on TV. And I will make Everything happen for you.” Her support warmed his heart. He loved his wife. He wondered if it would upset her if he asked her to lose a little weight.
THE FLICKED-UP WINGTIPS OF the G650ER reminded Dr. R. K. Smile of his wife’s hairdo. If Happy Smile’s hair were an executive jet, he thought, it would fly him nonstop to Dubai. The aircraft was his favorite toy. Sometimes on a still and sunny day he took it up from Hartsfield-Jackson just to potter about in the sky for a few hours, over Stone Mountain and Athens (pop. 115,452), Eatonton (pop. 6,555), and Milledgeville (pop. 18,933), the Chattahoochee and Talladega forests, or the route of Sherman’s march. Stonewall Jackson, Robert E. Lee, Brer Rabbit, the Tree That Owns Itself, and the War between the States were all down there and he was above them, feeling at such moments like a true son of the South, which of course he was not. He had tried to read Gone with the Wind and to learn the words of “Zip-a-Dee-Doo-Dah” and “Old Folks at Home,” but fiction and music weren’t his thing. Also, like all cultural artifacts, they reminded him of his wife; and when he went up in the sky he didn’t bring Happy along. Instead he invited a half dozen of the most attractive SPI sales reps, former colleagues of Dawn Ho’s at Jennifer’s strip club in West Palm Beach, and what happened up in the air stayed up in the air. Dr. R. K. Smile was not a perfect husband, he conceded that in his rare moments of inwardness and reflection, but in his opinion these episodes (a) did not take place on earth and so didn’t count on earth and (b) in fact made him a better husband by satisfying his secret recreational urges, his off-label desires.
Flying home from Flagstaff after his encounter with old Quichotte, he was sad, and not even the ministrations of all six salesladies simultaneously could blow away his blues. His poor relation Ismail Smile had always been an anomaly in the ranks of SPI employees, old among the young, emaciated among the luscious, a lonely figure, permanently out of step, everyone’s crazy grandpa. And yet he carried himself with a certain dignity, kept himself immaculately dressed and groomed, was well mannered, well spoken, and possessed an enviably large vocabulary, was almost always cheerful, and could unleash, at any moment, his one weapon of beauty, which was his smile. Dr. R. K. Smile feared the worst now that he had let Quichotte go. The old fellow would deteriorate into some sort of dharma bum, moving aimlessly from nowhere to nowhere, dreaming his impossible dream of love. And one of these days Dr. R. K. Smile would receive a call from a motel in the middle of nowhere and then he would have to climb into the G650ER and bring the old man’s body back with him to Atlanta and lay him to rest in Cobb County or Lovejoy. That day would probably not be far away.
In his final exchanges with Quichotte he had hinted at asking him to perform some small private services, some discreet deliveries, but he hadn’t meant it. It had been a way of getting out of the room while leaving Quichotte with a scrap of self-respect and the sense of still being needed. The private services, or VIP, division of Smile Pharmaceuticals did not officially exist, and its unofficial existence was known only to a very small group, which did not include Dr. R. K. Smile’s loyal wife. The discreet servicing of the desires of the very famous was a subsection of the American economy which it was important not to ignore, but the key word there was discreet. Dr. Smile was discreet, and was willing to make house calls to the right people. Lately the demand for InSmile™ among these special, house-call-worthy customers had increased significantly, owing to a change in the OxyContin formula that decreased its appeal to recreational users, and to the special customers’ growing awareness that the sublingual spray offered instant gratification in a way that the other popular products did not. More and more gated properties from Minneapolis to Beverly Hills opened themselves to his unpretentious rental cars. He himself, small, physically unimpressive, was the forgettable type, and being forgettable was an asset in this kind of work, it assisted discretion. Like everyone in America, Dr. Smile was in thrall to celebrity, and when he entered the boudoirs and man caves of magazine-cover faces and bodies, he experienced a profoundly American joy, deepened by his secret knowledge that his net worth was probably greater than that of most of the owners of those immensely celebrated, those erotically well-known eyes, mouths, breasts, and legs, those prime manifestations of what Dr. Smile—a doctor, after all—thought of as professionally assisted perfection. He, too, was a professional. In his own way he, too, could assist.
When, some time later, a whisper reached him, the faintest murmur from one of his top, inner-circle speakers’ bureau doctors, that a certain Indian movie actress turned American daytime TV superstar might appreciate a house call, Dr. R. K. Smile actually laughed out loud and clapped his hands. “Arré, kya baat!” he cried out in the privacy of his home office. “Whoa, what a thing!” Because now, if it all worked out as he hoped, he just might be able to make possible his poor relation’s impossible dream, at least once before the tragic inevitable occurred. He might find it in his power, and in his heart, to bring fantasy-besotted old Quichotte face-to-face with his lady love.
But we are getting ahead of ourselves. The secret approach from Miss Salma R still lay a little way ahead, in the shrinking future of the world.