Matt Hart

“Empire of Pain: The Secret History of the Sackler Dynasty” by Patrick Radden Keefe

Published 2021 by Doubleday Books
Pages: 452
ISBN-10 : 1529063108
Date Finished: April 13, 2022
How strongly I recommend it: 9/10
Find it at Amazon or Bookshop.org

I tore through this book, which is an impressive dissection of the opioid epidemic and the greedy family that unabashedly made billions of dollars from it.

My Notes:

High-end corporate attorneys like White are skilled professionals who enjoy a certain social respectability, but at the end of the day it's a client-driven business... You spend the first half of your career going after the bad guys and then the second half representing them.

One museum director likened the [Sackler] family to the Medicis, the noble clan in fifteenth-century Florence whose patronage of the arts helped give rise to the Renaissance. But whereas the Medicis made their fortune in banking, the precise origins of the Sacklers' wealth had, for a long time, been more mysterious.

Purdue Frederick was a drug manufacturer, which subsequently became known as Purdue Pharma. Based in Connecticut, it was the source of the vast majority of the Sackler fortune.

In 1996, Purdue had introduced a groundbreaking drug, a powerful opioid painkiller called OxyContin, which was heralded as a revolutionary way to treat chronic pain. The drug became one of the biggest blockbusters in pharmaceutical history, generating some $35 billion in revenue.

The attorney general of Massachusetts, who was also suing the Sacklers, maintained that "a single family made the choices that caused much of the opioid epidemic."

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.

As if electroshock therapy weren't bad enough, a far more severe technique was also coming into vogue: the lobotomy. This procedure, which involved severing nerves in the brain of a patient, appeared to alleviate psychological unrest. But it did so by, in effect, turning a light off in the brain. In overcrowded state hospitals like Creedmore, it was an attractive procedure, because it was quick and efficient. "Nothing to it," one doctor explained, demonstrating. how the procedure worked in 1952. "I take a sort of medical ice pick, push i into the brain, swiggle it around, cut the brain fibers like this, and that's it. The patient doesn't feel a thing." The procedure really was that quick. The patients were often on their way home a few hours later. You could spot them leaving the hospital, because they had black eyes. Some patients—many of them women—were lobotomized not for schizophrenia or psychosis but for depression. The procedure was irreversible, rendering people pliable by turning them into zombies.

This had become a mantra for Isaac. If you lose a fortune, you can always earn another, he pointed out. But if you lose your good name, you can never get it back.

Then, in the early 1940s, the introduction of penicillin ushered in a new era of antibiotics—powerful medications that can stop infections caused by bacteria. When the war broke out, the U.S. military needed greater quantities of penicillin to administer to the troops, and companies like Pfizer were enlisted to produce the drug. By the time the war ended, the business model of these chemical companies had forever changed: now they were mass-producing not just chemicals but finished drugs, which were ready for sale. Penicillin was a revolutionary medicine, but it wasn't patented, which meant that anyone could produce it. Because no company held a monopoly, it remained cheap and, thus, not particularly lucrative. So Pfizer, emboldened, began to hunt for other remedy that it could patent and sell at a higher price.

Seeing that physicians were most heavily influenced by their own peers, he enlisted prominent doctors to endorse his products. It was the equivalent, for physicians, of putting Mickey Mantle on a box of Wheaties. At Arthur's direction, drug companies cited scientific studies (which had often been underwritten by the companies themselves‚ as evidence of the efficacy and safety of each new drug.

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."

"The doctor is feted and courted by drug companies with the ardor of a spring love affair," one commentator observed. "The industry covets his soul and his prescription pad because he is in a unique economic position; he tells the consumer what to buy."

He worried about what he described as "an unwholesome entanglement" between the people who prescribe our medicines and the people who make and market them.

Working with Pfizer, he helped introduce one of the first forms of "native advertising"—as paid promotion that is camouflaged to resemble editorial content is known—when the company included a sixteen-page color supplement in the Sunday New York Times. (The Times later maintained that the supplement was "plainly labeled" as advertising but acknowledged that it was "intended to be taken as editorial matter by the casual reader.")

The article mentioned, in passing—as if this were not the whole point of the story—that Librium "may eventually have important human uses."

