"Empire of Pain"

Patrick Radden Keefe wrote a rock solid indictment of the Sackler family. Unfortunately, justice through the courts seems unlikely. The last couple of chapters were especially hard to read.

• Instead, they are decorated in the banal tones of any contemporary corporate office, with carpeted hallways, fishbowl conference rooms, and standing desks. In the twentieth century, power announced itself. In the twenty-first, the surest way to spot real power is by its understatement.
• in the quarter century following the introduction of OxyContin, some 450,000 Americans had died of opioid-related overdoses. Such overdoses were now the leading cause of accidental death in America, accounting for more deaths than car accidents—more deaths, even, than that most quintessentially American of metrics, gunshot wounds. In fact, more Americans had lost their lives from opioid overdoses than had died in all of the wars the country had fought since World War II.
• Erasmus issued “program cards” and other pieces of humdrum curricular paperwork to its eight thousand students. Why not sell advertising on the back of them?... By the time Arthur was fifteen, he was bringing in enough money from these various hustles to help support his family.
• It must have been painful for Isaac to say this. But he insisted that he had not given his children nothing. On the contrary, he had bestowed upon them something more valuable than money. “What I have given you is the most important thing a father can give,” Isaac told Arthur, Mortimer, and Raymond. What he had given them, he said, was “a good name.”
• Arthur and his brothers were born into what has been described as the golden age of American medicine, a period during the early twentieth century when the efficacy of medicine—and the credibility of the medical profession—were greatly enhanced by new scientific discoveries about the sources of various illnesses and the best means of treating them.
• Like Marietta, the brothers had commenced their medical training outside the United States... during the 1930s, many American medical programs had established quotas on the number of Jewish students who could be enrolled. By the mid-1930s, more than 60 percent of applicants to American medical schools were Jewish, and this perceived imbalance prompted sharp restrictions.
• Just a few decades earlier, the superintendent of a state hospital in New Jersey had become convinced that the way to cure insanity was to remove a patient’s teeth. When some of his patients did not appear to respond to this course of treatment, the superintendent kept going, removing tonsils, colons, gallbladders, appendixes, fallopian tubes, uteruses, ovaries, cervixes. In the end, he cured no patients with these experiments, but he did kill more than a hundred of them.
• When you were with Arthur, Marietta came to feel, it seemed as if anything were possible. There was no such thing as an insurmountable obstacle. In fact, by the time Marietta learned that Arthur Sackler, the man she had been seeing, already had a wife and two children, Arthur treated it as a mere detail, a minor technicality that should not slow the two of them down.
• strategy: you don’t want to niche a product; you want to sell it to as great a range of patients as possible. The term “broad spectrum” sounds clinical, but the truth is, it was coined by advertisers: it first entered the medical literature with Arthur’s campaign for Terramycin.
• It was Arthur Sackler who would be credited not just with this campaign but with revolutionizing the whole field of medical advertising. In the words of one of his longtime employees at McAdams, when it came to the marketing of pharmaceuticals, “Arthur invented the wheel.”
• Arthur now took on more projects than ever. He became editor of the Journal of Clinical and Experimental Psychobiology. He started a medical publishing company. He launched a news service for physicians, became the president of the Medical Radio and Television Institute, and started a round-the-clock radio service, which was sponsored by pharmaceutical companies. He opened a laboratory for therapeutic research at the Brooklyn College of Pharmacy, on Long Island. There was a frenzy to this activity;
• “We had oodles of money to spend on artwork, and artists would come in with their portfolios,” Rudi Wolff recalled. One young artist who visited the office was Andy Warhol. “Being art director and having all this money, I would say, ‘Andy, do ten heads of children, nice drawings,’ ” Wolff continued. “He drew beautifully.” Warhol liked to draw cats. McAdams used one of his cat pictures for an Upjohn ad.
• one of the entities in which Arthur possessed a clandestine stake was his ostensible rival, the L. W. Frohlich agency. To the outside world, Sackler and Frohlich were competitors. But the truth was, Arthur had helped Frohlich set up his business, staking him money, sending him clients, and, ultimately, colluding with him in secret to divvy up the pharmaceutical business... The challenge was that because of conflict of interest rules no single agency could handle two accounts for competing products.
