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Risky Business — How Buying a Car is Like Oxycontin Drug Marketing

Opioid overdoses resulted in 399,230 deaths over the past two decades. There currently are 2,600 lawsuits accusing Purdue of aggressively marketing the benefits of oxycontin while downplaying the risks.

Imagine this scenario.

You walk into your local car dealership intending to buy an SUV for your daughter’s seventeenth birthday. The salesman says he’s happy to help. With this scenario in mind, which of the following questions do you think the salesman is least likely to ask?

  • How much do you want to spend?
  • What options are you looking for?
  • Did you know that SUVs have the highest rollover rates (24%) of any type of vehicle and that rollovers are much more likely to kill or maim people than any other type of car accident?

Dollars to doughnuts, you answered that C was the question least likely to be asked. Because a car salesman is not going to bring up the subject of rollover fatalities to somebody about to buy an SUV for their teenage daughter. In the same way, Purdue was not about to tell doctors, consumers, or policy makers that oxycontin could lead to addiction or dependence.

Unlike car salesman, drug marketers are FDA-mandated to communicate safety and risk information regarding the drugs they sell. Unfortunately, like the car salesman, the drug company has a financial stake in framing information about their products in the most appealing way possible. And in a profit-driven healthcare industry, who can blame them?

This tendency to present safety risk information in a favorable light, however, comes with a price tag. It means that drug manufacturers downplay the risks of the drugs that we take. Minimizing concerns about drug safety is typical of pharmaceutical advertising and promotion as well as industry-supported continuing medical education (CME). Medical communication firms try to avoid biting the hand that feeds them, so pharmaceutical copywriters and medical writers are well versed in ways to present efficacy and safety information about prescription drugs that minimize the negative and accentuate the positive. 

Presentations of risk information can be both accurate and misleading at the same time. Subtle literary devices convey clinical information in ways that influence the recipients’ attitudes and perceptions regarding the information. Pharmaceutical communication specialists are paid handsomely to frame product and disease messages so as to favorably shape consumer and clinician beliefs about a drug’s benefits and harms. This is particularly true of how Purdue used communications to assuage concerns about addiction, overdose, and dependence, even though there was little evidence to support these claims. 

For example, this paragraph from a commercial CME course sounds authoritative without including any data, evidence, or clinical content. Instead, the phrasing, tonality, and word choice leave the reader with the impression that these knowledgeable experts all agree as to the safety of using opioids.

“The continued stigmatization of opioids and their prescription, coupled with often unfounded and self-imposed physician fear of dealing with the highly regulated distribution system for opioid analgesics, remains a barrier to effective pain management and must be addressed. Clinicians intimately involved with the treatment of patients with chronic pain recognize that the majority of suffering patients lack interest in substance abuse.” 

Whether you are Republican or Democrat, for single-payer health care or against it, in support of private health insurance options or a government-run system, it all comes down to this. In a market-driven healthcare system, drug companies make money by increasing demand for their products. Is that good? Is that bad? I cannot say for sure. I do know, however, that the tendency of drug companies to hide medication risks is an inescapable fact of life in the good ole USA.

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