As Arthur's friend and secret business partner Bill Frohlich had observed, the commercial life span of a branded drug is the short interval between the point when you start marketing it and the point when you lose patent exclusivity. Roche and Arthur didn't need to fight off regulation forever, they just needed to hold it off until the patents had run out.

... "Dr. Sackler is quite particular about the use of his name" and preferred that he personally not be mentioned in any promotional announcements. At the same time, however, he wanted all the materials purchased with the fund to be identified as part of "the Sackler Collection at Columbia University." He desired posterity, but not publicity.

In the blunt assessment of his personal attorney, Michael Sonnenreich, "if you put your name on something it is not charity, it's philanthropy. You get something for it. If you want your name on it, it's a business deal."

And it looked so plausible, so real, with the special patina of authority conferred by eight MDs. The ad was polished , impressive, and fundamentally deceptive. It had been produced by Arthur Sackler's agency.

"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.

Over time, the crude origins of any given clan's largesse might be forgotten, and instead future generations would remember only the philanthropic legacy, prompted to do so by the family's name on some gallery, some wing, perhaps even on the building itself.

... Edward Warburg, fell ill, Arthur opened the suitcase he always carried, and it turned out to be so brimming with medications that Warburg joked it resembled "an apothecary shop.")

Their daughter, Denise, took Marietta's side and effectively cut her father off. She ended up legally changing her last name to Marika, a portmanteau of the first names of her mother and grandmother, Marietta and Frederika.

It was often said that Arthur Sackler made a fetish of privacy, but compared with Raymond, Arthur was an exhibitionist, with his keynote speeches and his column in the Medical Tribune.

In the Norwalk offices, he [Richard Sackler] was regarded as a bit of a. princeling, an entitled dilettante, who cycled through departments—R&D, medical, marketing, sales—and presented himself to more seasoned colleagues not as someone who was there to learn but as someone who was there to teach.

"He [Richard Sackler] wanted to become the next Merck or Lilly," Bart Cobert said. "But he didn't know how to do it, and he probably didn't know he didn't know how to do it."

By one estimate, the litigation over the estate cost the Sacklers more than $7 million. But the real figure was likely much higher. pg 168

So when a drug does work, and gets approved, and addresses a medical need in a way that no previously available product has been able to, pharmaceutical companies will often charge exorbitant prices for it. The consumer is paying not just for the costs of producing a bottle of pills but for all the trial and error that went into creating the drug in the first place.

In 1990, Kaiko sent Richard a memo. "MS Contin may eventually face such serious competition that other controlled-release opioids must be considered," he wrote. If Purdue was going to lose the monopoly on its flagship painkiller, perhaps it would be possible to use the Contin time-release system as a delivery mechanism for other opiods, in order to secure new patents.

The real innovation in MS Contin was not the morphine but the Contin system, so they had been talking about other drugs that could be used with that system.

Richard would have a different recollection of this pivotal moment in the company's history. "The project started in the late eighties," he said. According to Richard, it was Bob Kaiko's idea, not Kathe's. Indeed, in the 1990 memo, Kaiko had suggested oxycodone, saying that it was "less likely to initially have generic competition."

It was "imperative," Friedman told the Sacklers, "that we establish a literature" to support this kind of positioning. They would suggest OxyContin for "the broadest range of use."

At the turn of the nineteenth century, an apothecary's assistant in Prussia had conducted a series of experiments in which he managed to isolate the chemical alkaloids in opium and synthesize the drug. He named this new substance morphine, after Morpheus, from Greek mythology—the god of dreams.

A century earlier, Bayer had marketed heroin as morphine without the unpleasant side effects, even though heroin was actually more powerful than morphine and every bit as addictive.

But now, Bayer claimed, they had been decoupled, by science, and with heroin, humans could enjoy all the therapeutic benefits of the opium poppy, with none of the drawbacks. In fact, some people advocated using heroin as a cure for morphine addiction.
None of this had any basis in fact. In reality, heroin was roughly six times more powerful than morphine and just as habit forming.

You might suppose that Purdue would conduct tests of the addictive properties of its new drug.

But he also credited the "unparalleled teamwork" between Purdue Pharma and the FDA.
As for Curtis Wright, he had been giving some thought, lately, to leaving the federal government. After the approval for OxyContin went through, he resigned from the FDA. ... Barely a year later, he moved on, to a new position with Purdue Pharma, in Norwalk, with a first-year compensation package of nearly $400,000.