• He had an almost clairvoyant grasp of “what pharmaceuticals could do.” And his timing could not have been better. One Librium ad, which ran in a medical journal, promoted the pill as a cure-all for “The Age of Anxiety,” and it turned out that the Cold War was a perfect moment to usher in a tranquilizer for the masses.


• Valium was the first $100 million drug in history, and Roche became not just the leading drug company in the world but one of the most profitable companies of any kind. Money was pouring in, and when it did, the company turned around and reinvested that money in the promotion campaign devised by Arthur Sackler.
• “Play with me, Daddy,” she pleaded.
  “I’m going to wait until you’re an adult,” Arthur said. “Then I’ll have a conversation with you.”
• At McAdams, where Arthur already seemed to be living a double life, because he came in and out and was also servicing his other careers, it did not go unnoticed that he appeared to be living a double life at home.
• Chinese furniture has “a double face,” Drummond liked to say—“a respect for what’s left unsaid.” Drummond had a double face himself: initially, his furniture business was merely a cover for his actual job as an American spy in China, working for the Office of Strategic Services, the precursor to the CIA. But that notion of leaving things unsaid could only have resonated with Arthur Sackler.
• Marietta, too, saw this in her husband. She recognized that the “hunt” was what excited Arthur, that identifying some precious artifact and then figuring out how to claim it was a “secretive, sensual” process... One of the dealers he got to know, a man named Dai Fubao, who went by the name Mr. Tai, had a shop on Madison Avenue... Mr. Tai had come into possession of a document, written on silk, that was known as the Ch’u Manuscript, and dated to 600 b.c.e. “If you were to dump your whole present collection into the Hudson, it would not matter as long as you were the owner of this piece of silk,” Singer said.
• Arthur was the quintessential self-made man, but he hated that expression, “self-made man.” So, the Sackler Collection at Columbia just appeared in the world, as if by virgin birth, with few discernible links to the man who made it.
• Senator Estes Kefauver was a ruddy, rawboned public servant who stood six feet three and had grown up in the mountains of Tennessee. A Yale-trained lawyer, he was a southern liberal and the sort of earnest do-gooder who can occasionally strike even his supporters as being a bit in love with his own virtue. Kefauver was a trustbuster, chairman of the powerful antitrust and monopoly subcommittee.
• Kefauver noticed that executives in the pharmaceutical industry had elevated this form of combat by well-paid proxy to an art. “These drug fellows pay for a lobby that makes the steel boys look like popcorn vendors,” one of his staffers remarked.
• the McAdams agency, some to MD Publications. The investigators identified no fewer than twenty separate corporate entities that were linked to the building... “The Sackler empire is a completely integrated operation,” Blair wrote. They could develop a drug, have it clinically tested, secure favorable reports from the doctors and hospitals with which they had connections, devise an advertising campaign in their agency, publish the clinical articles and the advertisements in their own medical journals, and use their public relations muscle to place articles in newspapers and magazines.
• The senator was discovering, however, that one minor public health crisis afflicting the nation appeared to derive from his own issuance of subpoenas, and like Welch and Martí-Ibáñez, Frohlich declined to testify, supplying a letter from his doctor that described “an eye disorder
• All those detailed battle plans Kefauver’s staff had drawn up had officially gone out the window. Arthur was lecturing the committee as if they were a bunch of first-year medical students. Doctors would never be seduced into believing false advertising, Arthur proclaimed, and, anyway, what false advertising?
• He suggested that he would purchase from the Met all of the artworks that would fill the new space—a series of Asian masterpieces that the Met had acquired back in the 1920s. He offered to pay the price that the Met had originally paid—the 1920s price—and then donate the works back to the museum, with the understanding that each piece would henceforth be described as a “gift of Arthur Sackler,” even though they had belonged to the museum all along. This would be a convenient way for the museum to generate some additional revenue and for Arthur to attach the Sackler name to more objects. Arthur had also become attuned to the advantages of gaming the tax code, so for tax purposes he declared each donation not at the price he paid for it but at the present market value. It was a classic Arthur Sackler play: innovative, showy, a little bit shady; a charitable gesture in which, considering the tax advantages, he would actually make money.
• And what about Cairo, Illinois? What better home for an Egyptian temple in America than a tiny midwestern city called Cairo? The contest for this magisterial prize grew intense and bitter. The press called it “the Dendur Derby.”
