The result’s a withering and encyclopedic indictment of a drug trade that usually appears to prioritize earnings over sufferers. Over 550 densely packed pages, Posner tells a tireless and sometimes tiring story that reads like a pharmaceutical model of cops and robbers. There are chapters on the invention and popularization of medication for nervousness, for menopause, for ache administration — every following an analogous narrative arc. First, the writer exposes how drug corporations pushed medical, moral and authorized boundaries, typically inflicting extra public hurt than well being profit. Then he describes lawmakers and regulators scrambling to catch up and rein within the drugmakers. And repeat.
One of essentially the most telling episodes entails antibiotics. The mass manufacturing of penicillin throughout World War II helped pharmaceutical corporations throw off their reputations as addictive drug pushers and rebrand themselves as producers of revolutionary, lifesaving merchandise. The drugmakers additionally reaped huge earnings from penicillin. And they have been keen to earn much more, “Pharma” explains, by patenting broad-spectrum antibiotics that may be used for all types of well being situations. It was a retro technique, harking again to the cure-all claims the businesses had made a long time earlier to promote narcotics like morphine. And it labored.
Posner recounts what number of docs got here to view tremendous antibiotics as their medicine of selection — not just for confirmed makes use of like treating bacterial infections, however “even prophylactically at the first signs of a fever, earache, scratchy throat or runny nose.” One researcher, he writes, “estimated that overenthusiasm about the new drugs meant they were prescribed unnecessarily more than 90 percent of the time.” That overeagerness drowned out troubling studies of allergic reactions to the medicine, fungal infections and the dangers of antibiotic resistance. But the Food and Drug Administration, established in 1906 to oversee product security, didn’t intervene, Posner notes, as a result of its commissioner on the time didn’t need to be seen as an impediment to lifesaving medicines.
By 1950, prescription drugs had turned essentially the most worthwhile trade within the United States. But the mass adoption of antibiotic “wonder drugs” had opened a schism. Industry veterans, together with the chief government of Merck, insisted that medicines must be developed for individuals first, not for revenue. Upstarts like John McKeen, the chairman of Pfizer, Posner writes, took the other view, arguing that it was not value investing in medicine that might not generate substantial income.
In 1951, McKeen determined to use the launch of Terramycin, the corporate’s new broad-spectrum antibiotic, to develop a playbook for making a blockbuster drug. For that he turned to Arthur M. Sackler, a hard-charging promoting government who had skilled as a physician — and who a long time later would change into often known as one of many three brothers behind Purdue Pharma, the developer of OxyContin, the painkiller on the middle of the present opioid abuse epidemic.
McKeen allotted $7.5 million for the Terramycin marketing campaign, an unheard-of sum for medical advertising on the time. Sackler used the funds for a novel saturation-marketing marketing campaign, adapting Madison Avenue’s strategies for promoting client items for his personal “Medicine Avenue” promoting strategies. Along the way in which, Sackler additionally reset the moral boundaries of medical advertising. “Pharma” reveals how he began one firm to plant drug promotions, disguised as articles, in widespread newspapers and magazines — and co-founded another company, IMS Health, to monitor docs’ prescribing habits the higher to affect them. It exhibits how the advertising maverick employed and co-opted a director of the F.D.A.’s antibiotics division to help unproven medical concepts favorable to the trade. And it exposes a deceptive Sackler-produced promoting marketing campaign that used pretend docs to promote precarious combos of antibiotics.
Sacklers’s aggressive, and sometimes transgressive, advertising strategies would radically remake the drug trade, contributing over the a long time to the overprescription of medication like Valium, menopause treatments, painkillers and antidepressants, in the end leading to untold well being harms. Indeed, Purdue Pharma, the drug firm owned by the Sackler brothers, tailored these affect strategies within the 1990s to deceptively market OxyContin, an opioid with a slow-release mechanism, Posner writes.