Books of Interest
Website: chetyarbrough.blog
Empire of Pain (The Secret History of the Sackler Dynasty)
Author: Patrick Radden Keefe
Narration by: Patrick Radden Keefe

Patrick Radden Keefe (Author, investigative journalist, staff writer for The New Yorker.)
Patrick Radden Keefe’s book is a detailed examination of the Sackler family, and more specifically, the dynasty that grew after the life and death of Arthur Mitchell Sackler who died in 1987. Arthur Sackler was a trained physician who specialized in biological psychiatry. Through hard work, he built a family fortune with a company specializing in medical advertising and pharmaceutical marketing. With wealth created by advertising, the Sackler patriarch acquired interests in specific drugs that added to the wealth of the Sackler empire. One of those investments is made by the sons of Arthur Sackler. It became known as OxyContin which became a huge revenue producer controlled by Arthur’s heirs. Dr. Paul Goldenheim and Dr. Robert Kaico were the scientists who invented OxyContin while working for Purdue Pharma, a company owned by Arthur’s brothers. Arthur Sackler is characterized by Keefe as secretive about his ownership interests while becoming a very rich man. The structure of his business interests and its conflicts of interest are passed on to his heirs.
Arthur M. Sackler (American psychiatrist and marketer of pharmaceuticals.)

Arthur dies nine years before OxyContin exists. Despite the difficult life Arthur Sadler had with the bankruptcy of his father, he works his way through school, becomes a licensed physician and starts a pharmaceutical advertising company. He worked as a physician, a medical researcher, and owner of a company that advertised his and other medically researched and discovered drugs. This opened the door to profiteering from drug promotions and conflicts of interest in groundbreaking and potentially harmful drugs. As a physician, it put Arthur and other research physicians in position to market drugs and influence prescriptions for drugs that may or may not be safe or effective. As an advertiser of a physician/scientists’ own drugs, they could skirt independent judgement of their effectiveness or possible side effects. The FDA is created to avoid that possibility, but Keefe illustrates how that roadblock is compromised. Keefe recounts how a leader of the FDA is compromised by his relationship with the drug industry.

Arthur’s wealth and investment interests are inherited by his divorced wife, his new wife, and his brothers, i.e., Ramond, Mortimer, and Richard who led the company after Arthur’s death. The brothers sell their patent on OxyContin to Purdue Pharma. The brothers start two branches of their business, one of which retains control of OxyContin’s manufacture, marketing, sale, and profit. Patent law is a legal ownership “smoke” screen that protects company owners from liability for harm from patents a company holds. A company may own a patent independently, without recourse to its company’s owners. Purdue Pharma grows and uses its wealth to influence politicians, government officials and doctors to endorse drugs like OxyContin.

OxyContin dosages.
As is known by many Americans, OxyContin has had a catastrophic impact on America. It its launch in 1996, OxyContin is considered by some to be a gateway to addictive drugs like heroin and fentanyl. In 2026, it is estimated that 200 deaths per day were happening from fentanyl overdoses. What Keefe argues is that when the structural conflicts of interest were introduced by the Sackler family (especially with the creation of Purdue Pharma) the lines between drug efficacy and profits were breached by the medical profession.

What Keefe reveals in his research is that pharmaceutical-physician relationships cross the line of conflicts of interest.
Doctors receiving “speaker fees”, continuing-education events, consulting positions, and industry-funded clinical guidelines are being lured into prescribing drugs that may or may not be safe or effective. Funding for medical research frequently comes from companies more interested in profit then drug efficacy. Government regulators are influence by lobbyist for a drug industry that is mired in potential conflicts of interest. Keefe notes there is a revolving door between the FDA and pharma employment. Keefe notes marketing has become a part of medical education. He infers philanthropy by the drug industry may be a bribe to influence public acceptance of drug treatments that are not effective.
Coming away from Keefe’s analysis of the drug industry, one is troubled by its corruption vulnerabilities in a society that prides itself on freedom and rule-of-law.

In one sense, Arthur Sackler is a tribute to how America became one of the wealthiest and most powerful countries in the world. One doubts that the Sackler family planned to create a drug that would addict and kill so many Americans. The Sackler family played a role but how many Americans have made mistakes in their drive for success. Keefe shows Arthur Sackler raised himself in America through grit and determination, i.e., little seems handed to him on a silver plate. This is not to suggest the drug industry or the Sackler’s of the world carry no responsibility for addiction but opportunity and a way to succeed in an American life is a choice.




















































