AILSA CHANG, HOST:
Isaac Sackler once told his three boys, what I have given you is the most important thing a father can give - a good name. Well, the Sackler name is now forever entwined with the company Purdue Pharma, the creator of OxyContin, the drug that helped steer the country into an opioid epidemic that has killed almost half a million people the last two decades. In his new book "Empire Of Pain," Patrick Radden Keefe tells the sweeping story of the rise and fall of an American dynasty, a family obsessed with emblazoning its name across museums and galleries all while largely obscuring any connection between its name and the drug that killed so many people. Keith begins this family saga in the mid-1900s with Isaac Sackler's three sons, the eldest of whom was Arthur Sackler.
PATRICK RADDEN KEEFE: Arthur was this amazing, protean character. He grew up poor during the Great Depression in Brooklyn to immigrant parents and became a doctor. But he was very restless and ambitious, and he wanted to do more than just be a doctor. And so he got into medical advertising. And he realized it's not the consumer that you need to advertise these drugs to; it's doctors, and that if you can persuade doctors to prescribe a medication, that's where the real riches will lie. And so he did this with any number of drugs in the 1950s and '60s, perhaps most significantly with Valium.
A CHANG: And how did he aggressively market Valium?
RADDEN KEEFE: In a bunch of ways. I mean, one of the things he did was he devised these really ingenious advertising campaigns that would go out to doctors and try and persuade doctors that Valium and other drugs like it had few side effects, that they were not particularly addictive, that they could cure any number of different afflictions.
Another thing he did was enlisted an army of sales representatives - so these were people who worked for Roche, the company that made Valium - and went out across the country meeting with doctors and nurses and pharmacists and trying to persuade them of the virtues of these drugs. And that became a template. And it was significant because Arthur, from the beginning, was really interested in kind of mingling medicine and commerce and in a way that I think ended up being pretty decisive in terms of the history of the pharmaceutical industry.
A CHANG: Well, Arthur Sackler died before OxyContin was ever introduced by Purdue Pharma. But as you say, he did lay out this template for how OxyContin would eventually be marketed. Purdue Pharma has pleaded guilty twice to federal crimes for marketing OxyContin illegally, and one of the ways the company was able to market the drug so widely was by selling a certain so-called personality for OxyContin. Can you explain what that meant?
RADDEN KEEFE: Yeah. So I discovered these emails between a series of executives at Purdue and also Richard Sackler, who was Arthur Sackler's nephew and was running the company in the 1990s. And they talk about this drug, OxyContin, and the idea that its active ingredient is oxycodone, which is an opioid, a strong opioid, which is quite powerful. And opioids, for thousands of years, we've known can be quite addictive. But there was this sense that oxycodone was perceived as having a non-threatening personality, that it was less threatening than morphine, even though morphine, which is another opioid, was actually weaker than oxycodone.
So there's this incredible exchange of emails in which these executives say, you know, it's the strangest thing. American doctors mistakenly believe that oxycodone is weaker than morphine even though it's stronger. Let's not do anything to interfere with that impression on their part. Let's let them think it is weaker even though we know it's stronger.
A CHANG: And that strategy takes off. I mean, OxyContin ends up being a blockbuster drug. And as opioid addiction sweeps across the country, you write that the Sacklers adopt an interpretation for why they are not at fault, that the drug addicts were to blame, not OxyContin itself. Tell us what their logic was.
RADDEN KEEFE: So OxyContin is first released in 1996. And one of the things I discovered in my research is that almost immediately by 1997, there are indications that the drug is being abused, that people are becoming addicted, that people are overdosing and dying in some cases, that there's a black market in the drug. And there might have been a moment where they said, God, maybe we shouldn't be marketing this as not addictive, which they were. Maybe we should recalibrate our marketing and maybe not push it quite as hard as we have been. They didn't do that. Instead, what they did was say, the real problem here is drug addicts, drug abusers. They're taking this good drug that we've developed, and they're using it in a way that we did not intend.
A CHANG: Well, let's talk about the central question. Do you feel that the Sacklers personally bear direct and significant responsibility for the opioid crisis in this country? And if you do, briefly lay out the case for us.
RADDEN KEEFE: I do. Purdue set out to basically change the mind of the American medical establishment about the dangers of strong opioids. So when they had this drug OxyContin to sell, they went out there with an army of sales reps, and they met with doctors. And they said, listen. We know that historically, doctors have been a little cautious about prescribing these types of drugs. But actually, they've been too cautious. And these drugs are good not just for cancer pain, not just for end of life care, but for back pain, sports injuries.
And the fascinating thing is they succeeded. They did help initiate a real sea change in the culture of prescribing, which you can date if you look back at the history to the introduction of OxyContin. So for that reason, I believe that the Sacklers do bear significant moral responsibility for having initiated - you know, not intentionally - right? - but carelessly a series of events that got us to where we are today.
A CHANG: Well, the Sacklers did provide NPR with a statement, and the statement said that you refused to correct errors in your past reporting and that you refused to meet with representatives for the Sackler family during the reporting of this book. Tell us; how do you respond to that?
RADDEN KEEFE: That's not true. I did not end up meeting with them. They met - representatives for the Sackler family met with representatives at Doubleday, my lawyer. Bear in mind they have been threatening to sue me for the last two years and presented, you know, their side of the story. I had gone to them with a very extensive list of fact-checking queries, which they sat on for five weeks and then refused to reply to.
A CHANG: Well, let's turn now to the notion of justice in all of this. In December of last year, Dr. Kathe Sackler, who served on Purdue Pharmacy Board - she testified before Congress, and she said that she wouldn't have done anything differently. And I want to ask you, why do you think it has been so utterly important to this family to never admit wrongdoing?
RADDEN KEEFE: This is one of the big riddles for me, having spent years now studying the family and writing about them, is trying to understand how they see the story. And I think this is a family that's very deep in denial. But I also think there's another thing when I try to empathize with the Sacklers, which is that the magnitude of the destruction associated with the opioid crisis is such that if you open up the door just a crack to the notion that you might have helped initiate this kind of catastrophic public health crisis, I feel as though that might be just too overwhelming for any human conscience to bear.
A CHANG: Patrick Radden Keefe's new book is called "Empire Of Pain: The Secret History Of The Sackler Dynasty."
Thank you very much for your tremendous reporting.
RADDEN KEEFE: Thank you so much.
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