Empire of Pain: The Secret History of the Sackler Dynasty

I finally worked myself up to read what I already knew was a frustrating and inconceivable story of greed on the part of the Sackler family, but after finishing, I am most horrified by the way the US government has failed over several decades and on multiple levels to simply do their job. As always, there are people who actually did the work to hold this bunch accountable but then the family and their myriad companies were protected from we the people by the politicians at the top -- repeatedly. From Michael Bloomberg to Rudy Giuliani, from ivy league schools to escalators in London, from FDA flacks who let advertising staff write medical inserts and didn't bother to do any research or check the company's bogus claims to prosecutors who changed their tunes (all of whom waltzed into jobs provided by the Sackler family and their many "interests,") to the DEA, the DOJ, the FDA, the courts and so many places in between, money greased the Sackler family's way to zero consequences, with deaths in the millions littered throughout their story. Actual Western Virginia prosecutors tried to stop this mess in 2007, but they (like everyone else) got shanked by their DC bosses after 5 years of work. This pattern repeats itself through decades with devastating consequences for the regular people and no consequences for the politicians and the pill peddling family. In 2024 we know that the family now can get sued, but various states are spending settlement money on more police toys and I have serious doubts that a bug hunk of that money will ever be used in a way that helps mitigate the disaster this greedy family and its paid government lackeys created. That said, this book is an easy read that makes what could have been an impossibly intricate bunch of details into as straightforward a narrative as possible. Mr. Radden Keefe writes well and molds a clear and compelling story while being much more fair to everyone involved than they probably deserved. He's also quite gracious to everyone who reported on this story before him. Assiduously endnoted, carefully researched, this book has a lot of pages but they read like a well-paced novel. Do yourself a favor and make the time to read this one.

Patrick Radden Keefe is the best writer I have read in a long time. You finish all 452 pages and you know very well the story could never have been more succinct, more tight: it’s perfect. Three Jewish brothers, sons of immigrants, are intelligent, enterprising, and devoted. One of them, Arthur Sackler, is attentive to dilemmas of mental patients and appalled at the lack of medical interventions to alleviate pain. His research led to the invention of Valium and eventually, Oxycontin. Arthur bought a pharmaceutical manufacturing company (Purdue),and brothers Mortimer and Raymond would manage it. As time evolves both the pain treatment world and the development of drugs to treat pain, Purdue folks realize that oxy condone seemed to prescribing physicians as less threatening than traditional morphine; earlier Bayer had manufactured heroin as morphogenetic without the pesky side effects—-even though heroin was more powerful and just as addictive. This is really a turning point in the narration of the opiod crisis story: Purdue executives decide to follow a similar strategy and they begin to exploit the misunderstanding that oxy was less strong, more safe. In those days, doctors knew what they knew about oxy based on Percocet in which a very small dose of oxycodone is combined with acetaminophen or aspirin. The company for reasons of profit and sales decides to enhance the product’s appeal to doctors by pushing it for non-malignant pain—-forms of chronic pain because, after all, who doesn't have some of that? So the appeal expanded far beyond cancer patients—-not only would its use become widened for all sorts of patients (even juveniles), but the dosage could be increased. And so it was. The relationships with doctors in the field, the Food and Drug Administration, and the countless museums which benefitted from Sackler generosity weaves a very tangled web of unchecked capitalism and moral poverty. Purdue decided to create a special coating which would minimize the risk of addiction—or perhaps remove that risk altogether. This unique “improvement” would eliminate the risk of serious addiction (when is addiction NOT serious?) so that the wedding of the opium poppy and pain management could be obtained without danger. The sales and marketing of the product and the wooing of doctors is the most sorrowful chapter of unfettered capitalism: people started dying from overdoses. There is something odd about “the guns-don’t- kill people; people- kill- people” thinking here—-the Sacklers claimed addicts misused the product and truly, it could not be seen as their fault nor their responsibility. Most of us would remember Big Tobacco litigation and walking a mile for a Camel or the Marlboro Man: now the Purdue company was spending millions per month on litigation, but that litigation was seen as an annoyance at best. A photographer widely recognized for her artistic expression and product, Nan Goldin, developed a painful case of tendinitis in a wrist and a doctor prescribed OxyContin. The drug felt to her “like a padding between you and the world.” For three years she took the pills, always upping the ante and taking more and more. She overdosed. She was hooked, and she knew it, so at the age of 62, she checked herself into a rehabilitation facility of great repute and began a journey to sobriety. In 2017, she read an article in the New Yorker magazine about the opiod crisis which mentioned the drug developed by the Sacklers and their company which painted a picture in stark contrast between their generosity in the world of culture and their —-well, depravity—-their source of Great Wealth. A Chair of Psychiatry at the esteemed Duke University noted that the Sackler name is known as the source of good and philanthropic work, but actually those gifts and their fortune come to us as the result of the millions of people who are addicted to their product. Phillip Radden Keefe was the writer of the magazine article. As a result of the readership of the magazine and the compelling content of the article (we all know the New Yorker doesn’t limit its writers—that the magazine tells the whole story), the Sackler family came under ever increasing scrutiny for their role in the opiod crisis. Nan Goldin arranged for protests in some of the very museums once blessed with Sackler funds and she just would not stop. Nor would Keefe: he interviewed Purdue employees and saw Denial in the lot of them; the reader of this expose will see Greed as the driving principle. This books calls into question the entire scheme—-advertisers and marketers, wholesalers, doctors who wrote the scripts, and the pharmacies who carried the drug. The only whistleblower who emerges from the entire dreadful Mess is Patrick Radden Keefe himself. Read this book if you want another example of how unfettered capitalism contains the seeds of its own destruction: sorrowful.