• Hoving genuinely liked Arthur, inasmuch as a professional seducer can like his conquest. “He was touchy, eccentric, arbitrary—and vulnerable,” Hoving would later remark, “which made the game much more fascinating.”
• He liked to tell people that in marrying Jillian, he had “got it right the third time.” But he also spoke about the decision as a sort of gambit to outwit the clock. “One thing about her being younger,” he told a friend, “is that it will lead to a hundred years of philanthropy and great works. My fifty years—and the fifty years after she outlives me.”

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• Udell showed unwavering loyalty to the Sacklers. “Corporate attorneys can do one of two things,” Bart Cobert said. “They can go to management and tell them, ‘You can’t do that.’ Or they can go to management and say, ‘Tell me what you want, and I’ll figure out a way to do it.’ Howard was in the second category.”
• But Napp had recently developed a special coating system for pills that allowed the diffusion of a drug into the bloodstream of a patient to be carefully regulated over time. They called the system Continus, and they had already used it for an asthma drug. But what if you applied it to morphine? It would mean that a patient could swallow a pill and the morphine would slowly release into the body, in the same manner that it would on a drip.
• Upon receiving the letter, Howard Udell and a squadron of Purdue attorneys descended on Washington for a series of urgent meetings with the agency. In theory, Purdue was in trouble and would have to recall the drug and start all over again, following the rules this time, with a New Drug Application, an extensive back-and-forth with the (FDA), approval (if they were lucky) and then a launch meeting. But by blithely upending this process and selling their painkiller without approval, Purdue had created new facts on the ground. There were cancer doctors now—and cancer patients, lots of them—who had come to depend on MS Contin for relieving pain.
• Arthur had wanted to pass along a coherent family legacy, but his estate was proving to be a poisoned chalice. Rather than bring the family together, the wealth and possessions that he had accumulated over a lifetime seemed to be pitting them against one another.
• It was not that Elizabeth had any problem with the Smithsonian’s receiving these works: it was that she wanted them to be described not as part of the “Singer Collection” but of “The Dr. Paul Singer Collection of Chinese Art of the Arthur M. Sackler Gallery.” She had inherited from her father a devotion to the talismanic significance of names.
• Arthur’s heirs ended up selling their one-third stock interest in Purdue Frederick to Mortimer and Raymond for $22 million. In light of what the company was about to become, this was, for Arthur’s heirs, a spectacularly foolish transaction.
• On one occasion, the brothers fought with such rancor at a board meeting that they physically came to blows, throwing punches at each other... Mortimer and his heirs were known, within the company, as the A side, after the designation of the shares they owned in Purdue. Raymond and his heirs were the B side.
• During the American Civil War, morphine was widely embraced as a salve for terrible battlefield injuries, but it produced a generation of veterans who came home after the war addicted to the drug. By one estimate, in 1898, a quarter of a million Americans were addicted to morphine. A decade later, President Theodore Roosevelt appointed an opium commissioner,.. heroin, which the German pharmaceutical company Bayer began to mass market as a wonder drug—a safer alternative to morphine.
• in Norwalk, Richard and his colleagues entertained the notion of a similar marketing strategy. In truth, oxycodone wasn’t weaker than morphine, either. In fact it was roughly twice as potent... Richard and his senior executives now devised a cunning strategy, which they outlined in a series of emails. If the true personality of oxycodone was misunderstood by America’s doctors, the company would not correct that misunderstanding. Instead, they would exploit it.
• What they could not see, or know, was that when water crept into the vat, it caused the sodium hydrosulfite to break down, which generated heat. The heat produced steam, which reacted with the aluminum powder to create hydrogen gas. Inside the great hull of the mixer, a chain reaction had initiated, and the pressure had been building, hour upon hour. As one chemist would subsequently observe, the contents of the steel drum had the makings of a hydrogen bomb.
• “We focused our salesmen’s attention,” Richard Sackler explained, “to physicians who…write a lot of prescriptions for opioids.” A doctor who wrote a lot of painkiller prescriptions was a priceless commodity. Like casino employees talking about an especially profligate gambler, the sales reps referred to these doctors as “whales.”
