Part One: The Vioxx Scandal: How Big Pharma Killed More Americans Than Vietnam

Robert sits down with Dr. Kaveh Hoda to talk about Vioxx, a pain medication released by pharmaceutical giant Merck even though they knew it caused fatal heart attacks. (2 Part Series) See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:04Robert Evans?

  Welcome back to Behind the Bastards, a podcast where Sophie is not in the room right now. So Dr. Cave Hoda and I are are the foxes watching the hen house. That is also we're also the hens.

• 0:20Speaker 01

  I am the producer. I am the captain now.

• 0:25Robert Evans?

  We're like hen foxes, like like a cat dog situation. Although I imagine a hen fox, the fox is just gonna try to eat its hen. That's part of its butt, I imagine.

• 0:34Speaker 01

  I love your quaint, country colloquialisms. It's great. Don't know what they mean, but

• 0:39Robert Evans?

  Oh, yeah, you're probably too young for that cartoon. I was the right age for it.

• 0:44Speaker 01

  No, yes.

• 0:45Robert Evans?

  Dr. Hoda, my healthcare expert, legally my doctor.

• 0:51Robert Evans?

  Do you have any, do you have any theories that you can't prove that are unprovable, that are probably nonsense, that you nonetheless believe about health?

• 0:59Speaker 01

  About health?

• 1:00Robert Evans?

  Yeah.

• 1:00Speaker 01

  Uh, yeah, I got a lot.

• 1:03Robert Evans?

  That's good.

• 1:08Speaker 01

  As a doctor, I feel like I should. Uh, I, you know, I will talk to you at great length about how supplements are a fantastic waste of time. And I will tell you in detail, and I have on many episodes, why they're more dangerous generally than they are good. And you should only use them with strict instructions from your physician. But that being said, I feel like ginger really helps me in like a power up way that it doesn't. I know it doesn't, but I love it. And the placebo factor is so strong for me that, uh, you know,

• 1:49Robert Evans?

  You gotta adopt that placebo.

• 1:51Speaker 01

  Yeah, ginger's my magic thing. My little magic creation in my mind that works more than it really does.

• 1:57Robert Evans?

  Yeah, I, I'm not big on supplements. I do take, my doctor advised me to take for for blood pressure, calcium and potassium. So, so I do, I do, I do some of that.

• 2:10Robert Evans?

  Which I've noticed I don't get cramps as much as I used to. So I guess, I guess I'll, I'll call that a win. Um, I do love looking at into the different potential side effect. I love going on to like biohacking subreddits and seeing people talk about like the hot, the side effects they're having with, uh, with various weird supplements they're taking to never die. Um, although my favorite is the lion's mane subreddit. So lion's mane is like a mushroom that does have like some, it does have like an effect on your, your, your brain, right? Like there's, there's actually some like studied benefits of lion's mane, but it's like, it's a pretty mild supplement, but there's this group of people who are convinced that like, taking it once has like destroyed their life in the way

• 2:51Robert Evans?

  that like a huge dose of psilocybin mushrooms might have like mind altering effects. And it's like, man, everyone at people I don't put like it in their smoothies. I don't, I don't think it's the fucking lion's mane that's giving you nightmares for the last seven years of your life.

• 3:06Speaker 01

  I mean, that is, that is, that's the kind of thing I hear a lot about like every medication. You name it out there. Someone has had, someone blames that medication for their life being in shambles. And you know, it's medication.

• 3:20Robert Evans?

  That's what we're talking about today.

• 3:21Speaker 01

  Lots of risks. There's, that's true. They all, they all do, uh, some more than others. I think we're probably going to discuss here, but, uh, yeah, I don't know if lion's mane, which I'm not familiar with really.

• 3:32Robert Evans?

  It's a mushroom. It's a mushroom. You know, it's got, you know, some mushrooms have, uh, like, uh, neurological impacts and stuff on people. Um, but you know, my, my particular favorite medical theory, doctor, Dr. Hoda is that, um, obviously cigarettes are bad, terrible for, for almost everyone, nearly always horrible. But I think there's a slightly less than 1% of the population that have a genetic abnormality that makes cigarettes make them live forever. Because every now and then I'll meet, you know, sometimes in like little corners of the world or whatever, I've met like little old ladies in Japan are like 96 and they're like, yeah, I've been chain smoking cigarettes since I was like 11 years old or something like that. And it's like, clearly it works for you.

