--:-- Sean Rameswaram: Support for Today Explained comes from the Quip Electric Toothbrush. No, no, no, wait. Support for Today Explained today comes from the Quip Electric Toothbrush. Over a million people have purchased it. Some at getquip.com slash explained, where the Quip starts at just $25 and your first set of refills is free. G-E-T-Q-U-I-P dot com slash explained.
--:-- Sean Rameswaram: Several years ago, I had this surgery. They cut open my face. It was pretty intense. When it was over, the hospital sent me home with a prescription for oxycodone for the pain. It was way more intense. I took one of the pills. I got dizzy. I got anxious. I started slurring my words. It was way worse an experience than the surgery. I stopped taking the Oxy and realized I didn't even need the drugs. I wasn't even in pain. But then I started wondering why I was given such potent painkillers in the first place. My best guess was pharmaceutical companies are really powerful. And now there's a study that suggests my guess wasn't all that bad. A study found recently that there seems to be a direct correlation between marketing for opioids. So like these drug companies send representatives to these doctors and directly market to them, telling them, hey, you should prescribe our drug. It's going to be safe, effective, etc. And there's a correlation between that kind of marketing and prescribing rates and opioid overdoses a year later.
--:-- Herman Lopez: He writes about legal and illegal drugs for Vox. He says this new study isn't the first to suggest that doctors are influenced by marketing from pharmaceutical companies. One study that came out last year looked at sending these doctors to conferences, giving them paid travel, speaking fees, that kind of thing. But one of the points in this paper is that some of the most effective marketing might be more subtle things, like just buying a meal. And that alone will influence whether doctors prescribe the drugs.
--:-- Sean Rameswaram: Marketing these jagged little pills starts to really ramp up in the mid-90s. In the mid-90s, OxyContin came out, and that led Purdue Pharma, which created it, to really start ramping up advertising and marketing campaign for it. There's no question that our best, strongest pain medicines are the opioids. They don't wear out. They go on working. They do not have serious medical side effects. And so these drugs, which I repeat are our best, strongest pain medications, should be used much more than they are for patients in pain.
--:-- Herman Lopez: It said that the drug was safe and effective, that doctors could prescribe it and they would see these dramatic benefits for people suffering from both acute pain and chronic pain. And at the same time, other pharmaceutical companies jumped in, started advertising their opioids, started saying, hey, joining with Purdue, these are safe and effective. We have these new types of drugs ready to go out to patients. And this is really where we saw the opioid crisis start. It started with these doctors because not only did these drugs go out to patients, but because patients had so many of these pills, they would sell them. They would keep them in a medicine cabinet where their teenagers could then go on and steal them. They would give them to friends or family. And since a lot of the advertising, a lot of the marketing at the time was like, hey, these drugs really aren't that dangerous, a lot of people were genuinely duped by this.
--:-- Sean Rameswaram: They thought that for whatever reason, these opioids on the market at the time were safer and more effective. These are the same drugs that have a reputation for causing addiction and other terrible things. Now, in fact, the rate of addiction amongst pain patients who are treated by doctors is much less than 1%. This was part of a campaign at the time to really just take pain more seriously. There have never been very good treatments for chronic pain. And so when opioids came in and they were advertised as this new, sexy, safe, effective drug, a lot of people were ready to buy that.
--:-- Dr. Daniel Young: I am a family physician in upstate New York. Over the last five years, I've transitioned into teaching younger physicians during their three-year training program. Doctors are visited by pharmaceutical representatives from many different companies in the office. I was seeing pharmaceutical representatives probably one or two a week where they would come to the office just to tell me about any new medications they might have out on the market, or they would bring the information in that way, or there was a lot of conferences going on.
--:-- Sean Rameswaram: I remember going to a pain conference probably in the mid-'90s to learn more about how to treat chronic pain. All of the literature and the pharmaceutical information was that we had these longer-acting pain medications and patients did not become dependent or addicted to the medication. So I think it definitely shifted what I was doing. I definitely increased the amount of long-acting pain medication that I was providing to patients, absolutely.
--:-- Dr. Daniel Young: I would start getting more patients coming to my office. If you were a physician who prescribed the chronic pain medications, you would suddenly start getting more and more patients as friends would refer their friends to you. So yeah, definitely like a light bulb goes off saying, hey, something's not right here. These are probably patients that should not be on chronic pain medication. We're out there to help people, not to cause them harm, and I definitely think that over the years there have probably been some patients that I have caused harm by creating either dependence or addiction on pain medicine.
