Empire of Pain by Patrick Radden Keefe #ABookADayInMay No.2

Day two of this project will reveal two things that I had previously left unstated. My aim is to finish a book each day in May, but that doesn’t mean that I have also started that book. I did not read all 560 pages of Empire of Pain (2021) by Patrick Radden Keefe in one day. In fact, I didn’t actually read any pages at all – I listen to the audiobook, and finished the final hour of it today.

When I downloaded the book, I thought it was about the opioid crisis in America and the court cases surrounding it. And it sort of is about that, but opioids don’t even exist until we’re a considerable way through the book. While a large chunk of the end of the book is about attempts to address the terrible cost of opioid addiction through the courts, Keefe takes us decades and generations back in the first half of the book. He is documenting the Sackler family’s rise from nobodies to billionaires right from the beginning.

As I’m writing this quite late in the day, and it’s an enormous book, I’m not going to detail all that much of it. But Empire of Pain is certainly a book of two halves. The first is about Arthur, Mortimer and Raymond Sackler and their humble origins – and how Arthur Sackler’s genius for advertising led to him being the first to advertise medication directly to doctors. He was, indeed, the first in many fields of advertising – he basically appears to have invented the idea of medical advertising, which still has such a stranglehold on the American healthcare system.

This half of the book documents every rung of the brothers’ steps to success, as well as all their feuding and pride. Their various marriages, dalliances, children and personal tragedies. Arthur’s obsession with art collections is dealt with in astonishing detail. Everything is dealt with in astonishing detail.

In the second half of the book, the Sackler family and their in-fighting gets a little sidelined as Purdue takes centre stage. This company developed research into opioids which would then turn into Oxycodone – and Keefe shows us, again in rigorous detail, how the marketing of the drug in a completely ruthless way led, incrementally (Keefe argues), to the deaths of hundreds of thousands of people – and how the company sought to tarnish those who were lost as wilful addicts rather than victims of their determination to prescribe higher doses for longer to as many people as possible. The end of the book looks at how the untouchable family start to become hate figures, as the truth about their tactics and deceit becomes wider known. It also shows how they’ll probably get away with everything.

I’ve skimmed the surface of this book. It really is researched to an astonishing degree. It will leave you furious about the total lack of ethics behind this company, and the granular way in which Keefe unpacks their lies and manipulations, and the way that good lawyers will let you get away with everything, will certainly infuriate most listeners. Even if, like me, you thankfully don’t have any connection to the opioid crisis. (It is worth noting, though this comes late in the book, that Purdue weren’t the only company to market opioids aggressively – apparently they never had more than about a third of the market – so Purdue and the Sackler family are certainly huge in this arena, but not lone wolves.)

Is all the detail necessary? I will say that, like almost any book over 500 pages, it would have been better if it were shorter. In the first half, where the level of granular detail has no bearing on showing injustices, I’d say that two out of every three sentences is extraneous. We hear about the lighting that someone chose to hang above their artwork. We hear about the graffiti on an archaeological item that Sackler paid to ship to the US. There is seemingly nothing that Keefe learns that he doesn’t include.

In the second half these details feel more like they are building a court case – and, in this half, Keefe leans a little towards repetition. We hear the same lines repeated over and over again – for instance, that Purdue marketed Oxycodone as giving pain relief for 12 hours even though their own studies had shown it wore off after eight. That fact must have been in the book at least six times.

It’s hard to fault somebody who has done years and years of research, and risked the notoriously litigious Sackler family, so I will say that this overlongness doesn’t lessen from Empire of Pain being a masterful and extraordinary work. It doesn’t make for fun reading – but, since opioid addiction is now the leading cause of preventable deaths in the US, it fees like essential reading.