Patrick Radden Keefe on exposing the Sackler family’s links to the opioid crisis | Opioids crisis
In December 2021, Patrick Radden Keefe travelled to London from New York to attend the Business Book of the Year award ceremony at the National Gallery. He had been shortlisted for Empire of Pain, his exhaustive portrait of three generations of the Sackler family, one of the world’s wealthiest and most secretive corporate dynasties.
For decades the Sackler name was synonymous with often extravagant art world philanthropy – since 2009, the Sackler Trust had given around £170m to art institutions in Britain alone. Of late, though, it has been tarnished by its association with OxyContin, the addictive painkiller at the heart of the ongoing opioid epidemic in America that has claimed around 500,000 lives there. Keefe’s book, which is about to be published in paperback, reveals in forensic detail how the Sacklers’ vast fortune was built in part on the profits made by their company, Purdue Pharma, which manufactured and aggressively marketed OxyContin to physicians who prescribed it in often dangerously high doses. It is an epic, intricately structured tale of obsession, greed and dizzying corporate irresponsibility, which has been lauded by the critics, awarded the 2021 Baillie Gifford prize for nonfiction and become a global bestseller.
Though flattered to be on the Business Book of the Year shortlist, Keefe felt ambivalent about the award, not least because it was co-sponsored by McKinsey & Company, a global management consultancy hired in 2007 by Purdue to “turbocharge” sales of OxyContin. In February of last year, McKinsey announced a settlement of almost $600m against lawsuits filed by 49 US states over its role in the opioid crisis, while also refusing to admit liability.
“Although it was an exciting and illustrious event and a nice validation,” Keefe tells me, “I was sick with anxiety because McKinsey was one of the villains in my book. I kept thinking: what happens if I win? If I accepted the award, would I be any different to all the art institutions who took the money and looked the other way and were co-opted into the system?” As he mingled with guests and fellow nominees over pre-dinner drinks, the irony was compounded when his British book editor drew his attention to a sign above an adjacent gallery: the Sackler Room. “So, there we were,” he says, smiling wryly, “adjacent to space named in honour of the Sacklers, while I’m waiting to see if I’d won the McKinsey prize.”
To his relief, he didn’t. What, though, would he have done if he had? “It would have been supremely awkward,” he replies, shaking his head. “I would have had to say what I ended up writing on Twitter the next day, having gathered my thoughts, which was basically that I could not have accepted the money. Thankfully, everyone was spared that embarrassment.” (Like all the shortlisted authors, Keefe did receive £10,000, which he donated to Odyssey House, a drug rehabilitation centre in New York.)
He relates this anecdote, he says, because it neatly illustrates one of the underlying themes of his book. “Basically, the system through which this kind of reputation laundering happens is now so integrated and evolved that it is almost inescapable. The situation I found myself in at the award ceremony is kind of emblematic of that.”
What I’m fascinated by is what happens to people when they start to get indications that they’re wrong. What do they do?
I am chatting to Keefe over a video link to his home in Westchester County, in the Hudson Valley, north of New York, where he lives with his wife, a lawyer, and their two children. He’s affable and well-spoken; one can see how his charm might put interviewees at ease, whether silver-tongued corporate lawyers or, as in the case of his previous book, Say Nothing, hardened IRA veterans. Published in 2018, the latter won the Orwell prize for political writing for its intricate exploration of the dark circumstances surrounding the disappearance of Jean McConville, a widowed mother of 10, who was abducted from her home in Belfast’s Divis Flats in 1972 by armed men. In 1999, the IRA admitted executing her, insisting that she had been passing information to the security forces, a charge which her family vehemently deny, and which was discredited by a later police ombudsman investigation.
I suggest to Keefe that both books deal, in their different ways, with loyalty, deceit, denial and tarnished ideals. “There are definitely certain themes I am interested in and seem to return to,” he says. “One is the notion that someone can have an ideal that they relentlessly pursue, or a theory that they plunge headlong into, and it turns out that they were wrong. Either they were wrong about what the end would be, or they were wrong about the means and what it would cost. What I’m really fascinated by is what happens to them when they start getting these indications that they are wrong. What do they do? In a way, that dilemma is at the heart of both books, which are both essentially human dramas.”
Part of what makes Empire of Pain so compelling, though, is that no one admits they were wrong. “I know!” he says. “Not only did they not admit they had got it wrong and decide to pull the drug from the shelves, they didn’t even say: ‘Maybe let’s just slow it all down here.’”
As Empire of Pain makes clear, the Sacklers were so adept at laundering their reputation that, for decades, their philanthropic largesse had given them an almost saintly status in the art world. For too long, the grateful recipients seemed unconcerned about the ethics of how their benefactors made their fortune. That all began to change in March 2019, when the National Portrait Gallery became the first major art institution to refuse Sackler money, announcing that it would no longer be accepting £1m that had been pledged by the trust towards a proposed building project.
