An Interview with Patrick Radden Keefe, author of Empire of Pain
Sackler family revelations, writing a book in quarantine, and more
Patrick Radden Keefe is a staff writer at The New Yorker and the author of Empire of Pain. The book details the family history of the Sacklers, who created and marketed OxyContin, the painkiller that was the catalyst for the opioid crisis.
This interview has been edited for length and clarity.
Amy Brinker: In 2017, you published your New Yorker article detailing everything you had uncovered about the Sackler family and the opioid crisis up to that point. And then, in 2019, when you got ahold of the court filing documents for this Massachusetts Sackler case, you put some of the biggest revelations on Twitter. What was a moment where you realized this could become a book?
Patrick Radden Keefe: Yeah. It was a very strange experience because when I worked on the article, a lot of what I had been curious about was, what do the Sacklers say behind closed doors? How do they talk about this? And they wouldn’t talk with me for the piece. They wouldn’t even give me a statement. I interviewed people who knew the family, but I felt as though there was only so close I could get.
And so what was so striking to me about reading that filing . . . there was so much and it was so rich. It was the emails of members of the family talking about these issues. And you could immediately sense how greedy they were, frankly, how much they were pushing the sales of these opioids. And then also how indifferent they were to the pretty disastrous consequences of their own actions.
AB: Yeah, the thing that I couldn’t wrap my head around was how much obfuscation there was and how privacy is part and parcel of the Sackler family. How did you even begin to wrap your arms around it? How did you start?
PRK: I started in a two-track way. One was talking to as many people as I could, and I wanted to find people who knew the family. I wanted to find people who had worked for the company. I wanted to get as close as I could. If they weren’t going to talk to me, then I wanted to get as close as I could in terms of talking to people who knew them. So one side was making phone calls and seeking people outside of it.
And, because I knew that a lot of the book would take place in the 1950s, I was really racing to talk to some people before they died, there were some people who I sought out who died before I could speak with them. So there was a phase where I was talking to a lot of very old people.
And then in parallel to that was a lot of hunting through documents. Some of that was court documents, some of that was internal documents that were leaked to me, a lot of that was archival material. I was going through a lot of archives and libraries. And there were these amazing, quite intimate moments.
You have this family that won’t talk to me, but I’m looking at birth announcements and bar mitzvah invitations, and wedding announcements—these moments from their lives.
AB: There’s a great line early on that refers to the Sackler empire as a completely integrated operation. Can you give a broad outline from the early days of the foundational business ties? Where were those tentacles?
PRK: Yeah, it’s funny. Arthur Sackler, who was the original patriarch of the family, he had this amazing personal quality where he never wanted to choose. He always wanted both, everything. And you saw it in his personal life, where he had these kind of overlapping relationships with these three different women. And in his professional life, he liked to straddle these different spheres.
So he was a physician, but he also had a medical advertising firm, which advertised pharmaceuticals. And he bought a pharmaceutical company for his brothers, which they ran, that he had a stake in. And he started a medical newspaper that was given away for free to doctors and subsidized by pharmaceutical advertising.
And so there was this sense in which he was trying to marry medicine and commerce in ways that at the time felt innovative, and probably to him, at least at first, quite harmless. We see the seeds of that in the 1950s, and I think that by the time you fast-forward to the 1990s, it’s kind of shocking, the extent to which the commerce side of things has hijacked the medicine side.
AB: Right. I was surprised by an archival advertisement you mentioned in the book that advertised heroin as a medicine and downplayed the addictive quality even before the 1940s.
PRK: Yeah. Arthur didn’t invent this phenomenon, but he really excelled at it. He was kind of a maestro when it came to overplaying the therapeutic benefits of any given drug, and underplaying the side effects and the potentially addictive qualities.
AB: Was there anything that shocked you when you were researching medical advertising? Where do you think it took a hard left turn?