• 4:14Robert Evans?

  Like there's some, some minority of the population that cigarettes make them vulnerable.

• 4:18Speaker 01

  I, I feel like this is that meme of the plane that returns from war with the bullet holes.

• 4:26Speaker 01

  You're never gonna hear me say cigarettes are okay. They know what they've done. They know.

• 4:31Robert Evans?

  I know. They've killed, they've killed uncountable more people than war in the 20th century. And war killed so many people in the 20th century. But every now and then I'll meet some like 90 year old woman who smokes four packs a day and she's doing fine. So clearly, clearly, science doesn't understand everything about the malign cigarette. Don't smoke cigarettes.

• 4:52Speaker 01

  Okay, fair enough.

• 4:53Robert Evans?

  Don't vape. That's the one that worries. I mean, like, especially since all of my friends vape heavily. It's one of those like, yeah, but it's gotta be doing something, right? Like, it's gotta do something.

• 5:04Speaker 01

  Oh, for sure, for sure. I'm not, I'm a huge fan of vaping either. There is harm reduction. There's a good argument about that, but I'm not, you're not gonna see me promote vaping either.

• 5:13Robert Evans?

  That said, you know, when we get into the whole, what is it responsible to tell people to do or not? A lot of times, the greatest harms are things that people, like cigarettes, were told by their doctors are great for them. And today, we're gonna tell one of those stories. A story of a drug that became the lead seller for a major pharmaceutical company that was backed by an alliance of physicians who had, shall we say, some, you know, financial interest in finding that this thing worked. Today, we're talking about Vioxx, which is, I think, an infamous name now in the annals of medical science. People tend to know what I'm talking about, but if you don't, this killed more Americans than the Vietnam War.

• 5:59Robert Evans?

  That's, that's the story we're getting into today.

• 6:06Robert Evans?

  What do you know about Vioxx?

• 6:08Speaker 01

  You know, I was too young to really be, I wasn't really practicing medicine when it happened. But I did know about it and I've, I've heard some about it since then. I'm really very fascinated by the story and I'm really looking forward to getting into it today. So I'm excited about that. I will say, I think it was, it feels like a turning point in regards to how people looked at pharmaceutical companies. I think it was really like a sentinel event in that, like, I think doctors were always skeptical of pharmaceutical companies, and we still are. But I think that was when people started to become cynical. That change started. It's because of what happened with Vioxx.

• 6:50Robert Evans?

  And Vioxx, I think it's also important, like, Vioxx. The scandal hits kind of right as, you know, before we're really starting to realize what has gone down with the, um, uh, with the, the, uh, prescription painkiller epidemic. Like when that's starting to really take off and we start to realize how fucked up some of what Purdue did. And so this one-two punch, it really is responsible. I think you're, that's very salient, what you said. It's really responsible for a lot of, I mean, for like RFK is about to be the Director of Health and Human Services, right? Like it has a lot to do with that because this is hard for people to imagine. Like folks my age, I have always grown up with big pharma being like the devil, right?

• 7:31Robert Evans?

  Um, in part because like as soon as I turned 18, 19, I was hanging out with a lot of hippies. Um, but in part because like there were a lot of like really, really high body count pharmaceutical company scandals. And it is hard for some people to remember that like pharmaceutical companies used to be very popular, uh, and well regarded in a lot of cases, in part because the generation, the generation that was kind of running the world in the eighties and nineties had largely lived through like, and, and we're still close to, oh, polio is this nightmare that just sweeps through and devastates like a generation. You know, you have these flus and then suddenly you have half as many friends after the flu passes. And that stops being a thing. Then they're really the first generation, you know, kind of the later boomers that

• 8:15Robert Evans?

  didn't have to deal with that, but we're close enough to it to like really appreciate like, wow, medical science did us a solid.

• 8:22Speaker 01

  Yeah. And we've drifted just far enough from that now that people have forgotten and revising whole parts of history.

