Empire of Pain by Patrick Radden Keefe

America is often touted as “the land of opportunity”. A place where clever people with great ideas can build great companies from nothing more than their imagination and hard work.

Families such as: the Fords who invented the motorcar; the Hewletts and the Packards who created the company that we now call HP; and the Johnsons who started Johnson and Johnson, perhaps the most well-known pharmaceutical brand? In terms of notoriety all of these companies have been outstripped by the Sackler Family. The Sacklers? You may ask, “Who?”

The Sacklers are the family behind Purdue Pharmaceuticals. Purdue are one the companies they made billions of dollars from selling Opioids to Americans, grieving rise to what we know refer to as “The Opioid Crisis”. This family, rather than putting their name at the forefront of their business, spent over 50 years hiding behind the name of the small innocuous company they purchased. They kept the original name, of the original family, whilst creating a sense of generous philanthropy in their own name.

The Sacklers built museums, art galleries and university libraries. One of the original brothers was knighted, the others celebrated wherever they went. This was a family with social ambition, which they were prepared to buy. Initially they spent their money on education, artworks, and philanthropy; later it was needed to pay lobbyists, lawyers and eventually to the individuals and states that sued them for their reckless and illegal activities.

The great American dream turned into an unbelievable nightmare for the Sackler family, but more so for their millions of victims.

In this incredibly readable and well researched book, Patrick Radden Keefe, tells the story of this family dynasty. He starts at the very beginning and it’s a necessary place to begin. Jewish refugees from Europe, the original three brothers Arthur, Mortimor and Raymond Sackler are likable. They are hardworking and ambitious young men making a life in a new country that should have offered a life of opportunity that was free of prejudice. But they encountered much prejudice which they conquered and all three graduated from medical school, despite a very modest financial background.

The cunning of survival led to some clever business acquisitions: a medical marketing company, and eventually a small pharmaceutical company. Purdue Pharmaceuticals was a small local company that sold over the counter medicines, including Betadine the iodine based antiseptic treatment that I suspect many of you reading this have in your bathroom cupboard. But how did a humble company led by men who had taken the Hippocratic Oath and agreed to “first do no harm” end up killing its customers? And why did nobody stop it? That’s the true story in this book. Not only were the Sacklers unstoppable, they managed to manipulate even the FDA into helping them. And as the book reveals, they used their immense wealth to defend every court case; to discredit every journalist who tried to expose them; to vilify every victim as a drug addict. They lost eventually, but they didn’t lose much. They remain a wealthy family, meanwhile, for 50,000 Americans die every year from opioid-related overdoses and many from the very drugs that Purdue provided and doctors prescribed. These became gateway drugs to heroin abuse (80% of people who first use heroin report using prescription opioids). More than half a million Americans lost their lives due to the so-called Opioid Crisis. But how did it go on for so long? Why did doctors continue to prescribe the drugs even when there did was overwhelming evidence they were addictive? And why were Purdue (and by proxy the Sacklers) allowed to continue to accumulate masses of wealth even after pleading guilty to federal crimes in 2007, only to be found guilty of federal crimes again in 2020?

This is a long and detailed read, akin to a good detective novel, but the story is a compelling worth the time.

Reviewer: Gillian Torckler

Macmillan Publishers