On the day Patrick Radden Keefe’s latest book, Empire of Pain, was published, my parents took our puppy for an ill-fated walk.
I’d set aside the entire day to read the book, which details the secret history of the Sackler dynasty, with the plan to write about it. For more than a year now, I have been a proud member of Nan Goldin’s Sackler PAIN group and have worked to translate the Purdue Pharma bankruptcy proceedings into plain English for the company’s victims and creditors. We’ve been waiting for the embargo on the book to lift — and I was thrilled finally to have the chance to expand my knowledge of the Sackler family and amplify Radden Keefe’s trusted reporting.
This is not the review I expected to write.
My parents are not what one would call “dog people.” They found our decision to get a dog baffling, they found the puppy puzzling, but they couldn’t deny that he appeared to be a good egg. When they visited, my father said a few friendly words to the dog in Arabic and walked him up the same hill to admire the same trees, a few times a day. My mother gingerly tapped the puppy’s head and greeted him politely. These were generous gestures, for a family that never ‘did’ pets.
When they proposed to take him for a long walk, on a day when I needed as much concentrated brain time as possible, I leashed the puppy for them, provided a few cautionary instructions (“no matter what happens, don’t let go!”) and handed over a poop baggie, relieved that I’d have more time. I practically ran to my shed and turned my attention back to the book that I’d been consuming avidly since 5:00 a.m.
To my surprise, the Sackler family history was replete with emotional, romantic dramas: double lives and betrayed wives. In a striking passage, Radden Keefe recounts how Arthur Sackler’s second wife, with whom he had taken up while still living with his first family, finds herself distanced from the man who’d courted her so assiduously. He’d groomed her to dress for dinner and wait quietly for him until he came home, but progressively returned home later and later, until he didn’t do so at all. Arthur Sackler’s life was an exercise in emotional manipulation, and the control he exercised upon his wives was expanded to a nation of women in his aggressive marketing of Valium.
No wonder, upon his death, that pent-up rage exploded into competition and litigation. The veneer of Sackler family civility shattered: Arthur Sacklers’ heirs — three wives and their offspring — fought for years, spending likely more than $7 million dollars to rip his belongings away from each other. The Sackler family’s pharmaceutical company, Purdue Pharma, was still in the hands of Arthur’s younger brothers, Mortimer and Raymond, and they were still years away from launching OxyContin. The lessons of psychological and legal warfare, however, clearly were not lost upon the Mortimer and Raymond branches; they later put the same tactics to use against anyone seeking to hold them responsible for the devastation caused by OxyContin.
Within a few decades, the families of the two surviving brothers, Mortimer and Raymond, also found themselves at odds — again, over money. The addiction and suicide of young Bobby Sackler added sharp pain to the narrative: his story was muted, his existence erased. Radden Keefe shares a simple vignette in his inimitable style: Bobby’s mother quietly redacting Bobby’s photos from a set she’s sharing with visitors.
I took a breath to collect myself, truly astounded by the cold cruelty playing out on the page. The phone rang. “Everything ok?” I asked, because that’s just how you open every conversation when you have four kids.
“No. Your mother took a bad fall — “
“I’ll be right there.”
When I arrived, there seemed to be another woman in my mother’s place: frail, bloodied and shocked. “I’m calling 911,” I announced, pulling my phone out of my pocket and dialing. “No, no,” both of my parents said, “let’s just go home and work it out there.” I ignored them and briefed the dispatcher.
My father was still holding the leash and searching the horizon of our tiny town for the rescue squad. I pulled my mother into my arms and coached her to breathe, worried about her uncontrollable shaking. When a station wagon pulled into the street and slowed down, I anticipated rubberneckers and mentally practiced fending them off, “we’re fine, thank you, just waiting for the ambulance.”
I was about to open my mouth when the woman stepping out from the driver’s seat pulled out a small backpack. We performed polite introductions then she pulled on her gloves and leaned in, “I’m a little bit in training,” she confessed. Her husband joined us and swept his arms into a diver’s position, bending over my mother to create a human sunshade. My mother pointed them to her ankle, which had already taken on the proportions of a Granny Smith apple. The puppy tugged over to us every few minutes, searching my face and my mother’s for clues.
