EMPIRE OF PAIN

Richly researched account of the Sackler pharmaceutical dynasty, agents of the opioid-addiction epidemic that plagues us today.

In his latest excellent book, Keefe opens in a conference room packed with lawyers, all there to depose “a woman in her early seventies, a medical doctor, though she had never actually practiced medicine.” Kathe Sackler, thanks to the invention of a drug called OxyContin, was a member of one of the wealthiest families in the world, holding some $14 billion. The founder of that dynasty had established numerous patterns that held for generations. Though he had insisted that family philanthropy be prominently credited “through elaborate ‘naming rights’ contracts,” the family name would not extend to their pharmaceutical company, Purdue Pharma. The family would also not accept responsibility for any untoward effects that its products might have. Thus, when asked whether she acknowledged that hundreds of thousands of Americans had become addicted to OxyContin, Kathe answered, “I don’t know the answer to that.” Keefe turns up plenty of answers, including the details of how the Sacklers—the first generation of three brothers, followed by their children and grandchildren—marketed their goods, beginning with “ethical drugs” (as distinct from illegal ones) to treat mental illness, Librium and then Valium, which were effectively the same thing but were advertised as treating different maladies: “If Librium was the cure for ‘anxiety,’ Valium should be prescribed for ‘psychic tension.’ ” By Keefe’s reckoning, by the mid-1970s, Valium was being prescribed 60 million times per year, resulting in fantastic profits for Purdue. OxyContin followed in 1996—and then the opioid crisis, responsibility for which has been heavily litigated and for which the Sacklers finally filed bankruptcy even though they “remained one of the wealthiest families in the United States.” Of particular interest is the book-closing account of the Sacklers’ legal efforts to intimidate the author as he tried to make his way through the “fog of collective denial” that shrouded them.

A definitive, damning, urgent tale of overweening avarice at tremendous cost to society.