PRK: Well, so it’s interesting. There is this phenomenon in our country where Big Pharma companies market directly to consumers. But what was so striking to me was that Arthur Sackler, and then later his nephew, Richard Sackler, perfected the art of marketing not to the consumer, but to physicians.
And that, was what I found most unsettling, because when you go to the doctor there is a tendency to want to put your health and safety in their hands and trust that they are kind of beyond influence.
And interestingly enough, that’s an image that generations of the Sacklers have always promoted, the idea of doctors as unimpeachable. And it turns out that’s just a big con. And so I was really shocked. Arthur Sackler used to say doctors wouldn’t be influenced by advertising. Of course, you remember he ran a firm which specialized in advertising to doctors.
I’ve talked to doctor friends who say, Oh, of course the pharma companies are always trying to influence us, but I would never be influenced by that sort of thing. Oh, you know, just because a pharma company buys me a steak dinner, that would never change the way I prescribe.
But it turns out that some years, Purdue Pharma would spend as much as $9 million just buying food for doctors. They so carefully went over those numbers, and they knew they were getting a return on investment on every dollar they spent.
AB: You spoke to something like two hundred sources, right? How did you weigh what they were saying and how did you prioritize the people you were speaking to?
PRK: Oh sure, yeah. I tend to like to do a lot of interviews for a bunch of reasons, in part because I’m always looking for stories and I really like to corroborate things as best I can, find as many people who were around. I find that it is helpful to just ground the reporting.
I’m also always looking for characters. I’m looking for people who are interesting and fit into the story in interesting ways. If I had to pick one, I’d throw out Richard Kapit, who was Richard Sackler’s college roommate . Richard Kapit actually found me; I didn’t find him. He reached out to me after he read my New Yorker article.
He was a revelation for me because there is a series of personality traits that Richard Sackler has that when you see them in the context of OxyContin and Purdue Pharma, they seem quite malevolent. What was fascinating about Richard Kapit is that he described those same traits in the guy he met as a college sophomore, and they were quite charismatic, almost magnetic, exciting traits in a young man where the stakes were much lower. Somebody who just pursues his passions with a headlong, kind of blind enthusiasm.
When you’re twenty years old, it’s really fun to spend time with somebody like that. It’s seductive and exciting. And to me, that felt as though there was a kind of novelistic depth to the character. I understood Richard Sackler. And I was sympathetic to him in ways that I couldn’t have been necessarily prior to spending time with Richard Kapit.
AB: Yeah, that makes a lot of sense. So many horrible things happened, and not everything came from malice. But certain callous, awful, devastating choices were made.
PRK: Yeah. I’m so glad you say that, because I think it’s important. And as anybody who reads the book can probably gather, I find a lot of the defenses that the Sacklers put out pretty unpersuasive. But I also don’t believe that they set out to kill a lot of people.
For me, part of what makes this so tragic is that in some ways, this is a story about idealism and a kind of idealistic bet that turned out to be a bad bet. And the denial and the stubbornness that prevented this family and their company from coming to terms with the mistake they made early on and recalibrating their behavior.
AB: You couldn’t get ahold of the Sacklers, you couldn’t get a statement out of them. Were there other dead ends besides that?
PRK: Oh, there were so many. A big one that was really painful was I made this discovery about Bobby Sackler, a second-generation Sackler who killed himself in 1975. And I really, really, really wanted to find out more about his life, but it was very hard. And this was mostly during the pandemic when I was trying to do that reporting, and I just hit a bunch of dead ends, and a lot of institutions that might have had files were just closed and totally inaccessible.
I was able to ascertain that there were police detectives who showed up on the day that he killed himself, and that they would have had files. And I got somebody at NYPD to seek out the files, the detective’s report. And it turns out that they had been in this one particular warehouse that was flooded during Hurricane Sandy. Months of reporting, and then it turns out that the files you’ve been seeking were irretrievably damaged.
There were a lot of COVID-related obstacles . . . to this day, there are specific letters that I know are in certain archives, and I know the box number and I know the folder number but I can’t get them.
