McKinsey, the FDA, and the Medical-Industrial Complex.

Posted on | April 26, 2022 | 2 Comments

Mike Magee

In today’s New York Times, Dr. Joshua M. Sharfstein, professor at the Bloomberg School of Public Health at Johns Hopkins, and principal deputy commissioner of the Food and Drug Administration from 2009 to 2011, recounted global consulting firm McKinsey’s simultaneous working relations with the FDA and Purdue Pharma.

The Congressional investigation currently underway reveals that McKinsey had been advising the FDA on how to reorganize its opioid oversight efforts while simultaneously imbedding a “mini-army” of advisers in Purdue Pharma’s Connecticut headquarters.

Sadly, such evidence of an integrated career ladder inside the Medical-Industrial Complex is neither a surprise nor news, but rather a long established pattern of behavior that dates back 70 years.

Between 1950 and 1957, advertising revenue in JAMA for pharmaceutical ads increased seven-fold. At the top of the list was Pfizer and its new antibiotic, Terramycin. Between 1950 and 1952, 68% of all JAMA broad spectrum antibiotic ads were funded by Pfizer. Between 1952 and 1956, nearly every JAMA issue included Pfizer’s in-house magazine titled “Spectrum”.

The push paralleled an increase in Pfizer detail men from 8 to 2000 (including medical students). They targeted doctors and hospital pharmacies, and developed a sophisticated range of Continuing Medical Education (CME) materials for the first time. Pfizer’s agency of record? The William Douglas MacAdams Advertising Agency. The principal on the account? Arthur M. Sackler.

Arthur’s groundbreaking innovations would, in the future, be enshrined in the Medical Advertising Hall of Fame. Their tribute included the following: “Dr. Sackler was a psychiatrist who published 140 scientific papers on neuroendocrinology, psychiatry, and experimental medicine.” What they didn’t mention is that the vast majority of these were self-published in journals and “medical newspapers” that Sackler himself had launched as promotional vehicles.

During this same period, his business dealings and associations were secretive and conspiratorial. He created hidden corporations, and listed them under his first wife to hide his own ownership. Behind the scenes, he colluded with his supposed arch-rival, agency head Bill Frolick, whose company International Medical Statistics (IMS) would marry databases with the AMA physician masterfile, reselling the progeny to pharma companies, and allowing them to track individual physician prescribing behavior. His own secret ownership stake in IMS would be revealed after his death. But while alive, he quietly purchased the near dead pharmaceutical manufacturer, Purdue-Frederick, and mothballed it for future use.

In a single decade, Sackler also invented the pharmaceutical rep – a business attired professional “detail man” who would visit doctors offices with branded trinkets and provide the scientific details and new drug samples doctors needed to keep up; and launched pharmaceutical funded “scientific advisory boards” and speakers bureaus that would assist friends like heart surgeon Michael DeBakey as they climbed the integrated career ladder from academia to industry to government and back again.

In 1957, he aired the first drug advertorial on television, an extravaganza describing a new mysterious condition called “Ataraxia” which kept stressed out business men in a state of psychic distress preventing sleep and relaxation. Sadly, no cure was mentioned in the broadcast. That came a few months later when Pfizer released their new tranquilizer, Atarax.

By 1960, he represented two new drugs that risked cannibalizing each other – Valium and Librium. He skillfully promoted one for nervous tension and the other for psychic stress, making both record breaking success stories. By then, 1 in every 7 Americans were on tranquilizers.

But for Arthur, this was just the beginning. He had a grander vision, and had already laid the seeds that would create wealth beyond his wildest dreams, and eventually threaten the health and stability of our nation.

Scratching at the surface of Arthur M. Sackler’s narrative reveals the rather staggering challenge we face in addressing the systemic issues underlying what appear to be isolated occurrences like McKinsey’s conflicts of interest. In Arthur Sackler, whose praise and awards, bestowed so luxuriously by the highest levels of American Science and Medicine, in equal measure to the resources he provided to these very same bodies, can be observed the full tangle that is the Medical Industrial Complex.

Over a period of a half century, under the title of beneficent physician, Arthur Sackler built a vertically integrated empire that created pharmaceutical demand, magnified and multiplied it, and then sold into it as it rose. And at every step along the way, he was aided and abetted by those who coveted the Sackler brand.

Modern day consulting firms like McKinsey are simply enablers – the sticky middlemen who hold it all together. Those who bear ultimately responsibility are their funders at every rung of these integrated career ladders – including scientific leaders in academic medicine, corporations, and government.

Comments

2 Responses to “McKinsey, the FDA, and the Medical-Industrial Complex.”

Joshua Sands
April 26th, 2022 @ 8:29 pm

Mike, your post uncovers an embarrassing truth of our Medical Education system and that is it is for sale. Physicians do not realize typically that they are being manipulated to change their behavior to enrich the sponsoring company and not to benefit their patients. Of course there are exceptions and changes are currently being made but your book, Code Blue, takes a good look at this problem and other problems with our medical system. I am so glad I read your cogent book. Thanks
Mike Magee
April 27th, 2022 @ 8:40 am

Thanks for the kind comments and insights, Josh. As you suggest, it’s important to acknowledge that many highly ethical health professionals are drawn into the scheme unaware. That is why I suggest in Code Blue that all medical students be required to take a course on medical ethics and the history of the medical-industrial complex. Best, Mike