Speaker 1: Also media, Welcome back to Behind the Bastards, a podcast
Speaker 1: where Sophie is not in the room right now. So
Speaker 1: doctor cave Hoda and I are are the foxes watching
Speaker 1: the hen house? That is also we're we're also the hens.
Speaker 2: I am the producer, I am the captain.
Speaker 1: Now we're like hin foxes, like like a cat dog situation.
Speaker 1: Although I imagine a hen fox. The fox is just
Speaker 1: going to try to eat it's hin. That's part of
Speaker 1: its butt, I imagine.
Speaker 2: I love your quaint country colloquialisms. It's great. I don't
Speaker 2: know what they mean.
Speaker 1: But oh yeah, you're probably too young for that cartoon.
Speaker 1: I was the right age for it.
Speaker 2: Now.
Speaker 1: Yes, doctor Hoda miser care expert legally my doctor, Do
Speaker 1: you have any do you have any theories that you
Speaker 1: can't prove, that are unprovable, that are probably nonsense, that
Speaker 1: you nonetheless believe about health? About health? Yeah, yeah, I
Speaker 1: got a lot.
Speaker 2: As a doctor. I feel like I should. Uh you know,
Speaker 2: I will talk to you at great length about how
Speaker 2: supplements are a fantastic waste of time. Uh And I
Speaker 2: will tell you in detail, and I have on many
Speaker 2: episodes why they're more dangerous generally than they are good
Speaker 2: and you should only use them with strict instructions from
Speaker 2: your physician. But that being said, I feel like ginger
Speaker 2: really helps me in like a power up way that
Speaker 2: it doesn't. I know it doesn't, but I love it,
Speaker 2: and the placebo effect is so strong for me that,
Speaker 2: you know, Yeah, Ginger's my magic thing, my little magic
Speaker 2: creation in my mind that works more than it really does.
Speaker 1: Yeah, I'm not big on supplements. I do take my
Speaker 1: doctor advised me to take for blood pressure, calcium and potassium.
Speaker 2: Uh so I do.
Speaker 1: I do. I do some of that, which I've noticed
Speaker 1: I don't get cramps as much as I used to,
Speaker 1: So I guess I guess I'll call that a win.
Speaker 1: I do love looking it into the different potential side effect.
Speaker 1: I love going on to like biohacking subreddits and seeing
Speaker 1: people talk about like the side effects they're having with
Speaker 1: with various weird supplements they're taking to never die. Although
Speaker 1: my favorite is the Lion's Main subreddit. So Lion's Main
Speaker 1: is like a mushroom that does have like some it
Speaker 1: does have like an effect on your your your brain right,
Speaker 1: Like there's there's actually some like studied benefits of Lion's maine.
Speaker 1: But it's like it's a pretty mild supplement, but there's
Speaker 1: this group of people who are convinced that like taking
Speaker 1: it once has like destroyed their life in the way
Speaker 1: that like a huge dose of psilocybin. Mushrooms might have
Speaker 1: like mind alter effects. And it's like, man, everyone at people,
Speaker 1: I don't put like it in their smoothies.
Speaker 2: I don't.
Speaker 1: I don't think it's the fucking lions main that's giving
Speaker 1: you nightmares for the last seven years of your life.
Speaker 2: I mean that is that is That's the kind of
Speaker 2: thing I hear a lot about, Like every medication you
Speaker 2: name it out there, someone has had someone blames that
Speaker 2: medication for their life being in shambles. Yeah, and you
Speaker 2: know it's medication we're talking about today. Lots of risks,
Speaker 2: It's true. They all they all do some more than others.
Speaker 2: I think we're probably going to discuss here. But uh, yeah,
Speaker 2: I don't know if Lion's maine, which I'm not familiar with,
Speaker 2: really so it's us.
Speaker 1: It's a mushroom, you know, it's got you know, some
Speaker 1: mushrooms have like, uh neurological impacts and stuff on people.
Speaker 1: But you know, my My particular favorite medical theory, doctor
Speaker 1: doctor Hoda is that obviously cigarettes are bad, terrible for
Speaker 1: for almost everyone, nearly always horrible. But I think there's
Speaker 1: a slightly less than one percent of the population that
Speaker 1: have a genetic abnormality that makes cigarettes make them live forever.
Speaker 1: Because every now and then I'll meet you know, sometimes
Speaker 1: in like little corners of the world or whatever. I've
Speaker 1: met f like little old ladies in Japan or like
Speaker 1: ninety six, and they're like, yeah, I've been chainsmoking cigarette
Speaker 1: since I was like eleven years old or something like that,
Speaker 1: and it's like, clearly it works for you. Like there's
Speaker 1: some some minority of the population that cigarettes make and vulnerable.
Speaker 2: I feel like this is that meme of the plane
Speaker 2: that returns from war with the bullet holes. You're never
Speaker 2: gonna hear me say cigarettes are okay. They know what
Speaker 2: they've done, they know.
Speaker 1: I know they've killed They've killed uncountable more people than
Speaker 1: war in the twentieth century, and war killed so many
Speaker 1: people in the twentieth century. But every now and then
Speaker 1: I'll meet some like ninety year old woman who smokes
Speaker 1: four packs a day and she's doing fine. So clearly
Speaker 1: clearly science doesn't understand everything about the maligned cigarette.
Speaker 2: Don't smoke cigarettes, okay enough.
Speaker 1: Don't vape o vape that's the one that worries I mean, like,
Speaker 1: especially since all of my friends vape heavily. It's one
Speaker 1: of those like, yeah, but it's got to be doing
Speaker 1: something right, Like it's got something.
Speaker 2: Like oh, for sure, for sure, I'm a huge fan
Speaker 2: of vaping. Either there is harm reduction. There's a good
Speaker 2: argument about that, but I'm not You're not going to
Speaker 2: see me promote vaping either.
Speaker 1: That said, you know, when we get into the whole
Speaker 1: what is it responsible to tell people to do or not?
Speaker 1: A lot of times the greatest harms are things that
Speaker 1: people like cigarettes, were told by their doctors are great
Speaker 1: for them. And today we're going to tell one of
Speaker 1: those stories, a story of a drug that became the
Speaker 1: lead seller for a major pharmaceutical company that was backed
Speaker 1: by an alliance of physicians who had shall we say,
Speaker 1: some you know, financial interest in finding that this thing worked.
Speaker 1: Today we're talking about vox, which is I think an
Speaker 1: infamous name now in the annals of medical science. People
Speaker 1: tend to know what I'm talking about. But if you
Speaker 1: don't this killed more Americans than the Vietnam War. Like that,
Speaker 1: that's the story we're getting into today. What do you
Speaker 1: know about ViOS.
Speaker 2: You know, I was too young to really be I
Speaker 2: wasn't really practicing medicine when it happened, but I did
Speaker 2: know about it, and I've heard some about it since then.
Speaker 2: I'm really very fascinated by the story and I'm really
Speaker 2: looking forward, yeah to getting into it today. So I'm
Speaker 2: excited about that. I will say I think it was
Speaker 2: It feels like a turning point in regards to how
Speaker 2: people looked at pharmaceutical companies. I think it was really
Speaker 2: like a sentinel event in that, Like I think doctors
Speaker 2: were always skeptical of pharmaceutical companies. We still are, but
Speaker 2: I think that was when people started to become cynical.
Speaker 2: That change started. It's because of what happened with Viox
Speaker 2: and VIAX.
Speaker 1: I think it's also important, Like Vias, the scandal hits
Speaker 1: kind of right as you know, before we're really starting
Speaker 1: to realize what has gone down with the h with
Speaker 1: the prescription painkiller epidemic, like when that's starting to really
Speaker 1: take off and we start to realize how fucked up
Speaker 1: some of what Purdue did. And so this one two punch,
Speaker 1: it really is responsible. I think that's very salient what
Speaker 1: you said. It's really responsible for a lot of I mean,
Speaker 1: for like RFK is about to be the director of
Speaker 1: Health and Human Services right, Like it has a lot
Speaker 1: to do with that, because this is hard for people
Speaker 1: to imagine, Like folks my age, I have always grown
Speaker 1: up with big Pharma being like the devil, right in
Speaker 1: part because like as soon as I turned eighteen nineteen,
Speaker 1: I was hanging out with a lot of hippies, but
Speaker 1: in part because like there were a lot of like
Speaker 1: really really high body count pharmaceutical company scandals, and it
Speaker 1: is hard for some people to remember that, like, pharmaceutical
Speaker 1: companies used to be very popular and well regarded in
Speaker 1: a lot of cases, in part because the generation, the
Speaker 1: generation that was kind of running the world in the
Speaker 1: eighties and nineties had largely lived through like and we're
Speaker 1: still close to Oh, polio is this nightmare that just
Speaker 1: sweeps through and devastates like a generation. You know, you
Speaker 1: have these flues and then suddenly you have half as
Speaker 1: many friends after the flu passes and that stops being
Speaker 1: a thing. And they're really the first generation you know,
Speaker 1: kind of the later boomers that didn't have to deal
Speaker 1: with that, but we're close enough to it to like
Speaker 1: really appreciate, like, Wow, medical science did us as solid.
