Your pain, their gain

A conversation with Patrick Radden Keefe about his magisterial and breathtaking new book on the Sackler family and the opioid crisis

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When I began to write and speak critically about big philanthropists, I would often encounter the “at least” defense. Yes, yes, the system is unfair and should be fixed. But at least, right now, they’re doing something.

From my seat, this analysis missed something fundamental. The “at least” stuff they were doing was part and parcel of how the unfair system was upheld. The giving back was all too often the wingman of taking too much. The generosity, the wingman of the injustice. The making a difference, the wingman of making a killing. And the changing of the world, the wingman of keeping their world and their immunities in it the same.

I have explored these themes in my own way, roaming the prairies of the plutocracy, investigating the billionaire class as a class. Today I want to tell you about a book by the New Yorker journalist Patrick Radden Keefe that takes a very different — and utterly mesmerizing — approach to the subject.

Keefe, an award-winning journalist and writer whom you might know from his past books — SAY NOTHING, THE SNAKEHEAD, CHATTER — recently dropped EMPIRE OF PAIN, which is a history of a single family, the Sacklers, who embody the construction and, for the rest of us, the catastrophic consequences of oligarchy.

The zoomed-in approach to the study of plutocracy makes for a page-turning, sweeping, emotionally gripping tale that doubles as a portrait of an entire system. As I told Keefe when I originally had this conversation with him courtesy of the Strand Book Store, I came away thinking he had taken a biopsy of American plutocracy. The narrowness of the incision was no bar to diagnosing a vastly diseased body politic.

I hope you enjoy this conversation. And I encourage you to check out Patrick’s book, while supporting Strand Book Store if you can.

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“The moral blindness that comes with greed”: a conversation with Patrick Radden Keefe

ANAND: You take an approach to the subject of plutocracy that's quite different from the one I've taken, the one many other writers have taken. Which is you take what I would call a biopsy — sticking with the medical theme of the book — a very thin slice of the American body politic, which is one family navigating, exploiting, and manipulating a system. You tell a focused tale of that family, and yet it becomes, in gripping detail, a portrait of a diseased society.

But to start with, there's this moment in time when there are three brothers Sackler, who eventually become famous businessmen and philanthropists and billionaires. And all three brothers are sharing a single bed in Williamsburg, Brooklyn. How did they go from that bed to being fabulously rich, even before OxyContin?

PATRICK: So you have these three brothers, as you say. They had immigrant parents. Their parents came over separately but met in Brooklyn. They came over from Europe at the turn of the last century. The brothers were Arthur, Mortimer, and Raymond Sackler, who were born in Brooklyn and came of age in this family. It's a classic immigrant striver American story, with parents who were very eager for them to assimilate and succeed. They felt that education would be the vehicle. Their parents very desperately wanted these three boys to become doctors. This was something that Arthur Sackler, the oldest of the brothers, later said. By the age of four, he knew that when he grew up he would become a doctor. In fact, all three brothers become doctors.

But almost from the very beginning, there is a sense that they also have a great interest in commerce. Commerce takes them in different entrepreneurial directions. For Arthur Sackler, there's medical advertising and medical marketing. But, also, there's pharmaceuticals. And you end up in a situation in which the three brothers purchase a pharmaceutical company based originally on Christopher Street in Greenwich Village, New York City, called the Purdue Frederick Company. They have their medical practice, their medical research, but also a whole range of entrepreneurial interests. Part of the story that I was very intrigued by in the book is that this is a story, right from the beginning, of conflicts of interest and of these permeable walls between these different areas involving medicine and commerce and the ways in which they influence one another.

ANAND: I want to dig into that, but if we skip almost to the end of the story, thanks in part to your reporting in the New Yorker in 2017 and other reporting, many people now know who the Sacklers are, now know what the opioid crisis is, now know what Oxy is, now know the catastrophe. Perhaps many people have experienced that close to home in one way or another. 

But there has been this refrain from some members of the family in recent years that if they were part of that earlier tradition you were just describing, they have nothing to do with the opioid crisis. While it's literally true that some of those people were not involved or even died before OxyContin was invented, you trace very clearly in the book — and it seems to be one of your core purposes — a through line of tactics, of marketing and advertising tactics, of sales tactics, of system-rigging tactics, of FDA-manipulation tactics, that actually go back right to the start.