• It did not take much trial and error to make this discovery. In fact, each bottle came with a warning that, in retrospect, doubled as an inadvertent how-to: “Taking broken, chewed, or crushed OxyContin tablets could lead to the rapid release and absorption of a potentially toxic dose of oxycodone.”
• According to this thesis, the real victim of the emerging crisis wasn’t some addict who, of her own free will, chose to crush and snort an FDA-approved drug. The real victim was Purdue Pharma. “We are losing sales because physicians have become scared or intimidated from press reports,” Michael Friedman
• It is a peculiar hallmark of the American economy that you can produce a dangerous product and effectively off-load any legal liability for whatever destruction that product may cause by pointing to the individual responsibility of the consumer. “Abusers aren’t victims,” Richard said. “They are the victimizers.”
• It was true, he allowed, that patients who were prescribed the drug tended to build up a tolerance to it, and it was not unusual for some patients who had been using OxyContin to find that they were experiencing symptoms of withdrawal—such as itching, nausea, or the shakes—before the twelve-hour dosing cycle was over. This was not actually addiction, Haddox argued, but mere physical dependence, which is different. In fact, he coined a term, “pseudo-addiction,” which Purdue started to incorporate into its promotional literature.
• Hogen telephoned his office and left a menacing voice mail in which he pointed out that Purdue was “a significant supporter of the Democratic party” and said that it was “very unfortunate that this had to happen to one of your major benefactors.” Hogen was a man with the sort of brash confidence to threaten a state attorney general in a voice mail.
• When he entered the private sector, Giuliani was looking to make a lot of money quickly. In 2001, he had a net worth of $1 million; five years later, he would report $17 million in income and some $50 million in assets. For Purdue, which was working hard to frame OxyContin abuse as a law enforcement problem, rather than an issue that might implicate the drug itself or the way it was marketed, the former prosecutor who had led New York City after the 9/11 attacks would make an ideal fixer.
• prosecutor who had been the first federal official to raise the alarm about OxyContin, stepped down from his position. He started working as a paid consultant for Purdue. It was, in some ways, the same pattern that had played out with Curtis Wright, the former FDA examiner: the very government officials whose job it was to regulate the company and hold it to account ended up seduced by a new job at the company itself. McCloskey
• The U.S. Senate would eventually publish a report about the origins and influence of these pain groups, detailing the manner in which they served as a “front” for the pharma industry. The report concluded that though numerous companies manufactured opioid painkillers, Purdue Pharma was the single largest funder of these “third party advocacy groups.”
• One rationale for this approach is that it is often easier to assemble evidence against this lower level, because these executives play a more hands-on operational role and leave behind a more extensive paper trail. But, in white-collar criminal cases, such defendants also make for notably soft targets. These are generally pampered men in middle age with soft hands and unblemished reputations. If you indict them on criminal charges, and they are suddenly looking at the prospect of actual jail time, the very thought of incarceration is enough to flood them with terror. As a consequence, they can often be persuaded to flip
• Years later, this decision, which was made behind closed doors at the Justice Department, would become an enduring mystery, because none of the officials involved wanted to own it. The choice to drop felony charges against Friedman, Goldenheim, and Udell appears to have been made by the assistant attorney general, Alice Fisher... It was an orphan directive: a backroom deal for which none of these former public servants would take responsibility.
• But Brownlee’s refusal to play the Washington game would not be forgotten. Less than two weeks after their phone call that evening, Michael Elston prepared a list of U.S. Attorneys to be fired, by the Bush administration, for political reasons... Elston added Brownlee’s name to the list.
• “ ‘Keep yourself out of prison; we’ll take care of you off the books.’ That’s just how they did business,” he said. Not long after the guilty plea, the Sacklers voted to pay Michael Friedman $3 million. Howard Udell got $5 million. The dynamics in play resembled nothing so much as a Mafia film. As one friend of Goldenheim’s put it, the three men had been designated to “take the fall.”

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• And he’ll ask a hundred questions, if that’s what it takes to get to the one you have no answer to.” Then, the executive continued, “if Richard gets his gotcha question, Kathe has to get hers in.” Kathe always seemed to want to one-up Richard, according to the executive. But Richard showed her nothing but disdain. “It almost felt like the board meetings were mostly about each side of the family trying to prove to the other that they were smarter.”
