23.1 Direct to Consumer Advertising with Michael Shuman, PharmD: Background and History

[00:00:00] Hey everybody, thanks for being here. I want to go back and have on one of my previous guests,

[00:00:06] pharmacist Michael Shuman, to talk to you again about direct to consumer advertising and marketing

[00:00:12] in healthcare and have a recurring series so that we can discuss all of the flagrant examples of

[00:00:22] lack of regulatory oversight and manipulation of data and statistics

[00:00:27] to where these companies are able to market their drugs as completely safe and completely effective

[00:00:36] when oftentimes history tells us that that was not the case. How many times are we going to fall victim

[00:00:43] to the same story playing out over and over again? Whether it is OxyContin or Vioxx, whether it is the

[00:00:50] original SSRI clinical trials, the Canamabs, the monoclonal antibodies for Alzheimer's dementia,

[00:00:58] it's the same story playing out over and over again. So I want to provide a recurring series with

[00:01:06] Michael Shuman where we talk about some of these examples and we explain them in a way that you can

[00:01:11] understand how obvious and gross the manipulation of data and that data then being broadcast to the

[00:01:21] American public as scientific dogma. So I hope you enjoy. Somebody get this guy some help.

[00:01:39] All right, we are back here today with Michael Shuman, a board-certified psychiatric

[00:01:47] pharmacist, BPP. And we had done a audio series in the past on direct-to-consumer advertising. We also

[00:01:55] did one on benzos. But now that we've got the video going, I wanted to have you back and record

[00:02:02] something on video, kind of talk about some of the previous issues, but really start a recurring series

[00:02:10] about some specific examples of data manipulation or pharmaceutical or government regulation malfeasance

[00:02:20] with what we do, just to try to give our listeners, our viewers more specific information about why they

[00:02:28] should be skeptical and ask a lot of questions of their providers about the data that they may see on

[00:02:35] TV or in advertising, etc., etc. So thank you for coming back. You are an awesome clinician.

[00:02:43] I've never known a pharmacist in my life that spends as much time with as many patients and never seen you

[00:02:52] take anything personally with a patient, even though you work with some very, very sick, mentally ill folks

[00:02:57] in the state hospital system. And so I've always had a huge amount of respect for you because you

[00:03:03] are passionate. Discussing these issues with you is fun. It never felt like work. And you just care

[00:03:10] about the patients, the person, the human being. So...

[00:03:14] Well, thank you very much for that. That very kind introduction. Again, I've enjoyed it because we've

[00:03:18] been able to even starting out with, you know, that just while you were there for even just for a couple

[00:03:23] months on rotation, just the idea that we can push each other a little bit, bounce ideas back off each

[00:03:27] other, hydroxyzine, for example, and have that dialogue because that's ultimately where the

[00:03:31] growth is basically ironing, sharpening iron. And I've had those people in the past at other places

[00:03:35] that have been, and it's great because then it's like learning back and sharing that information.

[00:03:38] It's great. And obviously we both get excited, a little bit heated about the subject. So I'm excited

[00:03:43] to get back on here and get to talk about these things more.

[00:03:45] Yeah. It's almost like I wish we could have those same types of discussions in the general public,

[00:03:51] maybe like regarding politics.

[00:03:54] Woo!

[00:03:55] Yeah. Sorry. The last couple of days have been rough on social media with some things.

[00:03:59] Oh yeah, absolutely. Absolutely. No, but it is a, you know, science, medicine is a field where

[00:04:09] nothing is ever really proven. Like we don't come from a philosophical place of proving things. We

[00:04:17] get more and more information. We want to see things be reproducible, but ultimately everything

[00:04:23] is still a theory.

[00:04:25] Yeah. And that's why even I tell my, you know, tell patients is, you know, it's all

[00:04:28] risk versus benefit pros and cons there for everything you're being offered. There are alternatives

[00:04:33] and the questions are, what does this provide better than the alternatives? What does it provide

[00:04:38] that's maybe not so better? And that's some of the things I think we'll probably talk about too,

[00:04:41] is, you know, there are unforeseen consequences of targeting one receptor over another or changing

[00:04:47] a mechanism of action to make it cleaner in one area sometimes doubles down on other things.