• 8:30Robert Evans?

  And I mean, part of the problem is that shit like the Vioxx scandal and like the Purdue pharmaceutical scandals, um, are closer to us than, than for example, fucking, uh, people being in iron lungs or whatever, you know? Recency bias is a hell of a thing, but since time immemorial, mankind has struggled against a terrible and implacable enemy, pain. Luckily for us, mother nature has provided a perfect painkiller, opium, that can be used as the basis for a variety of excellent medicines that really do exactly what they say they're going to do. Unfortunately, these medicines come with a downside, which is that when you start taking them, you might not ever want to stop taking them. For some people, this destroys their lives.

• 9:14Robert Evans?

  Let me take a sip of my kratom tea.

• 9:18Robert Evans?

  And since all the, all the health cops out there don't like people pill popping like Doctor House, even though he made it look incredibly sexy. Did he, did he?

• 9:29Speaker 01

  Fucking hate that show.

• 9:30Robert Evans?

  Oh, man, you're not, not a House fan, huh?

• 9:33Speaker 01

  No, it's just so ridiculous. I mean, all of those shows. Scrubs is the only one that's watchable for me.

• 9:40Robert Evans?

  Scrubs, really? Yeah, I mean, I did re-watch. I like to imagine that the movie Platoon is like a, uh, like the, uh, the, what, what you might call it, the-

• 9:48Speaker 01

  The prequel?

• 9:49Robert Evans?

  The prequel to-

• 9:50Speaker 01

  Because John C. McGinley's in it.

• 9:52Robert Evans?

  Because John C. McGinley said it, yeah.

• 9:53Speaker 01

  That's right.

• 9:54Robert Evans?

  That's why Doctor Cox is the way he is. He had to spend that night hiding under his friend's bodies in a trench line.

• 10:00Speaker 01

  Everyone ran away, man!

• 10:03Robert Evans?

  He had to watch Willem Dafoe die.

• 10:05Speaker 01

  Yeah.

• 10:06Robert Evans?

  Spoilers for the movie Platoon, which is older than most of you. Might be older than me. I don't remember when Platoon came out. Anyway, um, so because of, you know, the health cops don't like people becoming horrible pill addicts and destroying their lives, there's a, a market, a massive market, for anyone who can create a thing that is an effective painkiller that doesn't also inspire people to break into cars for drug money, right? There's a lot of money in a painkiller that does not have the kind of abuse potential that opiates have. Acetamethafen was discovered back in the 1880s, but it took us until the 1940s to actually figure out how to use it as a drug. And for reasons that are more complex than it's really worth getting into, because of how it was discovered, acetamethafen could never be patented, right?

• 10:51Robert Evans?

  Which means pharmaceutical companies are not super attracted to acetamethafen, right? Because like, well, I, you know, you can't only sell it for so much if everyone can make the damn thing. This meant that pharmaceutical companies had to get creative marketing it in order to make it profitable. As a result, Tylenol became a foundational part of the marketing drug story. McNeil, the company that started selling acetamethafen in the US, initially framed it as a painkiller for children. And the way, the, the ad campaign that they used is very weird. For some reason, and I've never found out why, but for unclear reasons, they had a huge number of toy fire trucks. And the way that they first sold Tylenol was they like stuffed fire trucks to the brim

• 11:33Robert Evans?

  with pills of Tylenol and like made that that was their marketing ploy to like get little kid parents to buy Tylenol for their small children.

• 11:41Speaker 01

  Always love fire trucks.

• 11:42Robert Evans?

  Kids love Tylenol too.

• 11:44Speaker 01

  They love their Tylenol. They love their liver damage and they love their fire trucks. It's just a thing about kids.

• 11:50Robert Evans?

  This is why the the I'm going to try to make the the chief Christmas toy of this season, the the little doctor house pill popper set where because kids you can take as much Tylenol as you want, right?

• 12:02Speaker 01

  It'll be like a big cane.

• 12:04Robert Evans?

  Just a big cane. A container at the top.

• 12:07Speaker 01

  A Tylenol dispenser, right? And and that's your little house toy for kids.

• 12:12Robert Evans?