If a doctor was already treating a patient with another painkiller, the sales reps would persuade the doctor to switch to OxyContin. Even in cases where the painkiller the doctor was already prescribing was Purdue's own drug MS Contin, the reps would counsel switching to Oxy; the Sacklers' commitment to the new product was so absolute that they were prepared to phase out the old one.

The company established a speakers bureau, through which it paid several thousand doctors to attend medical conferences and deliver presentations about the merits of strong opioids. Doctors were offered all-expenses-paid trips to "pain management seminars" in places like Scottsdale, Arizona, and Boca Raton, Florida. In the initial five years after OxyContin's release, the company sponsored seven thousand of these seminars.

Portenoy himself would later acknowledge that until OxyContin "no other company had previously promoted an opioid drug as aggressively."

Often, reps would devise wily strategies for cadging a few minutes of a busy doctor's time, like showing up at midday with a take-out lunch, compliments of Purdue.
Physicians often scoff at the suggestion that their prescribing habits might be swayed by the blandishments of pharmaceutical companies. This had been a cornerstone of Arthur Sackler's worldview: the notion that doctors are priest-like figures, immune to flattery or temptation of greed, focused exclusively on the narrow dictates of appropriate medical care.

A 2016 study found that purchasing even a single meal with a value of $20 for a physician can be enough to change the way that he prescribes.

"We felt like we were doing a righteous thing," May [a sales rep] recalled. "There's millions of people in pain, and we have the solution."

In one 1997 exchange with Richard Sackler, a company official pointed out that many physicians believed, erroneously, that oxycodone was weaker than morphine, when in fact it was twice as strong, and said, "It is important that we be careful not to change the perception of physicians."

In the first year, Purdue sold $44 million of OxyContin. The following year, sales more than doubled. The year after that, they doubled again.

Eventually, Michael Friedman informed the Sacklers that the principal barrier to higher sales at this point was just "product supply." The company literally could not make OxyContin fast enough to sell it.

In theory, the Contin coating on each pill was supposed to prevent users from experiencing the full force of the drug's narcotic payload right away. But people had figured out that if you crush the pills—even if you just chewed them with your teeth—you could override the controlled-release mechanism and unleash a mammoth hit of pure oxycodone. It didn't 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:

One day in 1999, Michael Friedman emailed Richard [Sackler] to inform him that the drug was now generating $20 million a week. Richard wrote back immediately, at midnight, that this was "not so great." They could do better. "Blah, humbug," he wrote. "Yawn."

Richard Sackler himself would later testify under oath that the first time he ever heard of OxyContin being diverted or abused was "early in the year 2000." This was not true. In fact, Purdue had been receiving notes from its own sales force, dating as far back as 1997, not long after the initial launch of OxyContin, informing the company that abuse was happening.

Some participants had said that "the only difference between heroin and OxyContin is that you can get OxyContin from a doctor."

But prescribing a pill on a twelve-hour schedule when, for many patients, it works for only eight is a recipe for withdrawal and precisely the sorts of "peaks and troughs" that Purdue's sales reps claimed OxyConton avoided. It is a recipe, in other words, for addiction.

Before heading in to work at her desk outside Howard Udell's office on the ninth floor at Purdue, with its regal purpal carpet, Martha West would crush one of her OxyConton pills and snort it.

[Robin] Hogen was a man with the sort of brash confidence to threaten a state attorney general in a voice mail.

Before long, Udell was spending $3 million a month on litigation. But it was worth it.
Lawyers, not unlike physicians, like to tell themselves that they swear an oath and answer to a code, that they are members of a professional tribe that is undiluted by improper influence. ... realistically, the practice of law can be heavily influenced by the subtle pressures of coterie politics, and if a client has the finances to buy that kind of influence, it can be enough to tip a case in his favor.

Shortly after Rudolph Giuliani stepped down from his position as mayor of New York City, he went into business as a consultant, and one of his first clients was Purdue.