[00:04:52] Yeah. Or we try to get the cleanest version of a drug that we can, that is isolated to affecting,

[00:04:59] you know, one of millions of complex systems going on internally for us at all times. And that may

[00:05:06] even be an underestimate. Yeah. But sometimes those drugs don't work as well, especially in psychiatry.

[00:05:13] So, but I loved what you said there, the benefit to risk ratio is what our job is all about. And

[00:05:21] trying to communicate that to patients, trying to embrace the uncertainty that comes with that benefit

[00:05:28] to risk ratio, but allow the patient ultimately to make the informed decision if they can, if they're

[00:05:35] in a position or a mental state where they can. And I think that since 1997, when direct to consumer

[00:05:44] advertising was de facto legalized, you've got a situation in America where you've got a vested

[00:05:52] interest pharmaceutical company that is running a trial to decipher what is beneficial or what has

[00:06:00] effectiveness. And they're also responsible for determining how safe that drug is, which they

[00:06:08] shouldn't be the ultimate determinants of what is effective and safe. But when you allow them to

[00:06:13] market directly to the American public, as opposed to previously marketing mostly to physicians, pharmacists,

[00:06:21] clinicians, then you've set up a situation where they're communicating directly with the public.

[00:06:28] The general public is not as savvy at reading through one of these and pointing at some of the

[00:06:38] discrepancies or the missing data or understanding that sometimes companies will do several trials and

[00:06:46] only publish a couple of the positive ones. So this, in my mind, the direct to consumer advertising

[00:06:53] kind of got the stone rolling down the hill.

[00:06:56] Yeah, again, I agree. Because we can talk about, yes, advancing medicine as an altruistic thing to

[00:07:02] allow people to have healthier, happier lives, but the idea that it's still profit driven. And so,

[00:07:06] of course, it's going to be in your best interest if you're doing this study. You want to see that drug

[00:07:11] do well. And so you bring it on the market. Again, you're wanting to put it in as favorable light because

[00:07:16] your job may depend upon it. Your stakeholders and shareholders and all that are going to depend

[00:07:21] upon that drug doing well. So what you do if maybe there is some concern, how do you manage that in a

[00:07:27] way that is ethical, but also is going to keep the company afloat?

[00:07:32] Yeah. And you and I wouldn't be sitting here if our regulatory agencies were actually doing their

[00:07:38] jobs. And if they weren't in the pockets of some of these pharmaceutical companies, I mean,

[00:07:44] FDA receives, I think now the majority of their funding from pharmaceutical companies.

[00:07:50] Yeah, the fast track designation was one way of the idea that, you know, if you can provide

[00:07:54] certain fees and things of that to allow certain products to be looked at in a little bit of a

[00:07:58] different way. And that certainly kind of, I hate to say, you know, pay for play, but there is a

[00:08:03] little bit of that to it. Yeah, absolutely. And we've talked a lot on the podcast and other episodes

[00:08:07] about this revolving door of FDA and top executives at pharmaceutical companies. So again, the regulatory

[00:08:17] agencies have been captured. And so that's why we're here because this is the way that I know how

[00:08:23] to try to educate people and young providers on how the system works so that you don't fall victim

[00:08:31] to some of the travesties that we'll discuss that come out of this system. Just a little bit of background,

[00:08:39] United States and New Zealand, the only two countries in the world that allow direct-to-consumer

[00:08:47] advertising. The European parliament, I believe in the early 2000s, they put it up to a vote and

[00:08:54] they have 540 members. They voted it down 500 to 40. That's again, a pretty solid right there.

[00:09:03] And if I remember right, New Zealand's even talking about maybe getting rid of it, but I don't hear any

[00:09:07] chatter on our end. No, no, no, not on our end at all. And I've heard that out of New Zealand for

[00:09:12] years and years in a row. And I just feel like nothing is actually happening there.

