(Audio)Book Review: ‘Empire of Pain: The Secret History of the Sackler Dynasty’ by Patrick Radden Keefe

The opioid crisis in the USA? A drug epidemic killing hundreds of thousands of people? Corporate dodgy dealing at the highest levels? I wouldn’t have said that any of this would be the ideal ingredients for a book that I’d love to read, to be honest.

I was utterly wrong.

This book had me absolutely hooked from the start. It was fascinating and incredibly well-researched, but its strength lay in the way it was just so shocking. On so many levels, this book surprised and angered me – yet I could not stop reading.

It traces the history of the Sackler dynasty, a family of wealthy philanthropists whose name I was familiar with because of their donations to many art galleries in the UK – I hadn’t realised the extent of their charitable giving to galleries and museums across the world. At the start, this is a family history of a man, Isaac Sackler, a Jewish immigrant into the US who established a grocery business in Brooklyn and had three sons. So far, so good…

Those sons went to medical school and bought a pharmaceutical company, Purdue-Frederick. One of the sons proved brilliant at medical marketing, they started donating to arts institutions, they had some marriages and some kids…all pretty interesting and bonkers in places. Arthur Sackler’s private art collection at the Met in New York springs to mind.

After Arthur’s death, his two brothers created Purdue Pharma and this is where the story takes a distinctly sinister air. The company took an opioid, oxycodone, developed a slow-release tablet system and sold it to drug prescribers across the US (as marketing directly to consumers wasn’t allowed). They worked on the basis that pain relief was a common need but that opioids (up to that point) tended to be limited to use in cancer patients – not a very broad market when there is a potential untapped market of other pain sufferers.

This led to widespread abuse of the drug, which Purdue Pharma were insisting was not addictive – they even explained people’s withdrawal symptoms as ‘pseudo-addiction’. It isn’t possible for me to do justice to the lies and obfuscations coming from the company – you really need to read this book so you can be duly angered too!

So many other things in the book are shocking – the company’s behaviour, the way the drug was pushed through the FDA (by someone who then went to work for Purdue), the corruption among the sales force and prescribers…I could go on, but you need to read it to believe it.

At the heart of the book though is the Sackler family’s distancing of themselves from Purdue Pharma. Even when (in the final sections of the book), lawsuits are being issued against them, there is a flat denial of involvement and wrongdoing. This is one of the real injustices of the book – the way that the Sackler family emerge from the whole crisis.

This is a looooong book, but it actually feels very compelling and engaging throughout. I listened to the audiobook (read by the author) so I had a near-permanent companion of an earnest, slightly irate American for quite a time. He did talk a bit slowly for me, but at 1.5 speed he became a much more animated American! Joking aside, I liked the fact that it was read by the author and felt that the narration was engaging.

The only downside of the audiobook was the fact that I could have done with a Sackler family tree. I don’t know if this is in the print edition, but it would be really helpful as there were 3 generations, plus multiple marriages and remarriages, to deal with.

I could go on about this book for ages – I have been recommending it to anyone I can and shoehorn it in to all conversations! I would urge anyone to read or listen to it as it is genuinely eye-opening. It will make you angry – and so it should.

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Header photo by Christina Victoria Craft on Unsplash.