Empire of Pain: The Secret History of the Sackler Dynasty
A grand, devastating portrait of three generations of the Sackler family, famed for their philanthropy, whose fortune was built by Valium and whose reputation was destroyed by OxyContin, by the prize-winning, bestselling author of Say Nothing
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Community Reviews
For those who are worried, this is not a trauma porn story like many other novels have been which address the opioid epidemic. It’s a thorough informational explanation of how the Sackler family transitioned from a few young doctors looking for solutions to traumatic and antiquated treatment methods to a greedy, deceitful empire. I thought I knew a lot about the opioid epidemic but this book really opened my eyes, there was a lot I did not know. Highly recommend if you want to learn more on this topic.
I often felt like a conspiracy theorist talking to other people about this book as it illustrates how creatively cruel the Sackler family has been throughout the years. Also reading this book during the internet's craze over the final episodes of Succession were uncanny to say the least. This book is beautifully researched, expertly crafted, and a true required reading for anyone working even partially adjacent to the healthcare industry.
I thought this was an exceptional book.
Keefe has a point of view. He reads more like an investigative journalist - looking for the smoking gun(s) - than a dispassionate historian or sociologist, sifting the wreckage wrought by the Sacklers for truth. And man did he look in the right place.
But I think this is the right style for this subject matter. Just as different subjects can benefit from analysis thru different styles (e.g., take a look at homelessness from the perspective of economics, race, history, urban planning, etc.) different styles are better or worse suited to the analysis of different subjects. I believe Keefe - an investigative journalist with an agenda to find the blameworthy party - was able to do something here that an academic might not. Keefe's approach provided me, as a reader, an outlet for the revulsion I felt for the behavior of the Sacklers and their impact on society. It also provided my mind with something that I needed: an explanation for how so many went so wrong. Had this book been filled with statistics and equivocation, I may have been academically satiated, but I would have felt unsatisfied... Fortunately, that is not the book we got.
Moreover, it is when Keefe does investigative journalism - tearing through the Sackler's purposeful opacity - that he lays bear the contingency of the Sacklers rise, the callousness with which they corrupted institutions, the absurd selfishness of generation upon generation of descendents, the wanton destruction. He teaches us - no he shows us something about humanity by exposing the part of humanity we seldom get to see. What does he show us? He shows us that somewhere deep in the ideal of capitalist success in America in the 20th century lies a terrifying reality.
He shows us Arthur Sackler: a striving son of an immigrant. He shows us that ambition can easily become a relentless pursuit of profit, that the pursuit of profit can become an obsession with power, that power demands legitimacy, and that legitimacy - like so much else in 20th century America - is for sale to those with the power and money to grab it. For Arthur Sackler.
He shows us that for Arthur Sackler, life becomes a quest to achieve not a sort of immortality (the author's suggestion) - but I think the psychic release that comes from being legitimated by ones peers as a sort of super-human. This drive: to not just win the money game, to not just dominate the power game, but to be perceived as somehow beyond reproach - and to use the tools of money and power, rather than morality - to achieve that is what the author shows us. And when Arthur Sackler's mind begins to believe he has achieved a legitimacy with his money and power that puts him above the mere mortal institutions that surround him, that is when we see his humanity slip from the scene. He shows us Arthur Sackler loses the ability to form relationships with his wives, with his associates, with his children. With the world.
He then shows us that when Arthur Sackler wraps himself in the legitimacy of philanthropy, this warps the social contract itself: and not just for Arthur Sackler. Those around him come to believe that nothing Arthur Sackler, philanthropist, does could be wrong and much of what he does must be right, no matter the actual effects. Those reared in this worldview come to see simple ideas as naive: duty, loyalty, honesty.
And once an individual - in this case Arthur Sackler - establishes his legitimacy upon not moral grounds but upon those conferred from money and power, that individual (a) will use all of that money and power and legitimacy to maintain his position - and for a long time can, because these are among the most powerful weapons one can posses - and make no mistake, to Arthur Sackler all three had become mere weapons, by this time; and (b) if that person is charismatic enough, he can reshape the worldview of generations in his wake.
And then the author shows us the dozens of Sacklers that resulted from Arthur Sackler's money and power and influence and the lessons they learned from it. The author lets us marvel at the oddity of what has resulted: these people's inability to understand their connection to and benefit from pain and destruction... their aloofness from it. Their belief that - having already achieved the legitimacy that money and power bought them that they did not need to think about, let alone honestly engage with, the basic reality of being decent human beings.
I think something about Keefe's approach brings poignancy to the subject that could otherwise devolve into mere demonization: he sheds so much light on events so that are so very recent, delving into motivation and exposing a seeming lack of humanity. His work on the lineage of the Sacklers and near-biogrpahy of Arthur Sackler as the poisoned root from which the whole clan sprung, is Shakespearean in its effect on the reader.
