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Authors State ‘It’s Time to Rethink Medical Innovation’

— May 1, 2019

Deceptive marketing isn’t new. The Sacklers have been at it for some time.

There are more than two dozen states suing Purdue Pharma, the manufacturer of OxyContin, for “the harm they inflicted in our state” in contributing to the opioid crisis. The case against the Sacklers and their company is centered on the pursuit of profit at the expense of the public’s health.  “Although the Sackler family did not invent the practice of selling drugs to physicians, they were pioneers whose story illustrates the ways marketers developed, naturalized, and monetized the interface between the pharmaceutical industry and prescribing physicians,” state authors Scott H. Podolsky, M.D., David Herzberg, Ph.D., and Jeremy A. Greene, M.D., Ph.D. in a recent article published in the New England Journal of Medicine.

It all started at Pfizer.  Under Author Sackler’s guidance, Pfizer increased its drug sales force from 8 “detail men” in 1950 to 2000 by 1957.  Internal memos revealed the marketing campaigns for Terramycin and Tetracyn (tetracycline) “were conducted like military campaigns and described in the language of combat,” the authors contend.  “Doctors in nearly every specialty were persuaded to consider conditions ranging from upper respiratory infections to urinary tract infections as necessitating antibiotics.  The ‘prey’ described in an internal Pfizer sales document from 1954 entitled ‘Easy Prey for Terramycin’ referred not to the microbes Terramycin killed, but the prescribing physicians whose behavior could easily be swayed by marketing tactics.”

The authors further state, “Many of the promotional techniques now commonplace in prescription-drug marketing — detailing, free samples, free food and drink, flashy journal advertising and mailings — were perfected by Pfizer and its competitors in the crucible of the broad-spectrum antibiotic marketing wars.”

Photo by Kaleidico on Unsplash

The Medical Advertising Hall of Fame declared in 1998, “No single individual did more to shape the character of medical advertising than the multi-talented Dr. Arthur Sackler.  His seminal contribution was bringing the full power of advertising and promotion to pharmaceutical marketing.”

“Pharmaceutical advertising has made one of the major contributions in the rapid dissemination of new therapeutic information,” Arthur Sackler said himself in 1957. “There are fascinating case histories of wonderful medications inadequately used and only applied to a small percentage of those patients who require them.”

In 1995, just prior to Arthur Sackler’s induction into the Medical Advertising Hall of Fame, Purdue launched OxyContin, and the company began pursuing aggressive approaches to educating physicians about the use of opioids for noncancer pain.

At the same time, the Sacklers were deflecting the addiction problem from themselves to those who abused their drug.  “We have to hammer on abusers in every way possible.  They are the culprits and the problem.  They are reckless criminals,” Richard Sackler said in an email.  In 2007, Purdue even pleaded guilty to misleading medical professionals and the public about the addictive side effects of Oxycontin.

“From the 1950s onward, therapeutic reformers have asked the medical profession to create barriers between pharmaceutical marketing and physician education, whether in journals, grand rounds, or formal continuing medical education.  Meanwhile, pharmaceutical marketing to clinicians marches on: from 1997 to 2016, spending increased from $15.6 billion to $20.3 billion, including $5.6 billion for drug detailing, $13.5 billion for drug samples, $979 million for direct physician payments, and $59 million for disease education.  In the case of OxyContin and its competitors, ‘education’ programs also included public relations campaigns that exploited and repurposed an existing reform effort to increase physicians’ responsiveness to people suffering from pain,” the authors state.

The bottom line?  As the article suggests, “Perhaps it is time to rethink our approach to medical innovation itself and ask whether a marketing model is even the right means for promoting the value of new therapeutic products.”


Preying on Prescribers (and Their Patients) — Pharmaceutical Marketing, Iatrogenic Epidemics, and the Sackler Legacy

Sacklers Want Everyone to Believe Addicts are the Real Problem

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