Can you talk about that through line and why you think it's important, given this defense we often hear from them?

PATRICK: So you have these three brothers, Arthur, Mortimer, and Raymond, who end up purchasing this pharmaceutical company in 1952, Purdue Frederick. Arthur ends up dying in 1987. 

And Purdue, which was subsequently named Purdue Pharma, ends up releasing OxyContin in 1996. There had already been a number of very good books about the opioid crisis and about Purdue Pharma and OxyContin. One of the very deliberate choices that I made in this book was to devote a third of the book, really, to Arthur Sackler, to those early years, to this guy who dies in 1987.

Some people might question that decision. I feel as though it was the right decision. Arthur Sackler's heirs sold their stake in Purdue after his death, so prior to the launch of OxyContin. They've always taken the position that his name should be mentioned nowhere in the same breath as his brothers’, much less as OxyContin, this drug that he couldn't have dreamed up when he was alive because it was invented after he died. 

I tend to resist that proposition for a couple of reasons. One thing I'll tell you is that when I wrote my piece in 2017 in the New Yorker — which was a very different moment — no institutions had turned their backs on the Sacklers. The Sackler name was still a very prestigious, blue-chip name at the time. Without divulging too much about whom I spoke with, I will say that I did make efforts to try and get some heirs of Arthur Sackler to go on the record, putting any daylight whatsoever between themselves and their cousins, or themselves and OxyContin. Had any of them been prepared to say anything on the record, suggesting even a shadow of disapproval in 2017, you better believe I would have put it in the piece.

There's nothing like that in the piece. The piece came out. Subsequently, there was a great deal of controversy, and they have since made statements saying, "We're appalled by the actions of the other Sacklers." The tone of high moral umbrage is a little bit difficult for me to square with two decades of silence. 

Moreover, Arthur Sackler is this Don Draper-type figure who revolutionized the marketing of pharmaceuticals in the 1950s. He has a pharmaceutical advertising firm, he makes his first great fortune on Librium and Valium, two addictive tranquilizers, and makes a huge amount of money selling those drugs. 

He is pushing these pharmaceuticals to doctors using literature that I think is sometimes of dubious value, but has a kind of official-looking, very medical patina. He is overplaying the therapeutic benefits of drugs, underplaying the side effects, influencing the FDA in ways that I think turned out to be outright corrupt. When the authorities came after him, what Arthur Sackler did was hire Clark Clifford, who was a very politically influential power lawyer, to come in and help get him out of a jam, which Clark Clifford did. For me, part of what was interesting was that there's this whole kind of prototype in place in the 1950s and 1960s that explains so much of what ends up coming later in the 1990s.

ANAND: Let's bring it forward to the OxyContin era. Everyone has taken pain medication before, I presume. Some people have taken strong pain medication, if they've had back surgery or other things. Tell us what was both medically new and important about Oxy, and then what turned out to be catastrophically new and different about Oxy that sowed this crisis.

PATRICK: There are a few things to understand. One is that there was, in the 1980s and 1990s, the beginning of a movement to reevaluate the treatment of pain in the United States. There were some physicians who began to feel that we were not treating pain adequately. That pain was too often treated as a symptom, and not actually as an ailment on its own that should be taken seriously and understood and treated. 

Along with that, there was a sense that there had been a reluctance by doctors to prescribe strong pain medications and particularly opioid medications — drugs that are derived from the opium poppy.

Purdue, this family company, actually had its first big pain blockbuster prior to OxyContin. They had a drug called MS Contin, which was basically just morphine but with a very innovative coating. The pill had a coating which would slowly regulate the drug as it entered your bloodstream over a series of hours. What this meant is that people could take morphine at home. They wouldn't need to get a drip or a shot. They wouldn’t need to go to the hospital. You could send them home with pills. For instance, cancer patients could treat their pain in this way, which felt much more humane.

