Comfortably Numb: the Sackler Oxycontin Cartel

Photograph Source: Cindy Shebley – CC BY 2.0

China has an opium problem — again.  And an American family is to blame.

As the avid historian of China’s insulated dynastic past knows, the Century of Humiliation, from 1839-1939, had as its centerpiece the Opium Wars fought by the Qing dynasty against the British to prevent its subjects going from casual opium users to full-blown addicts. When the Chinese began destroying opium caches, like Bostonians destroyed tea chests in protest just before the Revolutionary War, the Brits opened fire, razed palaces, raped women and looted priceless imperial treasures, and, ultimately, chased the Emperor out of town. Other Europeans and Americans exploited the opening to force China to “trade” with the West: for centuries, Europeans had lusted for Chinese goods, but had nothing much the Chinese wanted. Hong Kong was seized by the Brits as compensation for winning the Opium Wars they forced. Even the name “China” is derived externally, through the Portuguese, from Sanskrit. Internally, they called it Zhōngguó (Middle Kingdom).

Just yesterday, I was reading in Stat+ magazine that the infamous Sackler family is trying to sell off their Chinese branch of Mundipharma (read: world pusher) for more than a billion dollars.  Back in 2019, the family was forced to fess up their criminal misrepresentation of Oxycontin’s addictive qualities over the years, leading to a settlement in the billions of dollars, and driving Purdue Pharma, the drug’s manufacturer, into bankruptcy. Rather than feeling remorse or empathy for the addictions they caused and hundreds of thousands of overdose deaths, Sackler began an extension of their pain “relief” empire overseas, including entry into the Chinese pharma market through their worldwide tentacles embodied by Mundipharma — using the same tactics that had got them in trouble in America.

Talk about chutzpah. And an elite philanthropic doctor family with the criminal mindedness of a street pusher. The Sackler family started out decades ago as purveyors of fine laxatives — Senokot!  As they declared at the time, “Constipation is a world problem.” Now they’re a world problem, and, as their 2019 settlement and subsequent China incursion shows, they’re full of shit.  Patrick Radden Keefe, who provides the quote above, explains the whole epic shit storm of disgrace in his new book, Empire of Pain: The Secret History of the Sackler Dynasty. Keefe is an award-winning New Yorker writer who has previously put out other critically acclaimed works, such as the Orwell Prize-winning, Say Nothing: A True Story of Murder and Memory in Northern Ireland (2019) and, The Snakehead: An Epic Tale of the Chinatown Underworld and the American Dream (2010).

The first thing the reader wants to know is what Keefe can add to the, by now, broadly covered investigations and revelations about Purdue Pharma’s dishonesty in marketing Oxycontin, ignoring critics of their willful disregard of facts, and turning millions of Americans into dope addicts in the largest epidemic of its kind in American history. Keefe has an answer. He tells the reader that his interest in the Oxycontin story was inspired by the 2016 Los Angeles Timesreporting on the crisis, as well as his readings of Sam Quinones’ Dreamland: The True Tale of America’s Opiate Epidemic (2015), and Barry Meier’s, Pain Killer: The Extraordinary and True Story of Oxycontin (2003) — available for reading at Archive.Org.

But Keefe was after a different angle.  He wanted to pursue the secret life of the Sackler family, the rise of their dynasty, and the internal moral integrity of their decision-making over generations. The mentality, more than the material. Keefe writes,

There are many good books about the opioid crisis. My intention was to tell a different kind of story, however, a saga about three generations of a family dynasty and the ways in which it changed the world, a story about ambition, philanthropy, crime and impunity, the corruption of institutions, power, and greed. As such, there are aspects of the public health crisis that this book gives scant attention to, from the science of addiction to the best strategies for treatment and abatement to the struggles of people living with an opioid use disorder.

These addiction and treatment topics are treated in some detail in the works of some of the inspirational sources he cites in Empire of Pain.

