Reviews with content warning for Medical content - Empire of Pain: The Secret History of the Sackler Dynasty

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Empire of Pain: The Secret History of the Sackler Dynasty by Patrick Radden Keefe

36 reviews

_fallinglight_'s review against another edition

challenging dark informative sad tense medium-paced

4.5

Surreal, insightful, albeit and clinical deep dive into the depraved and unhinged Sackler criminal billionaire family. This book is one of many definitive proofs that the billionaire is incompatible with humanity at this point and greed is an addiction as equally destructive and demoralizing as any substance addiction if not more or worse. The lengths the rotting rich go to to keep their corrosive money are so twisted but it's also morbidly impressive how they weave the web of connections and buy their way into getting the results they want. Particularly this family who honestly wouldn't have made it without ass kissers and enablers and unscrupulous people making their perversity possible bc most of them are so offensively insensitive and stupid.

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aegagrus's review against another edition

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3.25

Empire of Pain is a smart and thorough chronicle of three generations of the notorious Sackler family. Radden Keefe may write in the dramatized language commonly found in tales of “true crime”, but his credibility is bolstered by the years he’s put into this story and the vast quantity of source material he’s able to cite. His book does many things well. It provides a fascinating case study of the ways in which ill-gotten wealth can change a family over time, altering each generation’s proclivities and character. It effectively demystifies relatively arcane fields like pharmaceutical advertising and bankruptcy law. It doesn’t spare those peripherally implicated in the Sackler saga – well-known political figures from both major parties, doctors, lawyers, consultants, and museum administrators. Most importantly, it elucidates where we stand today, unflinchingly demonstrating the insufficiency of the ways in which the Sacklers have been “held to account”.

For all its thoroughness, Empire of Pain has a fairly narrow focus. Radden Keefe readily admits that his book is not intended to be a broad sociological account of the opioid crisis. At times, this tight focus on the Sacklers leaves the reader with questions. Radden Keefe does a pretty good job separating out the impact of Purdue Pharma from that of other opioid suppliers, citing empirical studies to show the close association between Purdue’s activities and the emergence of the crisis writ large. Purdue was an early and aggressive mover; in ascribing responsibility for the crisis, to start at Purdue is entirely justified. In other instances, though, the centrality of the Sacklers to this narrative may have led Radden Keefe to overstate their centrality – on the birth of medication-based psychiatry, for instance, or even on the ideological battles over how the medical field should approach chronic non-malignant pain (which is not to say that the Sackler’s astroturfing did not have a major impact in this regard).

It is also notable that a full third of the book is spent on the activity of Arthur Sackler, the family patriarch, who was already dead by the time OxyContin was created. The ways in which Arthur shaped the family’s trajectory are certainly relevant, getting the Sacklers started in the worlds of art and philanthropy, passing down an array of corporate structures, and inculcating deeply held ideologies in the succeeding generations. Arthur’s role in creating modern pharmaceutical advertising and his aggressive profiteering off of non-opioid tranquilizers (namely Valium) are also interesting. Nonetheless, too much time is probably spent mythologizing the dynasty’s origins, time which could perhaps have been better spent providing somewhat broader context for later material about the marketing of OxyContin and the ensuing litigation.

Empire of Pain is, all in all, well worth reading. If the reader is seeking to understand the opioid crisis itself, this book is probably not a perfect starting point. If the reader already has some background in the opioid crisis, however, or is primarily interested in a case study of the corrupt abuse of corporate, legal, and political power, Empire of Pain is an excellent choice.

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idun_aurora's review against another edition

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dark informative medium-paced

5.0

The amount of work that has gone into this book is commendable. It's packed with information without ever getting trudgy, shedding light on not just the Sacklers and the opioid crisis, but many parts of the (ridiculous) American health care system and the marketing of prescription drugs.

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cghegan's review against another edition

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challenging dark emotional informative sad slow-paced

4.5

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carpfish's review against another edition

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challenging informative fast-paced

5.0

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orla_h's review against another edition

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dark informative sad medium-paced

4.75

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just_one_more_paige's review against another edition

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challenging informative reflective medium-paced

5.0

Alright. I did it. In one of the most overwhelming #bookstagrammademedoit reading choices I've ever made, with particular shout outs to @thestackspod and @irisbooklist, I decided to give this one a go. I've never really seen a nonfiction book talked about like this one was, with so much hype. I hesitated to read it though, because I worked in youth substance youth prevention for years, in a state (NC) and county (Orange) that were part of the suits brought against Purdue Pharma, and it was in the depth of argument while I worked there. I was really enmeshed in the world of prevention and harm reduction related to opioid use (pushing patient education materials and new tracking software on prescribers and pharmacists, among other things) and I wasn't sure I wanted or was ready to jump back into that world. Also, for a few years my partner worked as a pharma rep (for a small, now bankrupt/nonexistent company, that did not, in fact, have an opioid in their repertoire) and he truly hated the role. So, for that reason as well, I was concerned about revisiting some of that, mentally. However, I am nothing if not a sucker for book hype, especially from certain readers/reviewers, so in the end, I decided to give it a go.

