Empire of Pain

How does a family of three Brooklyn-born brothers build one of the most influential, wealthy, and ultimately reviled dynasties in medical history? In Empire of Pain, Patrick Radden Keefe argues that the Sackler family transformed both the practice of pharmaceutical marketing and the definition of public health itself. Across generations, the Sacklers blurred the line between medicine and commerce, using their medical titles, publishing platforms, and philanthropy to cultivate prestige while concealing profit. Their story is not simply about OxyContin or the opioid crisis—it is about how legitimate science and regulatory systems can be weaponized to sell relief, reshape pain, and perpetuate dependence.

From Medical Innovation to Marketing Empire

The story begins with Arthur Sackler, the eldest of three brothers and the architect of modern drug marketing. As a psychiatrist who also owned an advertising firm, Arthur discovered the financial potential of combining medical research with persuasion. In campaigns for Pfizer’s Terramycin and later Roche’s Librium and Valium, he pioneered tactics that treated doctors as both scientists and consumers: glossy reprints of journal articles, sponsored symposia, and a sales force of “detail men” who recited data like catechism. The technique—promotion disguised as education—became the template for the entire industry.

Roche’s tranquilizers, marketed as non-addictive aids for the stress of modern life, flourished under this strategy. Arthur’s network blurred the boundary between medicine and commerce, setting precedents that stunned senators at the Kefauver Hearings, where revelations about FDA conflicts and ghostwritten medical publications ignited early reforms. Yet Arthur largely escaped reproach. He had already learned how to use his medical credibility as a shield for marketing ingenuity.

From Laxatives to Opioids

Arthur’s brothers, Raymond and Mortimer, used the modest Purdue Frederick company, which sold products such as Senokot and Betadine, as the family’s entrepreneurial base. Through its British affiliate Napp Laboratories, they developed time-release technology that led to MS Contin—a morphine pill for cancer patients. Richard Sackler, Raymond’s ambitious son, saw in that technology a ticket to a new kind of blockbuster: a controlled-release form of oxycodone. The result was OxyContin, launched in 1996 with marketing scripts that borrowed directly from Arthur’s playbook but on a far more aggressive scale.

Meanwhile, the family’s internal culture mirrored its public methods: secretive, tightly bound by promises, adept at hiding wealth (through offshore entities such as Mundipharma) and manipulating image. Legal agreements among the “three musketeers” ensured that family control would outlive individuals. Philanthropic gifts to Harvard, the Met, and the Smithsonian converted pharmaceutical profits into a veneer of cultural permanence through the repetition of one name—Sackler.

The Mechanisms of Expansion and Denial

As OxyContin spread, Purdue replicated old strategies in new forms. Regulatory phrasing in FDA inserts blurred risk, citing that time-release was “believed to reduce abuse liability.” Sales reps, fed misleading data, told doctors that addiction was “rare.” Bonuses and luxury junkets rewarded top prescription writers. The company’s data systems tracked high-prescribing doctors, ensuring saturation. When abuse and overdose evidence mounted, executives shifted the blame to “abusers” rather than to the drug’s design or the culture of overprescription they had fostered.

Reckoning and Reinvention

Federal prosecutors in Virginia eventually proved Purdue’s misbranding of OxyContin, leading to a 2007 guilty plea and $600 million in fines. Yet the family itself remained untouched. A second wave of litigation, led by Massachusetts Attorney General Maura Healey, made the Sacklers visible, linking their personal decisions to public catastrophe. Meanwhile, artists such as Nan Goldin and her PAIN movement turned cultural shame into activism, compelling museums to sever ties and remove the family’s name from galleries. The same name that once connoted refinement now epitomized corporate deceit.

Why This Story Matters

In tracing the Sacklers’ trajectory from scientific medicine to empire, Keefe constructs an anatomy of influence. You see how medical authority, marketing sophistication, political lobbying, and cultural philanthropy can reinforce one another to produce both progress and devastation. Empire of Pain is not only a family biography—it is a study of systems: how private ambition coopts public trust, and how naming, wealth, and secrecy converge to rewrite the ethics of medicine itself. Understanding this story helps you see the modern pharmaceutical landscape not as an accident but as an inheritance from deliberate strategies born decades ago.

Arthur Sackler revolutionized pharmaceutical sales by merging scientific credibility with Madison Avenue advertising. As a psychiatrist and adman, he recognized that doctors crave authority and data—so he built marketing that looked like medical education. When Pfizer hired him for Terramycin, he flooded journals with teaser ads, sponsored scientific reprints, and cultivated 'detail men' who personally persuaded physicians. It was an elegant loop: research produced prestige; prestige sold drugs; and sales funded more research that echoed the original claims.

Education as Persuasion

Arthur’s genius lay in reframing advertising as “medical education.” He published and controlled platforms like Medical Tribune and MD Publications, turning what looked like independent medical literature into carefully orchestrated promotion. His Pfizer campaign for Terramycin used the slogan “Terra bona”—good earth—to associate antibiotic purity with scientific progress. Within months, he transformed a new antibiotic into a monumental success story, making his client the market leader. (Marketing scholars later described this as the birth of the 'prescriber-centered model.')