Early in 2001, the U.S. Attorney for eastern Kentucky, Joe Famularo, had characterized OxyContin as a "locust plague" that was rolling through his state. Later that year, he started working as an unpaid "consultant" for Purdue, though the company paid his expenses associated with speaking at conferences. Upon reflection, Famularo announced, that he didn't think OxyContin was a locust plague at all, but rather "a fine product."

But one compelling aspect of the argument that Purdue made for itself was that it was not some solitary corporate behemoth motivated by a selfish desire to continue reaping billions from a dangerous drug. On the contrary, Purdue was driven solely by a sincere—and, really, selfless—duty to help patients who were suffering from chronic pain.

This was a tactic that had been pioneered by the fossil fuel industry, to very successful effect—funding groups that appeared to be grassroots organizations but that actually were awash in corporate money: "astroturf" groups, as they are sometimes called. These organizations produce studies and lobbied agencies and lawmakers.

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."

In an effort to tilt the media narrative, Udell also hired an outside public relations specialist named Eric Dezenhall. A political operative turned "crisis management" mercenary, Dezenhall had developed a specialty in the dark arts of killing unfavorable media stories and "placing" favorable ones.

"In terms of narcotic firepower, OxyContin was a nuclear weapon," Meier wrote. [New York Times journalist]

During the months he spent working on Pain Killer, Barry Meier had not been publishing articles about OxyContin in the newspaper. But after the radio host Rush Limbaugh confessed, in the fall of 2003, that he had developed an addiction to OxyContin and other painkillers that had been prescribed to him for back pain, Meier wrote an article about the episode. With the book done and out, it appeared that he was back on the beat. ... Back in 2001, Udell had tried to go over Meier's head, arriving at the Times newsroom with a small posse of Purdue officials, to appeal directly to Meier's bosses. ..."they blew us off"...

Now, with the Times weakened [by the Jayson Blair affair] and Okrent looking for fodder in his new role, Udell and his war council saw an opportunity. They appealed directly to Okrent, making an appointment to see him and crowding his into his little office on the fifteenth floor at the Times. ...Anything Meier wrote in the paper was effectively jst advertising for the book, Udell contended.... Udell asserted that the publication of Pain Killer represented an egregious conflict.

"You're not going to write about opioids," Al Siegal told Meier. The Times as taking him off the story. Much later, Okrent would point to the fact that he was still new to his position at the Times when he wrote the column about Purdue, and acknowledge[d] that he has often wondered, in the years since, "whether I made a mistake." Meier was furios—"batshit," Okrent said.

Purdue had no evidence to suggest that OxyContin was less prone to abuse than other painkillers, yet the FDA allowed the company to make the claim. Then the sales reps proceeded to engineer the great con. Field notes from the sales force documented reps telling doctors and pharmacists, again and again, that there was no buzz with OxyContin, there were fewer peaks and troughs, and less than 1 percent of users became addicted... 'We had a few bad eggs.'...

Purdue turned over videotapes showing their own instructional sessions for the sales force, in which company supervisors explicitly encouraged them to make claims that Purdue officials knew were not true. Brownlee was agog. "They literally were training people to lie about the product."

Even Purdue's claims about its own noble contributions in alleviating pain turned out, in many instances, to be bogus. Back in the 1950s, Arthur had produced the advertisement for Sigmamycin with the real looking business cards of physicians who had supposedly endorsed the product, and John Lear, the Saturday Review journalist, discovered that the doctors did not exist.

For the Sacklers, the suggestion had always been that there is a simple taxonomy—patients on the one hand, abusers on the other—and that legitimate pain patients do not become addicted to OxyContin. But some patients did become addicted, even patients who appeared in Purdue's own promotional videos.

He [Mortimer Sackler] was knighted by the British queen, in 1999, as Raymond had been several years earlier.

"The conspirators trained Purdue's sales force, and provided them with training and marketing materials" to make fraudulent claims, the memo asserted. The sworn testimony of Friedman, Goldenheim, and Udell was flatly contradicted by the company's own documents, the report noted. The prosecutors did not mince words: the Purdue executives had testified "falsely and fraudulently" to Congress.

The prosecution memo told the story of an intricate, years-long, extraordinarily profitable criminal conspiracy. The company's records indicated that Purdue had already sold more than $9 billion of OxyContin.

It was an orphan directive: a backroom deal for which none of these former public servants would take responsibility. This was "a political outcome that Purdue bought," one former Justice official who was involved in the case said.