The book is segmented into three Books: Patriarch, Dynasty, and Legacy. Keefe begins with a benign take on the Sackler family, extolling their virtues as an American Dream success story.  Arthur, Mortimer and Raymond are first generation sons of Jewish immigrants from Ukraine and Poland. They are ‘miracle’ boys, each becoming psychiatrists, Arthur, the eldest, dominating and setting the developing family narrative of success on its way. In fact, Arthur provided for both his parents and his brothers, and was seen by them, writes Keefe, as more of a father figure than an older brother. Arthur is the key figure in the family, the catalyst of their shared dynamism.  And it begins with Arthur’s high school years. He attended Erasmus High:

Erasmus was a great stone temple to American meritocracy, and most of the time it seemed that the only practical limitation on what he could expect to get out of life would be what he was personally prepared to put into it.

Keefe notes that almost immediately Arthur took to writing ads for school publications.

Names were important to Arthur from the beginning — historical legacies: political leaders, artists, and cultural giants. As Keefe puts it, Erasmus pushed its own prescriptions:

This country was theirs for the taking, and in the span of a single lifetime true greatness could be achieved. They spent their days at Erasmus surrounded by traces of great men who had come before, images and names, legacies etched in stone.

This outlook would deeply influence the Sackler philanthropic purpose over the decades, as they gave generously to cultural and scientific institutions — the one stipulation being that the Sackler name was prominently displayed as the benefactor. It’s probably no stretch to assert that such achievable ‘greatness’ is the common thread that runs through the American patrician aristocracy.

Long before Purdue Pharma became the scourge of an industry that has heaps of ethical questions to answer for, with the introduction of their ‘magical’ reconfiguration of morphine that dramatically enhanced its potency in the form of Oxycontin, the Sackler family began its dynastic rise with the introduction of other manufacturer’s ‘miracle’ drugs. Arthur, through his McAdams ad agency, helped Pfizer come up with a big hit in antibiotics, specifically the Sigmamycin, which was touted as,

the antibiotic formulation with the greatest potential value and the least probable risk . . . highly effective—clinically proved new, multispectrum synergistically strengthened Sigmamycin particularly for the 90% of the patient population treated in home or office where sensitivity testing may not be practical.

But John Lear, senior editor of The Saturday Review, called out their claims in a 1959 piece, “Taking the Miracle Out of Miracle Drugs.” The Sackler fraud is clear from the beginning, as doctor testimonials included in the package are revealed to be fake. Even Ralph Nader’s Public Citizen’s Health Research Group found the ads hyperbolic. However, Lear and Nader do place Sackler’s dishonesty in the context of an industry-wide problem.

Keefe sees this deception as the beginning of the pattern that the Sackler brothers will establish to sell their drugs in the future in an industry rife with charlatans. Former presidential candidate and crime crusader Senator Estes Kefauver from Tennessee, a kind of forerunner to Frank Church, convened U.S. Senate Antitrust and Monopoly Subcommittee hearings to look into growing public complaints about muscle practices and phony claims:

The initial purpose of the hearings had been to focus on monopolistic pricing in the pharma industry. But once Kefauver and his staff started calling witnesses and asking them questions, the inquiry reoriented to the more profound and widespread problems of deceptive drug marketing.

The Sacklers, themselves an insulated mystery to investigators, proved to be pioneers of such deception.

Later, Arthur, Mortimer and Raymond worked together at Creedmoor Hospital, a state psychiatric facility in Queens, where, Keefe writes,  “Visitors would see patients roaming the grounds, confined in white straitjackets, like a visionfrom an etching by Goya.” There, the brothers introduced innovations in psychiatric care, including the use of histamines that allowed some patients to leave the institution — in some cases, for the first time in years.

But the most important work that came from their time at Creedmoor, and which had the greatest transformative development in their careers was the introduction of ‘miracle’ drugs, arguably just as important to today’s current pharmaceutical psychiatry as Oxycontin became for pain-killing, that the Sackler doctors administered at the hospital — Thorazine, Librium, and, later, Valium. Keefe writes that Thorazine “was precisely the sort of antipsychotic silver bullet that the brothers had envisaged.” And, he adds, “Arthur didn’t handle the advertising for the drug, but he might have: Smith, Kline’s slogan was that Thorazine keeps “patients out of mental hospitals.” The argument goes that Thorazine helped lead to deinstitutionalization.