• It appeared that OxyContin’s run might be over, a turn of events that would cost Purdue and the Sacklers billions of dollars. But Howard Udell had invested in very good patent lawyers, and they persuaded an appeals court to vacate the 2004 judgment, so Purdue was able to restore its monopoly on the drug. They were back in business, but more mindful than ever that they had to maximize the windfall from OxyContin before they lost exclusivity for good.
• You could slam one of the pills with a hammer, and it would crack but not shatter. With some effort, you could pry it into pieces, but if you tried to snort the bits that broke off, they’d get stuck in your nostril. This was a small miracle, more innovative, in its way, than OxyContin had been in the first place. As one former Purdue executive put it, when you tampered with the reformulated OxyContin, it turned “into a Gummy Bear.”
• the patent on the original formulation was set to expire, the company made an audacious about-face. Purdue filed papers with the FDA, asking the agency to refuse to accept generic versions of the original formulation of OxyContin—the version the company had been selling all these years—on grounds that it was unsafe. The company said that it was voluntarily withdrawing the original formulation from the market for reasons “of safety.” On the very day that the patent for the original formulation was set to expire, the FDA, ever obliging, declared that the benefits of the old version of OxyContin “no longer outweigh” the risks.
• According to a research abstract by a team of scientists at Purdue, after the reformulation, sales of 80-milligram OxyContin pills dropped 25 percent nationwide.
  On the one hand, this was an impressive metric of Purdue’s success in curbing abuse of OxyContin by developing the new crushproof pills... On the other hand, that drop in sales offered a stark indication that for years Purdue had been deriving a quarter of its revenue on the highest dose of OxyContin from the black market.
• Mortimer...complained, was that he was so busy working on behalf of the family business and having to “play hardball with Richard and Jon,” which was stressful, and perhaps not the most productive use of his energies. “I have been working for years on Purdue at what I consider to be a considerably discounted value relative to what MY TIME IS WORTH,” he wrote. “I am LOSING money by working in the pharma business.”
• Now the company did the same thing abroad, turning, in some instances, to the very doctors who had been so obliging the first time. They called these paid representatives “pain ambassadors,” and the company flew them to emerging markets to promote opioids and warn about the dangers of opiophobia.
• Richard had been living in Austin. In a town with a conspicuous overrepresentation of brainy rich eccentrics, he almost fit in. He had developed a friendship with a courtly law professor named Philip Bobbitt who was about Richard’s age and had also grown up in great privilege.
• According to a study by the Associated Press and the Center for Public Integrity, Purdue and other drug companies that manufacture opioid painkillers spent over $700 million between 2006 and 2015 on lobbying in Washington and in all fifty states. The combined spending of these groups amounted to roughly eight times what the gun lobby spent. (By comparison, during the same period, the small handful of groups pushing for limits on opioid prescribing spent $4 million.)
• But Goldin, with her particular allergy to the bullshit stories that families tell, was having none of it. Arthur might have died before OxyContin was introduced, she said, but “he was the architect of the advertising model used so effectively to push the drug.” And he made his money on tranquilizers! It was a bit rich, she thought, for the Valium Sacklers to be getting morally huffy about their OxyContin cousins.
• But the reason was not that the FDA was requiring them to or that the Sacklers thought there was a huge new market for the painkiller among children. Rather, it was because securing a pediatric indication from the FDA is yet another crafty way of extending the patent for a drug... One former executive pointed out that in 2011 six more months of exclusivity could have “meant more than a billion dollars” in revenue.
• According to a PowerPoint presentation for Project Tango, the “Abuse and Addiction market” would be a “good fit and next natural step for Purdue.” In some ways, this initiative was a riff on a business model that Purdue had long employed. One side effect of opioid use is constipation, and for years Purdue’s sales reps had marketed the company’s trusty laxative, Senokot, as a useful chaser to OxyContin.
• This is the breadbasket of the opioid boom. Though it is only about the size of West Virginia, Tasmania grows 85 percent of all the thebaine in the world. During the 1990s, just as Purdue Pharma was developing OxyContin, a company owned by the pharmaceutical giant Johnson & Johnson developed this new strain of opium poppy.
