Editors’ Note: Benjamin Soskis reviews Patrick Radden Keefe’s Empire of Pain: The Secret History of the Sackler Dynasty.

For a few weeks each summer for the last decade or so, one of my daughters has attended camp at the Smithsonian Institution. That meant that many July mornings and afternoons, when I was dropping off or picking up at the designated spot on the Washington Mall, I passed by an impressive looking granite edifice that houses one of the nation’s most important collections of Asian art. Its name is etched above its glass doors: the Arthur M. Sackler Gallery.

For many of those years, I have to admit, that name didn’t mean much to me. I had a vague sense that the Sacklers had made their money in pharmaceuticals. From trips to the Mall, visits to the Met (where there’s a Sackler wing), and occasional encounters with references to endowed professorships, I recognized them as a major American philanthropic family. I’m not sure I knew much more than that.

Until, several years ago, I did—as did many, many others. And from then on, I couldn’t pass the gallery without a shudder.

I came to know that Arthur M. Sackler was the oldest of three Brooklyn-born brothers and that in the 1950s he pioneered aggressive, borderline-unethical tactics in drug marketing and promotion. I came to know that Mortimer and Raymond Sackler built up a small pharmaceutical company purchased by Arthur, Purdue Frederick, which had initially made its money on products such as laxatives and ear-wax removers, but which under their direction branched out into pain medication. I came to know that in the 1990s, an offshoot of that company developed OxyContin, a powerful opioid with a time-release mechanism that revolutionized pain management. I came to know that the Sackler family, in control of the privately-owned company (and led by Raymond’s son Richard), relentlessly promoted sales of OxyContin, pushing doctors to prescribe the drug in doses as high and long-term as possible, claiming that it posed minimal addiction risk, even as it became abundantly clear that this was not the case. I came to know that the Sacklers continued these efforts, even as evidence of OxyContin abuse mounted, even as thousands died of overdoses, and even as the company and several of its executives (non-Sacklers) pled guilty to a series of charges related to these practices in 2007. I came to know that another spate of lawsuits, from individuals, states, and the federal government, were in the works, and that those leading them believed that the Sacklers, in the words of one legal complaint, “made the choices that caused much of the opioid epidemic.” As someone who studies the history of tainted money, I came to know that money didn’t get much more tainted than the Sacklers’.

The writer Patrick Radden Keefe is one of the main reasons why I came to know all this. His 2017New Yorker article on the family (along with one that appeared around the same time in Esquire by Christopher Glazek) did much to publicize the Sacklers’ complicity in the opioid epidemic. In his engrossing, infuriating new book, Empire of Pain, Keefe elaborates on that story, tracing the devastating effects of Sackler greed, venality and heedlessness through three generations. In doing so, he also chronicles the shift in public knowledge that I experienced over the course of a decade in front of that Smithsonian gallery. In this way, all of us who have patronized a Sackler institution, or even just walked by one, are minor characters in this book.

Empire of Pain is in many respects a “rise and fall” narrative, yet one in which the fall will likely leave the family shielded from prosecution and retaining billions of dollars. Philanthropy plays an important part in it—yet determining its precise nature isn’t so easy. The difficulty stems from one of the dynamics that makes the Sackler family so distinctive in the history of U.S. philanthropy: the ways they cultivated their public identity as benefactors even as they sought to hide their involvement with Purdue from public attention. They almost never appeared at company events, and were rarely mentioned in Purdue PR materials. They were masters of the arts of promotion when it came to putting the Sackler name on museum walls, medical schools or university programs and masters of the arts of discretion when it came to corporate disclosure or accountability.

As Keefe explains, they reconciled these two impulses by “positing a family fortune that had simply appeared, fully formed,” as if they were members of some long-established dynasty far-removed from the source of their wealth. This attitude was understandably pronounced among the third generation of Sacklers, many of whom were not involved with Purdue and OxyContin, but who were able to pursue careers in the arts or nonprofit sector because of wealth derived from the company or from its antecedents in the dealings of Arthur M. But even those who served on the Purdue board maintained a stark divide between the performative ethics they associated with the persona of the benefactor and the amoral secrecy they associated with the prerogatives of the money-maker. In this sense, they were out of step with many of the current crop of philanthro-capitalists, who have merged those two imperatives into a single public-facing identity.

For this reason, many of the ways we have come to understand contemporary philanthropy apply imperfectly to the Sacklers. Their commitment to giving has sometimes been described in terms of reputation laundering, or even as a form of “distraction.” But unlike a figure such as Bill Gates, who experienced a dramatic transformation in his public persona as he was associated first with Microsoft and then with his eponymous foundation, those labels don’t perfectly fit a case in which the family initially managed to avoid much of a stain on its name in the first place. They deliberately sought to shield the Sackler name from any association with opioids. “The Fords, Hewletts, Packards, Johnsons—all those families put their name on their product because they were proud,” one psychiatry professor cited by Keefe (and Glazek) notes. “The Sacklers have hidden their connection to their product.”

Keefe’s reporting also does not provide much evidence of claims that have been batted about that Sackler philanthropy bought the family immunity from legal accountability. One thing that Empire of Pain makes painfully clear is that such immunity was largely delivered by a corps of high-priced lawyers and fixers (former US Attorney Mary Jo White comes off especially poorly here), bankrolled by OxyContin profits. The Sacklers’ funding of pain research and advocacy groups is a different matter, one that has received less public scrutiny than their cultural philanthropy, but which Keefe covers adroitly; it’s likely that such support, in helping to shift attitudes toward addiction and pain management within the medical profession, did actively help them avoid accountability.

