Joe Rogan gave his millions of fans a New Year’s Eve gift – a 2.5 hour tutorial on corporate crime in the pharmaceutical industry.
Rogan’s Guest – John Abramson, author of the new book Sickening: How Big Pharma Broke American Healthcare And How We Can Fix It (Mariner Books, February 2022).
Abramson is a lecturer at Harvard Medical School and author of a book in 2004 America Overdose: The Broken Promise of American Medicine.
Abramson supports in Disgusting that America’s healthcare system is unique in that it prioritizes corporate interests over the public good.
“At the heart of the problem is Big Pharma, which controls the medical research program, holds actual data from its clinical trials as company secrets, and shapes the information available to medical professionals to maximize its profits,” writes Abramson.
Rogan opened his interview with Abramson with his favorite corporate criminal – Pfizer.
Rogan increased Pfizer’s payment by $ 2.3 billion in 2009 to settle criminal charges of mislabelling Bextra with intent to defraud or mislead. Bextra was an anti-inflammatory drug that Pfizer withdrew from the market in 2005.
“What did they do exactly? Rogan asked Abramson.
“I can’t tell you that,” Abramson said. “I know, but I can’t tell you. I spent a little over ten years in litigation as an expert in national drug cases. And when I was an expert, I was able to see all the documents. There would be like twenty million documents in a case. I could see the science. If I needed a statistician to do primary data reanalysis, I had it. I got to see how marketers have come up with strategies to harness science to make as much profit as possible. I got to see how they marketed to doctors, how they wrote articles in medical journals.
“I did it in the case of Pfizer. The plaintiffs’ lawyers hired me to analyze the situation. So I wrote a report and it went to court. Pfizer’s behavior was in my opinion so outrageous that I picked up the phone and called the Department of Justice. And I said – I know a lot about this drug. But I can’t tell you because I signed a confidentiality agreement as an expert.
“The Department of Justice and the FBI sent me a subpoena and said, you have to come with your computer and tell us what they did wrong. And I did. It was the end. They keep their cards close to their chest.
“And six months later, I read in the newspaper that the Justice Department found out that the company had committed a crime and that it had been sentenced to the biggest criminal fine in US history- United.”
“So I know what happened, but I can’t tell you. “
“We can read it, can’t we?” Rogan asked.
“No,” Abramson said. “You can read the press release from the Department of Justice on Bextra. “
“But no real data on what they lied about?” Rogan asked.
“No,” Abramson said. “Nada.”
“How is it possible?” Rogan asked. “There had been an agreement to pay the fine and the details of it would not be released?” “
“That’s right,” Abramson said.
“Do you remember the drug Vioxx? Abramson asked Rogan about Merck’s anti-inflammatory drug.
“Yes,” Rogan said. “I had a friend who had a stroke after taking Vioxx.”
“The problem is the size of the trial?” Rogan said. “You can have ten people and none of them can have a problem. Or you could have 10,000 people and you could have quite a bit of trouble. Need to make the study as big as possible so that you can get all of this biological variation between humans? “
“It’s part of it,” Abramson replied. “But you can have a study of 8,000 people where you omit three heart attacks and you flip the statistics and claim there is no cardiovascular risk.”
“It was a fraud,” Abramson said. “There was enough data on a Food and Drug Administration website to see that Merck had defrauded about heart attacks. And when I saw that, I said: I’m going to quit training and find a solution.
“I worked for two years on a book called America overdosed. It was released in 2004. And it contained the story of Vioxx. A week after the publication of this book, Vioxx was taken off the market. It wasn’t my fault. Merck had carried out another study which showed the same thing: the risks of strokes, heart attacks and blood clots were doubled. At that point, they had to take it out.
Vioxx had been on the market for four and a half years.
“Between twenty million and twenty-five million Americans had taken Vioxx and between 40,000 and 60,000 Americans had died from the cardiovascular consequences of Vioxx. It was the same approximation on the number of Americans who died in Vietnam. They died from taking a drug that was no more effective at treating arthritis or muscle aches than nonsteroidal anti-inflammatory drugs and caused 40,000 to 60,000 deaths.
“And what was the punishment for Merck?” Rogan asked.
“There were 27,000 plaintiffs in the litigation and they received $ 4.7 billion,” Abramson said. “Merck sold $ 12 billion worth of Vioxx in the four and a half years it was on the market. The Department of Justice fined them just under $ 1 billion. And no one went to jail.
“Did they still make a profit?” Rogan asked.
“They took in $ 12 billion. They had research and marketing costs. Maybe they made a billion.
Abramson quotes an internal email from Merck’s chief research officer saying there is still a danger to the drugs, but the drug “will do well and so will we.”
“And nobody went to jail for that?” Rogan asked. ” That’s crazy. Are there no consequences?
“There are fines,” Abramson said. “But generally, when fines are announced by the Department of Justice, the stock goes up because the shareholders are happy to get rid of that burden.”
“It’s very rare that someone goes to jail. But even when the company pleads guilty to a felony, the Department of Justice allows a subsidiary of the parent company to take the hit, so if there is another flagrant misconduct, the subsidiary is excluded from the Medicare program. The parent company is not held responsible for legal fault.
“In 1952 Milton Friedman wrote a book entitled Capitalism and freedom,Said Abramson. “Friedman said there are only three legitimate functions of government. Preserve public order, enforce private contracts and guarantee the functioning of private markets.
“It was radical at the time. But we fail on all three. We do not apply law and order. When drug companies commit fraud and crime, they pay a price, take their slap in the face and move on. “
“Is the fear that if you punish Pfizer and these drug companies, they’re going to go bankrupt and they won’t make drugs anymore?” Rogan asked.
“This is what Pfizer would have you believe,” Abramson said. “But there is a lot of money to be made honestly. If Pfizer wanted to be a responsible business, they would say let’s do a health technology assessment so that our drugs are tested fairly and used appropriately. If medical journals want to be responsible actors, they would say: let’s insist that clinical trial data be made available to peer reviewers.
“What if, when Vioxx went down, the people who knew the data went to jail for 25 to 30 years?” Rogan asked. “What if the business was stripped of all its assets? What if all that money goes to the victims? What if they made a public demonstration of genuine punitive damages? Would it have changed the way pharmaceuticals work in this country? “
“One hundred percent,” Abramson said. “Absolutely, it would have changed behavior. And if the people who orchestrated the oxycontin scandal not only risked losing their last $ 8 billion, but also going to jail, that too would change their behavior. But now there are no consequences. It is not what Milton Friedman said – the government must maintain law and order. “