identify that and might be influenced by what they read.”
If all that wasn’t sufficiently damning, the Baystate Medical Center in Springfield, Massachusetts, revealed that Scott S. Reuben, its highly influential former physician in charge of acute pain treatment, fabricated data from twenty-one medical studies that claimed to show the benefits of painkillers like Vioxx and Celebrex. “The pharmas are in big trouble in terms of credibility,” said Rob Frankel, a brand consultant who focuses on medical industries. “They’re just above Congress and used-car salesmen.”
THIRTY YEARS AGO NOBODY discussed the principal motive behind scientific research: nobody needed to. It was a quest for knowledge. Today, the default assumption is that money matters most of all, and people tend to see science through the prism of commerce. At least until Viagra was introduced, and endorsed on television by Bob Dole, a former candidate for the presidency, no drug had been marketed more successfully than Vioxx. In 2000, the year after it first appeared, Merck spent $160 million advertising their painkiller. They were able to do that thanks to the advent, just three years before, of direct-to-consumer advertising. Only two countries allowed pharmaceutical companies to advertise prescription drugs directly to consumers: New Zealand and the United States.
In America, such ads virtually always consist of glossy promotional materials used to announce major medical advances. (The federal government requires that they include tiny print “information” presented in medical jargon, the meaning of which, for most consumers, is nearly impossible to understand.) These advertisements are not really intended to educate patients, nor to help them become more sophisticated about their own health. They are purely an attempt to get doctors to fill more prescriptions, and they work with stunning regularity. “Blockbuster” drugs like Vioxx, Viagra, and the cholesterol medicine Lipitor can become a multinational corporation’s central source of income.
Our regulatory system encourages companies to invest in marketing, not in research: in the United States, a new drug typically takes a decade to develop and costs hundreds of millions of dollars. With stakes that high, and lawsuits waiting for any company that commits even the smallest error, pharmaceutical firms are far more likely to profit from aggressive sales of products that are already available than from introducing anything new. One reason the ads succeed is that it is nearly impossible to spend a day without seeing one or more major drugs advertised on television. (Another reason is the amount of money companies spend. The marketing budget for AstraZeneca’s heartburn pill Nexium, a sure moneymaker, is bigger than the comparable budget for Budweiser beer.)
Rheumatoid arthritis afflicts more than two million Americans, and it can be devastating. Many of those people were overjoyed when advertisements for Vioxx began blanketing the airwaves in 1999. Suddenly, men who couldn’t bend over were tying their shoes again, walking dogs, and regaining lives that slowly had been consumed by pain. Dorothy Hamill skated across millions of television screens on behalf of Vioxx, overcoming arthritis and moving with the nimble certainty of a teenager at the Olympics. “People dancing in the streets, twirling their partners in joy,” Topol said. “That’s all anybody ever saw.” Go talk to your doctor about Vioxx, the ad would say. And people did, by the millions. In 1996, American pharmaceutical companies spent $11.4 billion on direct advertisements; by 2005 the figure was more than $29 billion. Doctors were overwhelmed with requests, and for the most part were only too happy to comply, writing nearly one hundred million prescriptions for Vioxx alone between 1999 and 2004.
The words “ask your doctor” have become code for “change your prescription.” Often, what people ended up with was no
Learning to Kill: Stories