AB: Oh my god, how frustrating. Once you can access them, do you have any interest in tracking them down?
PRK: I do have interest in tracking them down. It’s funny. Now the book is out and I’ve heard from lots and lots of people just in the last three weeks who worked at Purdue or who know the Sacklers who have all kinds of interesting leads.
I kind of have two impulses. On the one hand, I’m ready to move on. I feel like I’ve told the story I wanted to tell. On the other hand, I’m always curious. So, yeah, I think probably when those letters become available, I’ll want to see what they say.
AB: Well, your last book, Say Nothing, and this book are about two groups that have a kind of baked-in silence. So I’m wondering, were there any other clear similarities in writing those two books?
PRK: There are reporting challenges in both cases, really. In Say Nothing, there are four major characters. And one of them wouldn’t talk with me and three of them are dead. And with the Sacklers, they completely froze me out and none would talk.
Then, in terms of the type of writing that I like to do, I want it to feel as vivid and immediate and absorbing as possible. I don’t want you to feel as though these people are very remote. I think if I’m doing my job, the reader should almost forget along the way that I didn’t have access to these people.
And so that’s just a huge reporting challenge in terms of gathering enough concrete detail, trying to get a sense of the way people’s voices sound, the way they talk, the way they think. And so the writing challenges were quite similar in some ways. But there are also major differences. For me, Say Nothing was very much a story of moral ambiguity. The narrative of the Troubles has been caricatured in one direction or another, depending on your point of view, and I was hoping to get close enough to these people that I would just complicate any preconceptions you had about them.
With the Sacklers, I feel a great deal of moral clarity. But again, I didn’t want to caricature them, I want to try and understand how they did what, to me, is seen in some cases to be quite monstrous things.
AB: You also show the environment in which they were able to do those things. There are other forces, and there’s the trend of pain management growing at the same time. They were lucky, in many ways.
PRK: Yeah. It’s a book about the way in which, certainly in the U.S., our capitalist system, and our system of government, and our system of justice, I think, tend to insulate the super-elite from the negative consequences of their own decisions.
Now that you mention it, there’s another thing, too. There’s another parallel between the two books, which is just that they’re both about the stories that people tell themselves and tell the world about the transgressive things they’ve done. They’re both about narrative construction.
AB: Is there any one moment that you’re glad you could include in the book? Something you’re really proud you got?
PRK: “Proud” is probably the wrong word, but there was a moment that happened very, very late in the game. I think it might have happened in January. So it was basically, I had basically already been told “pencils down” by my editor. But I had been for a year dialing in to bankruptcy hearings because Purdue Pharma was in bankruptcy. And these hearings were long and often very dull, and there were all these bankruptcy lawyers and this judge.
And they would always, many of them would make these [asides, like], Of course we’re all thinking about the victims of the opioid crisis. That’s why we’re all here billing $1,000 an hour. And it always felt like this strange disconnect to me.
It was palpably uncomfortable because it looked as though the fate of Purdue Pharma and the Sacklers was going to get decided in this bankruptcy court, everything was very sterile and antiseptic, lawyers talking to lawyers, and it felt very out of touch with the reality of the consequences of the opioid crisis.
And there was this moment in a hearing where people started calling in because it was a dial-in, so anybody could call in. And these victims started calling in and trying to break in to the proceedings. And the judge basically told them, We don’t want to hear from you. Get off the line.
And to me, it was heartbreaking, but also very profound in the sense that I had had this feeling that I couldn’t really articulate about what was wrong with these hearings. And then you suddenly have this incredibly vivid illustration in the form of these people, like a guy saying, I’m calling, I wanted to speak with you because my fiancée died.
And then for the judge to say, in a very kind of jargony way, I’m sorry, but that issue is not calendared for this hearing. We won’t be hearing from you, sir, just felt like a very apt illustration. It expressed in a scene what I was struggling to say in an editorial way.