How this pharmaceutical company tricked doctors


One of the tactics used by pharmaceutical companies to influence physician and public opinion is by recruiting doctors to serve as social media influencers. — Filepic

Pharmaceutical companies have a long history of managing physician and public opinion, say Canada’s Queen’s University professor of philosophy Dr Sergio Sismondo and the Netherlands’ Radboud University postdoctoral research fellow Dr Maud Bernisson.

For example, by recruiting physicians to serve as influencers, planting articles in scientific journals, coordinating conference presentations and developing continuing medical education (CME) courses.

Amid surging concerns over an addiction crisis in the United States, opioid giant Mallinckrodt faced growing hesitancy among frontline prescribers.

The American-Irish pharmaceutical company was forced by US courts to publish more than 1.3 million internal documents.

Prof Sismondo and Dr Bernisson sifted through nearly 900 contracts, which together reveal a carefully-coordinated effort to shape medical attitudes toward pain medicine.

They published their results in The BMJ medical journal on June 10 (2024).

The contracts show how Mallinckrodt employed each of the tactics mentioned above as it sought to reframe concerns about addiction as a phobia and muddle the very concept of dependence as “pseudoaddiction”.

It even went so far as casting opioids as preventive medicine for chronic pain.

“It’s like they used every trick in the book,” says US advocacy organisation Public Citizen’s Health Research Group director Dr Robert Steinbrook.

To many busy physicians, these messages would have appeared as trustworthy scholarship and evidence-based guidance, Prof Sismondo and Dr Bernisson explain.

The documents include a Mallinckrodt regulatory expert describing how its CME programme “underscores Mallinckrodt’s credibility with the [US] FDA as a company that cares about ... safe opioid prescribing”, while a sales manager’s exhortation in a 2013 email to the reps under him states: “You have only one responsibility, SELL BABY SELL!”

US’ Georgetown University pharmacology & physiology professor Dr Adriane Fugh-Berman, who has been researching the marketing tactics of the pharmaceutical industry for thirty years, adds that “creating the term ‘pseudoaddiction’ and distorting the terms ‘tolerance’ and ‘dependence’ were strategies that distracted physicians from noticing their patients were addicted”.

In spite of settling with the US government for lax handling of its opioid supply and later being ordered to pay USD1.7 billion (RM8 billion) over accusations of misleading and deceptive marketing practices to boost opioid sales, Mallinckrodt continues to sell opioids today, with sales of some US$262 million (RM1,236 million) in 2023, up 25% from the year before.

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