Speaker 2: Yeah, And we've drifted just far enough from that now
Speaker 2: that people have forgotten and revising whole parts of history.
Speaker 1: And I mean part of the problem is that shit
Speaker 1: like the Vox scandal and like the produe pharmaceutical scandals
Speaker 1: are closer to us than for example, fucking people being
Speaker 1: an iron lungs or whatever.
Speaker 3: You know.
Speaker 1: Recency bias is a hell of a thing. But since
Speaker 1: time immemorial, mankind has struggled against a terrible and implacable enemy, pain.
Speaker 1: Luckily for us, mother nature has provided a perfect painkiller, opium,
Speaker 1: that could be used as the basis for a variety
Speaker 1: of excellent medicines that really do exactly what they say
Speaker 1: they're going to do. Unfortunately, these medicines come with a downside,
Speaker 1: which is that when you start taking them, you might
Speaker 1: not ever want to stop taking them. For some people,
Speaker 1: this destroys their life and take a sip of my
Speaker 1: cratem tea. And since all the all the health cops
Speaker 1: out there don't like people pill popping, like doctor House
Speaker 1: even though he made it look incredibly sexy. Did he.
Speaker 2: Hate that show?
Speaker 1: Oh man, you're not not a house fan. Huh No,
Speaker 1: it's just so ridiculous.
Speaker 2: I mean, all of those shows, Scrubs is the only
Speaker 2: one that's watchable for me.
Speaker 1: Scrubs. Really yeah, I mean I did rewatch. I like
Speaker 1: to imagine that the movie Platoon is like a like
Speaker 1: the the what you might call it the prequel, the prequel.
Speaker 2: Toy said it.
Speaker 1: Yeah, that's why doctor Cox is the way he is.
Speaker 1: He had to spend that night hiding under his friend's
Speaker 1: bodies in a trench line. You had to watch Willem
Speaker 1: Dafoe die. Spoilers for the movie Platoon, which is older
Speaker 1: than most of you, might be illder than me. I
Speaker 1: don't remember when Blagin came out anyway. So because of
Speaker 1: you know, health cops don't like people becoming horrible pill
Speaker 1: addicts and destroying their lives. There's a market, a massive
Speaker 1: market for anyone who could create a thing that is
Speaker 1: an effective painkiller that doesn't also inspire people to break
Speaker 1: into cars for drug money. Right, there's a lot of
Speaker 1: money and a painkiller that does not have the kind
Speaker 1: of abuse potential that opiates have. A Ceda medaphin was
Speaker 1: discovered back in the eighteen eighties, but it took us
Speaker 1: intol the nineteen forties to actually figure out how to
Speaker 1: use it as a drug. And for reasons that are
Speaker 1: more complex than it's really worth getting into. Because of
Speaker 1: how it was discovered, a ceda medaphin could never be
Speaker 1: patented right, which means pharmaceutical companies are not super attracted
Speaker 1: to a ceda medaphin right because like, well, you know,
Speaker 1: you can't only sell it for so much of every
Speaker 1: one can make the damn thing. This meant that pharmaceutical
Speaker 1: companies had to get creative marketing it in order to
Speaker 1: make it profitable. As a result, tailand All became a
Speaker 1: foundational part of the marketing drugs story. McNeil, the company
Speaker 1: that started selling acid of metaphine in the US, initially
Speaker 1: framed it as a painkiller for children. And the way
Speaker 1: the ad campaign that they use is very weird for
Speaker 1: some reason, and I've never found out why, but for
Speaker 1: unclear reasons, they had a huge number of toy fire
Speaker 1: trucks and the way that they first sold Thailand all
Speaker 1: was they like stuffed fire trucks to the brim with
Speaker 1: pills of tailan All and like made that. That was
Speaker 1: their marketing ploy to like get little parents to buy
Speaker 1: tilant All for their small show.
Speaker 2: Always love fire trucks. Kids love Thailand All too. They
Speaker 2: love their Tilan Hall, they love their living damage, and
Speaker 2: they love their fire trucks. This is a thing about kids.
Speaker 1: This is why I'm going to try to make the
Speaker 1: chief Christmas toy of this season the little Doctor House
Speaker 1: pill popper set where because kids, you can take as
Speaker 1: much tilt All as you want.
Speaker 2: Right, you'll be like a big cane. That's dispenser, right,
Speaker 2: and that's your little house toy for kids.
Speaker 1: Takes your little house toy for kids. Yeah, now this
Speaker 1: worked better than any it had any right to work.
Speaker 1: Advertising was easier back then. I imagine today if you
Speaker 1: tried to sell parents on a chat, which is like
Speaker 1: a firetruck Philip Bills, I don't know this would make
Speaker 1: me feel good about any of this, But you have
Speaker 1: to remember so jaded.
Speaker 2: Now that's a problem. We're jaded.
Speaker 1: We're jaded, and like, prior to Thailand All, the chief
Speaker 1: method of dealing with pain for small children was to
Speaker 1: give them a spoonful of heroin and hope they woke
Speaker 1: up the next day right like. They literally sold it
Speaker 1: as a cough medicine for children. So the fire truck
Speaker 1: plan worked well. It worked so well that McNeil gets
Speaker 1: bought by Johnson and Johnson. And that's actually when it
Speaker 1: gets the name thailand All. McNeil's not selling it under
Speaker 1: tiland All Johnson and Johnson, which, for whatever reason is
Speaker 1: a great name. I don't know why. Doesn't make much
Speaker 1: sense to me. Easier remember, Yeah, So, in subsequent decades,
Speaker 1: tailand All was found to be useful in numerous medical
Speaker 1: applications as a painkiller, a fever reducer, and about a
Speaker 1: million other things. It was joined in the mild painkiller
Speaker 1: category by Bear's aspirin, which had its roots in herbal
Speaker 1: medications that had been used by peoples around the world
Speaker 1: since time immemorial. The Assyrians and Sumerians had actually been
Speaker 1: using willow leaves as treatments for various ailments, and a
Speaker 1: variety of plants containing sallasitic acid have been used in
Speaker 1: similar ways all over the globe. So Aceta metaphine and
Speaker 1: aspirin both quickly became foundational pieces of any medicine cabinet,
Speaker 1: but they weren't perfect. One issue that both painkillers had
Speaker 1: is that they could interact with other drugs or just
Speaker 1: interact badly with certain patients to cause substantial stomach distress.
Speaker 1: In the most severe cases, this could result in stomach
Speaker 1: ulcers and sometimes life threatening stomach ulcers. So, you know,
Speaker 1: this is one of these problems, is like you want
Speaker 1: to be able to give people as much of this
Speaker 1: as they need because it's you know, non adict diven
Speaker 1: helps with a lot of things, but there's some hard
Speaker 1: limits based on what this does to people's stomachs well
Speaker 1: and livers.
Speaker 2: I mean menafin, Yeah, you know, that's worldwide one of
Speaker 2: the biggest causes of liver failure from people taking too
Speaker 2: much a cedum, menaphin, and and then yeah, these other
Speaker 2: nonstroidal anti inflammatory drugs. They're the kind of thing that
Speaker 2: make me a gastro introologist have to go in the
Speaker 2: middle of the night to go put a scope into
Speaker 2: someone's stomach because they're bleeding a ton in the setting
Speaker 2: of you know, somebody's who's swallowed too much advil or
Speaker 2: something like a leave or something.
Speaker 1: Yeah, and I think that probably doesn't didn't make it
Speaker 1: as much into my research, just because in the seventies
Speaker 1: they didn't have as much data on that made sure
Speaker 1: they all they're all focused at least on the ulcers.
Speaker 1: But yeah, like the there's a there's a great bluegrass
Speaker 1: song called codeine with the lyrics Codeine, Codeine, You're the
Speaker 1: nicest thing I've seen for a while. And if you
Speaker 1: know anything about codine, it's the worst of the painkillers
Speaker 1: to get high on, which makes the song better because
Speaker 1: if you are the kind of person for whom like
Speaker 1: codeine is the nicest thing you've ever encountered, your life
Speaker 1: has been a hard life.