  It's your little house toy for kids. Yeah. Um, now this worked better than any it had any right to work. Advertising was easier back then. I imagine today if you tried to sell parents on a chat with just like a fire truck full of pills. I don't know, this doesn't make me feel good about any of this, but you have to remember.

• 12:30Speaker 01

  We're so jaded now. That's a problem. We're jaded.

• 12:33Robert Evans?

  We're jaded and like prior to Tylenol, the chief method of dealing with pain for small children was to give them a spoonful of heroin and hope they woke up the next day, right? Like they literally sold it as a cough medicine for children. Um, so the fire truck plan worked well. Uh, it worked so well that McNeil gets bought by Johnson and Johnson, and that's actually when it gets the name Tylenol. McNeil's not selling it under Tylenol, Johnson and Johnson, which for whatever reason is a great name. I don't know why. Um, doesn't make much sense to me.

• 13:01Speaker 01

  Easy to remember.

• 13:03Robert Evans?

  Yeah. So in subsequent decades, Tylenol was found to be useful in numerous medical applications as a painkiller, a fever reducer, and about a million other things. It was joined in the mild painkiller category by Bayer's aspirin, which had its roots in herbal medications that had been used by peoples around the world since time immemorial. The Assyrians and Sumerians had actually been using willow leaves as treatments for various ailments and a variety of plants containing salicytic acid have been used in similar ways all over the globe. So acetaminophen and aspirin both quickly became foundational pieces of any medicine cabinet, but they weren't perfect. One issue that both painkillers had is that they could interact with other drugs or just interact badly with certain patients to cause substantial stomach distress.

• 13:46Robert Evans?

  In the most severe cases, this could result in stomach ulcers and sometimes life-threatening stomach ulcers. So, you know, this is one of these problems is like you want to be able to give people as much of this as they need. Because it's, you know, non-addictive and helps with a lot of things, but there's some hard limits based on what this does to people's stomachs.

• 14:05Speaker 01

  And and livers, I mean acetaminophen.

• 14:07Robert Evans?

  Yeah.

• 14:07Speaker 01

  You know, that's worldwide, one of the biggest causes of liver failures from people taking too much acetaminophen. And and then, yeah, these other non-steroidal anti-inflammatory drugs. They're the kind of thing that make me a gastroenterologist have to go in the middle of the night to go put a scope into someone's stomach because they're bleeding a ton in the setting of, you know, somebody who's swallowed too much Advil or something like a leave or something.

• 14:36Robert Evans?

  Yeah, and I think that probably doesn't didn't make it as much into my research just because in the 70s, they didn't have as much data on that, maybe. They all they're all focused at least on the the ulcers, but yeah, like the there's a there's a great bluegrass song called Codeine with the lyrics codeine, codeine, you're the nicest thing I've seen for a while. And if you know anything about codeine, it's the worst of the painkillers to get high on, which makes the song better because if you are the kind of person for whom like codeine is the nicest thing you've ever encountered, your life is been shit. You have had a bad life.

• 15:13Robert Evans?

  So by the late 20th century, pharmaceutical researchers had started poking around both compounds to try to find ways to create new variants that didn't have any of those downsides. They called these hypothetical medications super aspirants because research pharmacologists aren't great at naming things.

• 15:30Speaker 01

  Terrible, terrible branding.

• 15:31Robert Evans?

  Terrible. The quest for a super aspirin seems to have really started in 1971 when a gaggle of British researchers, I think that's how you term a group of researchers, tried to unravel the mystery of why aspirin and Tylenol work. Again, we knew these things were good painkillers and we knew they did other stuff. The method of action was unclear to us at this point, which is a startling amount of the time true with drugs. There's a lot of medications you might be on that that doctors don't precisely know why it does what it does. We have some ideas, but like a lot of this is still being figured out.

• 16:04Speaker 01

  More than you want to know.

• 16:05Robert Evans?

  Yeah.

• 16:06Speaker 01

  A lot of things we do in medicine that we

• 16:08Robert Evans?

  Yeah.

• 16:09Speaker 01

  Were, we just, they seem to work.

• 16:10Robert Evans?

