Review of Empire of Pain, by Patrick Radden Keefe

Pill-anthropy

I was born and raised in small towns in Wales. People say that there are two camps. For example those who like dogs and those that don’t. Those that drink red wine and those that drink white. Those born in small towns and those who weren’t. You know what I mean, no matter what country you are in there is a difference between city and town people. You know because your friends born in cities are very, very different to those born in rural towns.

And so this is why leaving Wales aged eighteen and studying in London was an excellent counter to my village upbringing. Fast forward three years and I arrived at another educational establishment, again in London, where I was to study for a certificate for a year. The “Legal Practice Certificate”. I studied at a college on Store Street London. I didn’t really enjoy that year academically. I missed my university friends. But I also gained one.

This young girl was Cypriot. She was my age, but was so brainy that she was academically a year ahead of me. I met her in my first week. She was petite and very very comfortable in London, yet was born and raised in Cyprus. It was a freshers' type of week and a group of us went for a coffee. Me and her kind of made friends but didn’t. I think she thought I was a bit of an air head. I have met many people who originally think I am not as switched on as I look, and with the straight Indian hair and big eyes, I can see how people think I am a bit of an Indian Princess. This girl was anything but an air head. She had all the Cypriot beauty (sharp features), but she was mentally sharp and obviously intelligent. She was bookish and very politically aware. I don’t know how we became friends but we did.

At the time, EasyJet the low cost airline was taking off in popularity. The owner was Stelios Haji-Ioannou. He was Cypriot and had the associated style of appearing to stop between his sentences. I remember how we would mock her in jest, for the same (when she really did not stop between her sentences).

Whenever we met up (we both lived about 10 minutes walk on opposite sides of Oxford Street, London) she would always arrange what we were doing. Galleries, museums, coffee shops, high street clothes shopping, book shops and small restaurants. To add to her charm, she lived in a student digs on Wardour Street. I mean it when I say digs. We are not talking posh. The house was the one with THE yellow door. I don’t think the door is yellow any more. And the digs were a hub of mates and mates of mates from uni. The conversations amongst her flatmates were hilarious, and political. I loved going there especially as it was a very different scene to my own uni friends yet equally as international. It was a nice change. The building was dishevelled and accommodation over many floors. Wardour Street never slept. Stella was my first politico friend. Her knowledge enriched me and appealed to the side of me that questions everything.

Whilst my friends at university are the ones that broadened my mind to the countries, religions and demographics that they were from, they also were the ones who appealed to the Indian Princess in me. With Stella (her name), the Princess element was there also, but her gig was about art, history and culture.

I had studied art and history within my French A Level. Renoir, Manet, Monet etc. were familiar to me. I read Brecht as part of my German A Level. My background is arts but I never really lead with that, something that I am comfortable with, probably because I have a Welsh rural upbringing. Not leading with my arts knowledge has also led for many a time for women to describe me as shallow, and this is a criticism I cannot deflect. If I look or seem shallow, so be it. But Stella had a personality that was all arts. Meeting her aged twenty one was a game changer in my experience of art and history outside of the classroom that has stuck with me forever.

PAIN MIXED UP

So when Stella texted me in October 2022 from London:

“Book recommendation - this one is right up Mel street!” holding Patrick Radden Keefe’s, Empire of Pain, I registered it. I will also be honest. I had not really read the cover properly, and, as so many of you know, my writing is so linked to issues surrounding colonisation, my fleeting initial reaction was that it must be a book about the British Empire, and that I should read it. I will go further with my wrong assumption. I deduced that it must be a book about how much pain the British Empire caused. Yet at the same time, I recognised a word on the front cover:

“THE SECRET HISTORY OF THE SACKLER DYNASTY”.

Sackler. I knew that word. I just couldn’t place it. And again, in my ignorance and mindset geared towards colonisation (in my defence the Guardian are currently running a series on families and institutions and their links to slavery, and in my second defence many roads lead to colonisation), I assumed that they must be a wealthy family, and their money must be from slavery of something. Wrong.

And knowing Stella, I should have known I was going to be taken in to a deep dive in to the world of arts and more.

