By THIRSTY
Gerald Posner’s latest investigative book, PHARMA – Greed, Lies and the Poisoning of America, was released in March 2020 just as the coronavirus pandemic reared its head in America. A five-year project in the making, PHARMA was called by the New York Times, “A withering and encyclopedic indictment of a drug industry that often seems to prioritize profits over patients…[PHARMA] reads like a pharmaceutical version of cops and robbers."
The Chicago Tribune referred to Posner as a “merciless pit bull of an investigator” for his 2015 book on the Vatican bank entitled God’s Bankers. With twelve prior books to his credit, including Case Closed that was named a Pulitzer Prize finalist, Posner continues to prove with PHARMA why he is one of America’s greatest investigative authors.
Stay Thirsty Magazine was thrilled to visit with Gerald Posner at his home on Miami Beach for this Conversation about PHARM and its implications for the pharmaceutical industry in the United States.
STAY THIRSTY: In your new book, PHARMA – Greed, Lies and the Poisoning of America, you expose the truth about the pharmaceutical industry in the United States. What led you to devote five years of your life to exhaustively research and write this definitive work that the New York Times has called an “encyclopedic indictment” of the drug industry?
GERALD POSNER: I had the idea for a book about the drug industry for nearly twenty years. It came from a conversation in the late 1990s with James Phelan, the great investigative journalist who had exposed Clifford Irving’s “autobiography” of Howard Hughes as a hoax. When we spoke about the state of journalism, Phelan bemoaned that few magazine editors had the patience for long assignments that might not pay off with a big story. Books, he told me, was possibly the last venue in which “you have the time and space to get to the bottom of a good story.” He did not hesitate when I asked what subject he still wanted to write about. “The drug industry,” he said, was “like throwing a dart at a storyboard.”
A few months after that talk, Phelan died of lung cancer. His idea, however, stayed with me. It took until 2015 – after completing another six books – before I fleshed it out enough to get the backing of a publisher (Simon & Schuster’s new imprint, Avid Reader Press). The project was tentatively titled, “A History of the American Pharmaceutical Industry.”
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| Gerald Posner |
STAY THIRSTY: In your career, you have investigated the assassinations of John F. Kennedy and Martin Luther King, exposed terrorist networks, a cruel kingdom, drug cartels, and most recently, the inner workings of the Vatican bank. How difficult was it to investigate the pharmaceutical industry compared to your prior projects?
GERALD POSNER: Trisha, my wife and fellow author, and I, knew it would be massive project. Still, it turned out to be even more than we had envisioned. This project was by far the most difficult we ever tackled and that is a high bar considering our past books. The first year was a deep dive spent studying the industry and learning the technical aspects of diseases and drugs. Neither Trisha nor I have a science background, so it was literally a new world for us. Before we could start reaching out to people and requesting interviews , we had to feel we were completely competent in drugs and the industry.
The Vatican had refused to cooperate on God’s Bankers. It rejected my application to gain access to their Secret Archives. That forced me to find the information I needed scattered in court records and government and private archives in a dozen countries. The drug industry is not remotely as monolithic as the Vatican, yet still there was little overt assistance. I am sure that when some pharmaceutical executive did a Google search and learned that I am the biographer of Josef Mengele, Lee Harvey Oswald, and James Earl Ray, it might not have been the greatest incentive to cooperate. Nevertheless, Trisha and I were able to repeat what we have accomplished on earlier projects, slowly winning the trust of some key people at different levels of the industry. Some of them went on the record, and others fearing retribution, spoke only on the condition of anonymity.
As for documentation, we were buried ultimately under nearly a million pages of documents. There were decades of congressional hearings, FDA transcripts, court cases, private and company publications, science and drug journals, and government documents released we obtained under the Freedom of Information Act. We converted part of a wall in our home-office into a white board where we kept track of some of the links between the masses of information. A private investigator visited once and told us our home seemed more like a forensics investigation into a murder then a simple book project. Maybe that is why I particularly liked the comment in the recent New York Times review of the book, in which it said it “reads like a pharmaceutical version of cops and robbers.”
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| Gerald Posner at work mapping out PHARMA |
STAY THIRSTY: Of your key themes: greed, lies and poisonings, which one made your blood boil the most? Do you think your book will be a starting point for future investigations into the “ethical pharmaceutical” companies and eventually result in legislative changes to correct the abuses you chronicle?
GERALD POSNER: I certainly hope that it will be a springboard for change. One reviewer compared PHARMA to Upton Sinclair’s The Jungle. That novel’s fifteen stomach-wrenching pages about disgusting conditions in Chicago’s meatpacking industry was one of the sparks for Congress’s passage of the nation’s first comprehensive drug statute (the 1906 Pure Food and Drug Act).
Some of the things about which I write, such as how drug companies game existing laws through loopholes that the drafters of those laws never intended, would not be difficult to fix. In another instance, a key but mostly unknown factor in the high prices of prescription drugs is entrenched middlemen that get rebates from pharma firms for getting some drugs covered by medical insurances. Making those rebates public would likely put an end to many of them, reducing a large number of prescription prices overnight.
While those fixes are small and relatively simple, the biggest hurdle is finding the political will in Washington. My book cites many incidents in which both sides of the aisle have been unwilling to crack down on pharma because both are dependent on industry money. The last great attempt to rein in drug prices was 1962. Since then, every other effort has failed.