"Purdue Pharma acknowledged in the court proceeding today that 'with the intent to defraud or mislead,' it marketed and promoted OxyContin as a drug that was less addictive, less subject to abuse and less likely to cause other narcotic side effects than other pain medications," Meier wrote in the Times. But the subtext of his dispatch was clear. I told you so. Fuck you.

Skolek spoke about how her daughter had been prescribed OxyContin in January 2020 and died four months later. "She left behind her son, who was six years old at the time of her death," Skolek said. "Brian is here in the courtroom with me today because he needed to see that bad things do happen to bad people." Turning to Friedman, Goldenheim, and Udell, Skolek told the men that they were "sheer evil."

Friedman, Goldenheim, and Udell "took responsibility on themselves and pleaded guilty," Kathe Sackler would later say. In doing so, they were ensuring that the family would not be implicated. "Those three guys basically took the hit for the family, because the family was going to take care of them," Gary Ritchie, who spent eleven years at Purdue as a chemist, recalled. "'Keep yourself out of prison; we'll take care of you off the books.' That's how they did business." he said.

In a subsequent congressional hearing at which John Brownlee testified about the case, Arlen Specter, the Republican senator from Pennsylvania, remarked that when the government fines corporations, rather than sending executives to jail, it amounts to "expensive licenses for criminal misconduct." And this appears to be the way that the sanction against Purdue was perceived by the Sacklers and their executives.

When Richard Sackler was later asked, under oath, whether there had been anything in the document, in the way of corporate misconduct, that surprised him, he seemed curiously unprepared to answer.

"I can't say," Richard replied.

"As we sit here today, have you ever tried to read the entire document?" an attorney asked.

"No," said Richard Sackler.

It is cliche to observe that in any family dynasty in which great wealth is created, the second generation is often less impressive than the first. But it was precisely this though that often struck those who had occasion, in a social or professional milieu, to interact with the younger Mortimer Sackler

And there was Morimer, by her [Jacqueline] side at one catered function after another, looking coddled and vacant-eyed, like the kind of well-upholstered young man who seems untroubled by the possibility that his only real distinction in life might be his money.

Annual revenues for OxyContin continued to soar, and in the aftermath of the criminal case in Virginia, they reached a new high, of $3 billion. Having faced down a potentially mortal threat to its existence, OxyContin was booming. And it wasn't that Purdue kept selling the drug. The company continued to engage in the very same aggressive marketing tactics that it had vowed to put an end to.

To the degree that the Sacklers were forced to address this rising tide of misery and death, they tended to treat it as a business problem, one of a number of "pressures" that their company was facing.

The tremendous potency of Oxy led to its reputation as "heroin in a pill." When it first became popular as a recreational high in Appalachia, OxyContin acquired the nickname hillbilly heroin. So, it might have been only logical that when they could no longer count on OxyContin, people who already had an opioid use disorder would make the short segue to heroin itself.

"The reason heroin happened is because the whole OxyContin deal fell apart." In 2019, a team of economists from Notre Dame, Boston University, and the National Bureau of Economics Research published a dense research paper on the timing of the "rapid rise in the heroin death rate" in the years since 2010. The title of the paper was "How the Reformulation of OxyContin Ignited the Heroin Epidemic."

One unadvertised hazard in the life of a plutocrat is that the people around you can be prone to yes-man sycophancy. In theory, you should be able to avail yourself of state-of-the-art counsel. But instead, you often get lousy advice, because your courtiers are careful to tell you only what they think you want to hear.

The opioid crisis is, among other things, a parable about the awesome capability of private industry to subvert public institutions.

David Sackler agreed. The fundamental problem, he thought, wasn't anything that Purdue or the family had done but rather the narrative. "We have not done a good job of talking about this," he would say. "That's what I regret most." The family had a compelling story to tell, David thought. Rather than cowering defensively, they should come out swinging and tell it.

At a certain point, David and Joss decided to sell their New York apartment on East Sixty-Sixth Street and move to Florida. "I'm not a fearful person," Joss said, invoking her mountaineering bona fides. "If K2 doesn't scare me, Florida does not scare me." (She had not climbed K2.) "Sacklers Fleeing NYC," the gossip columns blared.

