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In the late 2000s, an employee of Purdue Pharma was stunned by the words of the corporation’s in-house counsel. At a meeting, the company’s lawyer, Stuart Baker, had been praising three former members of the leadership team, including his own predecessor. Those three men had pleaded guilty in 2007 to making fraudulent claims about the harmlessness of Purdue’s cash cow product, OxyContin, and had been forced to resign. “Those people had to take the fall to protect the family,” Baker said, as quoted in Empire of Pain, Patrick Radden Keefe’s masterfully damning new book about that family, the billionaire Sacklers, who owned Purdue. The company’s foremost priority, Baker went on to remind all present, was “to protect the family at all costs.” The unnamed (and now former) Purdue employee who witnessed this little speech told Keefe, “I remember going home and saying, ‘Where the fuck am I working?’ ”
Empire of Pain, Keefe explains in his afterword, is a dynastic saga. Like Purdue, it is all about the Sackler family: how it transformed American medicine, the key role it played in the opioid crisis that now costs tens of thousands of Americans their lives every year, and the family’s belated and incomplete downfall. The Sacklers went from an esteemed clan known primarily for their philanthropy on behalf of cultural, educational, and scientific institutions—including, most famously, the spectacular Sackler wing of the Metropolitan Museum of Art, which houses the Temple of Dendur—to public disgrace and repudiation. Among the final scenes in Empire of Pain is a student activist happily watching the Sackler name being chipped off the facade of a building at Tufts University. The family threatened to sue, claiming that the university was violating an agreement it had made when it received donations from one of its members. Keefe calls this “a graphic measure of the Sacklers’ vanity, and of their pathological denial, that the family was prepared to debase itself by trying to force its name back onto a university where the student body had said, quite explicitly, that they found it morally repugnant.” It’s also an illustration of how much the very rich, when crossed, operate like the Mafia, though they reinforce their power with shell companies and lawyers rather than omertà and violence.
Keefe is no stranger to covering gangster tactics. His previous book, 2019’s Say Nothing, was an acclaimed bestseller about the abduction and murder of a widowed mother of 10 by the Irish Republican Army, and for the New York Times Magazine, he wrote about the financial management of the Sinaloa drug cartel in Mexico. In fact, it was Keefe’s interest in how the cartels function as businesses that piqued his curiosity about Big Pharma, and specifically the Sackler family, which he wrote about for the New Yorker in the article that became the basis for Empire of Pain. Keefe doesn’t lean too hard on the Mafia comparison in this book, but when he refers to Howard Udell—Purdue’s ultraloyal longtime staff attorney, and one of the three men who took the fall in 2007—as the Sacklers’ “consigliere,” the dart hits home.
The Sackler story begins with three striving brothers, Arthur, Mortimer, and Raymond, born to a Jewish immigrant grocer and his wife in early 20th century Brooklyn. All three became doctors. Arthur, the eldest and a superhuman dynamo, seemed to start a new enterprise every week; after his death from a stroke in 1987, one of the greatest challenges facing his heirs was the task of locating all of his assets and paying off unexpected debts. Arthur Sackler didn’t like people knowing his business—literally—so no one had a grasp of the entire financial picture of his estate. This was partly because some of his dealings were ethically dubious. He secretly owned a controlling share in the chief competitor of one of his own firms, for example, and he kept his name out of medical newsletters that he published to conceal a self-interested editorial bias in favor of pharmaceuticals. When Arthur became obsessed with both collecting art and donating to cultural institutions in exchange for having galleries and wings named after himself and his family, he faced a challenge, as Keefe writes, to “reconcile this ardent desire for recognition of the Sackler name with his equally strong preference for personal anonymity.” He balanced this skillfully. In the art and philanthropy world, Arthur was known to have lots of money, but no one seemed to know where he’d gotten it.
