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Volume 1, Issue 1
Spring 2005:

Pain Killer: A Wonder Drug's Trail of Addiction and Death by Barry Meier

Review by: David Elpern

Cell 2 Soul. 2005 Spring; 1(1):a5

Rodale Books (2003); 336 pages; ISBN: 1579546382

I recently returned from a large dermatology meeting. The presence of the pharmaceutical industry is key to the opulence and largesse of the proceedings. Dermatologists are important prescribers and the drug makers, knowing this, contribute huge sums of money to keep us pampered and happy. There is a dark side to all of this; but these nether regions rarely are described our professional literature.

Pain Killer by investigative reporter, Barry Meier, is a searing look at the horror that can occasionally follow the promotion of prescription drugs. While it is a worst-case scenario, it is important for us to study it attentively, for this story keeps getting rewritten. Only the drugs and the companies change.

Most of us know bits and pieces of the Oxycontin® saga from the popular press. Meier is thorough in his coverage of this complex story. His narrative depicts the patients, their families, good and bad physicians and other care givers, drug representatives working to boost sales and make commissions, the FDA and DEA which often are at cross purposes, academic physicians who make enormous incomes "educating" their "colleagues" while in reality being highly paid salespersons, venal dishonest marketing executives and lawyers in the employ to the Pharmas, and company executives who are driven by the need to sell their products.

Oxycontin® is a singular product in that Purdue Frederick, the company that manufactures it, is privately-owned. This made it easier for them to cut corners in their quest for corporate profits. Meier makes a strong case that from the top levels down, Purdue Frederick executives and sales persons ignored facts that were clear and well-known on the streets and in physicians' offices of many small towns across this country. Purdue Frederick knew that a reckoning was coming; however with Oxycontin® sales of greater than one billion dollars per year, delaying further regulation by even a few months would assure that hefty corporate profits continued longer. It is curious that even at this writing, when the facts are known, Oxycontin® is still a blockbuster drug. (A "blockbuster drug" is defined as a product that has sales of a billion dollars or more per year.)

A particularly interesting chapter, "The Secrets of Dendur," chronicles the career of "[Arthur] SacklerŠthe godfather of the modern drug advertising industry. Many of the marketing and promotional techniques still used fifty years later by pharmaceutical producers were invented or refined by him." This is especially disillusioning, since Sackler and his family have been prominent donors to art museums and medical schools in the U.S. and abroad. The Sackler empire produced Oxycontin®, marketed it in the throwaway journals they owned and published and even hired physician-scientists to redefine "pain" as we know it today. This paved the way for narcotics to be used for chronic non-malignant pain and allowed for the development of the pain industry.

After reading Pain Killer one will never look at a pharmaceutical representative in quite the same way again. One will understand more fully that they know precisely what prescriptions one writes and that their job is simply to push their product. They are trained to be nice and solicitous. It is all sales, high stakes sales. Their doctors write the scripts that sell their drugs. If a physician doesn't write for the treatment, the reps stop coming by and there is no more free lunch for the staff. Those physicians who write the most for a given drug are rewarded in many tangible ways.

As physicians, we are the nexus between our patients and industry. Pain Killer is a fascinating read that helps us to more fully appreciate both our strange power and our value to an industry that thrives off the pens they hand out. It is a poignant and at times frightening tale of corporate greed and its consequences.

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