Empire of Pain: The Secret History of the Sackler Dynasty by Patrick Radden Keefe - review by Joanna Walters

Joanna Walters

Pills & Patronage

Empire of Pain: The Secret History of the Sackler Dynasty


Picador 560pp £20 order from our bookshop

The Sackler name adorns the buildings of many elite arts and academic institutions, from the Metropolitan, Guggenheim and Smithsonian museums to Harvard, Yale and Oxford universities, Tate Modern, the V&A and the Louvre. It even appears in a stained-glass window at Westminster Abbey. That’s what hundreds of millions of dollars of philanthropy buys you. Such money has also earned members of this elusive family access to refined circles, mansions and various top honours. One museum director has likened the Sacklers to the Medici in 15th-century Florence, whose patronage of the arts helped give rise to the Renaissance.

What the billionaire Sacklers disclose only sotto voce when they are waltzing at charity galas or opening a gallery, if at all, is that they earned their fortune from the prescription painkiller OxyContin. It’s a legal narcotic derived from the opium poppy, twice as powerful as morphine, and it revolutionised the treatment of pain in the United States after it was launched in 1996.

Unfortunately, the drug was so ruthlessly and deviously marketed for the masses that it became the object of widespread over-prescribing and is often blamed for being the catalyst of the US opioid crisis. This American public health catastrophe has spawned millions of addicts, from all walks of life, and has cost at least half a million lives.

If you are wondering how doctors and regulators were persuaded that something related to opium was safe to dole out for the treatment of quotidian pain and how intimately involved a core group of Sackler billionaires were in the whole process, the New Yorker staff writer Patrick Radden Keefe duly explains. He expertly draws all the threads together to bring us the full, frightening saga. The book doesn’t have one huge, jaw-dropping revelation, but the sum of its parts is a stunning crime story.

A handful of books have explored the US opioid crisis and Keefe pays tribute to them. Most include the tale of the three Sackler brothers, born to Jewish immigrants in Brooklyn, who became doctors, survived the Great Depression, bought a New York pharmaceutical company in 1952 called Purdue Frederick and crafted both the Sackler fortune and the scandal. But this is the first book to concentrate on the leading family members, their lives, relationships, habits, talents and rifts. It demonstrates comprehensively their role in the OxyContin scandal and other controversies before it.

Isaac Sackler arrived in Brooklyn in 1904 from the Austro-Hungarian Empire, a descendant of rabbis. He married a Polish immigrant called Sophie Greenberg, parenting three sons, Arthur, Mortimer and Raymond. Isaac lost his livelihood in the Great Depression but impressed upon his children that while fortunes could be lost and made again, what was invaluable, and irretrievable if ruined, was your good name in society.

We learn riveting details about the brothers becoming doctors, with Mortimer and Raymond studying in Glasgow after anti-Semitism led to them being excluded from US medical schools, and about how the three worked at a psychiatric institution in Brooklyn and devised drug treatments for patients as less brutal alternatives to the electric shocks and lobotomies typically used in 1940s asylums.

Arthur was also drawn to marketing and became a leading light in the nascent medical advertising industry and in medical publishing. He pioneered glossy ads and deft promotions of branded medications to the US medical profession. He also led the marketing campaigns for a new class of mild tranquillisers promoted as the answer for the anxious hordes. These benzodiazepines such as Librium and Valium – ‘mother’s little helper’ to the Rolling Stones – became the most prescribed drugs in America in the 1960s. Arthur Sackler didn’t invent or produce these drugs, but masterminding the marketing of them made him very rich. And all kinds of slippery tactics helped the industry deflect growing evidence that tranquillisers were addictive.

Keefe takes us on the queasy journey through the toxic marriage of pills and ad men, all the way to explaining how OxyContin similarly became a blockbuster new drug decades later.

When Arthur died in 1987, Mortimer and Raymond bought out his stake in Purdue Frederick from his heirs. The company specialised in unglamorous products such as earwax remover and laxatives. In 1991, with Mortimer and Raymond’s children now increasingly involved, the family created Purdue Pharma to be the new core business, based in Connecticut, and hit on a new formula for a painkiller. Mortimer’s daughter Kathe and Raymond’s son Richard – cousins but also rivals – became key players at Purdue Pharma, and both are described in the book as claiming credit for the OxyContin phenomenon.

In the making of this new painkiller, Purdue used a unique patented pill coating, previously developed by one of Mortimer’s UK businesses, that was designed to release a drug gradually and continuously into the body. Purdue paired that with the opioid oxycodone, an obscure cousin of morphine and heroin. They branded it OxyContin and launched an aggressive marketing campaign to get the efficacious but potent narcotic approved and prescribed as widely as possible.

Ten Sacklers have served as directors of Purdue Pharma. This core group and their loved ones enjoy a family fortune estimated at $14 billion. Keefe explains how they spent two decades dodging personal accountability for the addictions, abuses, overdoses and deaths that are the underbelly of the supposed wonder drug.

With this book, Keefe completes a mission he started with his research for a damning 2017 New Yorker article on the Sacklers. Not surprisingly, the author didn’t obtain direct access to either the Sacklers themselves or their nearest and dearest, so there’s something of a two-dimensional villainy to the portraits of the central characters.

The chief fascination lies in his detective work regarding who did what and how – and in how they have got away with it. Or have they? The Sacklers who own Purdue have avoided criminal prosecution (unlike the company), but in the last two years they have been sued personally by the authorities of at least three thousand cities, counties, tribes and states across the US, accused of kick-starting the opioid crisis. It’s all being fought out in the courts. In parallel, the American art photographer Nan Goldin, who became addicted after being prescribed OxyContin, has organised high-profile protests at the Metropolitan and Guggenheim museums and the Louvre, demanding that such institutions stop taking Sackler donations and remove the family name from buildings. There was resistance at first, but over time these institutions and many others, including the Serpentine Gallery and Tate group, signalled that they have no plans to accept future Sackler gifts. Some began removing the name.

When Keefe gets to the testimony that Kathe Sackler and Richard’s son, David Sackler, gave to a US Congress investigation last year – at which one congressman said, ‘I’m not sure I know of any family in America that’s more evil than yours’ – he brilliantly brings us full circle to patriarch Isaac’s warning. The billionaire Sacklers haven’t lost their fortune or been arrested yet. But they’ve ruined something invaluable, their good name, and that leaves them all the poorer.

Sign Up to our newsletter

Receive free articles, highlights from the archive, news, details of prizes, and much more.

Follow Literary Review on Twitter