  It's, it does it. Like, it definitely helps. We're not sure why. Um, but in this case, the research, research bore fruit, as author Tom Nessie describes in his excellent book, Poison Pills, quote, "When an injury takes place in the body, chemicals known as prostaglandins rush into the wound site to deal with the swelling, heat, and pain. Prostaglandins have important functions for human well-being. They play a part in ovulation, to protect the stomach from acids and to ensure that blood clots normally. The latter effect explains why aspirin reduces heart disease. It prevents clumps of blood from forming that could potentially block an artery. Prostaglandins actually make nerve endings more sensitive to pain. NSAIDs, NSAIDs?

• 16:50Speaker 01

  NSAIDs.

• 16:50Robert Evans?

  NSAIDs.

• 16:51Speaker 01

  The cool kids call them.

• 16:52Robert Evans?

  Yeah, NSAIDs. Reduce the production of prostaglandin and thereby relieve the pain associated with swelling and soreness. Unfortunately, in the process of doing so, they irritate the stomach. Sometime after this discovery, scientists found that a substance called cyclo-oxygenase, or COX, was produced as part of the mobilization of prostaglandin and was the enzyme that actually controlled pain and inflammation.

• 17:15Speaker 01

  You're doing a fantastic job, by the way. I just wanted, for a moment, you're doing a really good, you can call it Cox, by the way.

• 17:21Robert Evans?

  Cox, yeah, I was going to. Yeah, because Dr. Cox.

• 17:23Speaker 01

  Yeah, yeah, in his honor. Um, but this is interesting. I didn't expect I was gonna be getting this, like, trip down medical school, like, memory lane. This is fantastic. You're doing great. Keep it up.

• 17:35Robert Evans?

  We try to be complete. Also, Dr. Cox is in Born on the Fourth of July, which you can consider a stealth sequel to Platoon, if you assume that Willem Dafoe actually survived his injuries in Platoon.

• 17:45Speaker 01

  Was he in?

• 17:46Robert Evans?

  Oh, he's, he's, oh, he's, he's the crazy vet in Mexico that fucking Tom Cruise meets when they're both, like, doing drugs and hanging out with prostitutes after losing their legs. Yeah, it's great. Oh, man, that movie rules.

• 18:00Robert Evans?

  So these researchers began to theorize that Cox might include an additional substance that was separately the cause for stomach irritation. If someone could find and isolate said substance, it might allow for the creation of a super aspirin. But no one even knew if this theoretical substance was real and pharmaceutical companies like didn't exactly feel an immediate urge to jump on the matter because they had no idea if this was even a thing. Fast forward to 1990, a pharmacologist named Needleman gets close to isolating the Cox enzyme that he believes is causing all of the problems. He hasn't actually, doesn't actually find it, but he's confident enough in its existence for reasons that I, I'm sure makes sense to biochemists, that he gives it a name, Cox 2.

• 18:41Robert Evans?

  Research goes on and in July of 1992, several teams of researchers in Montreal announced that they have isolated two enzymes. Cox 2, and one of which Cox 2 seems to be the causal agent behind the side effects in said provoke in some patients, right? So 1992, they, they found finally this thing they've been looking for for like 20 years, right? This is the reason they believe why your, your aspirin or whatever can cause stomach ulcers. So the researchers muse that if you can find a medication that blocks Cox 2 and you compound it with like a painkiller with acetaminophen or whatever, then you'd have a super aspirin capable of being prescribed much more often to even more people.

• 19:23Robert Evans?

  Aspirin sales at that point are already like 50 billion tablets per year. So the amount of money on table for the first pharmaceutical company to figure this out is mind boggling because then you get to patent it. Then you are the only one that has the aspirin that doesn't cause stomach ulcers, right? And for like whatever 20 years, you're the only one who gets to sell that shit. That's so much fucking money, right? Like.

• 19:44Speaker 01

  Yeah, it's one of the most commonly used medications in the world.

• 19:47Robert Evans?

  Yes, yes. This is like an unfathomable fortune. We're talking like an oil and gas industry level fortune is on the table here.

• 19:54Speaker 01

  Yeah.

• 19:55Robert Evans?