If the Sacklers didn’t exactly understand themselves to be purchasing legal immunity with their philanthropy, they did clearly think it bought them something just as valuable: status and membership in high society. The Sackler brothers, and many of their progeny, were obsessed with their legacy. That obsession drove their giving. As Arthur Sacker’s lawyer once explained, “If you put your name on something, it’s not charity. It’s philanthropy. You get something for it. It’s a business deal.” Keefe brilliantly portrays how the Sacklers used the prospect of a donation, “the dangle,” to extract greater concessions and rewards and to burnish the family “brand.” (In a secret arrangement, for instance, the Met gave Arthur a private “enclave” to store his personal collection of Asian art in the assumption that he would eventually donate it to the museum; he didn’t, and the collection instead went to the Smithsonian, in part because they offered him his own named building). Curators and fundraisers often found the Sacklers pushy and unpleasant but put up with them in the hope of scoring a major gift somewhere down the line.

Yet one of the great ironies of Keefe’s book is that it’s this arrangement which ultimately led to the Sackler’s greatest “fall.” It’s true that, as Keefe points out, many institutions were willing to accept Sackler dollars well after their complicity in the opioid epidemic became widely known. But it’s striking to consider that, given the likely outcomes of the lawsuits targeting Purdue and the Sackler family, the most satisfyingly punitive measures taken in response to Sackler venality have occurred not in the legal but in the philanthropic realm. (Keefe details how the heroic efforts of many law enforcement officials were neutered by a conciliatory Trump Justice Department and a bankruptcy judge seemingly more concerned with efficiency than accountability.) The scenes of the Sackler name being chiseled off university walls, as occurred at Tufts, are as potent a measure of justice as are meted out in this book.

Of course, those measures are hardly commensurate with, and do little to remedy, the harm caused by the family’s irresponsible promotion of OxyContin (it’s worth noting that the family long resisted directing their giving to address the opioid crisis, because they feared it would be interpreted as an admission of culpability; only recently did they offer some support toward the research and treatment of addiction, and then only as part of a settlement). But the philanthropic repudiation that the Sacklers were ultimately subjected to points to a crucial dimension of this story that contextualizes it within the broader history of controversies over tainted money.

Those controversies aren’t new; they’ve been preoccupying those charged with accepting donations for centuries. But for much of history, the moral status of donations was an issue adjudicated by the donor, the beneficiary institution, and perhaps some religious authority. The main question was whether a donation was pure. But at the turn of the last century in the United States, as greater attention came to be cast on a surging tide of large-scale donations, the interests of another party to that transaction were elevated: those of the public. The public had interests in which gifts were accepted, and to which institutions they were directed, not merely because they might benefit from those gifts, but because they came to appreciate the ways in which philanthropy could shape public opinion about how the fortunes providing the funds were accumulated.

The inclination of the U.S. public to assert those interests has ebbed and flowed over the century since the last Gilded Age. Keefe’s book provides evidence that we’ve now entered a period of a more engaged, assertive philanthropic public. After all, while regulators and charitable trustees largely failed to hold the Sacklers accountable, it was Tufts medical students who pushed the school to sever its ties with the family; activists like Nan Goldin and the PAIN organization she led that compelled museums to do the same; and journalists like Keefe who sparked outrage that made it no longer possible for beneficiaries to turn a blind eye to the family’s misdeeds.

These efforts point to a very different relationship between philanthropy, the source of the financial resources it relies upon, and the social status it provides than the one the Sacklers promoted. In an astute review of Empire of Pain, New Republic writer Sarah Jones uses the case of the Sacklers to make a broader critique of philanthropy, indicting it for “ask[ing] no questions of a fortune.” This is certainly true for most of the Sacklers’ rise, and for most of the first 300-or-so pages of Empire of Pain. But it’s not the case with respect to the final sections detailing the Sacklers’ fall. Then, philanthropy did in fact ask questions of a fortune; or at least it prompted the public to do so. Keefe himself explains that it was the revelation that “the family that presided over the company that made OxyContin was a prominent philanthropic dynasty” that sparked his initial reporting on the Sacklers. (Before he started, he associated the name entirely with philanthropy and knew “nothing of the family’s business activities”).

In other words, far from being a “distraction,” in this case, philanthropy ended up drawing attention to the source of its funds. There is no reason why this cannot be so more generally, if the public become increasingly alert to the philanthropic landscape. In fact, at a time when living mega-donors increasingly dominate that landscape and are giving away fortunes at the same time as they are generating them, critics are more frequently insisting that the way money is made be considered when we assess how it is given away. In this view, every name etched in stone becomes a site for potential protest. Every announcement of a major donation in the press provides an opportunity to cast light on the gap between philanthropic ambition and capitalist reality.

At the end of the book, Richard Sackler’s son David, who also served on the Purdue board, complains that the family’s generosity has been “turned against us.” In a way, he was right; Keefe’s Empire of Pain shows how the Sacklers, though it was certainly not their intent, have helped prime the public to follow the philanthropic money back to its source and to assert their prerogatives as recipients and beneficiaries. Many of us now read the plaque on the wall a bit more skeptically. What an irony that the cultivation of a more critically engaged philanthropic public could be one of the Sacklers’ most enduring legacies.

-Benjamin Soskis

Benjamin Soskis is co-editor of HistPhil and senior research associate at the Urban Institute’s Center on Nonprofits & Philanthropy.