Empire of Pain

Empire of Pain is a story of many grey areas and a bright line in the shape of a little pill. At its heart sits a single family that profited from the pain of millions of Americans.

Anyone familiar with the art world or higher education has heard of the Sacklers. The Sackler Library at Oxford, the Freer Gallery of Art and Arther M. Sackler Gallery at the Smithsonian Institute, the Sackler Wing at the Metropolitan Museum. But, in recent years, the Sackler name has come to be associated with something much more negative: their company Purdue Pharma, its product OxyContin, and the opioid epidemic it helped jumpstart.

Patrick Radden Keefe’s latest book, Empire of Pain, an extension of a New Yorker article on the same topic, documents both sides of the Sackler legacy, examining how this family, the children of Jewish immigrants, made an enormous fortune that was designed to burnish their good names, but then helped create one of the worst public health crises in US history.

Empire of Pain is divided into three parts.

The first part focuses on the first generation of the Sackler dynasty. Arthur, Raymond, and Mortimer were the sons of Jewish immigrants in Brooklyn. All three attended Erasmus Hall High School and became doctors in an era when medical schools put in place severe quotas to exclude Jewish applicants. The oldest, Arthur, had already begun a career in marketing while in high school and paid his way through medical school with a job as a copywriter at the advertising firm William Douglas McAdams, a double career that would come to define his career. After graduating, Arthur pursued a residency at Creedmoor Psychiatric Center where, joined by his brothers, they helped pioneer pharmaceutical approaches to treating mental illness.

However, Arthur also kept up his second career as a medical ad-man, first working at and then coming to own William Douglas McAdams. As if that were not enough, Sackler became a silent partner in L.W. Frohlich, McAdams’ competitor agency founded by his childhood friend, as well as joining his brothers and Frohlich in founding IMS, a medical information company, and the Medical Tribune, a direct-to-physician newsletter that, unsurprisingly, featured numerous advertisements for products repped by McAdams and Frohlich.

In Keefe’s telling, Arthur Sackler was a powerful personality, a tireless font of energy, and a man with numerous and varied tastes that led him to take art classes at Cooper Union. But he also thrived in the grey areas. He made his fortune playing a shell game with advertising, always disguising how involved he was in any given company, to the point that he transferred a large portion of his stake in one to his then-ex wife Else, but continued to freely use “her” funds as he pleased. It was in this context that he purchased for his brothers an old pharmaceutical firm, Purdue Frederick, the maker of small number of staple products like earwax removers and laxatives.

Charitable giving was always part of the plan. The brothers and Frohlich initially agreed that their heirs would receive some money, but once all four died their companies would pass into a charitable trust that would burnish their names. In practice, the charitable giving was more of the same shades of grey. Keefe points out that Arthur Sackler liked having his name on things (so much so that he encouraged his third wife to take his name years before they married), but he always drove a hard bargain. For instance, he persuaded the Met to store his collection of Asian art on his behalf and often managed to defer the actual donations so as to extend the tax benefits of his gifts. In one case, he negotiated that he would purchase the collection of a gallery to at the original price from the 1920s and donate it back to the museum as a way of infusing a little more money to the institution—only to turn around and claim the present value of the gift as a tax write off in a maneuver that might as well be out of Winners Take All. Keefe suggests that Arthur Sackler made money on the transaction.

Arthur and his brothers rode these grey areas into the upper-crust of American society, but as early as the 1960s there were questions about their methods. In 1962, Arthur Sackler testified before a congressional committee chaired by Eses Kefauver that was then looking into the pharmaceutical industry, with particular questions about the ethics of advertising drugs and the process by which companies got their drugs approved. Arthur escaped unscathed, but these two questions remained unresolved.

The second part of Empire of Pain turns to the development of OxyContin in the 1990s (years after Arthur had passed away). The proprietary technology of OxyContin is the time-release coating that allows a powerful dose of opioids to be slowly released into the body. Purdue Pharma, now headed by Raymond’s son Richard, claimed that the slow release of the medication diminished the risks of addiction and thus that this was the perfect drug to address all sorts of chronic pain issues. With this marketing in hand, Purdue dispatched armies of sales reps across the country with a simple mandate: sell as much OxyContin as possible. After all, the clock was ticking until generic competitors would undermine profits. These were the same sales methods that Arthur had pioneered decades earlier, now turned toward a drug made by the family’s company.

Where the first two parts of the story are filled with domineering people who rode problematic practices to wealth, part three turns dark. Keefe uses court documents to show that the Purdue (and the Sacklers’ other company, IMS) were aware of doctors over-prescribing pain medication and all of the ways that the drug could be abused. And yet, Keefe shows, the family to this day denies responsibility—for its false advertising, for its sales-tactics, and for its role in inventing problems to be solved with an addictive substance. Instead, Richard and other company representatives blamed overdoses on the victims, claiming that criminals were the problem, not the company. They thus used an army of lawyers to quash lawsuits, all while refusing to heed calls from within to diversify their portfolio and voting themselves billions of dollars in payouts, leaving the company itself effectively broke.

Empire of Pain is an infuriating book. The standard defense of Arthur Sackler is that he had passed away before the invention of OxyContin and thus it is the responsibility of Raymond, Mortimer, and particularly Richard, who was then in charge of the company. This is the same claim made by the younger generation who insist that they be judged by their movies or actions without consideration of the family firm. Keefe’s argument though is that this was a family firm. Arthur’s methods of interacting with the FDA and marketing bled into Purdue pharma, and the money then came out of Purdue pharma and into the wallets of the younger Sacklers. There are some differences between the generations, sure, but Keefe suggests that this is built on wishful thinking—Arthur was in the analgesic business before his brothers were.

But the question of blame is only one facet of why I found this story infuriating. This is in fact the third book in the last two decades to make this connection, on top of the mountain of court filings. Rather, it is the sum total that makes it so frustrating: he grift, the marketing, the failures of oversight, the pain it wrought, and the lengths they went through (to say nothing of the millions of dollars they spent) to deny responsibility. The Sackler family is correct that they are not the only ones profiting from the sale of opioids and that the opioid epidemic goes far beyond Purdue pharma, but it is also hard to deny Keefe’s conclusion that the drugs and methods they pioneered have had profoundly toxic consequences.

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My reading continues practically without interruption. I have also finished Andrea Stewart’s excellent debut novel, The Bone Shard Daughter, which I plan to write about, and Yishai Sarid’s The Memory Monster, which I might not. The latter is a parable about an Israeli tour guide to Holocaust sites in Poland who becomes consumed by the memories of the Holocaust. This novel had a number of barbs, including children on tours saying that they needed to model themselves after the Nazis and do this to the arabs and the narrator’s frustration with how the Holocaust has become symbolic even to the point where people were associating it with Poland rather than Germany and thus forgetting the humans at the camps in all of their complexity, but I found the story itself a little shallow.

I am now reading Megha Majumdar’s debut novel, A Burning.