RINGING THE SACKLER BELL

Empire of Pain is set in three parts. It is four hundred and fifty two pages long. It has no illustrations and is in small print. The book is the start to somewhat “finish” account of the power of the Sackler family name. Is that name ringing a bell? If so, it is because you will have seen that name in every major museum that the art world praises. The Louvre, The Met, National Gallery and more. Not just the arts. Universities also housed their names, such as Harvard, Yale, Cornell, Oxford, King’s College, London, and more. As I turned the pages I remembered where I had last seen the name. It was when we went back home to the UK in July 2022 from New Zealand and we took the girls to Victoria and Albert Museum in London. They had a Sackler Courtyard. “Had” being the operative word. As an aside, I loved the V&A museum not only as I would go there with Stella, but also because I once bought a jade bangle from there that was exquisite.

Thanks to reading this book though, now my knowledge of the Sacklers has come full circle, although I think it's fair to assume that the Sacklers would dispute that. The Sacklers do not agree with the book. The Sacklers were the sons of Polish immigrant Sophie Greenberg and Galicia immigrant, Isaac Sackler. The couple met in America at the beginning of the 1900s. Their sons Arthur, Mortimer and Raymond went on to create so much wealth that it led to their giving away hundreds of millions of dollars. The act of giving money away in this manner is called “philanthropy”.

Empire of Pain felt like an A to Z of the three Sackler brothers’ lives. But it is that which is behind this wealth, that has become a modern talking point and genesis of this book. Keefe is a New Yorker journalist. Need I say more? Their journalists are forensic. And it was Keefe’s New Yorker article on Purdue Pharma, the company at the eye of the storm, that later led to Empire of Pain.

PILL - ANTHROPY

Keefe’s analysis (like many others) is that the Sackler philanthropy was money borne from pills. More precisely, it was the talent of the brothers when it came to marketing and advertising, and the distribution, by their company Purdue Pharma of “OxyContin,” an opioid, that was hailed as the centre of America’s opioid crisis. Oh, and I should mention, the brothers were also medical doctors and specialists. The Sacklers did it all. And it is also important to note that they were a Jewish family who experienced antisemitism.

I will clarify. The Sacklers made money from selling pharmaceutical drugs, the most major being OxyContin that was the baby of Purdue Pharma launching in 1996. If you haven’t heard of OxyContin, perhaps you have heard of the other drugs by the Sacklers such as Senokot and Valium?

OxyContin relieved pain. It was an opioid with a difference however (detailed in the book) and it was the pioneering marketing and subsequent mass prescribing of this drug (by Purdue Pharma) that caused an uproar amongst those who saw this drug over decades, as causing addiction, abuse, death, malpractice and a crisis (and more) across America. And yes, for those wondering, the drug had FDA approval the whole time.

As per the reviews on the back page, the book is so “exhaustively researched” that when it came to reading about Purdue Pharma, each page felt like a real day in the life of its corporate life. Nothing is spared in the write-up, from the decor, the employees, the fired employees, the meetings, emails - all the events that led to the Sacklers going from welcome philanthropists in the elite arts world, to having their names being taken down from elite art establishments and universities as a result of their association and some would argue actions (although the Sacklers did not admit liability) to the opioid crisis.

HIGHLIGHTS

THE DRUG

We learn how many people got hooked on and died from OxyContin. At one point, I wanted to go and try one myself. But then of course you are reminded of the people in this narrative that started on “one a day”, and then ended up on ten times more, dying in some cases within a handful of months. We are informed of doctors who were prescribing mega pills, black markets, and very very very famous people being addicted to and dying from opioid abuse (you can read for yourself which celebrities). We learn about how people took the drug for better highs and the lengths they went to experience them. The book reminded me that I also have taken an opioid. I took Pethedine, a synthetic opioid, in all three of my birthing labours and it made me very very happy. So happy that I was euphoric and still remember each high up to fifteen years ago.

