Tuesday, December 12, 2017

The dark magic of the market – – OxyContin edition

[The New Yorker piece, "The Family That Built an Empire of Pain” by Patrick Radden Keefe is an extraordinary piece of longform journalism and you should take the time to read the whole thing, particularly if you have any interest in scientific research, healthcare, and the second coming of the gilded age. I'm not going to attempt any kind of comprehensive summary (like I said, just read it), but I am going to do a few blog post highlighting some points that jump out at me.]

One of the most pernicious ideas of the past few decades is that markets are both magical and moral, that simply removing government oversight and unleashing market forces would always, automatically improve everything. This is, at best, a questionable approach, but it becomes absolutely disastrous when selectively applied. Removing certain regulations while keeping in place anticompetitive rules and government granted monopolies such as patents and copyrights produces a worst of both worlds scenario (at least for the consumer).

While the roots of this philosophy are complex and long-standing, its success can be explained in large part, perhaps even almost entirely, by the way it was subsidized by interested parties. Industries that stand to make windfall profits and billionaires with an ideological ax to grind (huge overlap in these two) pour stunning amounts of money into biased and often worthless academic research, fake institutes and think tanks that start with their conclusions and work backwards, and propaganda/lobbying operations that build themselves as educational foundations. You would have to put scare quotes around every other word to do this justice.

In this particular instance, the single-minded pursuit of optimal profit, rather than serving the social good, corrupted the process and inflicted a huge toll.[emphasis added.]
A 1995 memo sent to the launch team emphasized that the company did “not want to niche” OxyContin just for cancer pain. A primary objective in Purdue’s 2002 budget plan was to “broaden” the use of OxyContin for pain management. As May put it, “What Purdue did really well was target physicians, like general practitioners, who were not pain specialists.” In its internal literature, Purdue similarly spoke of reaching patients who were “opioid naïve.” Because OxyContin was so powerful and potentially addictive, David Kessler told me, from a public-health standpoint “the goal should have been to sell the least dose of the drug to the smallest number of patients.” But this approach was at odds with the competitive imperatives of a pharmaceutical company, he continued. So Purdue set out to do exactly the opposite.

Sales reps, May told me, received training in “overcoming objections” from clinicians. If a doctor inquired about addiction, May had a talking point ready. “ ‘The delivery system is believed to reduce the abuse liability of the drug,’ ” he recited to me, with a rueful laugh. “Those were the specific words. I can still remember, all these years later.” He went on, “I found out pretty fast that it wasn’t true.” In 2002, a sales manager from the company, William Gergely, told a state investigator in Florida that Purdue executives “told us to say things like it is ‘virtually’ non-addicting.”

May didn’t ask doctors simply to take his word on OxyContin; he presented them with studies and literature provided by other physicians. Purdue had a speakers’ bureau, and it paid several thousand clinicians to attend medical conferences and deliver presentations about the merits of the drug. Doctors were offered all-expenses-paid trips to pain-management seminars in places like Boca Raton. Such spending was worth the investment: internal Purdue records indicate that doctors who attended these seminars in 1996 wrote OxyContin prescriptions more than twice as often as those who didn’t. The company advertised in medical journals, sponsored Web sites about chronic pain, and distributed a dizzying variety of OxyContin swag: fishing hats, plush toys, luggage tags. Purdue also produced promotional videos featuring satisfied patients—like a construction worker who talked about how OxyContin had eased his chronic back pain, allowing him to return to work. The videos, which also included testimonials from pain specialists, were sent to tens of thousands of doctors. The marketing of OxyContin relied on an empirical circularity: the company convinced doctors of the drug’s safety with literature that had been produced by doctors who were paid, or funded, by the company.

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