The Pharmaceutical Industry

PHARMA:  GREED, LIES AND THE POISONING OF AMERICA BY GERALD POSNER
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This is a blistering indictment of the pharmaceutical industry focused especially on the deadly scandal of OxyContin and the Sackler family which pulled it off.

There aren’t many heroes in this book and villains abound.  The Sackler’s, of course; weak-kneed administrators in the FDA; and Rudy Giuliani, who ended up being the Sackler’s lawyer after he had the mayor position in New York.

It’s amazing to me how I failed to penetrate the severity of the opioid OxyContin crisis.  By 2015, opioid prescription rates were triple the number dispensed in 1999.  Enough OxyContin was prescribed that year to medicate every American for nearly a month, and it killed more people than had fatal car crashes and guns combined; 52,000.

The claims made on label and in detailing OxyContin were plain lies and the executives knew it.  Seventy-five percent of the $400 million spent on marketing OxyContin came after the year 2000, when executives first acknowledged knowing about the abuse.  

The premise of OxyContin’s differentiated position was that it would last for 12 hours and did not require repeat dosage as other similarly effective pain relievers did.  It counted on its slow-release coating to achieve that.  They also claimed that the slow-release coating meant that it would not produce the “highs” that could lead to addiction.  This claim was made despite the fact that a third of the subjects in their trials needed another dose to offset pain before 12 hours expired.  Not only that, addicted people learned to scrape the delayed coating off the tablet to get a quicker release and a high.

The Sackler’s made billions off OxyContin.  Particularly staggering to me was the fact they continued to promote the drug illegally after they had made a full-throated confession of guilt and had signed a consent order with the FDA in 2007.

The case that will determine how much money they will end up paying is still in the courts.  Nobody has gone to jail, despite all these deaths.

Stepping back, "Pharma" is not a well-balanced history of the pharmaceutical industry.  While it does, in the early pages, give credit to the breakthroughs that occurred in penicillin and other antibiotics, it does not step back and appraise the life-extending benefits and life-improving relief which pharmaceuticals have enabled.  

It does leave no doubt that a large part of the higher cost of pharmaceuticals in the U.S. is due to pharmaceutical benefit firms.  These middlemen are soaking up significant amounts of money.  This doesn’t happen in other universal healthcare plans in other countries.  It also illuminates the challenge posed by “orphan drugs,” often ones with very small differentiated claims, that enable an extension of patents for years.  Seven of the top ten selling pharmaceuticals as this book was written were orphan drugs.  

Posner also does a good job of pointing out the risk that we have of antibacterial resistant strains developing because antibiotics are being prescribed far too often for conditions that don’t warrant it.

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Posner may have ended his play one scene too soon: before the covid-19 crisis. He salutes the pharmaceutical industry for pooling their research on penicillin in the 1940s leading to the mass availability of the drug by the latter part of WWII, thereby saving tens of thousands of lives. The same opportunity for pharmaceutical companies to pool their research findings and supply chain capability exists today.. Doing so is vital to achieve the equitable distribution of the vaccine once it is proved.