The answer was Valium, the first $100 million drug in history. Arthur didn’t own F. Hoffmann-La Roche, the company that manufactured the tranquilizer (although he swanned around the headquarters so often that there were rumors he ran it). Though Arthur was an early proponent of psychopharmaceuticals, his greatest expertise lay in advertising and marketing, services provided by his agency, McAdams. The first inductee into the Medical Advertising Hall of Fame, Arthur Sackler was credited by that august institution with pioneering the field and bringing “the full power of advertising and promotion to pharmaceutical marketing.” Some of his innovations included making unfounded claims for the nonaddictive nature of Valium, producing the first promotional insert designed to look like editorial content (in the New York Times, no less), and creating ads filled with the testimonials of practicing MDs who, upon investigation, turned out to be entirely fictional.
Arthur died before OxyContin was developed, and his widow and children, according to Keefe, energetically strive to distance themselves from that most notorious of Sackler-associated products. Purdue, which the brothers bought in 1952, was run by Mortimer and Raymond’s children and grandchildren. But Empire of Pain amply demonstrates that Arthur created the playbook used to make OxyContin a blockbuster drug, from incentives for sales reps to speakers, publications, and “grassroots” advocacy groups that are secretly funded by the manufacturer. Opioids are powerful and addictive painkillers, but not necessarily dangerous if used carefully and properly. Purdue Pharma, however, did nothing to ensure that OxyContin was used that way, and in fact encouraged its misuse. Internal documents and correspondence quoted in Empire of Pain prove that Purdue’s staff and leadership, including several of Arthur’s nephews and nieces, knew full well that many doctors were operating illegal pill mills. Yet the company refrained from reporting them because it made money from every bogus prescription.
If you are someone who engages in this kind of sneaky conduct, the last person you want reporting on you is Keefe. Although the material in Empire of Pain is more complex and less action-packed than the crimes and terrorism of Say Nothing, the narrative is just as involving. Keefe has a knack for crafting lucid, readable descriptions of the sort of arcane business arrangements the Sacklers favored. He is also indefatigable. He will interview the yoga teacher you brought to Turks a few times to help with your bad back and who knows your wife ordered two butlers to escort you everywhere as “human crutches.” He will find the doorman who was standing outside your aunt’s apartment building when your cousin jumped out the window to his death. And he will not only dig up the third grade classmate who remembers you as “innocent and mocked and friendless and rich,” he’ll quote that classmate adding that “to be ostracized on that basis” at such a tony private school, “you had to be pretty fucking rich.”
The Sackler infighting described in Empire of Pain will surely prompt many comparisons to the HBO series Succession, but a real-world parallel also comes into focus. Around this time last year, I was knee-deep in memoirs by Trump staffers and associates, and while the Sacklers may be more housebroken than the former president, there are some significant similarities. The Sacklers who ran Purdue surrounded themselves with yes men and interfered with the more prudent employees who sought to curb their excessive demands for more and more OxyContin sales. They considered only their own enrichment when making any business decision. They lack basic empathy for other people, or any understanding of the difficulties life presents to those less fortunate than themselves. Richard Sackler—Arthur’s nephew and the driving force behind the OxyContin campaign—adamantly insisted that neither Purdue nor OxyContin was to blame for the abuse of the drug, and pointed his finger at the addicts themselves. They consider themselves victimized whenever they don’t get what they want or anyone criticizes them. The Sacklers are prone to feuds and tantrums and, finally, as Keefe puts it, there is their “reluctance to concede, even hypothetically, the possibility of error or wrongdoing.”
Held up to the Sacklers, Trump seems less outrageous and sui generis, his awful behavior less a manifestation of his dysfunctional individual upbringing than typical of his kind—the mediocre children of the rich. Only worse, of course—or is he? Cosmetically, Trump is certainly the more appalling, but when it comes to the deaths that can be chalked up to his heedless selfishness … well, Keefe’s book makes clear, the Sacklers can give him a run for his money.
By Patrick Radden Keefe. Doubleday.