[00:09:17] It was one of those people saying, it's like, oh, we'll get around to it.

[00:09:20] Right, right, right. But it goes back to the question, you know, should healthcare be sold to us

[00:09:26] or should healthcare be provided to us? And obviously you probably already know our answer. We think that

[00:09:34] healthcare should be provided. There is no inherent problem with capitalism in our society. It doesn't

[00:09:44] matter if you are trying to sell a toy Jeep to my two-year-old and you want to say it's the greatest

[00:09:50] toy Jeep that's ever existed. But when you're just making those very assertive statements without having

[00:09:59] the evidence to back it up or even the reproducibility, I mean, these companies are making these statements

[00:10:05] that this is a state-of-the-art drug and it's wildly effective when nobody has reproduced their study.

[00:10:12] Yeah. And there's the, you know, there's a little bit of that appeal to authority too,

[00:10:15] is that we're talking about medical providers, medical experts. You know, if these were,

[00:10:19] you know, UN generals coming out and saying that that toy Jeep was the best one in the world,

[00:10:23] now they know because they've, you know, sent Jeeps all over the world. Again,

[00:10:26] that'd be a little bit questionable appeal to authority too, but the idea that, okay,

[00:10:30] the individuals who are supposed to be tracking health and moving us in a healthier direction,

[00:10:34] again, are telling me that this is a good drug. And so, okay, there's a little bit of that. All

[00:10:37] right, well, doctor knows best. So we'll go with that. Yeah. It is an example of the toxicity of

[00:10:44] unfettered capitalism. I mean, we've got to be able to reign these things in, in areas like medicine,

[00:10:50] because our ultimate goal is to advance in our understanding of how diseases emerge, how they

[00:10:57] manifest, what symptoms they cause and how to best treat them. And those two don't always go

[00:11:04] hand in hand when you're on one end, just trying to sell a product. Yeah.

[00:11:08] So in 2021, there was $7 billion spent on direct to consumer advertising. So it's obviously,

[00:11:18] there is a lot of money being poured into this. And if they're spending $7 billion, then I think

[00:11:24] there's probably some smart people at those companies who have figured out that they're

[00:11:28] probably making a lot more than $7 billion on that spend. So let's go back in time and give you

[00:11:37] kind of some brief history of how the system has kind of changed over time. Do you want to start

[00:11:43] out and kind of talk about the 1800s, early 1900s, how medicine was kind of in the wild west phase?

[00:11:52] And it sometimes literally is in the, in the wild west phase. I mean, I was even playing,

[00:11:55] you know, red dead redemption a few years ago. And yeah, they talk about, you know,

[00:11:59] you're out helping the guy selling snake oil, but for years, you could say anything. You could make

[00:12:02] these claims about, you know, I have this product and it just, you know, these pills that you take

[00:12:07] and they just melt the pounds away. I think that was a slide I show when I teach about weight loss.

[00:12:12] You just say, you know, it does a thing. You make these ridiculous claims. You know,

[00:12:15] people have seen old, I love Lucy episodes about vitamin Dovegemony or these supplements you take

[00:12:19] and you drink it. And it does all these amazing things. And you could say whatever you want.

[00:12:23] It's kind of up to the buyer to beware as far as what's actually in it. And didn't have to

[00:12:28] say a lot of things as far as what was in it, whether it was safe, it was effective.

[00:12:32] And eventually, you know, there became a backlash to that. And, you know, anytime people start to then

[00:12:37] either die, you talk about kids getting poisoned or unregulation, it starts to have harsh outcomes.

[00:12:42] You think about kind of reining things in a little bit. And we also had some very powerful substances.

[00:12:47] I mean, you know, there's cocaine drops, opioids for kids for toothaches and things like that.

[00:12:51] And again, you know, dose, if doses get off or adulterings get added to things, people die.