When drug manufacturer Roche came out with the tranquilizer  Librium (“a portmanteau of “liberation” and “equilibrium”), they called on Arthur Sackler to work his magic with ads.  Ka-chong lights lit up. Writes Keefe,

When Roche conducted clinical trials on Librium, the company enthusiastically concluded that the drug could treat an astonishing range of afflictions. Anxiety. Depression. Phobias. Obsessive thoughts. Even alcoholism. With each new “indication,” the potential market for the drug expanded.

This ‘miracle’ expansion, which sounded so much like the quack offerings of frontier medicine men selling from wagons, deeply influenced the brothers Sackler’s later marketing of Oxycontin, pushed as another all-purpose ‘miracle’ drug.  In addition, Keefe notes, “Before he agreed to promote Librium and Valium, he had struck a deal with Roche in which he would receive an escalating series of bonuses in proportion with the volume of drugs sold.”  Sackler would later reward their own salespeople with “unlimited” bonuses based on sales.

Roche was so impressed by Arthur’s advertizing prowess that they put him in charge of pushing Valium, another tranquilizer that Roche saw as an improvement over Librium. The problem was that Librium was “doing gangbusters business” and Roche had to figure out how they would introduce Valium without affecting the sales of Librium. No worries.  As Keefe details,

What Arthur’s team at McAdams had to do was convince the world—both doctors and patients—that actually the drugs were different. The way to do this was to pitch them for different ailments. If Librium was the cure for “anxiety,” Valium should be prescribed for “psychic tension.” If Librium could help alcoholics stay off the bottle, then Valium could prevent muscle spasms.

Et cetera. This would become crucial for the Sacklers in the later iterations of oxycodone.

Arthur’s work for McAdams ad agency, produced prodigious amounts of copy for pharmaceutical ads. And he also established MD Publications. “MD put out a glossy magazine about medicine,” writes Keefe, “featuring lots of sumptuous advertising from pharmaceutical companies.”  So adept at pharma porn was Arthur that he became renowned. Keefe writes,

When Arthur was inducted into the Medical Advertising Hall of Fame, half a century later, the citation would say, “No single individual did more to shape the character of medical advertising than the multi-talented Dr. Arthur Sackler.” It was Arthur, the citation continued, who brought “the full power of advertising and promotion to pharmaceutical marketing.”

Critics of his work would probably see such praise more darkly — as indictments of his latent criminality.

Keefe attempts to provide some balance to his Mr. Hyde portrait, by showing the generosity of Arthur, and later the Sacklers in general as philanthropists and benefactors and donors to “worthy” causes.  The Sackler establishment of the School of Medicine in Tel Aviv was a deeply gratifying gift to the fledgling nation of Israel.  Sackler negotiations with the Museum of Modern Art in Manhattan guaranteed that ordinary people could visit the museum with its extraordinary exhibits for free.

And at the McAdams agency, where Arthur “was king,” he hired talented misfits, Jews who were being snubbed, and even communists who could not otherwise find work.  Keefe relates an office anecdote that shows his wit and good will. Keefe writes,

On one occasion, a Swedish designer, who was a communist, made a scene by starting a small fire in the office and burning some of McAdams’s own advertisements, to indicate his distaste for such “capitalist trash.” “The art director scolded him,” Wolff recalled. “We all thought it was hilarious. But he kept coming in.”

And despite the deceptions of his ads, you couldn’t find any salespeople who could find fault with his bonus program that made some of them very rich.

As successful as Arthur and his brothers were in their pharmacy careers — the family owned and operated dozens of companies — their breakthrough success didn’t come until after Arthur’s death, when Raymond (and his later son, Richard) came out with Oxycontin; Mortimer, living overseas, oversaw the expansion of their drug empire into Austria, Canada, Cyprus, Germany, Switzerland, the UK — and China. The narcotic started out as a ‘miracle’ remedy of medical patients suffering severe pain, such as cancer patients, but ballooned into absurd degrees of ‘indication’. Borrowing on the technique that Arthur had used to market Librium and Valium “for different purposes,” including patients with mild pain, and with no attempt to distinguish (the Sackler brothers were psychiatrists) those users who might have addictive personalities. Like the tobacco industry and the gun lobby, the Sacklers blamed the addicts — opioids don’t kill people, they seemed to argue, people kill themselves with opioids because they’re losers.