Nan Goldin with fellow protesters at the V&A’s Sackler Centre, November 2019. Photograph: Antonio Olmos/the Observer
The decision was widely regarded as a moral victory for a high-profile anti-Sackler activist campaign led by the American art photographer Nan Goldin, who, having overcome heroin addiction in the 1980s, had become addicted to OxyContin in 2014 after being prescribed it for tendonitis in her left wrist. A month before the NPG’s announcement, Goldin told the Observer: “I have been invited to have a retrospective at the National Portrait Gallery and I have told them I would not do it if they take the Sackler money.”
Goldin’s activism was sparked by an article she read in the New Yorker in 2017 entitled The Family That Built an Empire of Pain. It was written by Keefe and became the starting point for his book. “It exposed the Sackler family as the billionaire puppet masters who ignited the opioid crisis,” she later recalled. “I read the article and became furious. I’d always thought of the Sacklers as philanthropists in museums I went to as a kid… I worshipped Act Up [a grassroots political activist group formed during the Aids pandemic in the late 1980s], so I decided I would do something and that I would do it in the museums, because I figured that’s where the Sacklers would listen.”
Goldin launched the organisation Pain (Prescription Addiction Intervention Now), which has held demonstrations at several major art institutions that have taken funding from the Sacklers. In New York, Pain dropped fake prescriptions for OxyContin into the atrium of the Guggenheim Museum and scattered empty medicine bottles across the floors of the Metropolitan Museum of Art. They also staged noisy protests in the Louvre in Paris and the V&A in London. Over the past few months, on the back of this direct-action campaign, several galleries began reluctantly to take notice of the damage being done to their own reputations by their association with Sackler money.
In December 2021, the Metropolitan Museum in New York removed the Sackler name from seven of its galleries. Earlier this month, both Tate Britain and Tate Modern began removing plaques bearing the name – the former from the central octagon and a gallery, the latter from escalators, lifts and a gallery. Other institutions, including the Royal Botanic Gardens and Kettle’s Yard gallery in Cambridge, have decided to do the same, while the Globe theatre is looking for a replacement donor.
As yet, the V&A, the British Museum and the National Gallery have resisted pressure to dissociate themselves from the family. The V&A’s chairman, Nicholas Coleridge, recently expressed his gratitude to Dame Theresa Sackler, wife of Mortimer Sackler, co-owner with his brother Raymond of Purdue Pharma, and insisted the gallery would not be removing the family’s name from their walls. “We don’t think there’s very much to be gained by taking that step,” he said, loftily. “We don’t think, at the moment, there’s much pressure to do so.” Keefe smiles and shakes his head when I mention this. “This is a gallery where Nan Goldin staged a die-in!” he says. “You almost have to admire that level of detachment from reality.”
Keefe grew up in Boston, in a predominantly Irish-American neighbourhood in Dorchester. His route into non-fiction writing was, to say the least, circuitous. He studied law at Yale, International Relations at Cambridge and wrote a master’s thesis on state surveillance at the London School of Economics, at what he calls “an interesting paranoid moment when everyone was starting to wonder: can they actually listen to every phone call and read all our emails?”
Soon after he finished his studies in London and returned to America, 9/11 happened. “Suddenly,” he says, “the stuff I’d been researching about the National Security Agency was a lot more germane.” He sent a book proposal to Tina Bennett, an American literary agent whose name he had noticed in the acknowledgments of two books he had recently read – Eric Schlosser’s Fast Food Nation and Malcolm Gladwell’s The Tipping Point. “I often think, if she hadn’t responded, would I be just another miserable lawyer today?” he says, laughing.
Cheng Chui Ping, AKA ‘Sister Ping’, led a gang smuggling Chinese immigrants into the US, inspiring The Snakehead – Keefe’s second book. Photograph: NY Daily News/Getty Images
Keefe describes the resulting book, Chatter: Dispatches From the Secret World of Global Eavesdropping (2005), as the result of “youthful hubris”. He took a year off law school to write it and, on his return, embarked on what he describes as “a completely tedious course on aspects of contract law” at New York University . Often, he would sit at the back of the lecture hall and peruse the New York Post and New York Daily News, while feigning interest in the lectures. That summer, the local tabloids were obsessed with a woman known as Sister Ping, leader of a so-called Snakehead gang, a lucrative human smuggling operation that brought thousands of people into the US from China using forged documents. “The tabloids were reporting on her trial daily, and all these big Chinese gangsters were testifying,” Keefe says. “It was such an extraordinary story that I pitched to the New Yorker and, to my surprise, got the assignment, just weeks away from going to work in a law firm.”