STAY THIRSTY: The marketing of “pain” and medications for pain management in America has resulted in an opioid epidemic of enormous consequence not only for those directly impacted, but also as a cost to society. How does profiting from addictive drugs compare to profiting from tobacco and alcohol? How have the advertising and public relations companies worked with manufacturers to cash in on human misery?
GERALD POSNER: The drug industry has a pricing model like no other. Tobacco and alcohol companies spend enormous amounts on promotion and advertising, all directed at adult consumers to buy one brand over another. In the pharmaceutical model, there was no direct advertisements to consumers until 1997. Before then, all the promotion and ads were directed only to physicians. The ultimate consumer, patients who take a prescription medication, can only get it if it is dispensed by a physician. Direct-to-consumer ads are intended to create demand among patients to ask their doctors for a particular brand name, in the hope the doctor might write that scrip instead of one for a rival drug.
Doctors almost never know the prices of the medications they dispense. Even if they know the list price, they have no idea of what the copay might be under any patient’s healthcare insurance or Medicare drug plan.
The tale I tell inside PHARMA about Purdue Pharma and its marketing of OxyContin, its blockbuster opioid painkiller, is the ultimate x-ray into how modern drug companies blend promotion and medical research into a sales juggernaut. In exposing also the history of what made the Sacklers the Sacklers, I lay out how promotion and sales was in the family’s DNA. An early chapter titled “The $100 Million Dollar Drug” is about how the family’s patriarch, Arthur Sackler, revolutionized the way drugs were sold after World War II. His ground-breaking ad campaign in the 1960s for Hoffman LaRoche’s Valium, a mild tranquilizer, made Valium the first $100 million drug in the industry’s history and then the first billion-dollar seller.
STAY THIRSTY: Should corporate executives of pharmaceutical companies be subject to indictment and trial over their decisions and actions?
GERALD POSNER: Only when they break the law.
STAY THIRSTY: How have the biotech companies protected themselves with lobbyist and legislation in order to survive and prosper?
GERALD POSNER: For the most part, the same way as the traditional companies. I write in PHARMA about how the large traditional companies – led by Warner-Lambert, Glaxo-Wellcome, Pharmacia & Upjohn, Novartis, and SmithKline Beechem – have bought many biotech start-ups, blurring the distinction between the two. To the extent the independent biotechs took advantage of legislation to prosper, it was how they manipulated the legislation passed in the early 1980s to encourage firms to develop drugs for genetic diseases that affected only a small number of patients.
STAY THIRSTY: Is there blame to be apportioned to the medical community over the medicalization of illnesses or conditions in order to promote and benefit from the discovery and marketing of certain medications?
GERALD POSNER: I write at length in PHARMA a about the unwritten partnership between drug companies and medical and psychiatric journals that can determine whether or not a drug is a massive commercial success. This was true with menopause, the natural process by which women’s estrogen levels drop, usually in their fifties. As I show in a chapter titled “Targeting Women,” Wyeth medicalized menopause as a disease and played to women’s fears about losing their femininity and sexual vitality. That made their hit hormone replacement drug, Premarin, a top selling drug. At the same time, Wyeth hid reports that Premarin put women at significantly increased risks for blood clots and cancers.
For instance, in another chapter, “Everything can be Abused,” I cover the 1980 Third Edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). It listed anxiety as a stand-alone disorder. It was the first DSM update in a dozen years and increased the number of recognized mental illnesses from 182 to 265. Many of the new illnesses covered a wide range of emotional complaints. It separated depression from anxiety and offered a list of stand-alone mental illnesses under anxiety, including panic disorder (PD), generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), social phobias (SAD), and post-traumatic stress disorder (PTSD). By putting these in the DSM, the conditions were now subject to drug insurance coverage.
Harvard psychiatric professor Arthur Kleinman believed that the 1980 DSM minimized the frequent despair of those with serious mental illnesses at the cost of “medicalizing ordinary unhappiness.” Psychiatrist Peter Kramer concluded it was “diagnostic bracket creep.”
No matter the criticism, the drug companies instantly recognized there were large profits in developing medications to treat the new disorders. Xanax, a benzodiazepine released by Upjohn a year after that DSM, was the first drug widely prescribed to treat panic attacks. It dominated the extremely lucrative benzodiazepine market for the next twenty years and provided over a quarter of Upjohn’s record profits. Xanax was replaced as the top selling drug by a new class of meds – serotonin reuptake inhibitors, represented first by Prozac – to address some of the other anxiety and depression illnesses listed in the DSM.
STAY THIRSTY: What are your suggestions on how to clean up the American pharmaceutical industry and better police its work?
GERALD POSNER: America is the only country in the world that allows pharmaceutical companies to have unfettered power to set whatever price they desire on their drugs. Every other nation negotiates better prices or has some form of price controls. The drug lobby has defeated every serious effort to control prices in America since World War II. Little wonder, as I write in PHARMA, that the very same drug costs usually two to four times more in the U.S. than in any other country. It is time to stop the pharmaceutical industry using their outsized profits in America to subsidize their research and development worldwide. American patients and taxpayers deserve better treatment. I hope that PHARMA serves as a rallying cry for more public activism in confronting some of the drug industry’s excesses.
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