Empire of Pain: The Secret History of the Sackler Dynasty
Patrick Radden Keefe (2021, Doubleday)
Isaac and Sophie Sackler,
hard-working eastern European immigrants to Brooklyn, achieved a
version of the American dream: they had three sons who grew up to be
doctors. Arthur, Mortimer, and Raymond would also leave lasting marks
on the pharmaceutical industry, and, through their extravagant
philanthropy, on museums and educational institutions across the
world. There is, however, a movement afoot to take their names off of
some of those edifices, because their name has finally been
associated with the dangerous drugs they sold, to the detriment of
millions.
The eldest Sackler brother, Arthur, had a truly remarkable degree of entrepreneurial energy. Even in high school, he edited publications and hustled for advertising sales, delivered flowers, and had a paper route; when his plate was full, he enlisted his brothers to step into his old jobs. One of his most profitable sidelines, by the time he got to medical school, was copywriting for a drug company. In 1942, he joined the William Douglas McAdams agency, which specialized in pharmaceutical advertising; within five years, he bought the founder out, and was running the show. His clients were among the first to send out dozens, then hundreds, of sales reps, bringing free lunches and official-looking medical literature into doctors' offices, in the interest of persuading them to prescribe a particular drug by brand name.
Always in search of synergy, Arthur also started a weekly newspaper called the Medical Tribune. "The whole purpose was to reach physicians and to influence them ('educate' them, Arthur would insist), so the Medical Tribune was subsidized by pharma ads and distributed for free." In his capacity as advertising guru for companies like Pfizer (Terramycin) and Hoffman-La Roche (Librium and Valium), he was his own best customer. He was also a secret partner in an ostensibly competitive ad agency, run by a friend who had once worked for him; it was a simpler way to handle competing products without a visible conflict of interest. And he bought a small drug company, Purdue Frederick, naming his brothers as equal partners.
He needed Mortimer and Raymond to run that business as his own interest strayed into collecting Asian art, becoming a large force in the market; he had a special arrangement with the Metropolitan Museum to store as well as to display parts of his collection, and he gave them a wing to put an Egyptian temple in. Meanwhile, Purdue plodded along selling Betadine antiseptic and Senakot laxative. It was considered a minor part of Arthur's estate when he died in 1987, and his heirs were happy to sell their share to the younger brothers.
By then Mortimer's daughter Kathe and Raymond's son Richard had found places in the company, and were moving it into the pain relief business. An English subsidiary had invented a way to coat tablets so that morphine could be dispensed by mouth, because the coating released the drug over time. Purdue released MS Contin in the United States, and it did very well, but it still had the scary reputation of morphine, considered a last resort drug. Richard Sackler pushed the R&D department for a new formulation that could both renew the patent exclusivity of the Contin coating, and gain acceptance for the wider world of pain sufferers. OxyContin was the time-release form of oxycodone, a chemical cousin of morphine and heroin, and it met those criteria very well. Though stronger than morphine, it was perceived as an ordinary painkiller, familiar from Percocet and Percodan pills. OxyContin came in much larger doses, however, marketed to last twelve hours.
Real life was not so tidy. In many patients, the pills wore off in eight or ten hours; and the protective coating could be readily defeated by cutting or crushing the pills, leading to an immediate rush. In either case, withdrawal symptoms were miserable, and constantly on the verge of returning. An epidemic was born, as the Sacklers could very well have seen from their own sales figures, had they been willing to. As with Arthur Sackler and Valium, they tended to blame addicts for some character flaw, rather than considering the drugs themselves addictive. They probably didn't see themselves as addicted to the billions in profits, either.
Patrick Radden Keefe has done a beautiful job of telling this harrowing story. He's got citations for every detail and anecdote, and they're stitched together very naturally. A friend I mentioned it to said the book sounded depressing, and I couldn't quite explain why it isn't. Maddening, maybe, and horrifying, but the misery of the victims is not the focus of the story. No, this book is about the shamelessness of the Sacklers: "They could produce a rehearsed simulacrum of human empathy, but they seemed incapable of comprehending their own role in the story, and impervious to any genuine moral epiphany." Lord have mercy.
Any Good Books, February 2022 by emair 2/1/22
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