[00:12:57] And then now we start taking a look at should there be some sort of regulation on these products?

[00:13:01] Yeah. I mean, you had heroin in products, you had cocaine, you had alcohol. And for most of

[00:13:08] America's, you know, early and really into the 1900s, the majority of drugs that were taken

[00:13:15] were not by prescription. Most of them were supplements. In the 19, you know, 20s, 30s,

[00:13:22] early 1900s, you had gradually increasing regulations. You had the Pure Food Drug and

[00:13:29] Cosmetic Act. You had, you know, crises like the sulfanilamide antibiotic disaster where

[00:13:35] this company, I think it was S.E. Massengill Company was a distributor or a pharmaceutical

[00:13:42] company that was trying to make a new preparation of an antibiotic, a very common antibiotic that was

[00:13:49] suitable for kids and had a nice strawberry flavoring to it. Well, they ended up putting

[00:13:54] ethylene glycol or antifreeze unintentionally in it. And it led to a string of deaths across the

[00:14:01] nation, not just a string of deaths, but deaths of small children.

[00:14:06] Yeah. They, you know, that was something very early on pharmacy school. We watched videos about that

[00:14:10] and interviews with families and things, because that was such a touch point in the idea that,

[00:14:14] you know, people saying what could prevent this. And again, so many of these laws, unfortunately,

[00:14:19] coming in, reacting to crises. And so in this case, yeah, we're going to start regulating the

[00:14:24] safety of these products. There are so many other examples that will kind of skirt by,

[00:14:30] but there was another notable one in the 1960s regarding thalidomide. So thalidomide was a

[00:14:35] drug that was used in pregnancy for people who had severe nausea and vomiting. And at that time,

[00:14:43] the U S was actually pretty slow to adopt new drugs. Um, so the U S kind of didn't get the worst of the

[00:14:52] thalidomide crisis. It more hit Europe much more than it did here, but the adverse effects of thalidomide

[00:14:59] where these mothers started to give birth to babies with shortened limbs, basically flippers instead of

[00:15:08] actual limbs, like the bones wouldn't develop properly. A condition called phocomelia,

[00:15:13] philomide. And, you know, this crisis affected a whole generation of children. So all of these

[00:15:20] examples, uh, leading up to the 1970s, you had increasing amounts of regulations. And by 1970,

[00:15:29] 83% of drugs were prescription and pharmaceutical companies did DTPA direct to physician advertising.

[00:15:40] They still spent money on advertising. It was in the lower millions of dollars, not in the billions of

[00:15:47] dollars, but it was all promoted towards doctors. Yeah. For what's where some of those heads were

[00:15:52] wild. I love going through some of the old ones there and they've, some of them have, let's say

[00:15:56] they've not aged well, as far as the, you know, a little bit of classic misogyny or a little bit of

[00:16:02] xenophobia, things like that. But yeah, the idea was at least, okay, we can educate providers.

[00:16:06] Maybe we gloss over some things, but the idea too, we have an audience who understands these products

[00:16:10] can at least understand some of the limitations and knows how to access further information about

[00:16:15] them to contextualize this ad in front of them. 1980, Pfizer had all these public awareness campaigns

[00:16:21] where they would so generously educate the public on hypertension or high blood pressure on diabetes,

[00:16:30] on chest pain, but they wouldn't actually provide a drug name. Therefore, they didn't have to do all

[00:16:36] those brief summary requirements. 1983, part of the big backlash is a drug called Oroflex came out.

[00:16:43] It was touted as a miracle drug and it ended up being pulled five months later.

[00:16:50] It's something they're still doing is I've even think, you know, even you listen to the radio,

[00:16:55] we, they have it on in the main pharmacy is you'll hear one. The big one is just a little bit of a

[00:17:00] lecture about exotrin pancreatic insufficiency or EPI, as they say, and they'll talk about the

[00:17:06] condition and they'll say, here's a handy little rating scale you can take. And here's a website

[00:17:11] about don't keep a lid on and talking about if you experienced the following symptoms,

[00:17:15] you might have exotrin pancreatic insufficiency, almost empowering the individual to talk about

[00:17:20] this with their doctor so that you too can have your health improved. If you have this condition

[00:17:25] and they're right at the end, it says this is paid for by, and then the name of the drug company.

