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How Slick Consulting Firms Get Us on Drugs

Photograph by Nathaniel St. Clair

Ninety-one people a day die from opioids and 1000 visit ERs in the US according to the CDC. How did opioid makers get such a deathly grip on the US population? Recently, the New York Times reported that the global consulting firm McKinsey & Company had a big hand in these morbid figures.

McKinsey advised Purdue Pharma to “turbocharge” OxyContin sales and use mail orders to bypass pharmacy scrutiny claims a Massachusetts lawsuit against the drug maker. Another state lawsuit accuses McKinsey of advising an opioid maker to “get more patients on higher doses of opioids” and study techniques “for keeping patients on opioids longer.” We all know what happened.

Purdue Pharma also deliberately marketed OxyContin as a 12-hour med–providing pain relief for 12 hours, and only requiring a twice-a-day dose–though documents show that Purdue and its sales reps knew that was a lie the Los Angeles Times reported. At best, OxyContin only provided eight hours of pain relief exposing patients to returning pain, withdrawal symptoms and worse.

Consulting Firms Sell Other Drugs

Opioids are hardly the first time Pharma has used high level consulting firms to line its pockets and get millions on drugs. According to National Public Radio, Merck hired a consulting firm to whip up the fear of osteoporosis and therefor sales of its bone drug Fosamax by convincing medical practitioners to put bone density-measuring machines in their offices. The consulting firm also pushed through the federal Bone Mass Measurement Act which transferred the cost of bone scans onto Medicare and taxpayers.

Slick PR firm, Cohn and Wolfe, is credited with vaulting “shyness” to a national psychiatric problem to sell the SSRI Paxil and that also worked. And don’t forget Humira?

Humira, an expensive, dangerous injected drug vaulted to its number one sales position today through the consulting company stunt of giving the drug free to seniors to increase “demand” and get the government to cover the high cost. It worked. Does anyone believe a drug that treats the relatively rare conditions of rheumatoid arthritis (affecting 1.5 million), ankylosing spondylitis and plaque psoriasis could become the most prescribed drug in the nation without the help of cagey, conniving consulting companies? Compared to drugs treating diabetes or hypertension that afflict millions?

Off-Label Marketing to Push Drugs

The class of lucrative antipsychotics that includes Zyprexa, Seroquel and Risperdal also owes its sales success to cunning consulting companies. An Eli Lilly ad campaign called Viva Zyprexa sold 49,000 new prescriptions in just three months using profiles of patients who doctors were told needed Zyprexa even though they clearly didn’t have either of the diseases the drug was legally approved for—schizophrenia or bipolar disorder. It is legal for doctors to prescribe drugs for unapproved conditions but marketing them is not legal. Many, perhaps most big drug companies have settled related lawsuits

One character in the Viva Zyprexa campaign was a woman named Martha who “lives independently and has been your patient for some time,” and who has agitation and disturbed sleep. Though she doesn’t have symptoms of paranoia or mania, she is a candidate for Zyprexa, said the message.

Shock Campaigns to Push Drugs

Consultant crafted campaigns for younger demographics are even more ruthless. The London-based firm GSW Worldwide hired a noted Welsh oil painter to create “Living Nightmares” campaign for Risperdal to shock doctors into writing more prescriptions. The ad paintings were titled Dog-Woman, Witches, Rotting Flesh and Boiling Rain designed to be emotionally manipulative.

A similar Risperdal shock campaign, called “Prescribe Early,” uses a macabre abandoned wallet, a teddy bear, and keys on a barren street to get doctors who were said to be prescribing the drug “too late to achieve its maximum benefits” by the firm, Torre Lazur McCann, to prescribe earlier. Benefits for whom?

More Sales Creativity

Cozy relationships between doctors and sales reps create other unorthodox sales techniques. Court documents unsealed in South Carolina in 2009 show that Eli Lilly sales reps used golf bets to push Zyprexa; one doctor agreed to start new patients on Zyprexa “for each time a sales representative parred.”

Purdue sales reps gave prescribers OxyContin fishing hats, stuffed plush toys and music compact discs (“Get in the Swing With OxyContin”) that were “unprecedented for a schedule II opioid,” said a paper in the American Journal of Public Health.

Marketers for Seroquel considered creating Winnie-the-Pooh characters like Tigger (bipolar) and Eeyore (depressed) to sell Seroquel, according to published reports.

And cagey consultants came up with the idea of selling “adult ADHD” on a 26×20-foot screen in Times Square with the message “Can’t focus? Can’t sit still? Could you or your child have ADHD?”

Disease Mongering

Of course it has been decades since slick consulting companies told drug makers the best way to grow sales was to convince more people they have the disease that requires the drug–also known as disease mongering.

Who has missed the “toilet” campaigns that scare anyone with gas or diarrhea into thinking they actually have “exocrine pancreatic insufficiency” a rare condition treated with an extremely expensive drug?

Many successful campaigns have convinced people with real problems–money, work, family–that they are “depressed.” And one of the most memorable disease mongering schemes, for AstraZeneca’s Seroquel, used three page ad spreads in major magazines to shamelessly try to convince depressed people they were really bipolar and needed Seroquel (which was only approved for schizophrenia or bipolar disorder).

“Are there periods of time when you have racing thoughts? Fly off the handle at little things? Spend out of control? Need less sleep? Feel irritable?” baited the ads. “You may need treatment for bipolar disorder.”

Accompanying photos of a woman screaming into a phone and contorting her face looked like clips from the “Halloween” series movies; while Pharma tries to “sell” bipolar disorder, those who actually have the condition are also disparaged.

McKinsey & Company’s “turbocharging” of opioid sales is just the tip of the iceberg. Most blockbuster drugs have been turbocharged in the same way.

 

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Martha Rosenberg is an investigative health reporter. She is the author of  Born With A Junk Food Deficiency: How Flaks, Quacks and Hacks Pimp The Public Health (Prometheus).

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