Empire of Pain tells the tale of how three generations of the Sackler family built a wildly successful medical and pharmaceutical conglomerate. As a history of a corporate history, I find it an arduously researched and brilliantly written business biography. Those who enjoy reading about the entrepreneurial journeys of businesses and how they sometimes run astray business ethics will want to read Empire of Pain. I gave the book four stars rather than five because the author has so laced the book with liberal virtue signaling, political correctness and favor-currying with the New York Times that his arguments of corporate malfeasance and executive ill-intent are considerably weakened. Still the book is a must read for those who love stories of corporate intrigue. And despite his heavy use of liberal virtue signals, author Patrick Radden Keefe is a world class story teller.

What an insight into the incredible rise of this family and the means they went to for the price of money over lives

Sakura (cherry blossom) is a Japanese slang term that refers to adorning banal products by conspicuous hired people. Arthur Sackler's Sakura-marketing promotion brought exorbitant money to the Sackler family. Each country has a policy on drugs, and when it comes to painkillers, doctors are strictly prohibited from prescribing opioids in Japan, even though patients yearn to remove chronic pain. The book reveals the dark side of the pharmaceutical industry and the inappropriate drug authorization systems in the US—a very horrible non-fiction story. Pain is annoying but an essential vital sign we should accept to some extent. Would I take the COVID-19 vaccines if I had read this book before?

This was the first non fiction book i have read in a long long time and it was a great experience. It’s an astonishing story, written down in a very clear and captivating style. (And interesting to keep following it in the press).

“I started reading Patrick Radden Keefe due to the book ‘Say Nothing’ about IRA activities in Northern Ireland. Subsequently, I read ‘Empire of Pain,’ detailing how the Sackler family, posing as philanthropists, contributed to the opioid epidemic in the USA. They aggressively promoted OxyContin through Purdue Pharma reps, encouraging doctors to prescribe this highly addictive painkiller, containing oxycodone, a semi-synthetic derivative of opium. The book reveals the deceptive promotion, leading to widespread addiction and the destruction of lives and families over the past 30 years in the USA and beyond. Engaging read, a truly deserving 5-star book!”

Incredible book into the lives of the Sacklers and how they shaped the pharmaceutical and healthcare industries for the ultimate goal of making money. It's written brilliantly with great attention to detail, but I don't find any of it boring. Patrick Radden Keefe is an excellent writer. There is so much information in this book, but it all serves a purpose and delivers an exciting (if deeply upsetting) look into how OxyContin was developed and what made it so pervasive. The lengths that the Sacklers and Purdue went to all for extra money is astounding and deeply troubling.