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The Sackler family is one of the richest families in America, donating millions to some of the world’s most prestigious museums and universities. But the source of that wealth was for many years something of a mystery. William Brangham talks with Patrick Radden Keefe, the author of "Empire of Pain: The Secret History of the Sackler Dynasty," to shed light on the secretive dynasty.
The Sackler family is one of the richest families in America, donating millions to some of the world's most prestigious museums and universities.
But the source of that wealth was for many years something of a mystery. Some members of the Sackler family own Purdue Pharma, the company that makes and markets OxyContin, the addictive painkiller considered one of the initial sparks for the nation's opioid crisis, a crisis that has already left more than 450,000 Americans dead, and continues today.
William Brangham talks with the author of a new book that sheds light on this secretive dynasty.
Patrick Radden Keefe:
It's a story about a family with tremendous ambition, people who set out to really leave a mark on the world. And they did know, an enduring mark that we're all living with now.
But I happen to think that it is a sordid mark, and one that will be a great and longstanding source of shame.
Patrick Radden Keefe spent several years investigating the Sackler family. He's a staff writer for "The New Yorker" magazine and is just out with a new book, "Empire of Pain: The Secret History of the Sackler Dynasty."
The book starts with the family patriarch, Dr. Arthur Sackler, a man celebrated for his creativity and who first made his name treating mental illness in the 1940s.
He was a polymath. He was incredibly brilliant. He worked at an insane asylum in Queens, New York. And he had a notion that someday there might be a pill that could help people who were psychotic or schizophrenic, who had other afflictions.
And so he became very much a proponent of pharmaceutical innovation, of drugs, but then also of advertising, pharmaceutical advertising. And many people credit him with really being the father of pharmaceutical advertising in the United States.
And when you look at how, back in the '60s, Arthur first marketed and sold early tranquilizers, I mean, in some ways, it follows a very similar template to the accusations that have been made about Purdue in the modern era about how they marketed and sold their drugs.
This is what's so uncanny about this story, is that Arthur dies in 1987. He dies before OxyContin is ever introduced.
But the game plan that Purdue and the Sacklers used to roll out OxyContin in the 1990s is in many ways a game plan that Arthur Sackler invented.
So, he came up with a real kind of almost "Mad Man"-type series of very seductive tricks in order to try and persuade doctors that they should be prescribing his products. The side effects of a drug or the potential downsides of a drug were downplayed. The therapeutic benefits of a drug were way overplayed.
Purdue initially made millions selling the morphine drug MS-Contin, used mainly with cancer patients.
After his death, Arthur Sackler's heirs sold off their stake in the company, but his two brothers, Raymond and Mortimer, remained involved.
Purdue's real blockbuster came in the late 1990s with OxyContin, which contains the addictive opioid oxycodone. Purdue sealed the pills in a slow-release coating, which the company claimed would make them far less addictive.
This was a hypothesis, a hypothesis that they didn't actually have any real persuasive proof for. But it became a signature element of the marketing of OxyContin.
Another detail that you report was that the family and Purdue Pharma recognized also that if you were just marketing these drugs for cancer and end-of-life care, that that was a relatively small market, but that if you could market these to the masses, and make these pain pills for everybody, that was a huge market.
This, for me, was one of the most striking discoveries in the research for this book, was a trove of internal e-mails from senior executives at Purdue Pharma when they were talking about introducing OxyContin.
They talk about this very explicitly. We don't want to niche OxyContin for cancer is what they would say. And they did focus groups, and they realized that oxycodone, in the minds of doctors, was not as strong as morphine, it wasn't as threatening, it didn't have that same stigma attached to it.
The crazy thing is, oxycodone is actually significantly stronger than morphine. It's not weaker. But doctors had this misapprehension that it was a weaker drug. And there are all these e-mails in which these senior Purdue executives — and at least one of the Sacklers is actually copied on some of these e-mails — have these conversations in which they say explicitly, let's not do anything to make doctors realize they have this wrong.
The development and the rollout of these drugs also coincided with what seems to be a very genuine movement in the medical community to treat pain more effectively and more aggressively in patients.
Exactly. It was a perfect storm.
And doctors had what I think is probably an appropriate skepticism about the use of — the aggressive use of — the aggressive use of strong opioids for just about anybody, because of a fear that these drugs could be potentially quite addictive.
And so the drugs were used, but doctors were often hesitant to prescribe them. And so there's a very conscious campaign by Purdue, a campaign that recalls in many ways Arthur Sackler's earlier campaigns on behalf of other drugs, to change the mind of the medical establishment in the United States, to persuade them that, actually, all these fears about opioids are overblown, that they're not as addictive as people have said.
And, in fact, the claim with OxyContin was that it's addictive less than 1 percent of the time when it's prescribed by a doctor, which is a wild claim with no basis in fact, but one which Purdue's army of sales representatives made to doctors across this country.
When OxyContin hit the market, problems soon started emerging. Pills were diverted, stolen, abused, sold illicitly, and people began developing addictions.
Keefe repeatedly documents in his book how Purdue executives and salespeople were monitoring all this in real time.
This, to me, is the most interesting moment in the story, because, confronted with this new information, what do the Sacklers do? What does Purdue do?
The company went very hard after journalists who tried to tell these stories, something they're still doing today. And they also effectively claimed that the problem isn't the drug at all, that the drug is every bit as perfect as it was when we described it initially. The problem is the abusers.
And so they launched this campaign to target and attack and stigmatize the very people who were overdosing and becoming addicted to their own drug.
Representatives of the Sacklers say they have not read the book, but claim Keefe's earlier reporting about them in "The New Yorker" had mistakes.
The family and Purdue argue they weren't alone believing these opioids could be used safely, and assert that they were just a fraction of overall opioid sales during this period. They note that federal regulators approved their practices and products all along.
And they also argue, many of the people who abused OxyContin were doing so illegally, and to blame that on a company or its owners isn't fair.
While I believe I conducted myself legally and ethically, and I believe the full record will demonstrate that, I still feel absolutely terrible that a product created to help, and has helped so many people, has also been associated with death and addiction.
Two members of the Sackler family, David and Kathe, testified before Congress in December. While acknowledging the severity of the opioid crisis, they said there wasn't much they could've done.
I can't — there is nothing I can find that I would have done differently, based on what I believed and understood then.
This is a complicated story, but it's actually not that complicated. You sometimes need to back up and not lose sight of the basic contours here.
It's a family saga. It's a story about the opioid crisis and big pharma, but it's also a crime story. This is a crime story. This is a company that pled guilty to federal charges in 2007 and then again pled guilty to new charges, but similar kind of claims of fraud about the fraudulent marketing of drugs, in 2020, just a few months ago.
And that was something I very much wanted to capture. It may be that we don't end up with a satisfying version of accountability, but let's not lose sight of just what went down here.
All right, the book is called "Empire of Pain: The Secret History of the Sackler Dynasty"
Patrick Radden Keefe, great to have you back on the "NewsHour." Thank you.
And the Sacklers have agreed to pay more than $4 billion as part of a proposed bankruptcy restructuring plan. It would end thousands of lawsuits against the company. But a number of states have argued the plan is not tough enough on the Sackler family itself.
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William Brangham is a correspondent and producer for PBS NewsHour in Washington, D.C. He joined the flagship PBS program in 2015, after spending two years with PBS NewsHour Weekend in New York City.
Mike Fritz is a video journalist and producer for the PBS NewsHour.
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