At a certain point, the Sacklers realize that the patent on this drug, MS Contin, is going to run out. Generic companies are going to rush in, basically, make the same drug, charge less, and decimate their profits. They start thinking, What can we replace it with? The novel thing they have is not the morphine; it's what they call the Contin seal on the pills. What other opioids could we put in a pill with a Contin coating that could replace MS Contin and then we'd get a fresh patent and we could start again? 

They decided to use oxycodone. At that point, oxycodone was really familiar to people mostly in Percodan or Percocet, which is the kind of thing probably a lot of people, I assume, have taken — where it's very small doses of oxycodone cut with aspirin or acetaminophen. The real novelty here was to take the coating and apply it to this very powerful opioid, which actually is much more powerful than morphine, and then market it not just for cancer pain, but for moderate to severe pain.

ANAND: One of your most legendary predecessors at The New Yorker, Hannah Arendt, gave the world the phrase "the banality of evil," writing about a very different situation. It is a phrase that has endured as a way of understanding how in bureaucracies — particularly those kinds of dictatorial bureaucracies — awful, awful things can happen through people really not thinking, and not having the capacity for reflection, and following orders and all that stuff.

Although it is a profoundly different situation, when you're talking about hundreds of thousands of Americans who have died from this opioid crisis, and your book lays out in detail all the reasons people had, in this company and beyond, to know what was going on, it doesn’t strike me as the banality of evil, exactly, but I wonder what's the corporate analog to it.

It's some combination of greed and moral blindness and looking the other way. You don't, I think, have any receipts in the book where it's people being like, "We should try to kill people." It's something different that results in that outcome. What's the corporate version of the banality of evil as you feel you uncovered it?

PATRICK: It's a great question. I had no desire to write a book about a caricature series of mustache-twirling villains who deliberately set out to poison people and kill people. Or even a story in which greed is the sole determining, motivating factor. 

This is a privately owned company. It's a very weird company. Anthropologically, it's a bizarre place. I interviewed dozens and dozens of people who worked there over every decade since the 1960s, and people will tell you, This company was made in the image of the very eccentric, wealthy family that owned it.

You see the bizarre personality traits of the family played out in the corporate culture. Certain people stay and survive, and they're the ones who get with the program. The people who raised objections or thought it was a little weird, or tried to get the family to change, tended to get pushed out over the years. 

What that does is almost like when you're cooking and reducing a sauce. It just gets more and more concentrated, this bizarre culture. Part of what I was trying to capture was not just greed, which I do think is a very important aspect of this and, as you say, the moral blindness that comes with greed. But also stubbornness.

It's the stubbornness of an idealist who is a little in love with his sense of his own virtue, who starts getting confronted with indications that actually, maybe, his grand designs have not worked out in the way that he thought they would.

ANAND: You portray a family, but as anybody who watched “The Godfather” movies knows, the Tom Hagen figure is important. The consigliere, the advisor. They had many Tom Hagens over the years. 

You mentioned Clark Clifford. There is also Mary Jo White, the former U.S. attorney for the Southern District of New York, one of the nation's top prosecutorial jobs, who has become their principal legal defender, perhaps. McKinsey, which was very famously engaged in this corporate banality of evil with them and has faced some measure of pushback legally as well. 

But a surprising one I didn't know is Michael Bloomberg. Far into this crisis, far into the story you've told, they go to Mike Bloomberg for advice. And — correct me if I'm wrong — not on how to save lives, but on how to get out of the pickle of being pushed back on because people are dying. Mike Bloomberg, am I right, gives them messaging advice?

PATRICK: To give credit where credit is due, this is included in the book but not a scoop I can claim credit for. This was ProPublica that broke this news and found some internal emails backing this up, and got confirmation from Bloomberg's people that a meeting had happened between Mortimer Sackler, Jr., and Bloomberg. It's interesting you make this point about how they would go to him not for any advice on the public health angle but just purely on the spin. That's very much the way the family has always seen these things.

There's an extraordinary WhatsApp log that you published on The.Ink, and you broke that story, where the most striking thing for me is you have all these different descendants of the family going back and forth in this private channel that's just family. It's quite intimate. They're talking about family events and holidays and so on and so forth. But they're also really talking about the issues. It was strange for me to read them talking about how to react to my piece and this thing that I helped to start. And what is fascinating is that nobody at any point ever suggests that there's anything but PR to worry about. There's no solitary Sackler who pipes up and says, "God, do you think we actually do share some guilt here? Have we fucked this up?" Nobody said that.

