Empire of Pain

Summary of Empire of Pain

1. 1

   When Philanthropy Becomes a Blood-Soaked Shield

   

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   $600 million. That's what Purdue Pharma paid in 2007 for misleading doctors and patients about OxyContin. The fine made headlines as one of the largest pharmaceutical settlements in history. Behind closed doors, though, the Sackler family-Purdue's owners-were laughing. They'd paid themselves more than that in a single year. "It's nothing to us," one executive remarked. This moment reveals everything about how one family transformed American medicine into a profit machine fueled by addiction, all while plastering their name across museum wings and university buildings. Their strategy was breathtakingly simple: sell pills that hook patients, blame the victims when they get addicted, and use charitable donations to scrub away the bloodstains. For decades, it worked flawlessly. The Sacklers became synonymous with culture and healing even as their drug claimed hundreds of thousands of lives-more American casualties than the entire Vietnam War.

2. 2

   Three Brothers and the Art of Selling Sickness

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   Three sons of a failed Brooklyn grocer-Arthur, Mortimer, and Raymond Sackler-grew up in Depression-era poverty, shaped by their father Isaac's warning: "If you lose a fortune, you can always earn another, but if you lose your good name, you can never get it back." Arthur, the eldest, financed his brothers through medical school and secured them positions at Creedmoor Psychiatric Center in the 1940s. There they witnessed brutal mental healthcare-electroshock therapy, lobotomies turning vibrant humans into docile shells. Their research suggested mental illness had biochemical causes; injecting schizophrenic patients with histamine, nearly a third improved enough to leave the hospital. But Arthur's true genius wasn't in the lab-it was in persuasion. At William Douglas McAdams' advertising agency, he revolutionized pharmaceutical marketing by treating doctors like consumers, filling medical journals with glossy ads featuring celebrity physicians. When Pfizer launched Terramycin, Arthur made it a household word. His seductive philosophy: he wasn't advertising, he was educating. Doctors, he insisted, were unimpeachable professionals who couldn't be manipulated-a convenient fiction that made everyone complicit feel better.

3. 3

   The Valium Empire: Perfecting the Playbook

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   Arthur's marketing genius transformed Valium into pharma's first billion-dollar blockbuster. His campaigns targeted anxious women with taglines like "35, single and psychoneurotic," pathologizing normal stress into treatable conditions. By the 1970s, doctors wrote sixty million Valium prescriptions annually. When addiction and brutal withdrawal emerged, Arthur dismissed concerns-patients "just get addicted." The problem was weak-willed users, never the drug. Behind this success lay a corporate octopus. Senator Kefauver's investigators discovered the Sacklers' Manhattan headquarters housed at least twenty interconnected entities controlling everything from drug development to medical journal publication. Most troubling was Arthur's relationship with FDA antibiotics chief Henry Welch, who received substantial payments from Sackler-connected journals while approving their drugs. When exposed, Welch resigned. Arthur hired legendary fixer Clark Clifford and dominated his Senate hearing with what observers called a "patrician accent wielded like a switchblade." As wealth accumulated, the brothers cultivated philanthropic facades. Arthur negotiated a private "enclave" within the Metropolitan Museum with his own curator and special locks. He would purchase Asian masterpieces from the Met at original prices, donate them back, then declare current market value for tax deductions-charitable yet profitable.

4. Chapter 4

   Family Fractures and the Birth of a Killer

   As the empire expanded, family tensions festered. Mortimer divorced his first wife to marry Gertraud "Geri" Wimmer, an Austrian gallery manager barely twenty-the same age as his daughter. Raymond maintained a quieter suburban life. Arthur maintained three separate households with three women who each believed themselves "Mrs. Arthur Sackler." The definitive rupture came through betrayal. Arthur had secretly conceived IMS Health, a pharmaceutical data company, using associate Bill Frohlich as his front man. When Frohlich died in 1971, Raymond and Mortimer made nearly $37 million when IMS went public, refusing to share with Arthur. His daughter Elizabeth recalled this as "the beginning of the whole rift." A darker tragedy unfolded when Mortimer's son Bobby, struggling with mental illness and addiction, jumped to his death from his mother's ninth-floor apartment in 1975. Though the Sacklers plastered their name everywhere, they erased Bobby from their public narrative. After Arthur's death in 1987, his heirs sold their one-third interest in Purdue Frederick to Mortimer and Raymond for just $22 million-a catastrophic mistake. The company was launching MS Contin, a time-released morphine pill, and Richard Sackler was already developing its successor: OxyContin. Richard pursued the project with obsessive dedication, telling a friend: "You won't believe how committed I am to make OxyContin a huge success. It is almost that I dedicated my life to it."