Speaker 2: Yes, you have had a bad light.
Speaker 1: So by the late twentieth century, pharmaceutical researchers had started
Speaker 1: poking around both compounds to try to find ways to
Speaker 1: create new variants that didn't have any of those downsides.
Speaker 1: They called these hypothetical medications super aspirins, because research pharmacologists
Speaker 1: aren't great at naming things terrible, terrible, terrible. The quest
Speaker 1: for a super aspirin seems to have really started in
Speaker 1: nineteen seventy one when a gaggle of British researchers, I
Speaker 1: think that's how you term a group of researchers tried
Speaker 1: to unravel the mystery of why aspirin and thailand all work. Again,
Speaker 1: we knew these things were good painkillers, and we knew
Speaker 1: they did other stuff. The method of action was unclear
Speaker 1: to us at this point, which is a startling amount
Speaker 1: of the time. True with drugs. There's a lot of
Speaker 1: medications you might be on that the doctors don't precisely
Speaker 1: know why it does what it does. We have somebody,
Speaker 1: but like a.
Speaker 2: Lot of this is still being you want to know. Yeah,
Speaker 2: with a lot of things we do in medicine that
Speaker 2: we yeah, were we just they seem to work, it doesn't.
Speaker 1: It definitely helps. We're not sure why. But in this case,
Speaker 1: the research research board fruit. As author Tom NeSSI describes
Speaker 1: in his excellent book Poison Pills quote, when an injury
Speaker 1: takes place in the body, chemicals known as prostaglandins rush
Speaker 1: into the wound site to deal with the swelling, heat,
Speaker 1: and pain. Prostaglandins have important functions for human well being.
Speaker 1: They play a part in ovulation, to protect the stomach
Speaker 1: from acids and to ensure that blood clots normally. The
Speaker 1: latter effect explains why asprom reduces heart disease. It prevents
Speaker 1: clumps of blood from forming that can potentially block an artery.
Speaker 1: Prostaglandins actually make nerve endings more sensitive to pain. N
Speaker 1: s A I, d's in, SAIS and insetes.
Speaker 2: Yeah.
Speaker 1: Insades reduce the production of prostaglandin and thereby relieve the
Speaker 1: pain associated with swelling and soreness. Unfortunately, in the process
Speaker 1: of doing so, they irritate the stomach. Sometime after this discovery,
Speaker 1: scientists found that a substance called cyclooxygenase or COX, was
Speaker 1: produced as part of the mobilization of prostaglandin and was
Speaker 1: the enzyme that actually controlled pain and inflammation.
Speaker 2: You're doing a fantastic job, by the way, a moment,
Speaker 2: you're doing a really good You didn't call it Cox,
Speaker 2: by the way, Cox.
Speaker 1: Yeah, I was going to because doctor Cox.
Speaker 2: Yeah, yeah, in his honor. But this is interesting. I
Speaker 2: didn't expect I was going to be getting this like
Speaker 2: trip down medical school, like memory lane. This is fantastic.
Speaker 2: You're doing great.
Speaker 1: We try to be complete. Also, doctor Cox isn't born
Speaker 1: on the fourth of July, which you can consider a
Speaker 1: stealth sequel to Platoon if you assume that Williem Dafoe
Speaker 1: actually survived his injuries in Platoon?
Speaker 2: Was he in.
Speaker 1: He's the crazy vet in Mexico that fucking Tom Cruise
Speaker 1: meets when they're both like doing drugs and hanging out
Speaker 1: with prostitutes after losing their legs. Yeah, it's great, oh Man,
Speaker 1: that movie rules. So these researchers began to theorize that
Speaker 1: COX might include an additional substance that was separately the
Speaker 1: cause for stomach irritation. If someone could find an isolate
Speaker 1: said substance, it might allow for the creation of a
Speaker 1: super aspirin. But no one even knew if this theoretical
Speaker 1: substance was real, and pharmaceutical companies didn't exactly feel an
Speaker 1: immediate urge to jump on the matter because they had
Speaker 1: no idea if this was even a thing. Fast forward
Speaker 1: to nineteen ninety A pharmacologist named Needleman gets close to
Speaker 1: isolating the COX enzyme that he believes is causing all
Speaker 1: of the problems he hasn't actually doesn't actually find it,
Speaker 1: but he's confident enough in its existence for reasons that
Speaker 1: I'm sure makes sense to biochemists that he gives it
Speaker 1: a name Cox.
Speaker 2: Two.
Speaker 1: Research goes on, and in July of nineteen ninety two,
Speaker 1: several teams of researchers in Montreal announced that they have
Speaker 1: isolated two enzymes COX two and one, of which COX
Speaker 1: two seems to be the causal agent behind the side
Speaker 1: effects in SAIDs provoke in some patients. Right, So nineteen
Speaker 1: ninety two they found finally this thing they've been looking
Speaker 1: for for like twenty years. Right, this is the reason
Speaker 1: they believe why your aspirin or whatever can cause stomach olcers.
Speaker 1: So the researchers used that if you can find a
Speaker 1: medication that blocks COS two and you compound it with
Speaker 1: like a painkiller with a seat of metaphine or whatever,
Speaker 1: then you'd have a super aspirin capable of being prescribed
Speaker 1: much more often to even more people. Aspirin sales at
Speaker 1: that point are already like fifty billion tablets per year,
Speaker 1: So the amount of money on table for the first
Speaker 1: pharmaceutical company to figure this out is mind boggling, because
Speaker 1: then you get to patent it. Then you are the
Speaker 1: only one that has the aspirin that doesn't cause stomach ulcers, right,
Speaker 1: and for like whatever twenty years, you're the only one
Speaker 1: who gets to sell that shit. That's so much fucking money, right, Like, yeah.
Speaker 2: It's one of the most commonly used medications in the world.
Speaker 1: Yes, or this is like an unfathomable fortune. We're talking
Speaker 1: like an oil and gas industry level fortune is on
Speaker 1: the table here, and so a fucking race begins, right,
Speaker 1: And the two major companies that are going to wind
Speaker 1: up really throwing their money, throwing their hats into the
Speaker 1: table and to get into the super aspirin ring are
Speaker 1: our old friend Pfizer and our new friend Merk. Now, today, again,
Speaker 1: any pharmaceutical company you mentioned, people tend to say, like,
Speaker 1: fuck these guys. But in the late nineteen eighties and
Speaker 1: early nineties, people did not feel that way about Merk.
Speaker 1: They were very much considered to be one of the
Speaker 1: good guys. Now, I know that kind of sounds crazy,
Speaker 1: but I want to read a quote from an article
Speaker 1: by David Colp and Isabelle Berry in the Journal of
Speaker 1: Civil Rights and Economic Development. In its missions value statement,
Speaker 1: the company stresses that its business is preserving and improving
Speaker 1: human life. Merk's mission statement continues, we value above all
Speaker 1: the ability to serve everyone who can benefit from the
Speaker 1: appropriate use of our products and services. Throughout its history,
Speaker 1: Mirk has often lived up to its state admission. In
Speaker 1: the nineteen thirties, after streptomycin was developed by a Merk scientist,
Speaker 1: Merck gave up its patent protection since it believed the
Speaker 1: drug was too important a medical breakthrough to keep to itself.
Speaker 1: Other companies were allowed to produce streptomycin, and Merk lost
Speaker 1: potential profits. The nineteen eighties, when Merk found a cure
Speaker 1: for river blindness caused by a parasitic worm. The company
Speaker 1: had given away, free of charge, forty million pillars a
Speaker 1: year to African nations to treat and cure this. So
Speaker 1: Merks seems pretty good. Coming into the nineties, You're like, hey,
Speaker 1: maybe there's a company that I actually believes what it
Speaker 1: is they put. They gave up money, you know, a
Speaker 1: lot of it, so that sounds pretty great. But coming
Speaker 1: into the nineties, Murk is also staring down the barrel
Speaker 1: of a big problem a lot of its massive wealth,
Speaker 1: because this is a very wealthy company coming into the nineties.
Speaker 1: Was based on a pair of cholesterol drugs, zocore and Preachol,
Speaker 1: which were both about to lose their twenty year patent
Speaker 1: protection starting in the early two thousands, so not yet
Speaker 1: in about a decade, but a Decade's not a lot
Speaker 1: of time in terms of like researching a new medicine. Right,
Speaker 1: If you've only got a decade or so over your
Speaker 1: two big profit engines are going to.
Speaker 4: Time from really to get to market. Yeah, you got
Speaker 4: to start cooking. Yeah, you got to start moving. In
Speaker 4: addition to that, five of their best selling medications, including pepsid,
Speaker 4: were set to lose patent protection even soon in ninety nine,
Speaker 4: so they are looking at a looming, very serious problem
Speaker 4: for their profitability.