THE FAMILY

Keefe’s rendition is also a tale of a family saga, for those liking “succession” type entertainment. The Sacklers come off as no different to any other family with leaders and followers, some with big egos and others plain incompetent yet thinking the vast monies they benefited from were from their talent, not accident of birth. Then there is the mistrust. A poignant moment is when you realise Arthur, the OG Sackler money maker and eldest Sackler (part one is entirely dedicated to him), who put companies in his brothers names as he made money, BUT also downplayed to his brothers the worth of such companies. We later learn that all three brothers enlisted this tactic with each other, later in life as their “collective” medical wealth rose. Then there are the Sackler wives, children and grandchildren, and because the analysis is so forensic, I guarantee that you come away remembering every Sackler offspring, wife, second wife and third wife.

And then there was the family name. The more money they made, the more the name appeared in arts, education, medicine and science.

STATE OF PAIN

I welcomed the analysis Keefe gives to pain. Opioids were limited to cancer pain and considered too potent for any other use. One of the common defences offered by the Sacklers in accusations that they knew that their drug was addictive and was causing people to addiction and spiral, were that they were merely treating people for pain. The Sacklers pushed the idea that pain was the biggest untreated condition in American lives. Pain as a condition. Pain as an illness. In their view, if people were becoming addicted to OxyContin, that was not Purdue Pharma’s doing. They were just offering a solution to pain. Any associated addiction was not associated to OxyContin, but in the Sacklers’ eyes, this was the issue of the patient abusing the drug.

I can buy into the idea that pain is a major problem for people and we should help people alleviate it, so they may function. The Sacklers believed however that they were helping people and to do that ‘pain” had to be broadened as a condition beyond just using drugs for cancer pain. And that is where my upbringing comes in. From people to states, the opioid crisis of OxyContin, ravaged poor states. And, coming from a small town myself that resonated with me as I grew up seeing a lot of poverty. We are not talking about drug addicts taking to this drug, we are talking factory workers, people who are laid off, people who had injuries from work and so needed “pain relief”. OxyContin was giving highs to people on low incomes who merely listened to their doctors orders.

But it wasn't just poor people being addicted to it as we see in the book. Because doesn’t everyone have pain at some point? A few years ago I had a spasm in my shoulder and was given an opioid. I was given strict instructions when prescribed it. What would happen if the pain had not subsided and I needed more and more and got addicted?

RELENTLESS PEOPLE

The crisis, scandal and existence of the Sackler family has been written about before, and Keefe makes references to these books. This is commendable. Through his analysis, he names every person who tried to raise alarm bells around Purdue Pharma’s practices over the decades, and failed.

I could see now what Stella meant when she texted me “This is right up Mel street”. You see, the Purdue Pharma machine and the sheer wealth that it was created upon, meant that the Sacklers had all the money possible to crush naysayers with law, politics and silence. Silence is the weaponry of the powerful. Reading this book you will see for yourself how many people failed and never really got the justice they wanted, nor had their claims believed when they joined the dots that it was OxyContin that was a real scourge, causing normal people to become drug addicts. This list of people includes journalists, former workers and bereaved parents who simply did not get their day in the sun.

Good doesn’t always win. You uncover a network of absolute dodginess, with all the evidence, but for some reason, usually involving you having no power, those in power just look the other way. And you just have to go home and settle with yourself that you did what you could. I have been here many, many times.

Something that also resonated with me, is how many people who were part of the professional legal machine, attorneys, writers, activists, people who showed up to proceedings in person and online (due to COVID) to try and take Purdue Pharma down, were also people who had lost a relative to OxyContin. People had emotional loss in the game. Taking on a behemoth company like Purdue Pharma, knowing that the big company had all the cards, yet knowing that all you have on your side is your skills and sad personal experience that keeps you going. In a world where so many play it safe, and do not mix their personal with professional work, if these people had not put themselves forward, Purdue Pharma would still be pumping out a drug that ruined so many lives. Is it good to let your personal experiences guide your profession? I think so.

IN TODAY’S CULTURE

GUNS AND OPIOIDS

One argument you see in the book by pro OxyContiners is that if gun manufacturers aren't held culpable for what people do with guns, should the Sacklers have been held accountable for people getting hooked on OxyContin? What an analysis?!

MOVEMENTS

I wonder, is there a drug that is being used and hailed right now and being mass prescribed that will be the next OxyContin years from now, namely one that everyone fails to regulate for the benefit of people?