I couldn't put the book down.
Here are the four big things I'm left with.
1. Arthur Sackler was a historically bad guy. Here's a guy who invented exploitative medical marketing, corrupted the FDA, and popularized abusing prescription drugs for pharma profit. And he did so under the unimpeachable cover of his MD and his status as a philanthropist. And that's just the business part! He was also an emotionally abusive father, a philandering husband who subjected his wives to what was in effect polygamy, and a terrible family member. These folks exist and they often become important. Read the book for this chilling biography alone. Everything that follows in the Sackler family grows out of Arthur's shadow.
2. Regulatory bodies are run by people and people can be corrupted by money and there is virtually no force to counteract that tendency. By the time watchdogs become aware of any particular infraction, it is often far too late. This seems to be just a basic truth of the American free market capitalist bargain in which we underfund our civil service and try to keep them out of the way of capitalism. I have to tell you, I grew up hearing both parties generally agree that government really needed to get out of the way of the innovation that could be wrought by private actors. Well, what sort of civil service do you suppose you are left with?
3. When you try to stop someone doing the wrong thing, if you fail your life will be destroyed by the people doing that wrong thing. Yet another book that details you ought to think very carefully about challenging someone in power lest that person use all that power they have accumulated to utterly destroy you.
4. But (3) is not why people do not act in the face of evil. Most people do not act in the face of evil because society is telling them the thing they are seeing - and that they know is evil - is not evil. And when you face a choice between your pay check, your social standing, your fitting in with the group, and your recognizing something as fundamentally evil - the first three things almost always win out. How were Purdue employees and salespeople blind to the effects of these drugs? The answer is they were not (obviously). But they also never fully reckoned with the damage they were doing. Why is that? It's because their CEO was a world famous philanthropist. Their drugs were FDA approved. Their prescribing doctors loved the drug. Set against all of those signals that everything is ok, who am I to suggest these folks should have stood up and argued - from a limited point of view - that they alone had the right idea and could see what was wrong here. It's an impossible ask.
Those who make the mistake of talking to me about any of these subjects after a few beers already know that I am disposed toward believing the worst about: a) guilds (e.g., medicine); b) capitalism in its effect on healthcare; c) institutions and in particular regulatory bodies and their corruptibility; and d) psychologically deviant folks and their inherent knack for business / leadership and the damage they can bring both personally and socially as a result. In a sense, this was a book that played to all the biases I had going in. But hey, who doesn't love that!
If I could assign a book to every intro to economics freshman course that kids read alongside "objective" neo-libertarian screeds about free markets and their inherent productive effects, I can't think of a better one.
FIVE STARS.
Keefe has a point of view. He reads more like an investigative journalist - looking for the smoking gun(s) - than a dispassionate historian or sociologist, sifting the wreckage wrought by the Sacklers for truth. And man did he look in the right place.
But I think this is the right style for this subject matter. Just as different subjects can benefit from analysis thru different styles (e.g., take a look at homelessness from the perspective of economics, race, history, urban planning, etc.) different styles are better or worse suited to the analysis of different subjects. I believe Keefe - an investigative journalist with an agenda to find the blameworthy party - was able to do something here that an academic might not. Keefe's approach provided me, as a reader, an outlet for the revulsion I felt for the behavior of the Sacklers and their impact on society. It also provided my mind with something that I needed: an explanation for how so many went so wrong. Had this book been filled with statistics and equivocation, I may have been academically satiated, but I would have felt unsatisfied... Fortunately, that is not the book we got.
Moreover, it is when Keefe does investigative journalism - tearing through the Sackler's purposeful opacity - that he lays bear the contingency of the Sacklers rise, the callousness with which they corrupted institutions, the absurd selfishness of generation upon generation of descendents, the wanton destruction. He teaches us - no he shows us something about humanity by exposing the part of humanity we seldom get to see. What does he show us? He shows us that somewhere deep in the ideal of capitalist success in America in the 20th century lies a terrifying reality.
He shows us Arthur Sackler: a striving son of an immigrant. He shows us that ambition can easily become a relentless pursuit of profit, that the pursuit of profit can become an obsession with power, that power demands legitimacy, and that legitimacy - like so much else in 20th century America - is for sale to those with the power and money to grab it. For Arthur Sackler.