“When I fell,” my mother struggled to say, through her confusion and swollen lip, “I let go of the leash. But he didn’t run away — he ran back to me and licked my face.” Her voice cracked.
Did I mention that the Sackler brothers performed electroshock treatment on a rabbit? My mother loves rabbits. This is what was running through my mind. This is how the book became intertwined with the day’s events. “One day at Creedmor,” the story begins, referring to the psychiatric hospital where Arthur, Mortimer and Raymond worked, “the Sackler brothers chipped in a few dollars each to purchase a rabbit.”
Creedmor also happens to be the hospital where one of victims in the case I prosecuted received care for her compounded mental health and substance use disorder. I visited Creedmor in 2011 or 2012, and stood fascinated by a display case full of Creedmor mugs, magnets and other mementos. I’m so glad I didn’t buy one.
Sitting on the ground, holding my mother, I wished she never had fallen and knew that I could handle it only because she wasn’t my child. I felt relief that she never would be the one to hold me, unconscious, as so many mothers had when their children succumbed to the Sackler’s worst experiment. I thought about Patrick Radden Keefe’s other readers, many of whom have lost a loved one to OxyContin addiction or overdose: how painful it must be for them to read this family’s history and realize they are its epilogue.
Radden Keefe dug at the roots of the Sackler’s obsession with pharmaceutical marketing and found a wild ambition: to cure mental ills through medication. “It almost seems as though society has anesthetized itself or deluded it self,” Arthur Sackler once mused, “with the belief that such intense individual suffering and such mass destruction of human talents and capacities does not exist — because we have put it behind hospital walls.” The irony, of course, not lost upon Radden Keefe or his readers, is that the Sacklers’ work brought suffering into the mainstream and championed an attitude of delusion.
Just a few chapters in, I’d followed Arthur, Mortimer and Raymond Sackler in clandestine business deals that cemented corruption into the foundations of the FDA and medical advertising. I’d lost some last few shreds of innocence about the possibility of reform and tried to watch for the inflection points, the moments when they could have taken a different course. There were so many, but it also was apparent that the family roiled with jealousy, discontent, greed and undiagnosed, untreated mental illness. I was no longer surprised that the family had barreled headlong into the false marketing of OxyContin and failed to express any remorse. Their misery had propelled them to punish an entire nation.
“Do you want to sit with her,” I asked my father, suddenly aware that I’d sidelined him. “No,” he shook his head, “you’re doing fine.” He held the leash, standing very still, his eyes locked on his wife of 49 years and 10 months.
By the time the trained EMTs arrived, and began placing my mother’s foot in a splint, her shaking had intensified to the point where they worried that she was going into shock. Her lip had swollen to supermodel proportions. The nitrous oxide machine appeared and my mother finally took deep breaths. “I guess I’ll never need filler for my lips,” she joked, in between gulps of laughing gas.
I fought off a feeling of dread as they loaded my mother into the ambulance, unsure whether I was worried our separation or experiencing an anxious response to my morning reading. I was reminded, by the COVID-19 hospital rules and all the small uncertainties of a human emergency — that we cannot control much.
Sometimes we have no warning of the catastrophe around the corner, other times the red flags are slapping around in the wind, begging for our attention. I knew what was coming in Radden Keefe’s book: hundreds of thousands of deaths. It was torture to be reading a chronological account of a family’s history in which they actually did exercise tremendous control but blew past the warning signs, blew off the naysayers and shoved away responsibility.
My father sat in the passenger seat with the pup in his lap, hand to paw, as we made the short drive back to the house. I handed off the dog and we turned right around, making a long, country-road beeline for the community hospital where my mother had been transported. Once there, we weren’t allowed in so we waited in the parking lot. I thought about all the families who’d painfully accepted FaceTime goodbyes, out of respect for and deference to the worldwide COVID-19 emergency and the desperation of overwhelmed medical workers.
Following the rules is difficult in two circumstances: when you believe you’re exceptional — or when you’re madly in love. For my parents, it’s the latter. My father and I played a game: he came up with all sorts of excuses to go knock on the door, and I berated him gently, reminding him that they’d asked us not to.