--:-- Sean Rameswaram: Hello? Hello, is this Tim from Brooklyn? It is. Hey, it's Sean from Today Explained. Hi, Sean. Tim from Brooklyn. Late last year, we were talking about how you were hoping someone would send you the Quip electric toothbrush around the holidays, the one that over a million people have purchased, the one that's been endorsed by dentists, the one that's sensitive on your gums. Did that ever happen? Will you believe that it did not? And several people heard me talk about it on this very podcast and mentioned it to me, but did not purchase me one. How's your tooth brushing been since? I believe the last time we talked, you weren't brushing until the quip arrived. Have you stuck with that?
--:-- Tim from Brooklyn: Well, I just broke a bone in my right arm, which is my dominant hand. Ugh. And I have a cast on it. And it been very hard to brush my teeth with your non hand because you got to move it around I have been brushing it just been difficult You know it would be something that maybe an electric toothbrush could solve Man if ever there were a case to get Tim from Brooklyn a Quip electric toothbrush getquip slash explained G dot com slash explained The Quip starts at just $25, and Tim's first set of refills is free. Sounds like a good deal to me.
--:-- Herman Lopez: Hermann Lopez writes about legal and illegal drugs for Vox. He says this new study isn't the first to suggest that doctors are influenced by marketing from pharmaceutical companies. One study that came out last year looked at sending these doctors to conferences, giving them paid travel, speaking fees, that kind of thing. But one of the points in this paper is that some of the most effective marketing might be more subtle things, like just buying a meal. And that alone will influence whether doctors prescribe the drugs.
--:-- Herman Lopez: So the big thing that they advertise is that they use this extended release formula and they're slowly absorbing it into their body and it's slowly taking effect. That's going to be less risky than if they take a pill that takes effect all at once, right? Yeah. That was the thinking. And the thing is like, well, a patient will also need fewer of these pills since they'll only have to take one for 8 to 12 hours.
--:-- Herman Lopez: I should clarify that a lot of this turns out to have been extremely misleading. Like Purdue had evidence fairly early on that its drug was not working as long as it advertised. And the Los Angeles Times had a great report on this basically finding that they kept advertising it as long anyway Even when they knew it wasn't. Yeah, even when they knew it really wasn't.
--:-- Herman Lopez: But the key thing here is that even with this extended release formula, one way to get around it is to crush the pill and snort it or inject it. And so that would make all the opioid in there take effect at once. It's an extremely easy way to get around the medication essentially not getting you as high as you would want to right away.
--:-- Herman Lopez: Did Purdue know what it was cooking up in the 90s when it came up with Oxy? Did it know that it had like this blockbuster drug on its hands? It certainly seemed to based on how aggressively it marketed. It really wanted to sell as many opioids as possible, get as many doctors prescribing them as possible. I mean, how big an industry does this become? Up to this point, Purdue on its own has made tens of billions of dollars from Oxy. Other companies are probably making way more because in the end, Oxy is still only a part and a small part of the overall opioid market. I mean, there's Percocet. Morphine is still a big part of how patients get opioids in hospitals. There's fentanyl products. Yeah. Vicodin, codeine, Demerol.
--:-- Herman Lopez: Did these companies have any idea how addictive these painkillers were? They definitely should have known. I mean, we've known for centuries that opioids are addictive. Just about everyone who's been using opium for like thousands of years could tell you that. And even people who took like Oxy as prescribed got addicted and some of them overdosed and died. So Purdue really should have known that this product is not safe. It's not effective. It truly does help some pain patients, but it just wasn't as safe and effective as Purdue said it was. And now we're all facing the consequences of this in the opioid epidemic.
--:-- Dr. Daniel Young: I am a family physician in upstate New York. Over the last five years, I've transitioned into teaching younger physicians during their three-year training program. Doctors are visited by pharmaceutical representatives from many different companies in the office. I was seeing pharmaceutical representatives probably one or two a week where they would come to the office just to tell me about any new medications they might have out on the market, or they would bring the information in that way, or there was a lot of conferences going on.
--:-- Dr. Daniel Young: I remember going to a pain conference probably in the mid-'90s to learn more about how to treat chronic pain. All of the literature and the pharmaceutical information was that we had these longer-acting pain medications and patients did not become dependent or addicted to the medication. So I think it definitely shifted what I was doing. I definitely increased the amount of long-acting pain medication that I was providing to patients, absolutely.