Speaker 2: This is such a recurring theme with pharmaceutical companies. I
Speaker 2: just did an episode about a medication called Zygris, which
Speaker 2: was like, it sounds awesome, It sounds awesome. It's this
Speaker 2: medication that was touted as like this new breakthrough therapy
Speaker 2: for sepsis, and it was super exciting, ended up falling
Speaker 2: apart for a lot of different reasons and being withdrawn
Speaker 2: and end up being a big marketing scandal in my opinion.
Speaker 2: But at the end of the day, it all started
Speaker 2: because they were losing their patent on their big like
Speaker 2: sellings and medications like the one, The things that were
Speaker 2: making them tons of money were about to run out
Speaker 2: and they needed a new like cash stream as quick
Speaker 2: as possible. So things started happening probably faster than they
Speaker 2: should have.
Speaker 1: Yeah, yeah, yeah, And that's like that is the story
Speaker 1: here as the story a lot of the time right
Speaker 1: where these and I don't think this is a bad idea,
Speaker 1: Like the idea that drugs eventually age out to get
Speaker 1: generic is like kind of necessary in order to in
Speaker 1: our system at least in order to make it even
Speaker 1: have a chance of being affordable for some medications. But
Speaker 1: it does it leads to this as well.
Speaker 2: I don't know.
Speaker 1: Again, we don't need to go on another single payer
Speaker 1: healthcare rant, but like we have, so there's so many
Speaker 1: little things that are fucked up about, like even the
Speaker 1: things that seem like they make sense that also lead
Speaker 1: to fucked up outcomes. And because of how much money
Speaker 1: is at stake in these basins and how expensive it
Speaker 1: is to be a pharmaceutical company, right, Like, it's not
Speaker 1: cheap and most of the medications that they like, one
Speaker 1: of the things you have to accept as a pharma
Speaker 1: company is that most of the things you try to
Speaker 1: make into a medicine aren't going to work, right, Like,
Speaker 1: that's just and that's kind kind of the story. Here
Speaker 1: is a medication that if they had done more, spent
Speaker 1: more time, they would have realized this was not a
Speaker 1: viable product. But they've got shareholders to please.
Speaker 2: Right, and when the money start to shift from research
Speaker 2: and development in these companies to marketing, which it does
Speaker 2: more and more, and I.
Speaker 1: Mean really happening in the nineties.
Speaker 2: Yeah right, I'm assuming that's that their problem here, That's a.
Speaker 1: Big part of it. Yes, so you know, murk is
Speaker 1: coming into the nineties, not quite a five alarm fire yet,
Speaker 1: but definitely like a serious situation. And super Aspirins seems
Speaker 1: like it might be the salt solution to their problems
Speaker 1: and maybe even the key to greater profits than ever before.
Speaker 1: And speaking of greater profits than ever before, you know,
Speaker 1: who's making money like they've never made money.
Speaker 2: Oh, I'm the people who deserve to the people are
Speaker 2: the people who sponsored this podcast. They're the ones that
Speaker 2: deserve the most of the money.
Speaker 1: That's right. The products and services that support this podcast
Speaker 1: are literally the only ethical people in capitalism. And you
Speaker 1: can just trust them. Give them your wallet, give your kids,
Speaker 1: you know, hand with children over to our sponsors. They'll
Speaker 1: take care of them, they'll raise them as their own.
Speaker 1: You know better than better than we would, better than
Speaker 1: you would. Yeah, exactly, you know, just trust them and
Speaker 1: we're back. I didn't mean to imply that none of
Speaker 1: you were good parents. It's just that our sponsors are
Speaker 1: incredible parents, you know.
Speaker 2: That much better.
Speaker 1: They've never they've never yelled at me, never yelled at me,
Speaker 1: never even spanked me, and I deserved it sometimes. So
Speaker 1: you paid money for that sort of thing, I have. No,
Speaker 1: we don't even saying shit like that. The subredit's gotta
Speaker 1: get real uncomfortable, very fast. Okay, So super Aspirin seems
Speaker 1: like it could be the solution to their to Merk's problems.
Speaker 1: In nineteen ninety four, a new CEO takes over at Merk,
Speaker 1: and this is we were just talking about the shift
Speaker 1: from R and D to marketing. This is perfectly emblematic
Speaker 1: of that because Merk's new CEO is a guy named
Speaker 1: Raymond gil Martin. Now, the previous CEO, Raymond is an
Speaker 1: NBA from Harvard, right, which means he doesn't know anything
Speaker 1: about anything but making making money in the most sketchy
Speaker 1: ways possible. Whereas the previous CEO of Merk had been
Speaker 1: doctor Roy Vagelos, an actual medical scientist with a research background.
Speaker 2: Very famous.
Speaker 1: So yes, yes, yeah, so R goes from famous and
Speaker 1: widely respected medical researcher as their CEO to a guy
Speaker 1: with an MVA NBA from Harvard.
Speaker 2: Yeah. The Vagelos Award is like this award that's still
Speaker 2: given out to like people who are like doing humanitarian
Speaker 2: work for like in the pharmaceutical world. So yeah, like
Speaker 2: this is a major shift, a major shift away from
Speaker 2: somebody who was I think ostensibly a very good person
Speaker 2: from all the towns, a very good person, good researcher. Yeah,
Speaker 2: to something very different.
Speaker 1: Yeah. Maybe maybe the answer is, if you're going to
Speaker 1: be the CEO of a pharmaceutical company, you should have
Speaker 1: like watched a sick child die at a hospital. Like
Speaker 1: I don't mean to be blunt, blunt, but it seems
Speaker 1: like it leads you to do things like give up
Speaker 1: patents on life saving medication.
Speaker 2: For rotation, a rotation in the hospital.
Speaker 1: I keep thinking about, like fucking the polio vaccine guy
Speaker 1: who he was, like, I think his direct his direct
Speaker 1: question quote when asked if he was going to patent
Speaker 1: it was like would you patent the sun?
Speaker 2: Yeah?
Speaker 1: Sulk, yeah, real, real, real, g real Chad so Raymond's
Speaker 1: career up to that point this is the business guy.
Speaker 1: See new CEO Mark had included eight years as a
Speaker 1: consultant for Arthur D. Little, which lists as run of
Speaker 1: its great achievements, which is it. It's like Mackenzie kind of.
Speaker 1: It's a consulting firm and it listed as one of
Speaker 1: its great achievements the privatization of British rail So those
Speaker 1: of you over in the UK, sure you love this guy. Also,
Speaker 1: there was this time that they used a bucket of
Speaker 1: sow's ears to make a silk purse. I don't know
Speaker 1: why this is listed as an achievement of the Arthur D.
Speaker 1: Little company, but it is. He worked as the CEO
Speaker 1: at a medical device company after that, until he was
Speaker 1: hired by Merck as their first outside CEO for the
Speaker 1: express purpose of seeing them through the looming patent cliff scenario.
Speaker 1: So he was brought in as kind of like an
Speaker 1: emergency guy right now. It was Raymond who decided that
Speaker 1: Merk's future would be in super aspirin. Alongside their chief scientist,
Speaker 1: doctor Edward Skolnik, he launched a crash program to bring
Speaker 1: a cox to inhibitor pain medication to market. The name
Speaker 1: they picked for the wonder drug that did not yet exist,
Speaker 1: but they were going to have that they were going
Speaker 1: to hang the company's future on was Viox.
Speaker 2: Now.
Speaker 1: Time was of the essence here. Doctor Needleman, the guy
Speaker 1: who had failed to discover Cox two but had gone
Speaker 1: ahead and named it anyway, worked at a company called
Speaker 1: g D. Seerle which was a division of Monsanto and
Speaker 1: was leading research into a new inside that would eventually
Speaker 1: be called Celebrex. And while Celebrex was under development, Pfizer
Speaker 1: bought Seerrel from Monsanto and started throwing money into Celebrex
Speaker 1: as part of what was turning into a vicious competition
Speaker 1: to be the first pharmaceutical company to bring one of
Speaker 1: these new super aspirints to market. And there's probably a
Speaker 1: lot to be said about Celebrex. I am not competent
Speaker 1: to say it. I will say that it is currently
Speaker 1: a medication that the FDA says there's not evidence of
Speaker 1: significant harms for There is debate about that to this day.
Speaker 1: But that's all I can say on the matter because
Speaker 1: I'm not a not an expert on this. There are
Speaker 1: some activists who are very angry that Celebrex is still
Speaker 1: on the market. The FDA has said it's more or
Speaker 1: less fine. That's where we are with Celebrex.