[00:17:29] Well, it just so happens that that drug company has a patent on a pancreatic enzyme and the specific

[00:17:35] formulation of it. And so they have the desire to, you know, again, they may very much want to help

[00:17:42] people out, but obviously you want to increase your share. And so if you can encourage more people

[00:17:45] to identify that they have this condition, you get more of the drug being utilized. And so that is one

[00:17:51] of the goals of these things, but it's very knock it because it's not a drug ad in the sense of they're

[00:17:55] talking about a drug really at all. The only reason, you know, is because you hear the name

[00:18:00] of the company. Yeah. There's the one on non 24 also, right? I remember hearing the exotrin

[00:18:06] pancreatic insufficiency advertisement on the radio when I was in a residency.

[00:18:12] They've been doing that one for a number of years. I'm surprised that I'm like going and I'm like, did I

[00:18:17] miss something in the GI block? Like, I don't remember really learning much about exocrine

[00:18:22] pancreatic insufficiency. And I guess that's the goal then is to say, ah, since you haven't, well, now

[00:18:27] you know about it so you can look for it more. And as always, you know, when everyone, you have a hammer,

[00:18:31] everything looks like a nail. And so you see somebody with fullness, you see somebody with

[00:18:35] maybe, you know, changes in their stool and you start thinking that, and maybe that does lead to

[00:18:40] an increased utilization of the medication. Right. And they're not promoting for people to make diet

[00:18:45] and lifestyle changes that would also help their pancreas work better and more efficiently. They

[00:18:51] know what they're doing in that respect. Yeah. And actually in 1984, the commissioner of the FDA at

[00:18:59] the time, Arthur Hall Hayes had a very poignant quote that just is so relevant, even, you know,

[00:19:07] 40 years later, he said, direct to consumer advertising will lead to patients pressuring

[00:19:13] physicians to prescribe unnecessary drugs, confuse patients by leading them to believe minor differences

[00:19:20] equate to major therapeutic advances. It will promote brand name drugs over generic drugs,

[00:19:27] leading to an increased overall price of obtaining the drug. And it will also foster an increased

[00:19:34] drug taking in an already over-medicated society. Well, of course, none of those things have happened,

[00:19:40] right? Yeah. Yeah, exactly. I'm like, so he already thought the society was over-medicated in 1984.

[00:19:46] What is he going to say 40 years later in 2024? I wish I had the numbers in front of me to see how

[00:19:54] many, how much medicine we're taking now compared to then. I would bet my life, my everything in my

[00:20:02] bank account, my mortgage, et cetera, et cetera, on the fact that we for sure take more drugs now.

[00:20:08] Oh yeah, that is a safe bet. That is a safe bet. You even had major executives at Eli Lilly,

[00:20:15] at Shearing Plow that agreed that direct to consumer advertising was bad in these 1984 congressional

[00:20:21] hearings. Maybe they were just trying to appease the congresspersons, but even they were publicly

[00:20:26] saying this is a bad idea. So there's the HIV AIDS crisis of the, you know, eighties and into the

[00:20:35] nineties. And we are slow to adopt some of the antiretrovirals in America and there's backlash in

[00:20:41] the other direction. So by 1997, you have this situation emerge where a loophole is created

[00:20:50] for direct to consumer advertising to flourish. Can you give a little bit of background on

[00:20:56] what they are required to do and how they got to that loophole in 1997?