--:-- Dr. Daniel Young: I would start getting more patients coming to my office. If you were a physician who prescribed the chronic pain medications, you would suddenly start getting more and more patients as friends would refer their friends to you. So yeah, definitely like a light bulb goes off saying, hey, something's not right here. These are probably patients that should not be on chronic pain medication. We're out there to help people, not to cause them harm, and I definitely think that over the years there have probably been some patients that I have caused harm by creating either dependence or addiction on pain medicine.
--:-- Sean Rameswaram: Hello? Hello, is this Tim from Brooklyn? It is. Hey, it's Sean from Today Explained. Hi, Sean. Tim from Brooklyn. Late last year, we were talking about how you were hoping someone would send you the Quip electric toothbrush around the holidays, the one that over a million people have purchased, the one that's been endorsed by dentists, the one that's sensitive on your gums. Did that ever happen? Will you believe that it did not? And several people heard me talk about it on this very podcast and mentioned it to me, but did not purchase me one. How's your tooth brushing been since? I believe the last time we talked, you weren't brushing until the quip arrived. Have you stuck with that?
--:-- Tim from Brooklyn: Well, I just broke a bone in my right arm, which is my dominant hand. Ugh. And I have a cast on it. And it been very hard to brush my teeth with your non hand because you got to move it around I have been brushing it just been difficult You know it would be something that maybe an electric toothbrush could solve Man if ever there were a case to get Tim from Brooklyn a Quip electric toothbrush getquip slash explained G dot com slash explained The Quip starts at just $25, and Tim's first set of refills is free. Sounds like a good deal to me.
--:-- Herman Lopez: When exactly did the first signs that you know oxy and other opioids like it might be extremely addictive start to surface? So it happened pretty early on by the late 90s and in the early 2000s we had already seen opiate overdose deaths start rising particularly painkiller deaths yeah there were stories all over the news you can like look back at archives of people talking about misusing drugs, using them at parties and that kind of thing.
--:-- Herman Lopez: I mean, one of my favorite things here is that if you go back to old TV shows, if you re-watch Friends, there are jokes about misusing opioids and how they're making you feel high and all that stuff. On Friends? Yeah. How do you feel? I feel great. I feel great. Wow, those pills really worked, huh? Yeah, not the first two, but the second two. It's a bunch of like 90s shows that you would think are more innocent they do make these kind of remarks here and there.
--:-- Herman Lopez: Mr. President did you by any chance take your back pills? Well, I don't mind telling you, C.J. I was a little pain there. Which did you take, sir? The Vicodin or the Percocet? I wasn't supposed to take them both. I'm like really sensitive to this stuff. Obviously, I'm like what what the hell are they talking about these drugs are not like okay to just joke about like this. I mean I was in high school when I got my wisdom teeth removed and I got some opioids as a result of that. And my friends were all joking about like, hey, are you getting high? Can we try some? That kind of thing.
--:-- Herman Lopez: But at the end of the day, it just goes to show like these drugs are really going everywhere and everyone at some point seemed to know that they could be misused. And yet you still saw this kind of marketing. Did anyone hold these companies like Purdue and its peers accountable for this in the 90s, the way, let's say, you see President Trump, for example, talking about it now at least? No, it's not until like the mid-2000s where you start seeing government, law enforcement really start to crack down.
--:-- Herman Lopez: So actually in 2007, Purdue ended up paying $600 million in fines because of its misleading marketing. And some of its executives were wrapped up in this too, having to pay fines on their own, and then they had to go out and do community service as a result of that. So in the end, that's like peanuts compared to like the billions of dollars, literally, that they have made from opioids. So it's a question of like, were they held accountable enough? Or for them, was it just like a cost of doing business as they saw their profits grow anyway?
--:-- Sean Rameswaram: This morning, my office filed a lawsuit in Massachusetts state court against Purdue Pharma and its board members and executives. Jumping ahead to present day opioid crisis, There are now several lawsuits that suggest Purdue might actually get in more and perhaps more serious trouble. Who are the executives these lawsuits target? So you do hear a lot about the Sacklers, meaning the Sackler family, which owns Purdue. They're really wrapped up in all of this because not only were they involved in the creation of Oxy, but they also were involved in the marketing of it.
--:-- Herman Lopez: If the Sacklers haven't done enough damage, they also just patented a new drug to help wean addicts from opioids. So the Sacklers addicted the country to opioids. Now they're going to profit off the cure? That takes a pair of swinging Sacklers. Some recent lawsuits filed by Massachusetts Attorney General, the findings in there suggest that the Sacklers, or at least some members of the Sackler family, knew that these drugs were dangerous, knew that they were leading to all sorts of trouble. And still, they tried to cover that up and that they pushed them to market the drugs more aggressively. They don't want to accept blame for this. They blame doctors. They blame prescribers. And worst of all, they blame patients.
