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

Absolutely 5 stars. This was more absorbing than any other non fiction book I’ve ever read. I couldn’t stop turning the pages, as if I was reading a thriller. Even knowing something about the opioid crisis my jaw still dropped multiple times. The scope and detail of the reporting is incredible, and the content so shocking.

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kaitereads's review against another edition

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dark informative slow-paced

5.0

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maggies's review against another edition

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challenging emotional informative sad tense medium-paced

5.0

A tough but absorbing read/listen. Keefe's style of informative non-fiction as a narrative is engaging, and the story development was readable, high praise for a work of non-fiction! Recommended.

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bailee_f's review against another edition

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informative reflective medium-paced

5.0

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rjansen282's review against another edition

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dark informative medium-paced

5.0

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katylizg's review against another edition

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dark informative fast-paced

4.0

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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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