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BOOK REVIEW

Taking on the Sacklers in ‘Empire of Pain’

Ellen Weinstein for The Boston Globe

It didn’t have to turn out this way. The Sacklers didn’t have to be the poster children of corporate malignancy. OxyContin didn’t have to become a serial killer. America didn’t have to lose so many lives to opiates.

Patrick Radden Keefe’s “Empire of Pain” is a true tragedy in multiple acts. It is the story of a family that lost its moorings and its morals, of a drug that became a killer rather than a comforter, of philanthropy that didn’t wipe away the emotional pain that was the stepchild of the painkiller. It is also the story of idealism gone awry, of research being misused, of pills being abused.

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Written with novelistic family-dynasty and family-dynamic sweep, “Empire of Pain” is a pharmaceutical “Forsythe Saga,” a book that in its way is addictive, with a page-turning forward momentum. We see the Sacklers moving from marketing to entrepreneurship to art collecting to philanthropy to ignominy. It is an American story, and an American tragedy — and travesty.

Arthur Sackler, who even in death is at the center of this sordid tale, was not only a man of medicine, he also was a maven of merchandising. That is where the trouble started. His insight, according to Keefe: “Medicine [could] be pitched to doctors on more or less the same terms as swimwear or auto insurance was marketed to ordinary consumers.”

It started with terramycin. It ended with OxyContin. “Arthur felt as if he had seen the future,” Keefe writes, “and it was a future in which drug companies and drug advertisers would bring fantastic innovations to the public — and make a lot of money at the same time.” His pharmaceuticals would become phenomena.

The whole parade of human suffering — drug abuse, divorce, inheritance disputes, illness, suicide, even an aborted suicide attempt before Arthur Sackler’s very eyes — is portrayed in these pages. Meanwhile Sackler museums, schools, theaters, and science centers sprang up across the country and around the globe.

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The swindling — legal swindling — started early. With an eye toward the social approbation provided by association with New York’s Metropolitan Museum of Art, Arthur Sackler “bought” a passel of Asian paintings housed at the Met at the price the museum originally paid. He then “donated” them back to the Met, all with the stipulation that each be noted as a “gift of Arthur Sackler,” even though the museum already owned them. “It was a classic Arthur Sackler play: innovative, showy, a little bit shady; a charitable gesture in which, considering the tax advantages, he would actually make money,” Keefe writes.

Eventually the family company’s research developed a highly profitable morphine pill called MS Contin that ushered the family into pain management — and great wealth. Then came the far stronger OxyContin, which would produce even greater profits and, along with them, great despair and death. The drug’s target: the 50 million Americans who suffered from pain. “OxyContin,” Keefe writes, “would be a drug for everyone.”

The Sacklers not only manufactured the drug, they marketed it too, with phony studies and a blind eye to its dangers. Their company, Keefe writes, “explicitly instructed sales reps to target family physicians who were, in the company’s language, ‘opioid naive’ — doctors who had little experience prescribing this kind of medicine.” They also offered free samples. It was pills-a-poppin.

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Meanwhile, recreational drug users ignored, or perhaps heeded, the very words on the bottles of OxyContin: “Taking broken, chewed, or crushed OxyContin tablets could lead to the rapid release and absorption of a potentially toxic dose of oxycodone.” Even a secretary to a top executive at Purdue Pharma, the family’s company, became addicted. Purdue knew of the threat inherent in its drug but adopted what Keefe calls an “unapologetic posture.”

Soon the company and the family were consumed in legal battles, including one prompted by Massachusetts Attorney General Maura Healey, and it mobilized its own legal counter-force with such prominent figures as Eric Holder, Mary Jo White, and Rudy Giuliani. And while it was under siege, the company came up with a more tamper-resistant drug designed to prevent its cash cow from being replicated by generic-drug manufacturers.

Today the Sackler name is in ruins and has been removed from the names of buildings and institutions, including at Tufts University, where five facilities have been stripped of the family’s name. And the company pleaded guilty to, among other things, conspiracy and charges of violating the Food, Drug, and Cosmetic Act. “No individual would face charges,” Keefe writes. “In fact, no individual executives were mentioned at all: it was as if the corporation had acted autonomously, like a driverless car.”

But thanks in large part to Keefe, the anonymity of the principals behind OxyContin not only is shattered, the fog that has shrouded the entire sad episode also has been stripped away. Keefe writes that “a problem for the Sacklers was that, unlike a lot of human beings, they didn’t seem to learn from what they saw transpiring around them.” What we learn in this gripping volume helps explain the OxyContin tragedy we all saw transpiring around us. Shame.

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EMPIRE OF PAIN: The Secret History of the Sackler Dynasty

By Patrick Radden Keefe

Doubleday, 560 pp., $32.50

David M. Shribman, for a decade the Globe’s Washington bureau chief, is a nationally syndicated columnist.