   Chapter 5

   The Blizzard of Prescriptions: Marketing Addiction as Medicine

   In January 1996, as a blizzard paralyzed the East Coast, Purdue's sales force gathered at Arizona's Wigwam resort for OxyContin's launch. Richard Sackler declared the storm an "omen of change" heralding "a blizzard of prescriptions that will bury the competition." Purdue's marketing exploited a dangerous misconception: many physicians incorrectly believed oxycodone was weaker than morphine when it was actually twice as potent. Internal documents revealed they considered it "extremely dangerous" to correct this misunderstanding - weaponizing physicians' ignorance instead. Sales reps positioned OxyContin as "the painkiller to start with and to stay with." When doctors raised addiction concerns, reps deployed a devastating lie: "fewer than 1 percent" of patients became addicted, citing a misleading five-sentence letter in the New England Journal of Medicine. The marketing blitz included luxury "pain management seminars" and OxyContin-branded merchandise. Internal data showed doctors attending Purdue dinners wrote twice as many prescriptions. Using IMS data from Arthur's company, reps identified high-prescribing "whales" and targeted "opioid naive" family physicians rather than specialists. Sales reached $601 million by September 1999.

   Chapter 6

   When the Bodies Started Piling Up

   As OxyContin sales soared, abuse spread rapidly. Steven May, an ex-cop who joined Purdue in 1999, visited a top-prescribing West Virginia doctor in 2000. The physician was distraught-a relative had just died from an OxyContin overdose. The company's success was built on corpses. OxyContin ravaged rural communities across Maine, Pennsylvania, Ohio, and Appalachia. Purdue deliberately targeted these regions with high rates of manual labor, disability, and chronic pain. Users combined OxyContin with Valium for "the Cadillac high." Black market pills sold for a dollar per milligram. Despite Richard Sackler's testimony that he first heard of abuse in early 2000, Purdue had received warnings since 1997. Investigators found hundreds of sales reports mentioning "street value," "snort," and "crush." By 1999, reps reported "credibility issues" as physicians recognized OxyContin as "the street drug all the drug addicts are seeking." Richard adopted Arthur's strategy: blame the victims. "Hammer on the abusers in every way possible," he declared. Purdue's position became "Abusers aren't victims. They are the victimizers." Many victims were legitimate patients who developed withdrawal cycles-precisely the "peaks and troughs" OxyContin claimed to avoid. In 1999, Howard Udell tasked his secretary with researching abuse online using the pseudonym "Ann Hedonia." Her findings were circulated to senior officials and "all the Sacklers." They knew.

   Chapter 7

   The Reckoning: When Monuments Crumble

   When criticism mounted, Purdue deployed a $45 million legal defense, creating "grassroots" patient advocacy organizations that were corporate fronts. Richard Sackler boasted they could reach "virtually every senator and congressman" within 72 hours. Despite the 2007 guilty plea and $600 million fine, Purdue resumed aggressive marketing. By 2008, OxyContin sales hit $3 billion annually. In 2010, they reformulated OxyContin claiming abuse prevention - but the timing exposed their true motive: patent protection. With the original patent expiring in 2013, they employed an "evergreening" strategy to extend their monopoly. The reformulation backfired catastrophically. Four out of five new heroin users had initially abused prescription painkillers, and 70% of OxyContin abusers switched to heroin. The family's philanthropic image crumbled when photographer Nan Goldin, who had overcome OxyContin addiction, founded P.A.I.N. In March 2018, she led a protest at the Metropolitan Museum's Sackler Wing, where activists staged a "die-in," throwing nearly a thousand orange pill bottles into the reflecting pool. In 2019, Massachusetts Attorney General Maura Healey released a 274-page complaint with damning evidence - meeting minutes, board presentations, internal emails revealing the family's direct involvement. On September 15, 2019, Purdue filed for bankruptcy. The Sacklers proposed a "global resolution" - relinquishing control and contributing money for immunity from federal liability. Headlines announced "$10-12 Billion to Settle Opioid Claims," but the actual Sackler contribution was just $3 billion - financed by selling Mundipharma, their international opioid business. Prestigious institutions distanced themselves. The Louvre removed all Sackler signage. Tufts University stripped the name from five facilities, workers literally chiseling it off buildings. When called to testify before Congress in December 2020, David and Kathe Sackler expressed "deep sadness" but denied personal responsibility. Tennessee's Jim Cooper delivered a devastating assessment: "Watching you testify makes my blood boil. I'm not sure that I'm aware of any family in America that's more evil than yours." In 1947, Richard's father and uncles created their first family foundation "in memory of Isaac Sackler" to "help alleviate man's suffering." Isaac had warned his sons that while fortunes can be rebuilt, a lost good name can never be recovered. The Sacklers built museums and endowed universities, but their true monument is a graveyard - hundreds of thousands of Americans dead from an epidemic they engineered. Their name now stands as a permanent warning: some stains no amount of philanthropy can wash away.

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