He shows us that for Arthur Sackler, life becomes a quest to achieve not a sort of immortality (the author's suggestion) - but I think the psychic release that comes from being legitimated by ones peers as a sort of super-human. This drive: to not just win the money game, to not just dominate the power game, but to be perceived as somehow beyond reproach - and to use the tools of money and power, rather than morality - to achieve that is what the author shows us. And when Arthur Sackler's mind begins to believe he has achieved a legitimacy with his money and power that puts him above the mere mortal institutions that surround him, that is when we see his humanity slip from the scene. He shows us Arthur Sackler loses the ability to form relationships with his wives, with his associates, with his children. With the world.
He then shows us that when Arthur Sackler wraps himself in the legitimacy of philanthropy, this warps the social contract itself: and not just for Arthur Sackler. Those around him come to believe that nothing Arthur Sackler, philanthropist, does could be wrong and much of what he does must be right, no matter the actual effects. Those reared in this worldview come to see simple ideas as naive: duty, loyalty, honesty.
And once an individual - in this case Arthur Sackler - establishes his legitimacy upon not moral grounds but upon those conferred from money and power, that individual (a) will use all of that money and power and legitimacy to maintain his position - and for a long time can, because these are among the most powerful weapons one can posses - and make no mistake, to Arthur Sackler all three had become mere weapons, by this time; and (b) if that person is charismatic enough, he can reshape the worldview of generations in his wake.
And then the author shows us the dozens of Sacklers that resulted from Arthur Sackler's money and power and influence and the lessons they learned from it. The author lets us marvel at the oddity of what has resulted: these people's inability to understand their connection to and benefit from pain and destruction... their aloofness from it. Their belief that - having already achieved the legitimacy that money and power bought them that they did not need to think about, let alone honestly engage with, the basic reality of being decent human beings.
I think something about Keefe's approach brings poignancy to the subject that could otherwise devolve into mere demonization: he sheds so much light on events so that are so very recent, delving into motivation and exposing a seeming lack of humanity. His work on the lineage of the Sacklers and near-biogrpahy of Arthur Sackler as the poisoned root from which the whole clan sprung, is Shakespearean in its effect on the reader.
I couldn't put the book down.
Here are the four big things I'm left with.
1. Arthur Sackler was a historically bad guy. Here's a guy who invented exploitative medical marketing, corrupted the FDA, and popularized abusing prescription drugs for pharma profit. And he did so under the unimpeachable cover of his MD and his status as a philanthropist. And that's just the business part! He was also an emotionally abusive father, a philandering husband who subjected his wives to what was in effect polygamy, and a terrible family member. These folks exist and they often become important. Read the book for this chilling biography alone. Everything that follows in the Sackler family grows out of Arthur's shadow.
2. Regulatory bodies are run by people and people can be corrupted by money and there is virtually no force to counteract that tendency. By the time watchdogs become aware of any particular infraction, it is often far too late. This seems to be just a basic truth of the American free market capitalist bargain in which we underfund our civil service and try to keep them out of the way of capitalism. I have to tell you, I grew up hearing both parties generally agree that government really needed to get out of the way of the innovation that could be wrought by private actors. Well, what sort of civil service do you suppose you are left with?
3. When you try to stop someone doing the wrong thing, if you fail your life will be destroyed by the people doing that wrong thing. Yet another book that details you ought to think very carefully about challenging someone in power lest that person use all that power they have accumulated to utterly destroy you.
4. But (3) is not why people do not act in the face of evil. Most people do not act in the face of evil because society is telling them the thing they are seeing - and that they know is evil - is not evil. And when you face a choice between your pay check, your social standing, your fitting in with the group, and your recognizing something as fundamentally evil - the first three things almost always win out. How were Purdue employees and salespeople blind to the effects of these drugs? The answer is they were not (obviously). But they also never fully reckoned with the damage they were doing. Why is that? It's because their CEO was a world famous philanthropist. Their drugs were FDA approved. Their prescribing doctors loved the drug. Set against all of those signals that everything is ok, who am I to suggest these folks should have stood up and argued - from a limited point of view - that they alone had the right idea and could see what was wrong here. It's an impossible ask.
Those who make the mistake of talking to me about any of these subjects after a few beers already know that I am disposed toward believing the worst about: a) guilds (e.g., medicine); b) capitalism in its effect on healthcare; c) institutions and in particular regulatory bodies and their corruptibility; and d) psychologically deviant folks and their inherent knack for business / leadership and the damage they can bring both personally and socially as a result. In a sense, this was a book that played to all the biases I had going in. But hey, who doesn't love that!
If I could assign a book to every intro to economics freshman course that kids read alongside "objective" neo-libertarian screeds about free markets and their inherent productive effects, I can't think of a better one.
FIVE STARS.
A truly stellar work of nonfiction. Keefe's narrative of the generations of Sacklers is worth the hype. Fascinating (and horrifying) look into the greed and corruption of the family.
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