As with OxyContin’s pushy sales tactics, is there a present day similar initiative to the pain movement? I couldn’t help but think of the wellness movement of modern times when I read about Purdue Pharma’s strategy. In the same way we learn that OxyContin was not rigorously tested and that reps were selling it aggressively (you will read how sales reps were rewarded for the more pills they sold), I was reminded of the wellness and wellbeing movement - the workshops, the sign ups, the freebies, the movements, the campaigns, the endorsements, people claiming OxyContin was a life changing drug, the pressure on doctors to prescribe the drug, has reminded me of similar sales tactics in the well being movement.

Like Purdue Pharma’s OxyContin movement, is the wellbeing movement also just addicted to making money more than making you feel well? And on that note when I was recently sent an invitation to a “financial wellbeing” talk for financially empowering mothers by people who did not seem to be mothers (note that I was sent this as a private school, oh the irony), I literally nearly fell off my chair. I cannot see how making people who need financial wellbeing education, spend money on financial wellbeing education, brings financial wellbeing. And what is financial wellbeing anyway? Just as in what is pain? In both OxyContin, and the wellbeing movement, the promise is lofty. Be well. Be pain free. But it's all subjective! It seems the only profiteer of something tangible, is money going to the distibutor.

Yet to be devil’s advocate, shouldn't pain be treatable chemically? This is an interesting one for me as a daughter of a Chemist who worked in the big pharmaceutical companies and the daughter of a doctor. I take the view that you should pop a pill for pain. Yet increasingly I am encountering more and more people shying away from not only giving their children medication, but interestingly people with platforms saying they have mental illness, chronic issues, pain etc, but also share and boast that they do not medically treat it. In this regard part one of the book takes you on a hugely informative journey as to how the Sacklers worked in psychiatric facilities and saw how people suffered. It suggests that these experiences spurred the brothers to seek to treat pain.

But the Sacklers were clearly out of control on OxyContin. Whilst I think people should medicate for quality of life, they should do so responsibly. And, going back to my well being analysis, practising something responsibly, requires honesty, good will and professionalism of the person distributing the pain and wellbeing advice. Empire of Pain firmly lands against the side of the FDA and doctors hand in OxyContin who got it wrong in giving patients access to the drug. And if people with letters after their names and years on years of degrees in medicine can get it wrong, you would be correct to be wary of someone with no letters after their name, selling you wellbeing.

CANCEL CULTURE

The Sacklers got cancelled. In October of 2022, even the V&A parted ways with them. I welcome the universities and schools and museums taking down the Sackler name in light of the lawsuits that were eventually filed against the Sacklers. But on a separate note, the cancelling of their name reminded me of a European Kiwi artist I recently met in Rarotonga. This artist lived in Rarotonga and we were talking about the lives of the people of the Pacific Islands and how they were affected by colonisation, and how his art work was centred around preserving Island land and culture (he carves using the local wood). Yet on the topic of cancel culture, this artist offered that he believed that if we take down relics of the people who did bad things, how will we remember the bad?

EMPIRE AND LEARNING

And finally, as all roads do lead to colonisation and history, some of you will know that many are asking for an apology from King Charles III for the role of the Empire and colonisation. Personally I do not think that will happen any time soon. They have not offered one either. The Sacklers too have not and will not apologise for their role in the OxyContin crisis. And so, as we began, we fall into two categories. Those who like apologies and those who don’t care for them. Which one are you? Having read the book, seeing the extent of the business of the Sacklers and reading of the destruction of this drug caused, I would say an apology would go a long way.

Even if you are not interested in medicine, science, psychiatry, chemicals, marketing and the investigative journalism’s intersection with law, politics and money that this book offers, the other thing about Keefe’s account is that it educated me and reminded me of the “art world”. For example, how galleries build collections, how they take “gifts”, the politics and the way they are run, about the investors in art and diversity of art displays. I am super chuffed to have been recommended this book by a person who introduced me to the art world in action.

Empire of Pain by Patrick Radden Keefe - investigatory journalism from start to finish, delicately detailing the lives of one of the most famous family names in pills and philanthropy, the former which ruined many lives.

I hope this Substack informs you personal and professional outlook.