  And so, so a fucking race begins, right? And the two major companies that are going to wind up really throwing their money, throwing their hats into the table into the, to get into the super aspirin ring are our old friend Pfizer and our new friend Merck. Now, today, again, any pharmaceutical company you mentioned, people tend to say like, fuck these guys. But in the late 1980s and early 90s. People did not feel that way about Merck. They were very much considered to be one of the good guys. Now, I know that kind of sounds crazy, but I want to read a quote from an article by David Culp and Isabel Berry in the Journal of Civil Rights and Economic Development. "In its mission's values statement, the company stresses that its business is preserving and improving human life. Merck's mission statement continues, 'We value, above all, the ability to serve everyone

• 20:38Robert Evans?

  who can benefit from the appropriate use of our products and services.' Throughout its history, Merck has often lived up to its stated mission. In the 1930s, after streptomycin was developed by a Merck scientist, Merck gave up its patent protection since it believed the drug was too important a medical breakthrough to keep to itself. Other companies were allowed to produce streptomycin, and Merck lost potential profits. Since the 1980s, when Merck found a cure for river blindness caused by a parasitic worm, the company had given away, free of charge, 40 million pills a year to African nations to treat and cure this." So, Merck seems pretty good coming into the 90s. You're like, maybe this is a company that actually believes what they put, they gave up money, you know, a lot of it. So that sounds pretty great.

• 21:20Robert Evans?

  But coming into the 90s, Merck is also staring down the barrel of a big problem. A lot of its massive wealth, because this is a very wealthy company coming into the 90s, was based on a pair of cholesterol drugs, Zocor and Preachol, which were both about to lose their 20-year patent protection, starting in the early 2000s. So not yet, in about a decade, but a decade's not a lot of time in terms of like researching a new medicine, right? If you've only got a decade or so, where your two big profit engines are going to be generic.

• 21:49Speaker 01

  Takes a long time for research to get to market. Yeah, you gotta start cooking.

• 21:52Robert Evans?

  You gotta start moving. And in addition to that, five of their best-selling medications, including Pepsid, were set to lose patent protection even sooner in 99. So they are looking at a looming, very serious problem for their profitability.

• 22:06Speaker 01

  This is such a recurring theme with pharmaceutical companies. I just did an episode about a medication called Zygris, which was an Eli Lilly-

• 22:14Robert Evans?

  Wow, it sounds like the Tigress.

• 22:16Speaker 01

  It sounds awesome. It sounds awesome. It's this medication that was touted as like this new breakthrough therapy for sepsis, and it was super exciting. Ended up falling apart for a lot of different reasons and being withdrawn and then being a big marketing scandal, in my opinion. But at the end of the day, it all started because they were losing their patent on their big like sellings, medications, like the one, the things that were making them tons of money were about to run out and they needed a new like cash stream as quick as possible. So things started happening, probably faster than they should have.

• 22:51Robert Evans?

  Yeah, yeah, yeah. And that's like, that is the story here. It's the story a lot of the time, right? Where these, and I don't think this is a bad idea, like the idea that drugs eventually age out to get generic is like, kind of necessary in order to, in our system at least, in order to make it even have a chance of being affordable for some medications. But it does, it leads to this as well. I don't know. Again, we don't need to go on another single payer healthcare rant, but like, we have so, there's so many little things that are fucked up about like, even the things that seem like they make sense, that also lead to fucked up outcomes. And because, because of how much money is at stake in these businesses, and how expensive it is to be a pharmaceutical company, right?

• 23:31Speaker 01

  Yeah.

• 23:32Robert Evans?

  Like, it's not cheap and most of the medications that they, like, one of the things you have to accept as a pharma company is that most of the things you try to make into a medicine aren't going to work.

• 23:43Speaker 01

  Right.

• 23:44Robert Evans?

  Like, that's just, and that's kind of the story here is a medication that if they had done more, spent more time, they would have realized this was not a viable product. But they, they've got shareholders to please.

• 23:58Speaker 01

  Right. And when the money starts to shift from research and development in these companies to marketing, which it does more and more.

• 24:06Robert Evans?

  Oh, yeah. And that's really happening in the 90s. Yeah.

• 24:08Speaker 01

  Right. I'm assuming that's the problem here.