Speaker 2: Yeah, it's the same family, Yes, and it does have
Speaker 2: that comes with a warning on it that's more striking
Speaker 2: than most other ensades. Yes, I know. Actually it's a
Speaker 2: good question. I don't know how often it's used these days.
Speaker 1: I assume it's pretty rare or not as often as
Speaker 1: it was.
Speaker 2: For sure.
Speaker 1: It's one of those things where a few years ago
Speaker 1: there was a very scary study about heart effect like
Speaker 1: heart problems that it could cause, and then a few
Speaker 1: years later there was a study that suggests like, well, no,
Speaker 1: maybe we got that one wrong. Maybe it's no worse
Speaker 1: than other drugs in this class. Again, that's all I
Speaker 1: can really say about Celebres because I'm not qualified to
Speaker 1: judge a medication that there's still a lot of debate over.
Speaker 2: I don't have a lot more to add to it either,
Speaker 2: But it feels like there's other ensades out there that, yes,
Speaker 2: that we use a little frequently. It seem a little safer. Yeah.
Speaker 1: Yeah, But what you need to know is that Pfiser
Speaker 1: is putting there, is putting their money into Celebres after
Speaker 1: they acquire Merle, and you know vox is going to
Speaker 1: be the attempt made by Mark to do the same thing.
Speaker 1: So throughout the mid nineteen Ninetieskvet Merk scientists worked on VOCs,
Speaker 1: rushing it through stages of medical testing, harassed by the
Speaker 1: knowledge that any delay or bad finding. And when I
Speaker 1: say bad, not in a scientific sense. It's not bad
Speaker 1: scientifically to find out a drug doesn't work, but bad
Speaker 1: for the company if this drug doesn't work because they're
Speaker 1: on a timetable, would stop them from beating Pfizer and
Speaker 1: unfortunately forever. There were signs right from the beginning that
Speaker 1: viox might be dangerous. The first evidence of this was
Speaker 1: presented in the mid nineteen nineties by doctor Garrett Fitzgerald,
Speaker 1: a Merck consultant who was also professor of cardiovascular medicine
Speaker 1: at the University of Pennsylvania. He warned the company that
Speaker 1: Vyax might harm the walls of the blood vessels protecting
Speaker 1: the human heart. I'm going to quote again from the
Speaker 1: book Poison Pills by Tom NeSSI, which, if you're looking
Speaker 1: for like a really good exploration of how a pharmaceutical
Speaker 1: company does evil, Poison Pills is very well written. He
Speaker 1: suggested that Mark set up a series of experiments to
Speaker 1: test this theory, few of them wherever performed. Other scientists
Speaker 1: cautioned that yox was related to kidney damage an increase
Speaker 1: in blood pressure that could be linked to heart problems.
Speaker 1: Doctor Fitzgerald also found similar problems with the drug in
Speaker 1: the same class as vyax, called Celebres, made by rival
Speaker 1: drug company Pfiser. Like Merk, Pfeiser denied the finding of
Speaker 1: any cardiovascular problems with its drug, but cleverly began its
Speaker 1: own campaign to portray viox as the more dangerous of
Speaker 1: the compounds. That's smart at this point and victually warns
Speaker 1: them the drug is not on market. He is trying
Speaker 1: to stop it from getting to market by saying, like,
Speaker 1: there's some real evidence. This is sketchy, you should carry
Speaker 1: it more studies, and Murk is just kind of like,
Speaker 1: but what if we didn't.
Speaker 2: It's like when you've.
Speaker 1: Been like spending like crazy all month, and you know,
Speaker 1: you probably like you might be running down to the limit,
Speaker 1: but you're just like going to the grocery store hoping
Speaker 1: that like your card works this one more time or something.
Speaker 1: So now, at this point, there was no hard evidence
Speaker 1: of harm to the human heart, in large part because
Speaker 1: Merk had refused to do the studies that doctor Fitzgerald advised.
Speaker 1: This changed in nineteen ninety six, when an internal Mirk
Speaker 1: study showed that people who took viox in high doses
Speaker 1: suffered more heart problems than people given a placebo. A
Speaker 1: MIMO was issued internally that noted the treatment period was
Speaker 1: six weeks versus placebo. The initial dose of viox was
Speaker 1: one hundred and seventy five milligrams, but in mid study
Speaker 1: the dose was lowered to one hundred and twenty five milligrams.
Speaker 1: Adverse events of most concern were in the cardiovascular system
Speaker 1: i e. Heart attack, stable angina, rapid fallen hemoglobin and
Speaker 1: hematopec crip, dangerous blood problems and some subjects. So that's bad.
Speaker 1: Those are all really bad. Yeah, results, that's yeah.
Speaker 2: You're almost officially a doctor because that is correct. That
Speaker 2: is the appropriate diagnosis is that it's all not good,
Speaker 2: not good, not good, not good.
Speaker 1: It is important to underline the severity of these results, though.
Speaker 1: These extremely serious side effects were present after just a
Speaker 1: few weeks of medication for doses that were just about
Speaker 1: twice the approved amount for treating acute pain, which was
Speaker 1: fifty milligrams now twice sounds like a lot, but when
Speaker 1: we are talking about the way people use medicines, it's
Speaker 1: really not. People take way more, specially pain medicine than
Speaker 1: they ought to.
Speaker 2: It keeps me in business. Yeah, people do this. This
Speaker 2: is like almost You don't even have to take it
Speaker 2: more than is recommended to run into problems, because sometimes
Speaker 2: people only take a little and they run into problems
Speaker 2: in the GI system for example, or other issues that
Speaker 2: kid needed that can be affected for the heart. But
Speaker 2: it is a sole underlying known fact that whatever we
Speaker 2: think people are going to be taking, likely it'll be.
Speaker 1: More, and that is why it's standard in tests like
Speaker 1: the one they were conducting, actually to test ten times
Speaker 1: the effective acute dose when doing studies like this to
Speaker 1: check for side effects, which they didn't do because they
Speaker 1: knew that the results would be even worse. One doctor
Speaker 1: who analyzed these results noted, I recall very clearly many
Speaker 1: occasions where MERK scientists and doctors working with MERK were
Speaker 1: claiming that viox was safe as placebo, which we've already
Speaker 1: seen it's not.
Speaker 2: Now.
Speaker 1: The reality is that results like this were a big
Speaker 1: warning sign and should have been taken as evidence that
Speaker 1: biax might not be viable as a medication and certainly
Speaker 1: needed more testing, But Merk went full speed ahead. In
Speaker 1: November of nineteen ninety eight, they asked the FDA to
Speaker 1: approve viviocs after testing the drug on fifty four hundred patients.
Speaker 1: They bragged that they had conducted eight different studies which
Speaker 1: had shown owned biox's efficacy. Now, this is where we
Speaker 1: get into a complicated and uncomfortable topic, medical studies, and
Speaker 1: why they often don't work the way that they should.
Speaker 1: In theory, the process of conducting medical studies should identify
Speaker 1: dangers in new drugs and accurately measure their efficacy. But
Speaker 1: theory envisions a situation in which drugs are researched by
Speaker 1: disinterested parties who have no vested interest in anything but
Speaker 1: the truth. The reality is that studies are often funded
Speaker 1: by pharmaceutical companies who, like Merk, might be sweating the
Speaker 1: arrival of an upcoming patent cliff and headed by a
Speaker 1: new CEO who lacks the same commitment to medical ethics
Speaker 1: as his precursor. I'm going to quote now from an
Speaker 1: article on this in the Union of Concerned Scientists to
Speaker 1: increase the likelihood of FDA approval for its anti inflammatory
Speaker 1: and arthritis drug bios. Merk used flawed methodologies biased towards
Speaker 1: predetermined results to exaggerate the drug's private positive effects. Internal
Speaker 1: documents made public in litigation revealed that a Merk marketing
Speaker 1: team had developed a strategy called Advantage Assessment of Differences
Speaker 1: between bios and to ascertain gastrointestinal tolerability and effectiveness to
Speaker 1: skew the results of clinical trials in the drugs favor.