From Tranquilizers to Scandal

When Roche developed Librium and Valium, Arthur’s methods reached their apotheosis: promotional supplements, Life magazine placements, and endorsements portraying anxious housewives and stressed executives as patients needing relief. It worked perfectly—Valium became the world’s most prescribed drug. But dependence surfaced, sparking early debates about overmedicalization. The same marketing inventiveness that launched antibiotics and tranquilizers also paved the way for therapeutic excess and disguised addiction under the veneer of normalcy.

The Kefauver Shock

The 1962 Kefauver hearings exposed the tangled web connecting MD Publications, federal regulators like Henry Welch, and industry-funded symposia. Pfizer was caught using official speeches as ad copy, revealing how regulatory oversight could be quietly compromised. Arthur appeared before the Senate unflustered, invoking education and public service to mask commercial ties. His poise frustrated investigators but demonstrated a critical insight: authority, once captured, is nearly impossible to disentangle from influence.

Arthur’s model saturated medicine. By cloaking persuasion in science and ethics, he built the architecture upon which his brothers—and later his nephew Richard—would construct fortunes. That architecture, in its elegance and its deceit, shaped the marketing DNA of modern pharma.

The Sackler brothers called themselves “the musketeers,” bound by loyalty and secrecy. Their internal pact—to share everything and hide much—created one of the most private empires in American business. Through intricate ownership arrangements they controlled companies, publishing arms, and foundations while maintaining the appearance of separateness. This culture of concealment would later define Purdue’s ethos and the family’s ability to evade scrutiny.

The Musketeers Agreement

In the 1960s Arthur, Mortimer, and Raymond signed legal contracts affirming that their assets would stay within their circle and eventually feed into charitable trusts. It sounded altruistic but operated like a tontine—whoever survived longer controlled more wealth. When business partner Bill Frohlich died, a dispute over IMS (a market-data firm Arthur helped build) fractured the brothers. Litigation over estates and valuations later consumed their heirs, revealing that familial unity had depended entirely on secrecy and shared ambition.

Philanthropy as Legacy

Arthur translated his obsession with permanence into cultural capital. He donated vast collections of Chinese art to the Metropolitan Museum of Art, Harvard, and the Smithsonian—but always with one stipulation: his name. The Sackler Wing at the Met, built around the Temple of Dendur, epitomized this transaction between wealth and recognition. For Arthur, art collecting became both refuge and branding. (Note: historians compare his strategy to Carnegie’s libraries or Rockefeller’s foundations—nobility purchased through civic visibility.)

After his death, revelations about undisclosed holdings, secret storage rooms, and contested property turned this legacy ironic. The marble plaques reading “Sackler” became, decades later, targets of protest—a prophecy built into the naming strategy itself.

What the Family Culture Taught Purdue

Secrecy, loyalty, and control guided the family’s approach to business as much as to their art. Purdue under Raymond and Mortimer reflected those traits: centralized power, minimal transparency, and fierce protection of the name. When Richard Sackler rose to prominence, those habits translated into management policies that fused ambition with suppression—fuel for the empire’s eventual combustion.

By the 1980s the Sacklers had something novel: chemical innovation (time-release morphine) and inherited marketing genius. With Richard Sackler as strategist, Purdue reimagined the family’s modest enterprise as a global pharmaceutical challenger. Facing patent expiry on MS Contin, Richard looked for the next breakthrough and found it in oxycodone—a molecule with less stigma than morphine but equal potential. The goal was clear: dominate the pain market by redefining suffering as a long-term condition best managed with opioids.

Patents and Narrative Engineering

You learn how patents, which protect innovation for twenty years, create desperation near expiry—the “patent cliff.” To keep revenue flowing, Purdue engineered both a new chemical form and a new cultural story. Marketing shifted from cancer pain to chronic non-malignant pain, reframing aches and arthritis as diseases of under-treatment. Sales teams were told to say OxyContin offered twelve-hour relief and lower addiction risk, thanks to time release.

The FDA label, approved under reviewer Curtis Wright (who soon after joined Purdue), contained the magical phrase: “believed to reduce the abuse liability.” That belief, though unverified, operated like a permission slip for aggressive promotion. The same regulator who approved the drug later became a paid consultant—a case study in regulatory capture.

Building the Sales Machine

Richard launched OxyContin with evangelical zeal. Sales reps were armed with glossy materials, coupons for free first prescriptions, and paid-speaker programs. They targeted “whale” doctors using IMS prescribing data and rewarded top performers with luxury vacations known as “Toppers” trips. Even minimal clinical evidence—a five-sentence letter suggesting addiction was “rare”—was amplified into gospel. The mantra “start with and stay with OxyContin” reprogrammed a generation of physicians.

These strategies, echoing Arthur’s “education, not advertising” doctrine, proved alarmingly effective. By 2000 OxyContin was a billion-dollar product. The same pattern that normalized Valium now normalized oxycodone—this time with catastrophic public health consequences.

