Empire of Pain

A picture of Patrick Radden Keefe’s 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.

Say Nothing

In all of the issues around Brexit, one of the most pressing was the border between the Republic of Ireland and the UK country of Northern Ireland. With the UK and Ireland both in the European Union the border between the two countries was soft, but Brexit threatened to harden the border and thereby increase tensions. I am by no means an expert on these issues and am vastly oversimplifying them, but while the Good Friday Agreement largely ended the violence of the Troubles, it is hardly a forgotten issue. It was with this background that I brought into Patrick Radden Keefe’s Say Nothing, which the subtitle describes as A True Story of Murder and Memory in Northern Ireland.

Say Nothing, which draws its title from imperative motto of Provisional IRA operatives, builds its narrative around perhaps the most famous case of a “disappeared” person in Belfast. One night in December 1972, the 38 year old Jean McConville, widowed mother of ten, was abducted from her home in the low-income housing unit of Divis Flats allegedly for having passed information to the British soldiers. She was never seen alive again.

Over the years, the McConville case garnered international attention as one of the most prominent unsolved murders from this period, but hers was just one of some 17 disappeared persons whose abductions were blamed on units within the Provisional IRA, a Republican militia group.

Radden Keefe spends the first parts of Say Nothing pulling back from the disappearances in order to explore the operations of the “Provos,” introducing readers to operatives such as Dolours and Marian Price, two radical sisters in a group called the Unknowns, and leadership figures in the organization like Brendan Hughes and Gerry Adam. He asks important questions, such as how did the Provos become radicalized such that the violence accelerated with money and weapons from the US, most notably the Armalite—the same company that makes the AR-15—and how the conflict developed when prominent Provos ended up in prisons staging hunger strikes.

One of the core tensions in this portion of Say Nothing is the fundamental differences of interpretation in how the Provos and the British authorities saw the conflict. For the Provos, this was a war and they used this justification as an excuse for when they killed civilians. The British responded with the tactics and techniques learned in suppressing rebellions in their colonies. This meant draconian incarcerations and largely looking the other way at retributive violence committed by loyalist militias. The result was tragedy.

Where roughly the first half of Say Nothing is a harrowing, propulsive narrative of events, filled with the youthful fire of its protagonists, the second half is slower, messier, and perhaps more significant investigation into the memory of the conflict.

This happens in two ways. First, the protagonists age. Gerry Adams gains a measure of respectability as a mainstream politician, which his former comrades-in-arms saw as a betrayal of everything they fought for. The others emerged prematurely aged, broken by their time behind bars, and often struggling with alcohol and drug dependencies. They aren’t remorseful, though some expressed regrets about specific actions, but they appear much more subdued.

The second development in this part of the book is reportage on The Belfast Project, a secret project hosted by Boston College where ex-paramilitary members allowed themselves to be recorded on tape discussing their activities during the Troubles. In other words, after years of silence, they said something.

These tapes were to be kept in the US and embargoed until after the deaths of the participants in order to prevent prosecution for crimes committed and thereby get the participants to speak openly and thereby create an oral history archive. Despite this intent, the project turned out to be a mess. Once the existence of the tapes became known, the Atlantic Ocean (and the poorly-written confidentiality agreement) proved a flimsy shield against legal action.

Radden Keefe makes it clear from the outset that he is not a historian. In this sense, he has written a compelling book in which nobody comes off well. This is a story with only villains and victims. Gerry Adams appears sociopathic, for instance, and the Price sisters unrepentant. The through-line is the McConville murder and how the body came to light in part because of the Belfast Project, is a perfect entryway for an exploration into not only the Troubles, but also just how shallowly the Troubles were buried.

At the same time, his particular source-base and choice of subject sometimes leads this to being a one-sided story focused on the Provos and their quixotic war against the British. The British authorities necessarily appear as the antagonist, but since many of their records remain sealed, that side of the conflict is largely absent. The other missing character in all of this were the Loyalist paramilitaries who Radden Keefe mentions, but rarely explores.

I also might have liked further discussion of the historical development of the Troubles given that this was clearly not an isolated incident. Nevertheless, Say Nothing is worth reading, both because it is a propulsive story and because it is an object lesson in how memory and rhetoric form an explosive mixture that can lead to tragedy, particularly during times of economic crisis and when the authorities are not interested in the even application of the law.

Oh, wait…

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With the semester in full swing, my reading time has diminished. Right now, I’m slowly making my way through I.J. Singer’s The Brothers Ashkenazi, a generational family history set in the Polish town of Lodz and originally written in Yiddish.