When I was a new medical resident in the 1980s, I looked forward to free lunches several times a week sponsored by various pharmaceutical companies. It would usually be pizza or sandwiches, followed by complementary education about a particular product the drug company was detailing. We would also get little gifts, like pens or EKG calipers to thank us for coming. This practice stopped years ago, when it became apparent that it represented undue influence, even on a small scale.
I remembered those sandwiches when I read coverage of a bankruptcy trial featuring Raymond Sackler, the scion of the infamous Sackler family, who has made untold billions of dollars while contributing to the opioid epidemic. His company, Purdue Pharma, makes OxyContin, one of the most abused and powerful painkillers available.
In Empire of Pain: The Secret History of the Sackler Dynasty, author Patrick Radden Keefe describes the way the company aggressively told physicians about how pain control was possible with OxyContin without addiction and pushed more expensive high doses of the drug which they argued was needed for pain control. There is no denying the importance of pain control. But like all medications, safe practices must be employed. Purdue continued its marketing tactics even after they knew the dangers of OxyContin. They paid large amounts of money to so-called physician thought leaders to influence doctors’ prescribing habits.
The Sackler family kept accumulating wealth, and kept a high public profile focused on their charitable giving, and away from the source of the mone. They gave millions to put their name on such institutions as the Sackler Wing at the Smithsonian, and the Sackler School of Medicine in Tel Aviv.
I regret that medical doctors are not without blame. Many high prescribers took paid vacations and gifts from Purdue. Others gave lectures that were labeled as academic, but were ghost written by pharma. This practice continues to this day with other drugs.
As a result of the OxyContin debacle, prescribing habits have changed significantly in recent years. The Food and Drug Administration (FDA) has created a database of important information or warnings that every licensed physician must query before any narcotic can be prescribed. This has dramatically limited the use of prescription painkillers.
But the health care industry needs pharmaceutical companies. Their products often are key to better patient outcomes. For example, a positive story was in the news this week about a drug called empaglifoxin (Jardiace), which along with dapaglifixin (Farxiga), became the second drug the FDA has approved for congestive heart failure. It will likely be an important medication in the arsenal to treat this condition, which can occur when the body retains fluid after the heart has been damaged. Traditional therapies often work well, but many people with CHF still suffer from chronic shortness of breath or die, and new treatment is needed. As a cardiologist, I am grateful for this work by the pharmaceutical industry as it potentially will improve treatment and care for my patients.
This dichotomy between the potential harm and good that pharmaceutical research can bring is striking. Research is both necessary and expensive. Many drugs prove to not be useful after they are rigorously tested. This results in huge financial losses. The research process can also result in enormous financial rewards if a trial confirms a drug’s efficacy. Once a medication is FDA approved, it is up to the individual companies to promote and market it.
The actions of Purdue Pharma demonstrate how aggressive and slanted marketing can lead to dangerous outcomes. We as medical professionals have the responsibility to ensure that the process of developing, prescribing, and administering drugs does not cause harm. Cases like that of Purdue illustrate how the present process can go wrong.
David Becker is a frequent Inquirer contributor and a board-certified cardiologist with Chestnut Hill Temple Cardiology in Flourtown. He has been in practice for more than 25 years.