[00:21:02] So one of the main things is the idea that, you know, you still have a certain amount of

[00:21:07] information that is required to be provided, but rather than necessarily provide that within

[00:21:13] the commercial. So again, you have a TV commercial, you only have so many seconds to talk about a

[00:21:18] product. There are certain statements that can be made, certain required statements,

[00:21:22] and then the ability to then consult the product labeling or consult the inserts or a link that this

[00:21:27] is where you can go to gain more information. So the idea that you may not go there, but if we provide

[00:21:32] some sort of avenue for you to get this extra information, that allows us to maybe focus on

[00:21:39] other things within the advertisement or the commercial, the highlights of the drug and

[00:21:44] a flashy jingle and some nice colors and things like that. But as long as you're having some basic

[00:21:49] statements, you have the indication for use, some of the serious side effects, providing a link for

[00:21:54] further information. Again, you can, you know, paint it in a way that's that's very, very, very positive.

[00:22:00] Yeah, absolutely. And so that brief summary requirement involved things like every risk of the drug,

[00:22:06] every benefit, every side effect, every alternative. And realistically, if you were going to put that into a TV

[00:22:13] advertisement, it would probably push close to like 10 minutes. If you've ever seen the tiny little patient

[00:22:19] package insert that comes with any drug that you pick up from the pharmacy, when you fold that thing out and get

[00:22:25] your magnifying glass out to actually be able to read what it says, it takes a long time to read through that,

[00:22:32] especially if you're reading it out loud. So some of the things they're still required to present on TV

[00:22:38] advertisements, you will hear that stuff at the very end. And it will sound like you are at a Texas State

[00:22:45] Fair auction or something. It's very hard to pick up on any of that. So the pharmaceutical companies used

[00:22:52] to kind of skirt around this after this loophole was created in 1997. You just had direct to consumer

[00:22:59] advertising takeoff. The amount of money spent on TV ads in 1997 was $300 million. By a year later in 1998,

[00:23:08] it was $660 million. The total amount spent on direct to consumer advertising in 1998 was $1.3 billion.

[00:23:18] By 2005, it was $3.3 billion. And now we're up to $7 billion as of 2021. I think maybe one of the

[00:23:26] scariest parts of this is the public response to it. There are, you know, a lot of good critically

[00:23:35] thinking people who are skeptical about pharmaceutical companies, but there's a lot of

[00:23:40] people that are also not very skeptical. And they promote this idea that this drug could be life-changing

[00:23:48] for you. And the public really kind of eats it up. That makes me think about one of the first ones I

[00:23:55] remember seeing was Viagra. And again, it almost became this cultural icon and this joke and a meme

[00:24:00] about, oh, hey, you know, we've gotten, you know, very, even the ads, you know, a little bit sexualized,

[00:24:05] kind of a wink and a nut. And they became accepted, became funny. Oh, look, there's a new Viagra ad.

[00:24:09] Let's see, you know, you got the Budweiser ad, you got the Viagra ad, you know, what are they

[00:24:12] going to do next? And it, I think that kind of eased it in. Right. And it eased it in to the idea that,

[00:24:19] hey, you know, this is a new part of American culture. Yeah. Yeah. So there was a 2002 survey

[00:24:26] of Americans done and 98% of the respondents said that they had seen or heard an advertisement on

[00:24:33] TV or the radio. A third of those people, so about 33%, then went to the doctor and inquired about it.

[00:24:44] And a third of those people, about 11%, asked their doctor for a prescription.

[00:24:52] 80% of the people who asked their doctor for a prescription got a prescription, which to me

[00:24:58] is terrifying because that means that about five to 7% of all Americans got a prescription just based

[00:25:08] on seeing an advertisement on TV. Yeah. And again, it shows it works. From one end,

[00:25:12] it's horrifying from the other end. Ah, these work. Yeah. Yeah. And even scary to me is that 80%

[00:25:18] of the people who asked their doctor got a prescription. And these are drugs that their

[00:25:22] doctor probably didn't know a whole lot about. Prime example of that is Oxycontin. But, you know,

[00:25:28] the role of the physician and pharmacist is kind of as a gatekeeper to make sure that your patient is not

[00:25:36] harmed by bad information, essentially, and to not get steamrolled by a patient who's very

[00:25:42] excited or even demanding about a prescription because you don't feel like that is in the best

[00:25:49] medical or psychiatric interest of the patient. But clearly, there are a lot of people who did not

[00:25:55] give very much pushback from our position. Yeah. And there's plenty of reasons that we don't have

[00:26:00] time to unpack them all. But the idea that, you know, word of mouth and positive feedback on providers

[00:26:05] is a, you know, a big metric. And so the idea that, well, if I say no, you know, am I going to get a

[00:26:12] bad review? Are they going to come back? Are they just going to get it from somebody else anyway?