Speaker 1: As part of the strategy, scientists manipulated the trial design
Speaker 1: by comparing to the drug to neproxin, a pain reliever
Speaker 1: sold under brand names such as a Leave, rather than
Speaker 1: to a placebo. The scientists then highlighted the results that
Speaker 1: neproxyen decreased the risk of heart attack by eighty percent
Speaker 1: and downplayed the results that viax increased the rate the
Speaker 1: risk of heart attack by four hundred percent. This misleading
Speaker 1: presentation of the evidence made it looked like the proxen
Speaker 1: was protecting patients from heart attacks and that vax only
Speaker 1: looked risky by comparison. So instead of comparing this drug
Speaker 1: to a placebo in which it would have been like Wow,
Speaker 1: the rate of heart attacks is much higher. They compared
Speaker 1: it to a drug that reduced the risk of heart
Speaker 1: attacks and were like, well, of course people have more
Speaker 1: heart attacks on this drug. This other drug reduces heart attacks,
Speaker 1: but that doesn't mean this is danger. Like that's so
Speaker 1: fucking shady.
Speaker 2: Is It's a bit tricky how they're doing it too,
Speaker 2: because you know, so far, a lot of what they
Speaker 2: have done sounds very I mean it sounds sound from
Speaker 2: a distance. You know, the whole idea of like looking
Speaker 2: at COX two inhibitors, like looking at medications specifically for
Speaker 2: this and comparing it, you know, say, hey, look at
Speaker 2: least we're better than the other medications to some degree.
Speaker 2: From a high from your way back vantage point, it
Speaker 2: all makes sense. It's when you start to like look
Speaker 2: a little bit more closely that it's questionable, especially given
Speaker 2: that they seem to know early on that there was
Speaker 2: high risk of these cardiovascular injuries and that the whole
Speaker 2: narrative is being shifted to try and take focus away
Speaker 2: from that. Yeah, it's it's all. This is why it's
Speaker 2: a difference between marketing and between like a scientist running
Speaker 2: the program. Yeah.
Speaker 1: Yeah, and that's like that's really the whole story here, right.
Speaker 1: So Merks fuckery extended to the hiring of ghostwriters to
Speaker 1: write scientific articles reporting on clinical trials of bias to
Speaker 1: try and convince doctors and regulators that the medication was safe.
Speaker 1: Internal Mirk documents later revealed that in sixteen out of
Speaker 1: twenty papers reporting on early VYAX clinical trials, a Merk
Speaker 1: employee was listed as the lead author of the first draft,
Speaker 1: but in the published versions credit for authorship was given
Speaker 1: to an outside academic to continue in that from that
Speaker 1: piece by the Union of Concerned Scientists. In one draft
Speaker 1: of a Yox research study that did not yet have
Speaker 1: a prominent outside name attached, MIRK officials listed the lead
Speaker 1: author only as external author question mark. A MERK scientist
Speaker 1: was also found to have removed the evidence of free
Speaker 1: heart attacks among patients in a data set from the
Speaker 1: results presented some great stuff.
Speaker 2: I mean, in wonder what numbers were in that paper,
Speaker 2: but removing three can make a huge difference.
Speaker 1: Yes, yes, especially if you're not talking about a huge study.
Speaker 2: You know, did say anything about how many people were
Speaker 2: in that study?
Speaker 1: I you know what, I'm sure I could have looked
Speaker 1: into it, but I did not.
Speaker 2: And I'm wondering if in these studies they were talking
Speaker 2: about the rates of ulcer bleed and gastric bleeding as well,
Speaker 2: because I mean that's o sensibly the whole reason that.
Speaker 1: They're doing it was the whole thing that advantage was
Speaker 1: supposed to show, right, is that it reduced the rate
Speaker 1: of like peptic ulcer bleeding and stuff. And yeah, just
Speaker 1: the whole the fact that we have drafts of them
Speaker 1: just being like, we'll figure out who the author of
Speaker 1: this piece is later, once we find a science, once
Speaker 1: we find an outside doctor who you know, wants some cash.
Speaker 1: And a lot of times these aren't direct bribes. These
Speaker 1: are like, okay, you'll stick your name on this and
Speaker 1: then this research project you want, we'll get a little
Speaker 1: bit of funding from a from from a Papa merk.
Speaker 2: You know. Not even just that these are all being
Speaker 2: published in decent journals. I'm sure that just people want
Speaker 2: to be in good journals. They want to have another
Speaker 2: publication and you know, New Journal and Medicine or the
Speaker 2: Lancet or whatever.
Speaker 1: And you you also have to remember people think a
Speaker 1: lot of people think this is the next big miracle drugs.
Speaker 1: So yeah, you want you want to you want to
Speaker 1: have a you want to have a little bit of
Speaker 1: play in that, right of course.
Speaker 2: Uh so. Yeah.
Speaker 1: The worst piece of evidence against BIOS of this peerod
Speaker 1: came out the same year Merk asked for FDA approval
Speaker 1: nineteen ninety eight. Merk Study zero ninety involved nine hundred
Speaker 1: and seventy eight patients and showed that people on BIOS
Speaker 1: experienced serious cardiovascular events six times as often as patients
Speaker 1: taking a different drug or a placebo for arthritis pain.
Speaker 1: Merks shelled the study and never published it. Later that
Speaker 1: same year, a group of medical researchers at the University
Speaker 1: of Pennsylvania and by the way, thanks to that doctor
Speaker 1: we named earlier, U of pen really tried to stop
Speaker 1: biox from being a thing, published a study that showed
Speaker 1: that COX two inhibitors might interfere with other enzymes that
Speaker 1: helped prevent heart disease. Warnings were sent to Mercandfiser, who
Speaker 1: quickly shoved them off into the circular file and kept
Speaker 1: right on begging the FDA to say yes. And say yes,
Speaker 1: the FDA did. They approved bios for use as a
Speaker 1: painent killer in results in adults in nineteen ninety nine.
Speaker 1: A minstrel pain medication and an anti inflammatory for people
Speaker 1: with osteoarthritis. Despite approving the drug, FDA reviewer doctor Villalba
Speaker 1: warned in his memorandum that there was evidence suggesting vyax
Speaker 1: caused more frequent cardiovascular events and patients. So Vox goes
Speaker 1: to market, it immediately becomes a best seller. Celebrex also
Speaker 1: goes to market. It drives massive profits for Pfizer. And
Speaker 1: this is in spite of the fact that particularly viox
Speaker 1: is not great at I mean, neither drug is really
Speaker 1: all that good at fighting pain. And I'm going to
Speaker 1: quote from the New York Times here. When studies on
Speaker 1: viox and rex became available in nineteen ninety eight nineteen
Speaker 1: ninety nine, many doctors were disappointed. Neither drug alleviated pain
Speaker 1: any better than the old medications, and the drugs cost
Speaker 1: close to three dollars a pill over the counter. Pain relievers,
Speaker 1: in contrast, cost pennies a dose, and by the way,
Speaker 1: they weren't all that much better at preventing ulcers. Some
Speaker 1: studies suggest like viox was no better at preventing ulcers,
Speaker 1: although that seems to be unclear now. Analysts say that
Speaker 1: the success of viox was critical to MRK. The patents
Speaker 1: on those popular mark drugs Aspire started expiring in two
Speaker 1: thousand and two thousand and one, which opened them up
Speaker 1: to eric competition, and Vyox comes through and is I
Speaker 1: mean almost immediately billions of dollars a year in profits
Speaker 1: for the company. Michael krint Savage, a drug industry analyst
Speaker 1: at the investment bank Raymond Jameson Associates, says vax was
Speaker 1: Merk savior. It's as simple as that, like he puts
Speaker 1: it down, as the company might have gone on or
Speaker 1: under at least, you know, probably been acquired if it
Speaker 1: hadn't been for a Yox.
Speaker 2: I mean, I remember at the time it was huge.
Speaker 2: It was I had never seen a campaign like it
Speaker 2: about that I remember. I think it was one of
Speaker 2: the first times I remember really having like being conscious
Speaker 2: of like how much a medicine was being marketed, you know.
Speaker 2: And you know, I think it's one of these medicines
Speaker 2: where it's like, you know, maybe five to ten percent
Speaker 2: of the people who are using it maybe had some benefit,
Speaker 2: real benefit where they maybe it did help them from
Speaker 2: a gastric ulcer perspective, maybe they didn't have the option
Speaker 2: of taking another medicine. But for the other ninety percent
Speaker 2: of people there taking it, it wasn't necessary for them.
Speaker 2: It wasn't something that they needed, and it was just
Speaker 2: increasing their risk of heart attack or stroke. And I
Speaker 2: think that this is I bet you. I mean, you
Speaker 2: probably know this, but I bet up to this point
Speaker 2: this was the most that ever been spent on direct marketing.
Speaker 1: Yeah, I mean, and that is what we're actually about
Speaker 1: to talk about is the marketing campaign, which surprise, surprise,
Speaker 1: involves beloved figure skater Dorothy Hamill.
Speaker 2: But I knew it.
Speaker 1: Yes, she's the great monster in this in all of
Speaker 1: our episodes, every episode we have ever done, Dorothy Hamill
Speaker 1: and building into this.