The story had reached a tipping point. The late-night host Stephen Colbert did a segment on the Sacklers, joking that they had amended the Hippocratic oath to "First, do no harm. Unless harming is incredibly profitable." He displayed a photograph of Richard, Jonathon, Raymond, and Beverly, "seen here not giving a fuck."

Oliver told viewers that he had set up a website, sacklergallery.com , where they could watch more of these clips. He'd chosen the web address, he said, because "they love having their name on fucking galleries."

The concept that David and his team outlined was that the Sacklers would relinquish control of Purdue and turn the company into a public trust, and the family would donate a large sum of money to address the opioid crisis. In exchange, the Sacklers would be granted immunity from "all potential federal liability" related to OxyContin. It was a grand bargain, a single negotiated pact that would resolve all of the cases at once and deliver the Sacklers the peace of mind of knowing that they would not spend the rest of their lives in litigation.

So the personal contribution of the Sacklers would be not $10 billion (much less $12 billion) but $3 billion.

There was also one very notable nonmonetary provisions. Under the terms of the deal that David Sackler offered, his family would admit to no wrongdoing whatsoever.

The recalcitrance left the negotiator son the plantiff's side feeling openly disgusted. "I think they are a group of sanctimonious billionaires who lied and cheated so they could make a handsome profit." Pennsylvania's attorney general, Josh Shapiro, said. "I truly believe that they have blood on their hands."

And if Purdue did go bankrupt, it would leave virtually every state and all the other entities that had filed suit against the company with no choice but to fight over its remaining assets in bankruptcy court. Take the money now, Mary Jo White warned, or the alternative would be to "pay attorneys' fees for years and years and years to come."

"The Sacklers have done a pretty good job of sucking the life out of Purdue," she said. "Year after year, month after month, they were draining hundreds of millions of dollars." All that was left at this point, she said, was "essentially a shell."

One major sticking point for the Democratic prosecutors was that Purdue might be crying poverty, but the Sacklers remained one of the wealthiest families in the United States.

The Sackler fortune was dispersed in a vast global web of hundreds of shell companies and trusts and LLCs, many of them established in tax havens and jurisdictions with powerful bank secrecy laws. The structure of their financial arrangements could seem deliberately obscure, with an infinity of anonymous corporate entities, all nested like Matryoshka dolls.

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.

"The Sacklers want the backruptcy court to stop our lawsuits so they can keep the billions of dollars they pocketed from OxyContin and walk away without ever being held accountable," Healey said. "That's unacceptable."

Purdue had created a generation of people who were addicted to opioids, through the careful and relentless cultivation of demand for the drug.

As they sought to hide from a historic crisis of their own creation, the Sacklers could sometimes seem like Pandora, gazing, slack-jawed, at the momentous downstream consequences of their own decisions. They told the world, and themselves, that the jar was full of blessings, that it was a gift from the gods. Then they opened it, and they were wrong.

The family sent Tufts a letter accusing the university of breach of contract. It was a graphic measure of the Sacklers' vanity, and of their pathological denial, that the family was prepared to debase itself by trying to force its name back onto a university where the student body had said, quite explicitly, that they found it morally repugnant. But the administrators at Tufts held firm.

A mother from California, Barbara Van Rooyan, spoke about losing her son, Patrick, after he took a single OxyContin pill and stopped breathing, in 2004.

“A lot of Americans got addicted to OxyContin,” Krishnamoorthi said, "I would submit, sir, that you and your family are addicted to money."

"I think Upton Sinclair once wrote that a man has difficulty understanding something if his salary depends on his not understanding." He continued, his voice soft and deliberate, "Watching you testify makes my blood boil. I'm not sure that I'm aware of any family in America that's more evil than your."

But it seemed like more than a coincidence that Goldin, Kapler, and I had all had the same experience. When I asked Purdue Pharma about this survaeillance, the company emphatically denied having any knowledge of it. When I posed the question to the Sacklers, a family representative made no similar denial, and instead declined to comment.

It was a measure of Clare's moxie that he marked all of these letters "Confidential, Off-the-Record, Not for Publication or Attribution," even though anyone with even a passing knowledge of how journalism works would know that he would need my agreement for such a condition, and that unilateral pronouncements are meaningless, even in bold type.

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