When addiction epidemics surfaced—from Appalachia to New England—federal investigators began tracing responsibility back to Purdue. The case mounted in a small office in Abingdon, Virginia, where prosecutors Rick Mountcastle and Randy Ramseyer built a detailed archive showing that misbranding was company policy, not accident. Training videos and field notes demonstrated systematic exaggeration of safety claims. Internally, executives knew many patients couldn’t last twelve hours between doses but resisted admitting it because frequent dosing would erode the brand promise.

The 2007 Plea

After years of investigation, Purdue Frederick—an older legal shell—pled guilty to felony misbranding. Three top executives pleaded to misdemeanors, and the company paid $600 million in fines. The Sacklers themselves were untouched. High-profile lawyers, including Rudy Giuliani and Mary Jo White, negotiated outcomes that blunted accountability. Inside Purdue, the executives were quietly compensated after the plea, confirming suspicions they had taken the fall for the family.

The Family Behind the Curtain

While prosecutors focused on the corporate entity, the Sacklers continued to run the company through the “ninth-floor” boardroom, shielded by family counsel. Emails instructed staff to delete messages after months and downplay troubling reports of abuse. Richard Sackler ordered that Purdue “hammer on the abusers,” externalizing blame. Employees who protested were marginalized or dismissed. The insular culture ensured not just profitability but institutionalized denial.

The prosecution’s limited outcome underscored a deeper truth: when ownership, legal structures, and influence intertwine, formal justice rarely reaches the powerful. The system penalized impropriety but left intact the mechanisms that produced it.

By 2010 Purdue sought to rehabilitate its image and protect its revenue. The answer was a 'tamper‑resistant' OxyContin—an engineering tweak that made pills gummy when crushed. Publicly, the company framed this as harm reduction; privately, it extended patents and blocked generics. (Critics called it classic evergreening.)

Technical Fix, Public Disaster

While the new formula made snorting harder, it didn’t stop oral abuse. Demand for high-dose opioids remained. Within months, many dependent users turned to heroin, which was cheaper and increasingly pure. Studies later showed that heroin use spiked in direct correlation with the 2010 reformulation. A technical fix thus inadvertently catalyzed a broader narcotics crisis.

Exporting the Model

Overseas, the family’s affiliate network Mundipharma replicated Purdue’s approach in Latin America, Asia, and the Middle East. The narrative—pain as an undertreated epidemic, opioids as humane liberation—became the rallying cry. Paid “pain ambassadors” toured hospitals preaching that denying opioids was unethical. Internal documents flaunted enormous markets: tens of millions of potential patients. Behind the humanitarian rhetoric lay tax structures routed through Bermuda and a global echo of the same marketing that had devastated the U.S.

The reformulation’s dual purpose—public defense and private extension—revealed how corporate ingenuity can outpace regulation. The harm migrated, not disappeared, leaving a legacy of addiction exported under the guise of medical advancement.

If early decades of the Sackler saga were defined by invisibility, the final acts unfolded under glaring light. Photographer and activist Nan Goldin transformed private grief into public action, leading the group PAIN (Prescription Addiction Intervention Now). Where prosecutors sought legal admissions, Goldin aimed for moral exposure. Her protests—die-ins, prescription rainstorms at the Guggenheim, and demonstrations at the Met—converted museum walls into battlegrounds for truth.

The Un-Naming Campaign

Goldin’s theater of protest forced a wave of institutional reckoning. Within months, the National Portrait Gallery declined a Sackler donation, the Tate and Serpentine followed suit, and the Louvre removed the Sackler name entirely. Tufts University stripped it from its medical campus. These moves marked a profound reversal: what had once been a mark of benevolence was reclassified as guilt by association.

Law and Public Truth

Meanwhile, legal breakthroughs mirrored activism. Massachusetts attorney general Maura Healey unsealed internal Purdue and Sackler documents, showing the family’s direct role in strategy after 2008. Her complaint used emails, minutes, and finance ledgers to turn private decisions into public record—naming names in a way prior settlements never had. For many families of victims, those documents mattered more than money: they confirmed intention and disproved ignorance.

Bankruptcy and the Struggle for Accountability

Purdue’s 2019 bankruptcy in Judge Robert Drain’s court became the family’s most audacious shield. Through “third-party releases,” the Sacklers sought immunity without personal bankruptcy—a maneuver rooted in prior mass torts but ethically explosive given their retained billions. Critics argued that if accepted, this precedent would allow the ultra-rich to buy moral peace through financial engineering. In his courtroom, Drain emphasized efficiency over truth-finding, illustrating how legal systems often substitute reconciliation for reckoning.

Goldin’s protests and Healey’s documents ultimately converged into a cultural verdict: you can remove a name, expose emails, and fine billions, but you cannot restore lost lives. The book closes on that tension—between settlement and truth, money and memory. Accountability, Keefe suggests, is now as much a cultural project as a legal one.