The New Yorker published his piece, The Snakehead, in April 2006, and in 2009 a book of the same name came out. Subsequent books Say Nothing and Empire of Pain also began as long-form New Yorker features. “I like the metabolism of working there and doing those sorts of pieces,” he says. “Writing for the New Yorker was something I dreamed of when I was at college.”
In the afterword to Say Nothing, he describes his approach as “narrative non-fiction”. How would he define the term? He thinks for a moment. “I worked as a research assistant for thehistorian Simon Schama at Columbia and he would always talk about narrative history – that he was not just writing for other historians. In my own way, I want to write something that is sophisticated and rigorous but approachable by anyone. You don’t have to have an interest in big pharma or the Troubles, because hopefully the characters and their dynamics will be rich and intriguing enough that I can pull you into their world.”
His books, I say, are often as suspenseful and as tightly structured as crime fiction. “Well, that’s good to hear… I do use certain devices that may be more familiar from fiction. I’m thinking about a person reading my book on the subway. You don’t take that reader for granted, so you cannot be shy about thinking about character and suspense and editing in a way that’s compelling for the reader.”
For Say Nothing, which explores the darkest aspects of the Troubles through a single killing, Keefe drew on long interviews given to others – including the veteran Irish journalist and author Ed Moloney – by former IRA members. One of them was with Dolours Price, who before her death admitted that she had driven McConville across the border into County Louth, where she was executed. I wondered if Keefe’s interest in the dark dramas of the Troubles emerged from his Irish-American upbringing.
“People see my name and know I come from Boston, so they often assume I must have some personal connection, which is not true. I’d never heard of Dolours Price until I read her obituary in 2013, but she was so fascinating on so many levels. This was someone who took people across the River Styx, but, in middle age, she was having misgivings. The collision between her beliefs and her humanity was right there on the surface.”
Jean McConville (left) with three of her 10 children, before she vanished in 1972. Her murder by the IRA inspired Keefe’s book Say Nothing. Photograph: PA
Intriguingly, Keefe’s on-the-ground research for Say Nothing seems to have been less risky than his investigations for Empire of Pain. In the afterword to that book, he recounts how in the summer of 2020 a neighbour told him that he had spotted a stranger lingering ominously outside his house. “It did make me feel a bit jumpy,” he says. “What upset me most is that our boys were present when he told us. Ideally this would not have been something that my two small kids, who were seven and nine at the time, would have heard. I think it was unsettling for them. Nan Goldin had something similar, but it was much more in-your-face. But these things happen. It comes with the territory.”
In both Say Nothing and Empire of Pain, it is the characters at the heart of the narratives that most intrigue. The latter begins with the ascendency of Arthur Sackler, a psychiatrist who believed that depression was a chemical imbalance in the brain best treated by chemicals rather that electro shock therapy. In many ways, his complex personality – obsessive, ruthlessly ambitious, philanthropic and almost neurotically secretive – is a template for the company itself. As Keefe puts it, “He sought posterity but not publicity.”
Likewise, Sackler’s determination to “do things the way I want to do them” included taking over a medical advertising agency and launching a weekly medical newspaper distributed to American physicians in which most of the products advertised, including Librium and Valium, were produced by that agency’s clients, which included Hoffmann-La Roche. By 1973, as the age of big pharma began in earnest, some 20 million Americans were on Valium. The drug’s extraordinary success was a precursor to the OxyContin marketing campaign launched by Sackler’s nephew Richard a generation later, who promised “a blizzard of prescriptions that will bury the competition”.
The deployment of influence and the deployment of money in pursuit of influence, have been normalised in our system
What struck me as I read Empire of Pain, I say, was the sense that the culture of deception, followed by denial, that defined almost every aspect of the Sackler-Purdue Pharma enterprise may in some way also now define contemporary corporate capitalism as a whole. That and the fact that although a $6bn settlement seems to have been reached to compensate the victims, no one has yet been held criminally accountable. Does he think that the super-rich are now, to a degree, beyond the law?
“Well, my perception is that the goalposts keep moving, so that things that used to be out of bounds are no longer. Lobbyists are a good example. There are now all kinds of ways in which the deployment of influence and the deployment of money in pursuit of influence have been normalised in our system. As a result, the conflicts of influence are more pronounced than they have ever been, but they are also harder to police and harder to disentangle, because they are so completely woven into the fabric of our lives.”
Is the saga of the Sacklers is a quintessentially American tale, I wonder. He mulls this over for a long moment. “On one level, yes, because it illustrates the belief that many immigrants have that you can come to America, and in the space of one lifetime, completely transform the fortunes of your family, rise to the pinnacle of society and leave your mark on your new country. But it is also a story about corporate impunity and impunity for the super-rich. The whole last third of the book is about the bad guy getting away with it in the end. To me, that’s a story I could just as readily see taking place in London, as indeed it has – because many of the Sacklers are based there. You have to remember that OxyContin generated upwards of $35bn. That buys a level of influence that is hard to fathom.”