Empire of Pain: The Secret History of the Sackler Family by Patrick Radden Keefe

Doubleday 560 pp.

By Paul Markowitz

Arthur Sackler, the patriarch of the Sackler family, was born in Brooklyn in 1913. He was a truly remarkable man. He was brilliant, industrious, hard-working, entrepreneurial and innovative. He was in an accelerated program at Erasmus High School, worked several jobs to help support the family by the age of fifteen, graduated from NYU in pre-med, and bought a store for his struggling family, all by the age of twenty. And then he graduated from NYC Medical School.

Sackler had been taught from an early age that to be a physician was the epitome of success because it provided prestige and financial stability while promoting the public good. He held multiple jobs simultaneously, often working horrific hours — and he became wealthy beyond anyone’s expectations, Sackler purchased expensive art, and giving much of it away, and he donated generously to universities, museums and medical schools. It seemed that he had only one fault. He appeared to have an unusual lack of empathy for everyone and anyone who was not a member of his immediate family. This trait seemed to be passed along to three generations of Sacklers with staggering results.

Patrick Radden Keefe, an author and staff writer for The New Yorker, has written an immersive, compelling and illustrative book about a unique family that was able to use the system that they helped create to make themselves rich beyond belief, and to become renowned philanthropists on the order of Rockefeller and Carnegie, while keeping their activities largely unknown, and contributing to the destruction of hundreds, if not millions, of lives. As in his earlier book, Say Nothing; A True Story of Murder and Memory in Northern Ireland, Keefe writes with fiction-like flare and makes the story one of universal interest and shocking realities.

The first third of the book is devoted to Arthur Sackler, the founder of the Sackler dynasty. In addition to being a brilliant and hard-driving doctor, he had an “entrepreneurial sensibility” that led him to become an innovative salesman while bending the system of drug approval and sales strongly in his favor. He was able to do this with his two younger brothers, who were also doctors, while keeping the Sackler name largely hidden from view.

The key to Sackler’s success was to patent a drug, thus securing a twenty-year window to sell it at whatever the market would bear; protect the patent at all costs; develop a large, aggressive sales force; offer doctors extravagant incentives to purchase their drug; and just to be safe, start a boutique agency that published a magazine for doctors that covers innovations in drugs while simultaneously buying ads in medical journals touting the wonders of the drug with endorsements from prominent physicians.

This playbook worked astoundingly well. Within a year and a half the salesforce for Sackler expanded from eight to three hundred. The salespeople were taught a stratagem that Sackler invented – visit doctors in their offices, ply them with literature, buy them meals and “always keep on closing.”

During these formative years, Arthur became enamored with an impressive new woman, got her pregnant, and divorced his wife to marry her. He also bought a drug company for a mere $50,000, a small firm that sold undistinguished medicines by the name of Purdue. And he developed a sideline of assisting other people in starting pharmaceutical companies, having them use similar sales techniques, and arrange for them to share the profits, all while keeping his involvement secret.

Now the question was what to sell. The 50s and 60s, the Cold War decades, were a time of global anxiety. Roche had developed a tranquilizer called Valium which was an improvement over a previous wonder drug, because it had fewer side effects. With the Food and Drug Administration (FDA) barring pharmaceutical companies from advertising directly to the public, Roche turned to Sackler to sell its product. Since Sackler owned the Medical Tribune he was able to extol the virtues of the new drug without running afoul of the FDA. By 1975, Valium became the leading drug in the world, commonly called “penicillin for the blues,” or as the Rolling Stones lyric put it, “mother’s little helper.” Although the FDA was concerned about its addictive qualities, it wasn’t until 1973 — when its patent was close to expiring — that Roche stopped fighting and voluntarily agreed to make Valium a controlled substance.

During this time Sackler developed an interest in China and began to purchase rare art works from the Ming dynasty. Within a decade he amassed one of the finest collections of Chinese art in the world. This was the start of a period of intense art accumulation, and major donations of art and money to non-profit institutions, with the sole condition that the contributions be publicly recognized. As a result, an enormous number of art museums, universities, and medical schools prominently promoted, usually in bold letters, the Sackler name.

In this era of cultural generosity on a massive scale, Sackler had the Metropolitan Museum of Art competing against the Smithsonian for the rights to house the his spectacular Egyptian art collection. He also found time, at the age of fifty, to meet and marry a twenty-year-old woman. Back at the office, he managed to game the system of drug approval by becoming close to political and administrative officials who would side with Purdue on key decisions regarding its pharmaceuticals. Occasionally, some of these well-placed officials would be hired into a lucrative job at one of Sackler’s firms after a discreet period of time.

The second part of Empire of Pain covers the period when Richard Sackler, nephew of the patriarch, took control of the company and ran it in the style of his pioneering uncle. It was more of the same for the company, except that this time the star drug was Oxycontin, which supposedly delivered morphine in pill form but without fear of dependency due to a time-release coating. When medical problems seemed to crop up, they were handled as PR problems. Very quickly a drug that had been used for late-stage cancer patients was being prescribed for simple back pain — and it was becoming the most popular drug on the planet. It was also making the Sacklers extraordinarily wealthy.

Purdue remained a mid-sized company that focused on selling rather than developing drugs, but it was profitable on the level of companies that came up with major pharmaceuticals. After the FDA approved Oxycontin. saying that it was good for both acute short term pain and chronic long term pain, a massive salesforce was put into operation. The plan was to cultivate pain specialists, cajole regulators, develop strategies to convince physicians to prescribe their product — and to watch the money roll in.

While the Sacklers increased their philanthropic activities and got members of the family knighted by the British and the French, a whole generation of Americans was being addicted to opioids thanks significantly, though not exclusively, to their products. By keeping the family in control of the board of directors but away from executive positions, they managed to keep themselves out of the line of fire. It helped considerably that Purdue was a privately owned company, which could operate in relative darkness. Many of the Sacklers’ fellow philanthropists did not even know how they made their money.

When reports of deaths from opioids started to pile up, the problem was initially presented as one of too many “addictive personalities” getting prescriptions — and as a public relations challenge. Many users discovered how to circumvent the time-release coating, and the claim that it remained effective up to 12 hours appeared to be overstated, but Purdue professed ignorance. It even, at times, presented itself as the real victim.

As time went on, stories of opioid addiction began to fill the evening news, starting in Appalachia but quickly spreading. As they did, things slowly began to turn against the Sackler family. First the entire corporate leadership of the company was sacrificed in response to public relations and regulatory problems. As the crisis grew, sales began to decrease, though Purdue had already sold 3 billion Oxycontin pills. Throughout this period, the Sacklers had increased their financial withdrawals from the company to virtually unheard-of amounts and transferred money to offshore accounts.

When the Sacklers were eventually sued, it became clear that they were well aware of the problems with their drugs. The family went to great lengths to avoid legal responsibility, while steadily reducing the amount of money in the company’s coffers. When they were finally held accountable, to the extent that they were, they escaped with minimal damage to themselves, and did not even have to take personal responsibility for the harm that was done. There is no little irony in the fact that, for a family that played such a large role in the Oxycotin crisis, the ultimate resolution was nearly pain-free.

Paul Markowitz is a California-based writer.