Empire of Pain is a book that will make you shake your head so much, you will be in danger of injuring your neck.  You are also likely to gasp, gape and rage at Patrick Radden Keefe’s secret history of the Sackler family dynasty.  Despite the difficult subject matter, the book is so well written and so thoroughly researched, that you won’t put it down for long.  I breezed through the volume’s 400 plus pages in less than a week. And it was that very week that the Sacklers reached a settlement with about 120,000 U.S. state and local governments, families and individuals that have sued Purdue Pharma for opioid related damages.

The Sackler family are associated with the marketing of Valium, and, more infamously, with the production and aggressive marketing of OxyContin, the pill considered the prime culprit in the opioid epidemic now facing much of the world.  The book is divided into three parts:  “Patriarch” focuses on the exploits of Arthur Sackler and his younger brothers Mortimer and Raymond; “Dynasty” revolves around Raymond’s son Richard who ran Purdue Pharma as it developed, promoted and defended OxyContin; “Legacy” examines the protests and lawsuits that eventually arose when it became clear that Purdue Pharma and the Sackler family acted without concern for the horrible addiction that OxyContin unleashed.

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Arthur Sackler, the eldest child of Isaac and Sophie Sackler, was born in Brooklyn to an immigrant family short on cash but big on dreams.  Keefe makes a point of relaying the story that while Arthur’s father Isaac, who had suffered business reverses, could not give his sons much cash, he insisted that he was giving them something much more important than money:  a good name.  Two generations later, the Sackler name would be one of the most reviled in America. Keefe carefully documents the early years of the Sackler family’s exploits and convincingly makes the case that the model for much of what was to follow was established in the decades of the 40’s, 50’s and 60’s.  Arthur, Mortimer and Raymond all become doctors.  Their early work at the Creedmoor Psychiatric Centre in Queens, New York led them to an interest in a biochemical solution to mental illness; this was an era where electroshock therapy and lobotomy were the common treatments given to serious mental illnesses.  Arthur’s position at the advertising agency William Douglas McAdams saw him rise due to his aptitude with visuals and language; he soon handled the Pfizer account for McAdams and would be essential in the advertising of anti-biotics, and later of Valium.  Arthur made a fortune advertising drugs and began buying businesses at which he installed his younger brothers.

The template that Arthur set up was one that would work for the Sacklers for decades:  promote drugs in the medical journals that he owned; recruit key people in regulatory and legal positions to take his side; aggressively deny any hint of wrongdoing in terms of knowledge of side effects/addiction potential of these drugs; downplay the size and impact of their ‘minor enterprises’; carefully keep the Sackler family name separate from any decisions made by businesses the family owned; aggressively promote the family name by becoming artistic philantropists and insisting that donations be exchanged for naming Halls and Wings of prestigious museums in New York, Washington, London and Paris, and at universities throughout the States after the Sacklers.  It is both disturbing and illuminating to read of how the Sacklers manipulated those who were charged with regulating the licencing and sale of drugs, often through outright bribery.  Equally fascinating is the appearance that was maintained of performing a valuable public service.

Just as being pioneers in using pills to treat anxiety and mental illness had made Arthur’s generation a fortune, so the next generation of Sacklers would make an exponentially bigger fortune in using pills to treat chronic pain.  To read about how Purdue Pharma, led by Richard Sackler, pushed OxyContin on America and later the world is to witness the excesses of capitalism at its worst.  The book documents how profit crazy the Sacklers were regardless of how many people were suffering as a result of their irresponsible marketing of a highly addictive drug.  They ignored studies that might interfere with OxyContin sales and lied about when they knew what they knew.  The extent of their callousness is something that in fiction might be seen as unbelievable, but, sadly, research bears out that this not only happened, but that the toll on individuals, families, communities and countries continues to mount.

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The final section of the book is frustrating because attempts to bring the Sacklers to justice fail so miserably.  Keefe explains how the Sackler family used Purdue Pharma as a cash cow, withdrew umpteen billions for the family and then left the company on the verge of bankruptcy just as the lawsuits finally started to catch up to them.  While museums and universities eventually caved to pressure and began to refuse further Sackler donations and strip many esteemed halls of the family name, the Sacklers played the justice system by hiring and bribing so many insiders that they managed to evade any personal responsibility for what they had wrought. Empire of Pain is a deeply disturbing book, but it’s a book worth reading both because it is so powerfully written and because it is a quintessential example of what happens when regulators and justice officials are as singlemindedly profit hungry as drug pushers.