[00:26:15] And so, yeah, I can see where some of the hesitancy as well as sometimes it's, you know,

[00:26:19] what's the worst they could do? You know, I give it to them. They're happy. Okay.

[00:26:23] Yeah, absolutely. One of my previous guests, OBGYN, Adam Murato, his big tagline is chemicals have

[00:26:32] consequences. So some of those consequences can be good and desired, but oftentimes there's a lot of

[00:26:38] consequences that are not desired. So the prime example, the one that I've talked about a lot on

[00:26:45] the podcast is OxyContin. And so OxyContin was FDA approved for chronic pain in, I think it was

[00:26:52] December of 95 or December of 96, one of the two. 1997, this gets, you know, the loophole is created

[00:27:00] and all of a sudden OxyContin is aggressively marketed to specifically our region here in

[00:27:06] Appalachia. So Michael's from outside of Lexington, close to Appalachian mountains and Purdue Pharma

[00:27:14] really rolled out this aggressive marketing campaign in that region where I think that they knew

[00:27:21] there were a lot of down and out economically folks there who had lost jobs, textile factories, steel,

[00:27:28] and the doctors there were, you know, people were coming in seeing ads for OxyContin and how much it did

[00:27:35] for their pain, which I hate to tell you, but we're all going to have pain like to some degree or some

[00:27:40] level. And OxyContin has killed millions of people and disabled millions and millions more.

[00:27:46] To go to your earlier point about Viagra, by 2001, Viagra, which was the top earning drug,

[00:27:54] sex definitely sells, was superseded by OxyContin. Just five years into, four years into OxyContin's

[00:28:03] existence was already the top drug in the entire country. So we're not going to talk anymore about

[00:28:10] that. Don't worry. You won't hear me go off on that rant any longer.

[00:28:14] That's another episode. Yeah. It's a whole nother series really on the patient side. You wouldn't

[00:28:20] look at an advertisement for a grill that says it's the best grill that's ever been created

[00:28:25] and actually believe that because this is the same message promoted by other grill companies.

[00:28:32] So why do we look at pharmaceutical ads and make that jump that they say it's the greatest thing,

[00:28:41] the greatest new foundational advance? So why do we automatically believe them? Why doesn't our

[00:28:47] skepticism about more material items sold to us carry over into skepticism with our medications that

[00:28:56] are advertised to us? Again, this doesn't happen anywhere else in the world other than New Zealand.

[00:29:02] So before we get into, you know, some of the psychiatric drug examples, I want to review that this is

[00:29:10] not just corruption in psychiatric medicine or psychiatric practice. This is corruption in every field of

[00:29:16] medicine. You know, you've got the chronic pain epidemic that suddenly came about in the 90s and 80s

[00:29:25] in early 2000s that really promoted Oxycontin as a good medication that was non-addictive. And really,

[00:29:35] the DTCA loophole in 1997 opened the door for Oxycontin being aggressively marketed by Purdue Pharmaceutical.

[00:29:44] It's probably the number one biggest example of disastrous consequences of direct-to-consumer advertising.

[00:29:53] There's a couple other examples, though, one of which is Vioxx, which Michael and I will talk to

[00:30:00] you about in this next segment. Disclaimer, this podcast is for informational purposes only. The

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[00:30:26] medical advice, diagnosis, or treatment. Or, put more simply, if you need help like this guy,

[00:30:32] call your own doctor. Somebody get this guy some help!

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