Speaker 2: She's the fanos of the behind the Bastard's world.
Speaker 1: That's right. Joseph Stalin would never have accomplished his greatest
Speaker 1: crimes without Dorothy Hamill's assistance. That's obvious though. Evil historians
Speaker 1: have been talking about that for decades. Anyway, you know
Speaker 1: who's not Dorothy Hamill. I don't know why I'm shitting
Speaker 1: on Dorothy Hamill. None of this is really her fault. Anyway,
Speaker 1: here's as we're back. Okay, so we're talking the viox
Speaker 1: marketing campaign. How do you sell America on this drug
Speaker 1: that is going to get a decent percentage of America killed?
Speaker 1: And the answer is figure skating superstar Dorothy Hamill. So yeah,
Speaker 1: this is this is where the real villain of the
Speaker 1: story comes into it.
Speaker 2: The haircut is a problem for me.
Speaker 1: I had Hamil's haircut.
Speaker 2: My first girlfriend, The first girl that really smashed my
Speaker 2: heart into like a billion pieces, scattered them across the globe.
Speaker 1: Was Dorothy Hamill. That has really taking some strays in
Speaker 1: this episode.
Speaker 2: Just she had Dorothy Hamill's haircut. Oh, which I don't
Speaker 2: know why at the time didn't bother me, But so
Speaker 2: now when I see that haircut, I'm like, oh, yeah,
Speaker 2: that reminds.
Speaker 1: Me of that that lost love.
Speaker 2: Yeah, painful, painful. So for those of you.
Speaker 1: Who don't know what we're talking about, back in the
Speaker 1: nineteen seventies, an incredible athlete named Dorothy Hamill became one
Speaker 1: of the most famous people in the world. When she
Speaker 1: was just nineteen. She performed at the nineteen seventy six
Speaker 1: Innsbruck Olympics and won the gold. Time declared her America's
Speaker 1: Sweetheart and as his customary for world class athletes, corporations
Speaker 1: began offering her embarrassing piles of money to endorse their products.
Speaker 1: Hamil's first run as a famous person didn't go great.
Speaker 1: She married Dean Martin's kid, and then he died in
Speaker 1: a plane crash. She fell out with her coach. She
Speaker 1: spent all of her money buying the ice capades, and
Speaker 1: then wound up burning out and developing a bleeding ulcer.
Speaker 1: She had another marriage that ended badly and wound up well,
Speaker 1: not broke, you wouldn't say, but no longer rich, and
Speaker 1: she suffered from a substantial amount of pain from a
Speaker 1: lifetime of pushing her body to athletic excess. The pain
Speaker 1: was bad enough that at the worst Dorothy could no
Speaker 1: longer even play with her daughter. Some days she could
Speaker 1: barely get out of bed. And then her doctor told
Speaker 1: her to try biox. She would later claim that it
Speaker 1: was effectively a miracle cure for her, not only soothing
Speaker 1: her pain, but bringing back her ability to perform on
Speaker 1: the ice in a way she hadn't in years. In
Speaker 1: August of two thousand, Hamil made an appearance on Larry
Speaker 1: King Live with Caitlyn Jenner, and Jenner is also talking
Speaker 1: about viox and this this. Jenner is also claiming that
Speaker 1: like this this really helped her arthritis. She told the
Speaker 1: audience a heart wrenching story about loss and pain and
Speaker 1: her miraculous return to the world of the living thanks
Speaker 1: to Vyos quote. I just I felt old. I felt depressed,
Speaker 1: tired all the time. I mean, having chronic pain is exhausting.
Speaker 1: And I got to the point this year I was
Speaker 1: on tour and I couldn't skate, and so I went
Speaker 1: to a doctor and we finally got to the bottom
Speaker 1: of it, and my doctor prescribed VOX for me. And
Speaker 1: it's as if I've been given a new life. It's
Speaker 1: just it's been amazing. I feel twenty years younger. I
Speaker 1: don't look it, and I don't skate it, but I
Speaker 1: feel that way.
Speaker 2: Was this when Larry King still had some credibility?
Speaker 1: Oh yeah, he was big at this point. This is
Speaker 1: like right around the turn of the century. He's still
Speaker 1: a big, a major major. This is like before infomercial
Speaker 1: Larry Yes, yes, okay, and this is I mean, maybe
Speaker 1: this is part of his downfall. But people still take
Speaker 1: the show series and they take this very seriously. And
Speaker 1: to be clear, I'm not saying that, you know, even
Speaker 1: Caitlin or or Hamilorthy were lying about their experiences on
Speaker 1: viox because some people did gain benefits of this. Yeah,
Speaker 1: and you know, so I'm not doubting that. The problem
Speaker 1: again is that a single person's having a good reaction
Speaker 1: to a drug is not evidence that the drug is safe.
Speaker 3: You know.
Speaker 1: For example, I know some people in their seventies who
Speaker 1: have been doing heroin for fifty straight years and are
Speaker 1: and are fine. That doesn't mean heroin is safe. It
Speaker 1: means some people are lucky, right, Yeah, or they afore
Speaker 1: mentioned ninety year old women doing you know.
Speaker 2: Those ancient people who do you get drugs and smokes
Speaker 2: that you now with a.
Speaker 1: Little burning Man regionals, you run into a lot of
Speaker 1: elderly people who have been doing drugs for forever. Some
Speaker 1: of them are very good at it. I've been gas
Speaker 1: stations sober for years now, Kava, that's Responlifornia sober.
Speaker 2: But you can only get the things you buy at
Speaker 2: the gas station.
Speaker 1: I don't mess with that marijuana. That shit's dangerous. I
Speaker 1: just take those trucker yellow jackets that they give to
Speaker 1: keep people driving long haul awake. You know, I don't
Speaker 1: know what's in them. They're big and yellow. That means
Speaker 1: they're safe. Yeah, it's danger'd me red if it was dangerous.
Speaker 1: They can't put dangerous drugs in a yellow and black
Speaker 1: pill and call it yellow jackets and it doesn't mean dangerous.
Speaker 2: Yeah.
Speaker 1: So I never take more than like twelve in a day. Yeah,
Speaker 1: thank god for yellow jackets.
Speaker 2: I just some I sometimes don't know if you're kidding,
Speaker 2: and I just hope in my heart that you are.
Speaker 2: And I'm just going to pretend that this is all
Speaker 2: part of a bit.
Speaker 1: I do the safe thing. I like, open the pill
Speaker 1: and I pour all the powder in the pill into
Speaker 1: a glass, and then I pour in a bunch of
Speaker 1: my krateion into the glass, and then I add a
Speaker 1: banana for the potassium because your heart level.
Speaker 2: This level of detail is what bothers me.
Speaker 1: The more I don't like it's fine. It's mostly just
Speaker 1: B twelve in caffeine and god knows what else, because
Speaker 1: there's absolutely no no agency that looks into what gets
Speaker 1: put into substances that are sold in gas stations in
Speaker 1: this country.
Speaker 2: Oh my god, and what little oversight there is is
Speaker 2: gonna be gone.
Speaker 1: Yes, thanks gone, thank god. Look, RFK Junior might ban
Speaker 1: the HPV vaccine, but we could get legal heroin.
Speaker 2: It's all one big, organized end of humanity cash grab
Speaker 2: the next couple of years. Any drug you want to
Speaker 2: get through is gonna get through god willing.
Speaker 1: Look, if the world's ending, do you want heroin to
Speaker 1: not be legal?
Speaker 2: That's fair, But it's not gonna be heroin. It's gonna
Speaker 2: be like, you know, blood pressure pills that the company
Speaker 2: just gets through and then it makes people's hearts explode,
Speaker 2: and then the company will just say, hey, we're bank
Speaker 2: and then they're fine, and then they just move on
Speaker 2: with their lives, and then people are going to be
Speaker 2: left in the wake.
Speaker 1: Then no, you're right, they're going to ban prozac and
Speaker 1: replace it with like polar Bear liver pills. It's just
Speaker 1: going to be a disaster.
Speaker 2: He was always doing research that in RFK.
Speaker 1: He's always trying something new. So the fact that this
Speaker 1: beloved celebrity athlete has gone on Larry King and said
Speaker 1: exactly what viox PR would want her to say was
Speaker 1: a godsend. You know, that's the kind of pr no
Speaker 1: money can buy. Although I have to tell you now
Speaker 1: that moment was in fact bought and paid for by
Speaker 1: MERK they had found out that Dorothy was a customer.