• the burgeoning opioid industry pushed to raise these limits, lobbying doggedly, and over time the DEA accommodated. The opioid crisis is, among other things, a parable about the awesome capability of private industry to subvert public institutions. Just as the FDA was compromised and Congress was neutralized or outright co-opted with generous donations and some federal prosecutors were undermined with a back-channel appeal in Washington while others were mollified with the promise of a corporate job, just as state legislators and the CDC were hindered and sabotaged when they tried to curb opioid prescribing, the DEA was not immune to these pressures and proceeded to soften its position under a steady barrage of industry encouragement. Between 1994 and 2015, the quota of oxycodone that the DEA permitted to be legally manufactured was raised thirty-six times.
• The vast majority of prescriptions for opioid pain medications is for generics, he said. But to some who worked at Purdue and were familiar with the convoluted holdings of the Sackler clan, this talking point seemed egregiously insincere, because the Sacklers secretly owned another pharmaceutical company, in addition to Purdue, and it was one of the biggest manufacturers of generic opioids in the United States.
• The family convened a weekly conference call, at 8:00 a.m. each Tuesday, to discuss the crisis with their ever-expanding retinue of lawyers and public relations advisers. Everyone seemed to have their own representatives, and the number of participants just kept growing. Mortimer would go to a party and meet someone who recommended a new consultant; then that person would pop up on the call. “All of a sudden you have six different PR firms ringing the cash register, saying, ‘For $50,000 a month, I’ll do whatever you want,’ ” one person who advised the family during this period said.
• “They’re going to regret fucking with a linguist,” she said, of her detractors. “They already do.” During the interview, with no encouragement from the reporter, she literally ordered the suckling pig. This Marie Antoinette routine was so over the top (could she possibly be sincere? Or was this some kind of conceptual art performance?) that it seemed custom engineered for the gossip pages, and before long Page Six was chronicling Joss’s every outré utterance. The paper crowned her “the Lady Macbeth of Opioids.”
• Purdue and the Sacklers had employed their usual tactics. As local counsel, they hired a woman named Joan Lukey, who happened to be Healey’s friend and mentor and had served as the finance chair on her campaign.
• The Sacklers didn’t just own Purdue, the Massachusetts prosecutors realized. They ran it. Healey’s team updated their complaint, incorporating this explosive new material.
• In her opinion, Judge Sanders pointed out that Purdue’s stated concerns—that the release would “embarrass individuals and spark public outrage”—were not exactly a compelling basis for keeping the complaint suppressed. She also invoked a dark precedent in Massachusetts: the shameful history of local courts “impounding” information in cases involving allegations of child sexual abuse by Catholic priests.
• But also, on a more symbolic level, Feiner was struck by the fact that in a legal controversy about how destructive the rampant sale of OxyContin had been, one major plank of David Sackler’s proposal was that after Purdue was set up as a charitable trust, the plaintiffs would raise money to address the opioid crisis through ongoing proceeds from Purdue—which is to say, by selling the very drug that had started the crisis in the first place. This would create a perverse incentive in which the states, having inherited the company, would suddenly find themselves in the opioid business.
• If the states did not want to sign off on their generous offer, the Sacklers indicated, then Purdue would just declare bankruptcy without a deal in place. Doing so would have one big near-term advantage for the Sacklers: after a company files for bankruptcy, the judge handling the process will generally freeze all litigation against the company so that it can be restructured. The Sacklers did not want Purdue to go to trial in October. If their settlement proposal wouldn’t keep the company out of the courtroom, then bankruptcy would.
• After all, the family wasn’t filing for bankruptcy. The Sacklers had “extracted nearly all the money out of Purdue and pushed the carcass of the company into bankruptcy,” Josh Stein, the North Carolina AG, said. “Multi-billionaires are the opposite of bankrupt.” But on September 18, Purdue made a special appeal to Judge Drain. Having maintained the ruse, for decades, that the Sacklers and Purdue were separate, their lawyers now argued that the Sacklers were “inextricably twined” in any lawsuits against their company... It wasn’t just the implicit threat that rankled Maura Healey. It was the fact that the Sacklers were playing a shell game: they were throwing their lot in with Purdue when it suited them to do so and distancing themselves from the company when it didn’t.
• The Sacklers might have become social pariahs, but in White Plains their handpicked bankruptcy judge, Robert Drain, was proving to be an excellent choice. A declaration of bankruptcy conjures images of failure and shame, but for the Sacklers, Drain’s courtroom had become a safe harbor.