As generous as the Sacklers were for legacy-burnishing philanthropic purposes, donating billions of dollars, they were callous and indifferent when it came to compensating people for their losses — loved ones, careers, health.  Beginning in 2017, when it became clear that the family would not be able to avoid paying huge sums in penalty settlements for the pain they caused, they began taking stupendous amounts of money out of Purdue Pharma and baking it offshore to protect their wealth.  In 2019, rather than take a hit directly in their purse, they offered to sell off a branch of Mundipharma (China) to make the settlement payment of $4.2b, a ‘self-serving’ arrangement that didn’t go down well. In fact, left unchecked, they’d be heavily pushing opioids in China the same way that led to their forced bankruptcy in America.  All in all, you’d have to conclude that they are not philanthropic at heart, but misanthropic.

Keefe’s account of the rise of the Sackler family is an engrossing narrative of immigrant success in America. How they became rich over-promoting a dangerous drug is fascinating and a picture of pure capitalist greed at work. There’s a lot of dynamism on display. But the sub-narrative of the family dynamics was, at times, a study in ennui; you find there’s nothing inherently interesting about wealthy people, per se. People born with silver spoons aren’t a whole lot different than people born  with wooden spoons — except maybe more boring for the lack of struggle in life. Keefe writes,

More than one person who worked at Purdue during this era likened the experience to the acidly humorous HBO show Succession, in which a trio of overindulged adult children vie, haplessly, to seize control of a conglomerate built by their hard-driving father.

There’s some truth to this observation, although it should be noted that there’s very few “acidly humorous” moments expressed by the Sacklers and their heirs. They’re pretty self-serious.

Many institutions came to the same conclusions and stopped taking their money, and began removing their name from exhibit rooms and foundations. When Keefe wrote his first piece on the Sacklers in 2017 for New Yorker, he heard from Nan Goldin, an American photographer, and founder of the Sackler protest group PAIN (Prescription Addiction Intervention Now). In Paris at the Louvre, she and other protesters unfurled a banner that read: “Take down the Sackler name!” And soon thereafter the Sackler Wing no longer bore their name. More protests followed, Keefe writes,

Nan Goldin and her allies in PAIN, who had spent so much of the past year feeling hamstrung by the bankruptcy and the COVID pandemic, experienced a surge of energy and hope. They would redouble their efforts, at the universities, at the Guggenheim, and especially at the Met. They were determined to keep fighting until they saw the name come down.

Others now feel similarly, after seeing how the family has responded to their criminality.

Aside from a fascination with the Jekyll-and-Hyde nature of Keefe’s Sackler narrative, as it flims and flams between the noble posturing of mega philanthropy and the down-and-out darkness Oxycontin brings to the doped-up masses, Empire of Pain sadly recalls, for the reader of a certain age, the period between 1965 and 1975 when young Americans were dropping dead steadily from heroin overdoses, and their loss was the everyday news, and methadone took people from the cooking spoon to the fire of addiction, and the counterculture seemed to get obliterated overnight and the world returned to the “squares.”  Keefe reminds us that in the 60s the drugs were illegal; killer Oxy is prescribed.

All in all, Empire of Pain is an absorbing account of plentitude and wealth, of privilege and entitlement, of class in-breeding and its consequence, that is at once full of ennui and entertaining dysfunction.  As if we needed a push, Keefe adequately lays out reasons we shouldn’t bow or kow-tow to patricians and rogue nobles and the one-percenters the MSM dresses up like Ken and GI Joe and Barbie dolls to distract us from the fact that we live in an abattoir world, a realm of haves and have-nots filled with riches for some who get wealthy off the pain of others, even when they claim to be peddling relief.

John Kendall Hawkins is an American ex-pat freelancer based in Australia.  He is a former reporter for The New Bedford Standard-Times.

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