A few years ago I read Patrick Radden Keefe’s book Say Nothing, about The Troubles in Northern Ireland, because I was interested in the subject and wanted to learn more. That book was so phenomenal that I read this one just because it was written by Patrick Radden Keefe. Beforehand, I had no particular interest or prior knowledge of the opioid crisis, but Keefe managed to make the subject incredibly absorbing.
Keefe focuses on the Sackler family, who spent decades burnishing their reputation through extreme generosity to museums and universities but were hiding the unsavory source of their family fortune: their ownership of Purdue Pharma, the makers of OxyContin. Keefe goes all the way back to the beginning, following Arthur Sackler, son of a failed grocer, as he hustles and strives his way through medical school while simultaneously embarking on a career in advertising. Arthur’s work ethic and determination to see his family succeed are almost inspiring, but when Arthur becomes a pioneer in the field of pharmaceutical advertising, the reader begins to get an idea of just what the Sackler family is capable of. Along with his brothers Mortimer and Raymond, Arthur conducts business in a scorched-earth manner, and has few if any scruples about ethics. He also develops a passion for antiquities, amassing a private collection of Asian artifacts that is the envy of many museums. Through financial gifts and promises of future donations from his collection, Arthur is able to plaster the Sackler family name on many buildings and museum wings. (A particular interesting chapter follows Arthur’s involvement in the effort to bring the ancient Egyptian Temple of Dendur to the Metropolitan Museum in New York.)
After Arthur’s death his brothers and the younger generation of Sacklers took the family business in a wildly lucrative new direction: prescription pain medicine. After gaining approval for a truly innovate pill coating that allowed the medicine to be distributed over a longer period of time, Purdue introduced the first morphine pill, MS Contin, and it’s even more successful successor, OxyContin, using oxycodone.
Keefe is at his best when the Sacklers are at their worst. He deftly chronicles the unbelievable choices they made in order to exploit people’s pain for profit. He digs into the ways they side-stepped and even thwarted FDA regulations, the way they fabricated promises about the pills not being habit-forming despite ample evidence to the contrary, and the way they’ve used their high-powered attorneys to escape all but the merest penalties for their malfeasance. There are revelations within this book that stopped me in my tracks. The level of evil is breathtaking. Keefe underlines the point by comparing Purdue’s business practices to that of the Mexican cartels.
The human cost of the Sackler family’s greed is incalculable, from the hundreds of thousands of deaths to the devastation wrought on communities all across the country. Keefe follows the many efforts over the years to get the Sacklers to pay retribution or even just to acknowledge their culpability. While there are some impressive, heroic figures involved in this struggle, like the photographer Nan Goldin, overall it is a fairly bleak picture of America and its institutions. Though the Sacklers finally came under scrutiny for their unfathomable greed, their vast resources have shielded them from and robbed their victims of true justice. It’s hardly surprising to anyone who’s been paying attention, but the details in this particular story are shocking and enraging.
Despite the heavy and frequently depressing subject matter, I was blown away by Keefe’s ability to handle such a large, multifaceted story. I can pretty much guarantee you that I will gladly read any book written by Keefe, no matter what the subject.