I came to read Empire of Pain not because of any strong interest in learning about the family and the pharmaceutical company which profited greatly and met their downfall from marketing a version of oxycodone, OxyContin, but because of my appreciation of the author. I had read another book by Patrick Radden Keefe, Say Nothing: A True Story of Murder and Memory in Northern Ireland, which I greatly liked and came to the conclusion that any book Mr. Keefe writes is probably worth reading. Both Empire of Pain and Say Nothing are nonfiction but read like novels. Keefe does a prodigious amount of research and then tells a captivating story. In addition to be entertained by the narratives, both books impart a great deal of information in a painless way. In reading Say Nothing, the reader will learn a great deal about sectarian conflict in Northern Ireland, and in reading Empire of Pain, the reader may come away somewhat horrified by pharmaceutical industry marketing practices and political influence.
Empire of Pain recounts a multi-generational history
of the Sacklers. The first part of the book devotes considerable attention to
Arthur Sackler, who personally had nothing to do with OxyContin, having died
before Purdue Pharma started selling the drug. In fact, his direct descendants did
not profit from OxyContin either, since they did not have an ownership interest
in the company when it was selling OxyContin. It was Arthur’s two younger
brothers and their children and descendants who reaped the benefit.
Keefe’s rationale for focusing on Arthur until his death is
that he pioneered the marketing techniques that later were used to sell OxyContin. Roche had developed two minor tranquilizers
to compete with Miltown (derisively referred to as “mother’s little helper”), Librium
and Valium. These tranquilizers, especially Valium, became widely prescribed starting
in the 1960s, but they can be abused and can lead to dependency or addiction. Of
course, they are not as dangerous as opioids.
Arthur Sackler became rich from his company helping Roche to
market Valium and then used some of his wealth for philanthropic purposes,
especially for art museums. The tale of his business practices, including convincing
doctors to prescribe Valium, interactions with the U.S. Food and Drug Administration,
and secretly having part ownership of his principal competitor are fascinating
to read.
The rest of the book is mainly about OxyContin, which when used as directed, provides time-released oxycondone to relieve pain. It was the main drug that Purdue sold, and the company did nothing to monitor its use, such as certain pharmacies and doctors dispensing and prescribing enormous amounts of the drug. Purdue continued to send their marketing teams to doctors’ offices to convince them of the safety and usefulness of the drug even though they knew it was being abused in dangerous ways. The company blamed those who became addicted on the addicts.
All of this was a major factor in the opioid addiction crisis.
For many years, the Sacklers and Purdue were able to fend off legal challenges
from prosecutors concerned about what was happening in their communities. The
problems eventually became too much for Purdue and it declared bankruptcy in
2019. None of the Sacklers were prosecuted for crimes. While they left the
company, they were able to keep most of their wealth. However, to the extent it
matters, the Sackler name was erased at many of the museums and other
institutions which had benefitted from Sackler donations.
Keefe’s book is partly an indictment of the Sackler family. For example, he
is quite harsh towards the granddaughter of one of the Sackler brothers, who is
a documentary film maker. Madeleine Sackler has never had anything to do with
Pharma, but of course some of her wealth is likely derived from what she inherited.
At a minimum, she should probably be more upfront about that, but does that
mean her films are forever tarnished?
The book does forcefully document the ways the legal system
can sometimes let the rich get away with crimes. This is indicated in the
prologue, which describes Mary Jo White, a former prosecutor who was appointed chair of
the SEC by President Obama, assisting one of the Sacklers in a 2019 deposition.
When I read the prologue, I thought this deposition, just as
Chekhov’s gun, would resurface at the end of the book. It does not. But Keefe
does quote a lawyer as saying, “Everyone is entitled to a lawyer, but it
doesn’t have to be you.” That will have to do.
Finally, the book reminds me of the mangled rendition of
what Honoré de Balzac once wrote: “Behind every great fortune lies a great
crime.” What Balzac actually wrote in Le Père Goriot was: “Le secret
des grandes fortunes sans cause apparente est un crime oublié, parce qu'il a
été proprement fait.” While this has been translated in various ways, a
literal translation is: “The secret
of great fortunes without apparent cause is a forgotten crime, because it was
properly done.” In this book, Keefe is trying to make sure that the Sackler’s
crimes are not forgotten.
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