Speaker 1: They had reached out to her with an idea and
Speaker 1: a pile of money. Her life story had been used
Speaker 1: as the basis for an entire marketing campaign, and her
Speaker 1: appearance on Larry King was just the first step in
Speaker 1: launching it. Tom NeSSI writes the day after Dorothy Hamill's appearance,
Speaker 1: even Merks CEO Raymond gil Martin was smitten. He received
Speaker 1: heart written letters from arthritis sufferers saying they were going
Speaker 1: to immediately ask their physicians for a viox. Gil Martin
Speaker 1: personally congratulated the public relations department. One marketing executive wrote
Speaker 1: that with Dorothy telling our story, vyox sales were going
Speaker 1: to soar and overtake celebrates and obsession within the.
Speaker 2: You'll slipped into like your fifties radio announcer voice. You
Speaker 2: kind of shifted to the nineties. I saw what you
Speaker 2: did there.
Speaker 1: I love it. I love it. I love it. So yeah,
Speaker 1: patients are are coming in, They're begging doctors to write prescriptions.
Speaker 1: Doctors are going, well, shit, how bad could it be.
Speaker 1: It's basically just aspirin, you know, And a lot of
Speaker 1: people are suddenly taking viox. Now the FDA does push
Speaker 1: back a little on this campaign because Dorothy's appearance on
Speaker 1: Larry King counted as an ad and she had not
Speaker 1: mentioned that she was being paid by Merk, which you're
Speaker 1: not supposed to do. They also had an issue that
Speaker 1: she was kind of basically saying she had not told
Speaker 1: people that viox was extremely dangerous if you prescribed it
Speaker 1: to patients with the history of bleeding ulcers. In fact,
Speaker 1: she had stated that she was taking it despite her
Speaker 1: history of bleeding ulcers, which is kind of telling people
Speaker 1: this is safe to say in the exact situation that
Speaker 1: the FDA knows. We know it is not safe to
Speaker 1: tell people to take it in. So the FDA gets
Speaker 1: kind of unhappy with this, and Merk replied, she just
Speaker 1: slipped up. We taught Hammil the proper way to sell
Speaker 1: our product, but she went off script. They promised to
Speaker 1: retrain her before following up with any additional advertisements. This
Speaker 1: happened on September twelfth, two thousand. The next day, in
Speaker 1: violation of their promise to the FDA, Hamill appeared on
Speaker 1: a local TV station in Atlanta to urge people to
Speaker 1: consider a biox. The FDA never found out about this
Speaker 1: and might not have cared if they had, if you
Speaker 1: wanted to get away with something. September twelfth, will actually
Speaker 1: that was two thousand. Never mind, everything was still fine.
Speaker 1: I was gonna. I was just like, did I just
Speaker 1: go over to September twelfth and not make it?
Speaker 2: I feel like that. No, No, it's fine.
Speaker 1: Research didn't happen yet, everything was fine. Plenty of towers
Speaker 1: in New York still at this now. The unfortunate reality
Speaker 1: of the FDA is that it is stand and operated
Speaker 1: by a lot of people who want to work in
Speaker 1: the private sector of the pharmaceutical industry someday, and some
Speaker 1: of these people feel a need to avoid making waves
Speaker 1: and killing a golden goose that is currently injecting cash
Speaker 1: into someone they want as a future employer who made
Speaker 1: a bit of past employer that they're hoping we'll hire
Speaker 1: them on for a lucrative consulting gig in the future.
Speaker 1: Beyond that, the teams at the FDA who we rely
Speaker 1: on to monitor food and drug advertising are hideously understaffed,
Speaker 1: operating on a shoe string budget. There may not have
Speaker 1: been anyone watching Dorothy Hamill's ad on local Atlanta TV
Speaker 1: because no one was being paid to do so. Now,
Speaker 1: MERK did change their TV ads for vyox based on
Speaker 1: the FDA's feedback, and you can see one example of
Speaker 1: that here. We've got to play just one of these
Speaker 1: bad boys. Here is Dorothy Hamill's revised vyox ad.
Speaker 5: When I started skating at eight years old, I never
Speaker 5: thought i'd experience the thrill of winning a medal with
Speaker 5: all the great memories. Has come another thing I thought
Speaker 5: I'd never experience, The pain of osteo Arthur writers.
Speaker 6: Yox is here. Medicine for ustioar threat is pain. With
Speaker 6: one little pill of day, biox can provide powerful twenty
Speaker 6: four hour relief. Biox specifically targets only the COX two enzyme.
Speaker 6: A key source of our threat is pain. People with
Speaker 6: allergic reactions such as asthma to aspirin or other arthreatus
Speaker 6: medicines should not take bios. In rare cases, serious stomach
Speaker 6: problems such as bleeding can occur without warning. Tell your
Speaker 6: doctor if you have liver or kidney problems. For more information,
Speaker 6: talk to your doctor about once daily biox for the
Speaker 6: relief of ostio war threat is pain.
Speaker 5: Perhaps my biggest victory is to be able to plan
Speaker 5: my day around my life instead of my pain after.
Speaker 6: Your doctor Biox is right for you, bios for everyday victories.
Speaker 2: First of all, I take back what I said about
Speaker 2: her hair. I think it actually looked really good there.
Speaker 2: I don't know, like time and the cycle change and fashion.
Speaker 1: I don't know it was the Viox. You don't know.
Speaker 1: Maybe vix makes your hair look great.
Speaker 2: Everybody. It's a by Biox. It's a brilliant strategy. Like
Speaker 2: the people who grew up watching her and knew who
Speaker 2: she was and admired her are that age where they
Speaker 2: were having lots of the osteoarthritis and joint pains looking
Speaker 2: for medication. It's a she's the perfect spokesperson. Yeah, and
Speaker 2: she has that innocence so that you believe, you know.
Speaker 1: Yeah. And the Dorothy hammel Ads are a huge success.
Speaker 1: Millions of Americans saw their former child sweetheart skating and
Speaker 1: skiing and living an active, healthy life thanks to this
Speaker 1: new miracle drug, and millions of them decided I want
Speaker 1: that for myself, And ultimately tens of thousands of them
Speaker 1: are going to die as a result. And that's the
Speaker 1: story we're going to tell in Part two. Kaba can't wait,
Speaker 1: Yay But first off, do you have anything to plug
Speaker 1: before we roll out here?
Speaker 2: I do plug is my show. That is the plug
Speaker 2: that I want to plug is my show. I'm plugging
Speaker 2: it now. It's called The House of Pod. It is
Speaker 2: a humor adjacent medical podcast. If you like the subjects,
Speaker 2: like today's subject, you'll like our show. In fact, one
Speaker 2: of our most recent episodes is about sort of similar
Speaker 2: a little bit less egregious, but similar pharmaceutical shenanigaree. I
Speaker 2: don't know if that's a word about the medication zygris
Speaker 2: And and there's all kinds of fun guests like Robert
Speaker 2: and prop and all the people you know and love here, Margaret.
Speaker 2: So check out my show, The House of Pod. And
Speaker 2: if you want, you can follow me at Blue Sky,
Speaker 2: which I'm giving a shot now. Seems a little bit
Speaker 2: less fascist.
Speaker 1: Yeah, definitely less fascist. It's got its own annoyances, but
Speaker 1: all of social media has things that annoy me. So
Speaker 1: what are you gonna do exactly?
Speaker 2: You can follow me there at Cave MD.
Speaker 1: You can also follow me there and I write, okay,
Speaker 1: where you can follow me on the other place too,
Speaker 1: But you know what you could do that I would
Speaker 1: appreciate most get off the internet. Feed somebody you know
Speaker 1: do something good in the world. Like it online, I
Speaker 1: like it. And to listen to podcasts. Keep listening. For
Speaker 1: the love of God, keep listening. Do not stop listening
Speaker 1: to the podcast under no circumstances.
Speaker 2: Stop. Will you ever stop? In fact no, just for
Speaker 2: thinking about stopping. You should listen to extra podcasts today.
Speaker 1: Yeah, you know what, I'll say it right now. If
Speaker 1: you have stomach holcers podcast on the podcast.
Speaker 2: Your Way Through It podcast Your Way Through.
Speaker 1: It, that's right.
Speaker 3: Behind the Bastards is a production of cool Zone Media.
Speaker 3: For more from cool Zone Media, visit our website Coolzonemedia
Speaker 3: dot com or check us out on the iHeartRadio app,
Speaker 3: Apple Podcasts, or wherever you get your podcasts. Behind the
Speaker 3: Bastards is now available on YouTube, new episodes every Wednesday
Speaker 3: and Friday.
Speaker 1: Subscribe to our
Speaker 3: Channel YouTube dot com slash at Behind the Bastards