The Sackler Family’s Dynasty of Guilt
A sweeping account of Big Pharma's first family provides a full and damning picture of their moral culpability for the opioid crisis.
Empire of Pain: The Secret History of the Sackler Dynasty, by Patrick Radden Keefe (Doubleday: 2021), 560 pages.
It hasn’t been easy to get to the bottom of the Sackler story. From the beginning, the family hid its business dealings in a tangle of subsidiaries. When reporter Barry Meier blew open the story of OxyContin in 2003 with his book Pain Killer: A Wonder Drug’s Trail of Addiction and Death, the Sacklers convinced his employers at the New York Times to ban him from writing about opioids over a contrived conflict of interest. Depositions have been sealed, whistleblowers intimidated, critics bought off, publications threatened with lawsuits.
Patrick Radden Keefe got the full Sackler treatment when he published his blockbuster article “The Family That Built an Empire of Pain” in the New Yorker in 2017, which launched the trend of taking the Sackler name off various endowed buildings, galleries, and professorships. Their lawyer fired off dozens of letters to Keefe’s editors alleging factual errors and threatening to sue Keefe if he proceeded with this book project. Some unknown party even sent a mysterious man in an SUV to stake out Keefe’s house. These attempts at intimidation failed, and we now have the book, Empire of Pain: The Secret History of the Sackler Dynasty.
Sadly, the Sacklers are an underwhelming lot to have ruined so many lives. They were not evil geniuses. Of the original three brothers, Arthur, Mortimer, and Raymond, two got their degrees from an unaccredited medical school that closed down shortly after they graduated. Raymond’s son Richard, who ran Purdue Pharma during the height of the OxyContin surge, couldn’t manage to get into a better med school than SUNY Buffalo (he later transferred to NYU), even with his family’s money.
The only impressive Sackler was Arthur, the eldest of the original three, and his genius was not for medicine but for advertising. In the field of pharmaceutical marketing, “Arthur invented the wheel,” as one of his employees put it. It was his innovation to get around the legal ban on direct-to-consumer medical advertising by targeting doctors. “It was laughable, he asserted, to suggest that a physician might be seduced by a glossy layout in a medical journal in the same manner that a housewife might be swayed by a slick ad in a magazine,” Keefe explains. His tactics made a bestseller of the antibiotic Terramycin in 1957 and, later, of the early sedatives Librium and Valium.
His advertising firm came to the attention of the FBI during the McCarthy era. Sackler had a habit of hiring refugees, immigrants, and blacklisted journalists who had been fired from other jobs for their political connections. The result, Keefe says, was a radical atmosphere around the office. “On one occasion, a Swedish designer, who was a communist, made a scene by starting a small fire in the office and burning some of the firm’s own advertisements, to indicate his distaste for such ‘capitalist trash.’” According to one coworker, “We all thought it was hilarious.”
The FBI might have been onto something. It was not until the FBI files were FOIA’d by Keefe and other researchers that it became publicly known that at least one Sackler brother, and possibly all three, were Communist Party members. Raymond and his wife Beverly Feldman cared enough to transfer their membership to the Boston chapter when they moved there in 1944 and then back again to New York when they relocated. Arthur was close friends with millionaire Soviet spies Alfred Stern and Martha Dodd. One veteran Daily Worker journalist who worked for Arthur told a researcher in 1991 that, as he understood it, “all three Sacklers had been party members early on.”
There certainly was a Soviet grandiosity to Arthur’s vision for “narcobiotics,” a catchall term for the tranquilizers of the future, which he predicted would be dispensed as easily as antibiotics. All forms of distress had a biological basis, he believed, so naturally all pain and even unease should be treated medically. (He told his second wife she was wasting her time with psychoanalysis when she tried therapy during the breakdown of their marriage.) By boosting sales of Librium, Arthur wasn’t just serving his client. He was pursuing his vision.
The slogan the Purdue sales reps came up with for OxyContin in 1999 would have made Arthur (who died in 1987) proud: “The One to Start With and the One to Stay With.” The Sacklers’ innovation, and the source of their moral culpability, lay in overcoming doctors’ reluctance to start patients on strong opioids out of fear of addicting them. After Purdue’s campaign claiming, based on spurious studies, that addiction to OxyContin was vanishingly rare, sales jumped from $50 million in 1996 to more than $1 billion in 2000 and oxycodone became the most prescribed drug in America.
Their second sin was not changing course when it became clear from Purdue’s own sales data that doctors were running pill mills. Here the Sacklers had assistance from conservative think tanks such as the American Enterprise Institute. AEI fellow Sally Satel wrote in 2004 that “the typical OxyContin addict does not start out as a pain patient who fell unwittingly into a drug habit… When you scratch the surface of someone who is addicted to painkillers, you usually find a seasoned drug abuser.” Keefe notes that Purdue Pharma was a five-figure AEI donor.
Emails sent in 2001 and finally made public in 2019 reveal that Richard Sackler was equally contemptuous of opioid addicts. “Abusers aren’t victims, they are the victimizers,” he wrote to an unidentified correspondent, who responded, “The whole thing is a sham and if people die because they abuse it then good riddance.” Alas, Richard wrote back, “calling drug addicts ‘scum of the earth’” won’t play well “when I’m ambushed by 60 Minutes.”
So the Sacklers’ defense that they didn’t know their product was fueling an epidemic is false. They did know. They just didn’t care. But their other defense has more merit: that they were not the only ones responsible.
Medicare Part D, for example, caused the annual price of a typical oxy prescription to drop from $39,420 to $2,677. Three-fourths of the growth in opioid prescriptions between 2001 and 2010 came from government programs. Seniors discovered they could sell their pills on the street for huge profits, and young people connived to qualify for Social Security Disability Insurance and the Medicaid card that went with it. “For a three-dollar Medicaid co-pay,” Sam Quinones explains in Dreamland, “an addict got pills priced at a thousand dollars, with the difference paid for by U.S. and state taxpayers.”
In 2018, President Trump’s Council of Economic Advisers prepared a report on opioid prices and their contribution to the crisis, but the Justice Department and the Department of Health and Human Services attempted to suppress it. According to Trump CEA chief economist Casey Mulligan, then-HHS secretary Alex Azar, who was among Medicare Part D’s architects during the Bush era, did not want anyone connecting that great Republican policy success with the opioid epidemic. Clearly the Sacklers are not the only ones trying to bury their role in the crisis.
The point is that the opioid epidemic was something that was done to Middle America. They “trusted the science,” as we are now constantly exhorted to do. OxyContin was marketed to them and subsidized for them as a safe alternative to morphine by people who knew that it was not. Far more than the tobacco plaintiffs who claimed to have been duped by the cigarette companies, the people who became addicted to OxyContin really were duped.
Keefe ends his book with the settlement that the Trump Justice Department reached with Purdue Pharma in October 2020, which was far less comprehensive than the Master Settlement Agreement with Big Tobacco. No individual executives were charged and the Sacklers’ personal fortune was left intact. Keefe seems disappointed by the deal, which may be fair enough, but litigation might not be the best way for a healthy polity to process something like the opioid crisis. The black-and-white world of the law requires boiling down the Sackler family story into narrow questions of legal liability. To appreciate their moral responsibility demands a fuller telling, the kind of sweeping dynastic saga that Keefe has given us.