ANAND: I want to ask about the philanthropy theme that I have a special interest in. You quote a Sackler lawyer as saying, "Philanthropy isn't charity. It's a business deal." That quote made me feel like I had wasted 300 pages in my book trying very verbosely to say, "Philanthropy isn't charity. It's a business deal." And here it was all along, said by an actual Sackler consigliere. Can you explain what that pair of sentences means and how they lived that pair of sentences?

PATRICK: That was Michael Sonnenreich, who was Arthur Sackler's long-time lawyer. He's spoken with a bunch of different journalists over the years. He would never speak to me. But he’s wonderfully candid about all this stuff. He's forever just saying the quiet part loud.

ANAND: As journalists, we love those people.

PATRICK: They're amazing. The Sacklers started donating money in the 1950s. At that point, they're building fortunes, they're building names for themselves. The first place where they really start giving money in a significant way is Columbia University. I went into the archives there and found all of the old paperwork, the letters, the internal memos. 

You see it there, even before the Met and before various other institutions where Arthur Sackler initially, but then also his brothers, comes in. They have a very keen sense of, I want to come in. I want to give a gift. In exchange, you are going to put my name on things. You're going to put my name on the wall. You're going to put my name on the building. Each individual object that I give you, you're going to put my name on it. Here's how you're going to write my name. You're going to include my middle initial. You're going to include “MD” after my name. When you send invitations out to any event in this space, my name is going to be on it.

There were often weird tax things going on. With the Sacklers, they were so sophisticated and sneaky. My favorite example of this is that, in the '60s, Arthur Sackler went to the Met and the Met was hard-up for cash. Arthur Sackler said, "I'll make you a deal. I want to buy a bunch of objects that you have in your collection," Asian objects that they had purchased decades earlier. "I will buy them from you, and then I will donate them back to you as gifts of Arthur Sackler. This way you can get revenue. They never leave the building." 

And then what Arthur did was he said he would buy them at the price that the Met had paid decades earlier, and he would write them off for his own taxes at the current market value. So he ends up making money on this deal and plastering his name on all these things. 

ANAND: There are so many beautiful sentences in the book, but there was one that was a more workmanlike sentence that I felt captured something so fundamental. "If there was one attribute that Richard shared with his uncle, Arthur — apart from a common name, a genius at marketing, and a sense of unquenchable ambition — it was the stubborn refusal to admit doubt."

Reflect on that refusal to admit doubt at the center of this story.

PATRICK: It goes back to what I was saying earlier — that it's not just greed; it's stubbornness. I dwell on this at the end of the book, that the Sacklers all believe that they're 100 percent innocent and just totally misunderstood. That you and I are wrong, that the 49 states that are suing their company are wrong, that the 24 states that are suing individual members of the family are wrong. That all of the different reports and the investigative journalism and the protest by Nan Goldin and the institutions that are backing away, that they've all just fallen for a topsy-turvy narrative. That, in fact, the Sacklers are the heroes and the victims of this story.

Part of what I wanted to try and do in the book is to understand, How do you get there? How do you get that deluded? I think some of that is in the family character. I think some of it is actually a hazard of being a plutocrat — that you're surrounded by people whose job it is to reaffirm your most blinkered ideas and to laugh really hard when you tell a joke. I think that's there's a tendency, if you're that kind of person, to just go deeper and deeper into your own delusions.

There was this moment where Kathe Sackler ends up testifying before Congress last December, and she's asked if she feels any responsibility for the opioid crisis, and she says, “There's nothing I can find that I would have done differently.” It's funny because, for me, I look at that and I'm like, I couldn't find a day in my life that I wouldn't do differently in some way. The notion that she could look back at this trail of carnage and not have an ounce of reflection is scary and kind of impressive, frankly.

Patrick Radden Keefe is an author, journalist, and staff writer at The New Yorker. His latest book is “Empire of Pain: The Secret History of the Sackler Dynasty.” This interview was edited and condensed for clarity, and the conversation was originally hosted by Strand Book Store.

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Photo: Craig Barritt/Getty