After that intro, this nonfiction chunk is, obviously, about the opioid crisis/epidemic in the United States. There have been many other books, both fiction and nonfiction, that address this topic from a variety of perspectives. This expose in particular focuses on the Sackler family, the family who owns Purdue Pharma, and their history and rise to financial and social prestige, and the way their marketing and business decisions were pivotal in the way the opioid crisis played out. As the author addresses in the afterward, this book touches on but doesn't delve as deeply into the affected people/communities, the consideration of prevention and treatment availability moving forwards, etc. - as other books have done that well already and otherwise this book would be too wieldy to pick up. This particular book delves into the Sackler family itself, and their internal development/issues, as well as how they managed (for so long) to keep their name disconnected from this unfolding epidemic, despite how deeply involved they actually were, in an attempt to call them to account, to responsibility, in a way that hadn't yet been done.

We begin with the "original three" Sackler brothers Arthur, Mortimer and Raymond in the early 20th century and their general rise through medical school, the first investment in the company that became (expanded into), Purdue Pharma and what was, essentially, the creation of the field of medical/pharmaceutical marketing. In addition, this beginning part chronicles the way the family put an emphasis on philanthropic giving, to arts and sciences foundations, widely and generously, but always was an obvious attachment of their name to the giving. On the other hand, we see how, from the beginning the family chose to disassociate their name from their business interests, in a dichotomy that is fascinating and does cause one to question, even before things got really shady. Anyways, we then follow the next generation, Richard Sackler in particular, as Purdue Pharma created and aggressively marketed the opioid OxyContin without real scientific evidence of its safety, and even against all (increasing) evidence that it was deeply addictive. Keefe uses court documents, company communications, employee/family friend interviews, and many other primary sources to detail the way the Sackler's ignored the actual needs of patients with a view solely on creating their "empire of pain." There are no words of the Sackler's own, at least in interviews or in response to Keefe's writing here, because they have steadfastly refused public commentary. However, even without that, this is an incredibly robust and intricately researched work of nonfiction, really bringing this family and their history to life on the page.

So, after all that background, let me just start by saying that everyone was right. This was truly a spell-binding piece of nonfiction. I listened to the audiobook (which Keefe himself reads) and it was unputdownable. The 18 hours went by so fast. I couldn't believe it. And, as a few people messaged when I posted about having started reading this, I was both astounded and infuriated, in alternating reactions, over the course of the book. I mean, with my personal/partner background in what this epidemic turned into (sales and prevention), I shouldn't have been surprised by as much as I was, but seeing the narrative unfold "in order" like this, I honestly sometimes was. To start, the amount of conflicting interest in the Sacklers' rise to fortune through monopolistic drug production/testing/medical journals/advertising, etc. is unbelievable. So many legitimate efforts to move treatment and medicine forwards were co-opted for prestige and money with no regard for anything else (like patient safety or sales/marketing regulations) and it's sickening. Also, like I knew the FDA has not always been above reproach (re: lobbying and bribing and sub-par investigation), but honestly reading about the corruption here was sickening, making one question (more than before) and lose trust in all FDA approvals and now here we sit with the shit end of that stick mid opioid crisis and COVID with no end in sight...

Anyways, this whole book was an astounding primer on willful ignorance, detachment from reality and lack of cognitive dissonance. The outmanned/over-gunned smear campaigns against individuals bringing attention to red flags, and the efforts to cast all naysayers as “addicts”/unstable. The systematic undermining, through lobbying/bribing, of Congress, the DEA, the CDC, state legislatures, federal prosecutors, and more. Basically, the way that rich white people can get away with stuff, in this case legitimate mob and drug dealing type shit is unreal to see this clearly displayed; what money can get you as far as leverage is frightening. This kind of elitist bullshit is the baseline of so many social issues now.

The Sacklers were just so blind to their own immorality, to an unbelievable degree, with an addiction to money and prestige and the lengths they went to (what they ignored and willingly misunderstood) to get and maintain it. Keefe highlights so many really fascinating insights into this family's rise and the way they were hyper-focused on philanthropy (being known for "good"), but ignored how much harm they were causing the world; the way they started out so diversified and ended so single-minded. Plus, the internal family drama was kinda unbelievable and entertaining in the way that messy families and rich people behaving badly can be. Honestly, I have no idea how Keefe made this long of a book, on such an intense, heavy topic, such a parge-turner. But damn, he sure did.

“The doctor is feted and courted by drug companies with the ardor of a spring love affair [...] The industry covets his soul and his prescription pad because he is in a unique economic position; he tells the consumer what to buy.”

“...a classic Arthur Sackler play: innovative, showy, a little bit shady...”

“…Arthur liked limbo. He thrived on it. He'd built a life around fuzzy boundaries, overlapping identities, conflicts of interest. Limbo was his element.”

“It is a peculiar hallmark of the American economy that you can produce a dangerous product and effectively off-load any legal liability for whatever destruction that product may cause by pointing to the individual responsibility of the consumer.” (With guns, underage access to/overuse of substances like tobacco and alcohol, addiction, and more - it’s freaking infuriating.)

“He had a hubris, a blindness to consequences, and unshakable certainty in his own convictions. If there was one attribute that Richard shared with his uncle Arthur - apart from a common name, a genius at marketing, and a sense of unquenchable ambition - it was the stubborn refusal to admit doubt, even in the face of contrary evidence, and a corresponding ability to delude himself into a blinkered faith in his own virtue.” (And let me add a disgustingly nonexistent ability to accept responsibility for his own choices and actions.)

“I wondered if, for some of these people, it was just too demoralizing to take a sober measure of their own complicity, if it was simply too much for the human conscience to bear.”

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