Scan barcode
A review by jasonfurman
Empire of Pain: The Secret History of the Sackler Dynasty by Patrick Radden Keefe
4.0
I listened to the audiobook with rapt attention, Patrick Radden Keefe is an extraordinary journalist and narrative nonfiction writer. The first part is the story of Arthur Sackler, a Jewish kid from the Bronx with manic energy who holds down multiple jobs in high school, goes to medical school but uses it to become an entrepreneur in multiple overlapping spaces including drug advertising (he oversaw the Librium and Valium launches), medical periodicals and starting several companies—many of them on behalf of his younger brothers Mortimer and Raymond.
The second part of the book is about the brothers and their children, how they grew Purdue, and actively managed it as it went from a sleepy maker of commodity-like products and a laxative to the highly profitable maker of Oxycodone and then Oxycontin.
In the activities of Arthur and his brothers there is a mixture of profit seeking (or avarice) and idealism. Arthur Sackler was involved early on in trying to find scientifically-based solutions to replace the lobotomies and electroshock therapy he abhorred. Subsequently they appeared genuinely motivated by pain management and taking it broader than just terminal cancer patients on a morphine drip in the hospital. Originally the three brothers and a fourth partner had a deal that all their companies would become charitable trusts after the last of the four of them died.
It is never completely clear where they—and their children—crossed the line into the deeply unethical and arguably criminal. Certainly by a few years into the release of OxyContin it was clear that it was being heavily abused and they did not just deny it but they also actively fed it with incentive programs for salespeople that got more doctors to prescribe which rewarded the pill mills.
The third part of the book largely is about the reckoning as the empire unravels, very slowly at first and then incredibly quickly as thousands of lawsuits are filed, Purdue the company pleads guilty to felonies, the Sacklers names are taken off numerous cultural landmarks around the world, and they are completely disgraced. This third part of the book was in some ways the weakest (comparatively speaking, it was still very good), in that it read more like journalism of current events than a unique archival retelling and excavation of history. Moreover, Patrick Radden Keefe got more opinionated and judgmental in the third part which diminished its power because I sometimes worried he had a (legitimate) ax to grind, would rather he stuck to the news and let his readers make the obvious editorial judgments.
The book does not pretend to tell the full history of the opioid epidemic, its victims, and its many perpetrators. Instead it focuses on the Sackler family and their role—which he argues, likely correctly, was a large part of the story (even if it was not, you could write the story of a serial killer without needing to prove they were responsibility for the majority of murders in the country). In many ways that is a strength but the system shows through, like the way in which they captured the FDA, the senior leadership at the Justice Department, and manipulated the bankruptcy system including picking their own judge, all of which is enough to make ones blood boil.
There are places where I found Keefe less than fully balanced. He treats pharmaceutical advertising as a sort of original sin but the story is more nuanced, a lot of good has come from—for example—advertising anti-depressants in a way that has helped destigmatize mental illness. He treats greed as bad but it also is the source of innovation and the many amazing drugs we have today. I sympathize with Keefe’s concerns about the overly-strong patent system but it was not obvious to me that Purdue was worse than anyone else. And Keefe seems to share the moral judgment that Arthur Sackler’s name should be removed from his various donations despite the fact that he died before OxyContin was invented (the argument that he would have supported it if he had lived is tendentious and irrelevant).
Overall, its an excellent and important book. Not as exciting and dramatic and original as his [b:Say Nothing: A True Story of Murder and Memory in Northern Ireland|40163119|Say Nothing A True Story of Murder and Memory in Northern Ireland|Patrick Radden Keefe|https://i.gr-assets.com/images/S/compressed.photo.goodreads.com/books/1537315266l/40163119._SY75_.jpg|62303430] but an important and impressive exercise in accountability, one that could have been even stronger and more damning with just a little more nuance and less judgment—although many of the people in this book deserve a judgment that they have at least legally escaped from so far.
The second part of the book is about the brothers and their children, how they grew Purdue, and actively managed it as it went from a sleepy maker of commodity-like products and a laxative to the highly profitable maker of Oxycodone and then Oxycontin.
In the activities of Arthur and his brothers there is a mixture of profit seeking (or avarice) and idealism. Arthur Sackler was involved early on in trying to find scientifically-based solutions to replace the lobotomies and electroshock therapy he abhorred. Subsequently they appeared genuinely motivated by pain management and taking it broader than just terminal cancer patients on a morphine drip in the hospital. Originally the three brothers and a fourth partner had a deal that all their companies would become charitable trusts after the last of the four of them died.
It is never completely clear where they—and their children—crossed the line into the deeply unethical and arguably criminal. Certainly by a few years into the release of OxyContin it was clear that it was being heavily abused and they did not just deny it but they also actively fed it with incentive programs for salespeople that got more doctors to prescribe which rewarded the pill mills.
The third part of the book largely is about the reckoning as the empire unravels, very slowly at first and then incredibly quickly as thousands of lawsuits are filed, Purdue the company pleads guilty to felonies, the Sacklers names are taken off numerous cultural landmarks around the world, and they are completely disgraced. This third part of the book was in some ways the weakest (comparatively speaking, it was still very good), in that it read more like journalism of current events than a unique archival retelling and excavation of history. Moreover, Patrick Radden Keefe got more opinionated and judgmental in the third part which diminished its power because I sometimes worried he had a (legitimate) ax to grind, would rather he stuck to the news and let his readers make the obvious editorial judgments.
The book does not pretend to tell the full history of the opioid epidemic, its victims, and its many perpetrators. Instead it focuses on the Sackler family and their role—which he argues, likely correctly, was a large part of the story (even if it was not, you could write the story of a serial killer without needing to prove they were responsibility for the majority of murders in the country). In many ways that is a strength but the system shows through, like the way in which they captured the FDA, the senior leadership at the Justice Department, and manipulated the bankruptcy system including picking their own judge, all of which is enough to make ones blood boil.
There are places where I found Keefe less than fully balanced. He treats pharmaceutical advertising as a sort of original sin but the story is more nuanced, a lot of good has come from—for example—advertising anti-depressants in a way that has helped destigmatize mental illness. He treats greed as bad but it also is the source of innovation and the many amazing drugs we have today. I sympathize with Keefe’s concerns about the overly-strong patent system but it was not obvious to me that Purdue was worse than anyone else. And Keefe seems to share the moral judgment that Arthur Sackler’s name should be removed from his various donations despite the fact that he died before OxyContin was invented (the argument that he would have supported it if he had lived is tendentious and irrelevant).
Overall, its an excellent and important book. Not as exciting and dramatic and original as his [b:Say Nothing: A True Story of Murder and Memory in Northern Ireland|40163119|Say Nothing A True Story of Murder and Memory in Northern Ireland|Patrick Radden Keefe|https://i.gr-assets.com/images/S/compressed.photo.goodreads.com/books/1537315266l/40163119._SY75_.jpg|62303430] but an important and impressive exercise in accountability, one that could have been even stronger and more damning with just a little more nuance and less judgment—although many of the people in this book deserve a judgment that they have at least legally escaped from so far.