Empire of Pain | Patrick Radden Keefe

Summary of: Empire of Pain: The Secret History of the Sackler Dynasty
By: Patrick Radden Keefe

Introduction

Embark on a journey through the rise and fall of the Sackler Dynasty, a family notorious for its part in the opioid crisis in the US. In ‘Empire of Pain,’ Patrick Radden Keefe pulls back the curtain on the secretive world of the Sacklers, revealing the ambitious beginnings of Arthur Sackler, who transformed pharmaceutical advertising, and the eventual dominance of Purdue Pharma, launched by his brothers Mortimer and Raymond. Explore the story of how OxyContin, a potent painkiller, was aggressively marketed and became the catalyst for widespread addiction and devastation, while the Sackler family reaped massive financial rewards. From their luxurious lifestyles to their philanthropic ventures, uncover the true cost of the Sackler’s deeds and the indelible stain on their legacy.

The Sackler Brothers’ Empire

Growing up during the Great Depression, Arthur Sackler was known for his hustling mentality. He dabbled in various jobs, eventually enrolling in medical school at NYU and working multiple side gigs simultaneously. After medical school, Arthur joined the medical advertising agency, William McAdams, where he revolutionized the pharmaceutical advertising industry. His monumental success came from leading the advertising campaign for Valium, making it America’s most prescribed drug for years. Arthur’s younger brothers, Mortimer and Raymond, also became doctors, and together they explored alternative drug treatment options at a psychiatric hospital. In 1952, Arthur purchased a small pharmaceutical company called Purdue Frederick for his brothers, paving the way for the future of their powerful empire.

The Sackler Brothers’ Journey

Purdue Frederick, owned by the Sackler brothers, revolved around unglamorous products like laxatives and ear wax removers, but by the 1960s, the company was thriving. The brothers led different lives and pursued diverse interests. Mortimer focused on expanding the business in Europe, Raymond concentrated on maintaining family-centric American operations, and Arthur managed a complex advertising empire intertwining pharmaceutical companies. Their collective efforts resulted in the development of MS Contin—a revolutionary time-release morphine pill that changed pain management for cancer patients.

From humble beginnings with laxatives and ear wax removers, Purdue Frederick, owned by the Sackler brothers—Arthur, Mortimer, and Raymond—blossomed into a successful business by the mid-1960s. Though the trio shared equal stakes in the company, each pursued different paths.

Arthur, the eldest, remained busy running his advertising agency, leaving the reins of Purdue Frederick to Mortimer and Raymond. The former, fascinated by Europe and its prospective business opportunities, would jet off frequently in search of expansion opportunities. Mortimer had a penchant for luxury and led a lavish lifestyle. Meanwhile, his brother Raymond was the peacemaker, preferring a quiet life near the family business in Connecticut with his wife and two children.

Arthur’s advertising agency counted Purdue Frederick as a client, but he also held shares in a competing pharmaceutical firm—strategic ownership that would come to light later. His diverse ventures were all strategically integrated, with a medical newspaper featuring ads from his own agency and a research institute producing studies on the efficacy of drugs.

The collective efforts of the Sacklers ultimately led Purdue Frederick to acquire a British company that developed a time-release morphine pill. Initially, doctors were hesitant to prescribe addictive opiates except for terminal illnesses. However, this new time-release pill allowed cancer patients to manage their pain from the comfort of home instead of requiring frequent hospital visits. This breakthrough in pain management was christened MS Contin, marking another milestone on the Sackler brothers’ entrepreneurial journey.

Behind the Sacklers’ Legacy

The renowned Sackler family built a prominent name in the art world while remaining enigmatic in their business dealings. Despite their numerous philanthropic endeavors, Arthur Sackler’s questionable marketing techniques and Purdue Frederick’s controversial drug OxyContin have raised concerns about the reasons behind their reclusiveness.

At the heart of New York City lies the Metropolitan Museum of Art, a prestigious art institution that has played host to the extensive collection of Chinese art owned by Arthur Sackler. Ranking among the elite of New York high society, Sackler strove for an even grander space, culminating in the opening of the spectacular Sackler Wing in 1978. The wing boasted a towering glass wall, an immense reflecting pool, and the ruins of an ancient Egyptian temple.

The Sackler brothers were known for their philanthropy, generously donating funds to secure naming rights in renowned institutions worldwide. As a result, the Sackler name graces countless landmarks, such as the University of Oxford’s Sackler Library, Tate Modern’s Sackler Escalator, and Guggenheim Museum’s Sackler Center for Arts Education.

Strangely, the Sacklers were substantially more private regarding their business affairs. They were known to avoid interviews and shunned the spotlight, choosing to wield their influence from behind the scenes. Arthur’s intention may have been to veil the interconnected nature of his various enterprises. However, his wealth accumulation due to questionable marketing practices to promote Valium usage has raised eyebrows in hindsight.

Moreover, Purdue Frederick, their pharmaceutical company, faced FDA scrutiny for releasing MS Contin without approval. The company’s lawyer, Howard Udell, contended that FDA approval was unnecessary, citing that the active ingredient, morphine, was not a new substance.

Although the Sacklers’ motivations for maintaining secrecy in their business dealings remain uncertain, their reclusive behavior gained significance with the emergence of their powerful painkiller, OxyContin, and the controversies that followed.

The Sacklers and OxyContin Origins

After Arthur Sackler’s death, the Sackler family split into two factions over the Purdue Frederick Company, later becoming Purdue Pharma. Amidst intense family rivalries, Purdue Pharma focused on creating a successor to their morphine-based MS Contin. The idea of applying the time-release coating of MS Contin to oxycodone emerged, and Richard Sackler, much like his uncle Arthur, became fanatically devoted to the development of what would become OxyContin. Facing skepticism from physicians about opioids, Purdue aimed to transform the perception of pain management in order to tap into a broader and more profitable market.

As the Sackler family struggled to manage the estate after Arthur’s death in 1987, disagreements and disputes tore the once-close siblings’ families apart. The Mortimer side and the Raymond side sat on opposite ends of the Purdue Frederick boardroom, often clashing in heated discussions and even physical altercations.

By 1990, the second generation of Sacklers joined the board and established Purdue Pharma. While Mortimer’s daughters, Ilene and Kathe, represented one side, Raymond’s sons Richard and Jonathan formed the other. The company found success with their morphine-based MS Contin, but they knew this prosperous period had an expiration date. As patents lapsed, generic drug manufacturers would swoop in and dismantle their monopoly.

The solution came in the form of oxycodone, believed to be conceived by either Kathe or Richard. Richard, sharing many similarities with his uncle Arthur, took the reins, pushing the development of the new drug that would soon become OxyContin.

However, there was more than scientific breakthroughs to consider. Physicians remained wary of opioids, especially with oxycodone being about twice as potent as morphine. Purdue Pharma needed a paradigm shift that would facilitate their entry into the general pain relief market. In a confidential memo in 1994, the company introduced a secret plan to promote OxyContin for usage beyond treating cancer pain, setting the stage for an ambitious and far-reaching marketing campaign with unforeseen consequences.

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