By the time we recovered my mother, a few hours later, bruised and booted but on her feet, I was filled with nervous anticipation about resuming my reading. The first few chapters of the book provided an explanation for the family’s rotten sense of exceptionalism and entitlement: now it was time to learn how they’d exercised it.
In the Sacklers’ world, as Radden Keefe describes through meticulous, well-selected interviews with members of their entourage, there’s always someone to clean up, whether it’s to pull a dead body off a beach, design search terms to avoid seeing bad press, or scoop up dog messes from executive suites. Teams of lawyers and public relations professionals eliminate obstacles, and sycophants take the fall for the family. Meanwhile, the OxySacklers, as they are dismissively called by more remote branches of the family, dare to complain. “It’s quite literally the hardest job in the world,” wrote David Sackler, the only member of the now-adult generation who’d taken a job with Purdue Pharma. His uncle Jonathan claimed a kinship of suffering with victims of mass incarceration.
Bent over the book in my shed, I noticed that the light had turned. Anger turned to anxiety. Tears welled up. The area around my heart tightened and I felt an impending sense of doom. I was deeply familiar with the fallout of OxyContin from my work on the case of a corrupt doctor. I’d met the parents of OxyContin overdose victims. I’d fought out the court battles in person, against an attorney and defendant who peddled the same lies as the Sacklers. I’d spent hours preparing to question a medical expert about “pseudoaddiction” — probably more time than it took for one of the Sacklers’ sidekicks to gin up the notion. There were so many people suffering out there, but also hundreds of thousands volunteering to help, by distributing Narcan, testing drugs, supporting families, saving a few lives at a time. Could it ever accomplish enough, compared to the number of lives the Sacklers might have saved with a few genuine strokes of humanity?
Maybe I should rejoin my family, I decided, putting the book down. I’d been away all day; I knew there were dishes piled in the sink; I wondered whether my kids needed more reassurance about their grandmother’s accident. I ran into the house, only to find my toddler with a fake tube of lipstick, hoping to use her grandmother as a canvas. “Thank goodness I knew to call for 911 immediately,” my father winked, doling out generic ibuprofen to his patient.
Two days later, I finally finished the book. The disillusionment was complete: my former law firm, Debevoise & Plimpton LLP, is a crucial advocate for the Mortimer Sackler branch. The Justice Department, as far back as 2007 and as recently as 2020, remains under the sway of plutocratic allies. My New York world is full of recycled Sackler death money, from the chain of Smith restaurants where my husband and I used to meet for date night, to the museums where I’ve spent so many hours. I still can’t shake the guilt of a million personal, middling lapses of judgment in the course of my ordinary life but there are Mortimer(s), Madeleine, David and Joss Sacklers in the world drawing artificial lines between themselves and the devastating drug that made them unthinkably rich.
And then there’s the rabbit — still, always. That poor little rabbit, at the root of it all. If there is a mystery of brain chemistry to be resolved, is it that of entitlement. In its worst form, it is an excuse to inflict harm upon others.
‘Empire of Pain’ is an unforgettable work of journalism. It makes you want to bring the world to a stop, identify the danger zones and right them, now. To find the corruption and root it out. To find the good, and glorify it. Radden Keefe shines a light on our angels — famed journalist Barry Meier, the courageous and talented artist and activist Nan Goldin, the blunt and badass Maura Healey, Attorney General for the State of Massachusetts — but he knows they don’t need his direct praise to earn our eternal gratitude. The book has dignity, restraint, density and depth. Journalism of this caliber is a public service.
When my parents left town, the puppy tugged at the leash to run to my mother. He leapt up, tipping his nose to her face, and she hugged him tightly. She’d be in a boot for a few months, no quick fixes. She stood there in my driveway, with the dog in her arms, bracketed by the volunteer emergency workers who’d helped her out of the dirt and the medical professionals who’d guide her through recovery. Our days are not uniformly glorious. They light up when love hits. They light up when we encounter people who have devoted years to learning, training, rescuing and healing — who save others without selling anything. Now that is, quite literally, the hardest job in the world.