The opioid crisis is, among other things, a parable about the awesome capability of private industry to subvert public institutions.
Empire of Pain is about many things. It's the saga of a peculiar, insular, and enormously wealthy family. It's an exposé of extremely dangerous and widespread corruption in the medical profession. It's about greed -- rampant, predatory, insatiable greed.
But if there's one thread -- one lesson -- running through every aspect of this book, it is exactly what that sentence states: how the rich and powerful can buy any public institution, and the tragic, criminal consequences of that corruption. Consequences that mostly go unpunished.
Every check on power, every watchdog agency, every hard-won safeguard -- fought for by people's movements and enshrined in law -- can be bought, their goals upended and perverted to the bidding of the ultra-rich.
There are many honest people working in every level of these institutions -- people who are passionate about what they do, who care deeply about justice, people who fully intend to faithfully carry out their duties. Prosecutors, agents, scientists, administrators who value and serve the public good. But all it takes is one former administrator who has been guaranteed a wealthy retirement, one corrupt official placed in a powerful position by the dynasty (more rightly called organized crime) -- one phone call -- and all their work is erased.
Can you imagine working on a case for five years -- five years of painstakingly hunting, tracking, and collecting evidence, five years of investigations and depositions, five years of building a case to demonstrate an irrefutable truth -- and it is all wiped out, by one phone call?
That was inside the Department of Justice. On the outside, there are the activist families -- families who have endured brutal loss, and who use their pain to fuel a movement demanding change. What despair and frustration they must feel, when their work becomes almost irrelevant.
Families who have lost loved ones to opioid addiction are not very present in Empire of Pain; they are only glimpsed on the sidelines. That's not a criticism. There are many books about the victims of the opioid crisis, but this isn't one of them. This is about how the crisis came to be.
How the elder Sackler learned his craft -- and made his first fortune -- by marketing "mother's little helper" -- Valium.
How later Sacklers invented a drug that they knew was highly addictive, then dispatched an army of hardcore salespeople to seduce doctors with dangerous lies.
How the Sacklers bought FDA approval, and how that falsified approval was used to scaffold ever-increasing dosages in an ever-expanding network of addiction and greed.
How august cultural institutions didn't ask questions as Sackler millions rolled in.
How, no matter how widespread the wreckage and how profitable, it was never enough. And how the Sacklers refused to take even a shred of responsibility, and tried to publicly frame themselves as victims.
And because they have enormous wealth, they were able to game the system, sailing gently away on their billions.
Is it any wonder that most people are cynical and apathetic? As a reviewer writes in The New York Times, "Simply put, this book will make your blood boil."
Last year, I wrote about Say Nothing: A True Story of Murder and Memory in Northern Ireland, another extraordinary work of nonfiction by the same author, Patrick Radden Keefe. I read Empire of Pain at the end of 2022 and beginning of 2023.
Both books are true page-turners. While I'm sure most wmtc readers do not share my enduring fascination (slightly downgraded from a 10 years of obsession) with Ireland and Irish history, Empire of Pain is a book that everyone should read. The implications of this story extend far beyond the evil Sacklers, and into the systems that govern our lives.