--:-- Herman Lopez: When you say that, you mean Purdue or you mean the Sackler family? Or are they one and the same? They're one and the same. In one alleged instance, then-President Richard Sackler devised what Healy describes as Sackler's solution to the overwhelming evidence of overdose and death. Writing in a confidential email, we have to hammer on the abusers in every way possible. They are the culprits and the problem. Now, Purdue will come back and say that the findings in that lawsuit are misleading or taking some of their communications out of context. But generally, we do know that Purdue was very aggressive in marketing this, and the Sacklers had to be involved in some way, given that they own the company, in that kind of marketing.
--:-- Herman Lopez: Is that lawsuit now settled, or is it ongoing? No the Massachusetts lawsuit is relatively new but there are I mean literally hundreds of lawsuits around the country against not just Purdue but all sorts of pharmaceutical companies and also distributors So like Walgreens for example is wrapped up in some of these lawsuits because the argument is also that these distributors should have known that they were supplying a bunch of these drugs to people who should not be getting them A bunch of those lawsuits, like again, literally hundreds, are now being consolidated in Ohio and the hope is that will lead to some sort of big settlement agreement that will once and for all tamp down on not just opioid prescription but also provide money that can then be directed to addiction treatment and prevention.
--:-- Herman Lopez: Is the problem bigger than that though i mean you're talking about dealing with addiction and dealing with the misleading marketing of these opioids but like as you said and as I said like I got a moderately serious surgery did not need any painkillers really and I was sent home with oxy you had a dental procedure and you were sent home with oxy like this has become a part of this country's medical culture. And you see this in the statistics, even though since 2010 there's been a drop in prescriptions for opioids overall. Okay. America still prescribes way more than any other country. I mean, there are different ways to measure this, but when you look at the statistics, like, the second place country is, like, not even close. Overall, opioid prescriptions in America is way ahead. I mean, why the heck is it? Why is that even the case that we're above and beyond any other country in terms of our usage of these drugs?
--:-- Herman Lopez: If you're a chronic pain patient, you're suffering from serious pain, genuine pain, it's debilitating. You go to the doctor and the doctor wants to find a solution for you. But the doctor is also under pressure to see as many patients as possible throughout the day. That's how they get the most money out of essentially this system. So if you're phased with that, are you going to talk through the patient about how there might be psychological factors in their pain? Are you talking about how it might involve lifestyle changes and all of that stuff? Or are you going to give them a pill? And like if you're under pressure to do this as quickly as possible, the pill is the easiest answer.
--:-- Herman Lopez: Now, there are a lot of good doctors out there who do not want to do that because they know that these opioids are risky. But even like well-meaning doctors facing this kind of pressure, the scales are just tilted against them. They are pressured to essentially give out these pills. It's the easiest answer. In other countries, if you talk to like Japanese doctors, for example, they will tell you that it's kind of expected that you will just have some pain at some point in your life. And if you talk to doctors here, they feel like they're under more pressure to make sure that there is zero pain in somebody's life.
--:-- Herman Lopez: The other thing is while there are some patients who do benefit from these drugs in terms of like acute pain specifically and in terms of chronic pain, the evidence that they are actually better than other treatments for chronic pain is really weak. Like there's almost no scientific basis for that. The studies have been found that they're similar results whether you give somebody opioids or whether you put them on some other drug regimen, sometimes involving like Tylenol. And that's because over time opioids, you grow tolerant to them. So they just become less effective.
--:-- Herman Lopez: When I donated a kidney, I personally said I do not want opioids because they make me nauseous. They actually don't help my pain. I still got opioids. Like, I had trouble, like, telling the nurses and doctors involved, like, please do not prescribe these drugs. I mean, it's a serious surgery, so I can see why they would want to, but at the same time, if somebody is telling you I don't want these dangerous drugs, maybe listen to them. What did you take for the pain instead? I just took extra strength Tylenol.
--:-- Sean Rameswaram: Herman Lopez is a senior correspondent at Vox. You heard from a doctor earlier in the show. He came to us via The Impact, which is another Vox podcast you should listen to. I'm Sean Rameswaram from This One's Today Explained. Thanks again to Quip Electric Toothbrushers for supporting the show today. Let's hope Tim from Brooklyn joins the over 1 million people who have purchased the Quip sometime soon. The Quip starts at $25 at getquip.com slash explained. That's G-E-T-Q-U-I-P dot com slash E-X-P-L-A-I-N-E-D. And your first set of refills is F-R-E-E.
