Patrick Radden Keefe chronicles the Sackler family, whose pharmaceutical company Purdue Pharma created OxyContin and whose aggressive marketing sparked the opioid epidemic that has killed hundreds of thousands of Americans. Keefe, a staff writer at the New Yorker, traces the family from its origins with three brothers who built a pharmaceutical marketing empire to their descendants who inherited immense wealth and prestigious museum affiliations. The book examines how the Sacklers developed marketing techniques that blurred the line between education and promotion, how they minimized OxyContin's addictive potential while targeting doctors who would prescribe it liberally, and how they deflected blame onto patients even as overdose deaths mounted. Keefe gained access to internal documents and conducted extensive interviews to reconstruct how decisions were made and responsibilities evaded. The Sacklers' story illuminates broader themes: how wealth insulates from accountability, how corporations externalize costs onto communities, and how philanthropy can launder reputations without repairing harm. The book follows various protagonists--prosecutors, activists, survivors--who sought to hold the family accountable, leading to settlements that allowed the Sacklers to retain billions while declaring bankruptcy. Keefe writes with controlled outrage, letting documented facts build an indictment of a family that epitomizes impunity among the American elite.