The Sackler Legacy: Pharmaceutical Marketing Strategies and Blockbuster Drugs

You know, occasionally we start to read the literature and then we're stopped short with a feeling somewhere deep in our viscera that this just is not right. And I was so moved just recently, early in the morning, when I was reading my recent issue of the New England Journal of Medicine. I think all of us are, when we would have read or heard about this article entitled Preying on Prescribers and Their Patients, Pharmaceutical Marketing, Iatrogenic Epidemics and the Sackler Legacy. I'm not going to spend a whole bunch of time with the details of this, other than just to give the context of why I think this is such an important thing for us to consider. This is in the May 5 issue of 2019 in the New England Journal of Medicine. And as you probably know, the Sackler legacy lives on. If you've gone through the New York Museum Art, you know about the Sackler's contribution philanthropically to arts. You also know probably that he was a very noteworthy psychiatrist who played a very significant role in the development of the modern pharmaceutical industry. And you recall that it's really not that long ago. It's in the lifetime, certainly of my parents, where the modern pharmaceutical era was born with the development of antibiotics, when many of the chemical companies, one being Pfizer, came across from being a chemical company to using their fermentation tanks to not just produce citric acid as a chemical, but to produce antibiotics. And the era of modern pharmaceutical medicine was born through antibiotics. And these companies did really an interesting job in trying to find a way for their product and eventually, as you know, introduced really very effective advertising. They didn't have direct to consumer advertising back in those days, but they started to enlist the talents of Madison Avenue in New York. And this is one of the legacies that Sackler, through his work at Pfizer, was capable of of implementing into the pharmaceutical industry. So it started to develop the perception of need for antibiotics, and antibiotics became more and more frequently used and for conditions often that weren't even really susceptible to treatment with antibiotics. But they become the therapy du jour for medicine, and they were heavily promoted and became the first major advertising success stories for the pharmaceutical industry. It's interesting that, as you know, the Sackler family then bought a very interesting small pharmaceutical company as part of their activities within the pharmaceutical industry. That was for the Purdue Group that, as you know, is OxyContin, and from that then were able to transfer their successes in advertising and the experience they had in the development of the foundation of promotion of pharmaceuticals into the promotion of these what now we recognize are very addictive drugs. And as a consequence, this model then grew up to build this very small company into a very powerful financial juggernaut. And this particular Purdue production of these pain remedies through proper and very effective advertising to physicians and their readily availability for all sorts of things that we're not designed to really treat, which would be acute cancer pain became very common in the marketplace and ultimately became the problem that we see today producing epidemic adverse effects in our population in creating more deaths than traffic accidents or even war dead in Vietnam. So I think that this construct of how we communicate information and how it ultimately ends up in manipulating people's behavior patterns and their belief systems is just as important in medicine as it is in any other field, and maybe even more so in medicine. And I think when you read this editorial that appeared in the New England Journal of Medicine, you've come to recognize how powerful advertising has been in manipulating doctors. Not even talking yet about direct to consumer medical pharmaceutical advertising, which is certainly effective in manipulating consumers as well. But I think that this story is a story that needs to really be looked at very seriously, because we are certainly quick to point fingers at individuals that are saying things that don't appear well grounded in science and are not properly vetted with the appropriate bodies of distinction. But yet at the same time, these same bodies are allowing this kind of advertising and promotion to occur that is certainly deleterious to the health and well being of literally hundreds of thousands of people. So I think one needs to be very cautious about how quick we are to criticize and start looking internally at our own methods of communication and what is truth, what are the foundations of fact? And how do we take the profit motive out of medicine to make it delivering the value service to individuals that are expected. So I suggest this is a good read for those of you not familiar with this editorial in the New England Journal of Medicine. It's a watchword for all of us.