• 24:11Robert Evans?

  Yeah, that's a big part of it. Yes. So, you know, Merck is coming into the 90s, not quite a five alarm fire yet, but definitely like a serious situation. And super aspirin seems like it might be the solution to their problems, and maybe even the key to greater profits than ever before. And speaking of greater profits than ever before, you know who's making money like they've never made money?

• 24:34Speaker 01

  Oh, I'm the people who deserve to?

• 24:38Robert Evans?

  Yes, yes.

• 24:38Speaker 01

  Are the people who sponsor this podcast.

• 24:40Robert Evans?

  That's right.

• 24:41Speaker 01

  They're the ones that deserve the most of the money.

• 24:42Robert Evans?

  That's right. The products and services that support this podcast are literally the only ethical people in capitalism, and you can just trust them. Give them your wallet. Give them your kids, you know? Hand your children over to our sponsors. They'll take care of them. They'll raise them as their own, you know?

• 24:58Speaker 01

  Better than, better than we would.

• 25:00Robert Evans?

  Better than you would. Yeah, exactly. You know, just trust them.

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• 25:36Robert Evans?

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• 26:35Robert Evans?

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• 26:44Speaker 04

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• 27:15Robert Evans?

  And we're back. I didn't mean to imply that none of you were good parents. It's just that our sponsors are incredible parents, you know?

• 27:22Speaker 01

  That much better.

• 27:23Robert Evans?

  They've never, they've never yelled at me. Never yelled at me. Never even spanked me. And I deserved it sometimes. Um, so-

• 27:31Speaker 01

  You paid money for that sort of thing.

• 27:33Robert Evans?

  I, I have. No. We don't, we don't even be saying shit like that. The subreddit's gonna get real uncomfortable very fast.

• 27:42Robert Evans?

  Okay, so, super aspirin seems like it could be the solution to their, to Merck's problems. Uh, in 1994, a new CEO takes over at Merck. And this is, we, we were just talking about the shift from R and D to marketing. This is perfectly emblematic of that because Merck's new CEO is a guy named Raymond Gilmar. Now, the previous CEO, Raymond is an MBA from Harbor, Harvard, right? Which, uh, means he doesn't know anything about anything, uh, but making, making money in the most sketchy ways possible. Whereas the previous CEO of Merck had been Dr. Roy Vagellos, an actual medical scientist with a research background.

• 28:17Speaker 01

  Very famous.

• 28:18Robert Evans?

  Yes, yes. So Merck goes from famous and widely respected medical researcher as their CEO to a guy with an MBA, MBA from Harvard.

• 28:29Speaker 01

  Yeah, the, uh, the Vagellos Award is like this award that's still given out to like people who are like doing humanitarian work for like, in the pharmaceutical world. So-

• 28:40Robert Evans?

  Yeah.

• 28:41Speaker 01

  Like, this is a major shift, a major shift from, away from somebody who was, I think ostensibly a very good person, from all accounts, a very good person, good researcher-

• 28:51Robert Evans?

  Yeah.

• 28:52Speaker 01

  To something very different.

• 28:53Robert Evans?

  Yeah, maybe- Maybe the answer is if you're going to be a CEO of a pharmaceutical company, you should have like watched a sick child die at a hospital. I don't mean to be blunt blunt, but it seems like it leads you to do things like give up patents on life-saving medication.

• 29:10Speaker 01

  A rotation, do a rotation in the hospital.

• 29:13Robert Evans?

  I keep thinking about like fucking the the the polio vaccine guy who he was like, I think his direct his direct question quote when asked if he was going to patent it was like, would you patent the sun?

• 29:27Robert Evans?

  Yeah, sulk. Yeah, real, real, real G, real Chad. So Raymond's career up to that point, this is the business guy, C new CEO of Merck, had included eight years as a consultant for Arthur D. Little, which lists as one of its great achievements, which is it, it's like McKinsey kind of, it's a consulting firm, and it listed as one of its great achievements, the privatization of British Rail. So those of you over in the UK,

• 29:55Robert Evans?

  sure you love this guy. Also, there was this time that they used a bucket of sow's ears to make a silk purse. I don't know why this is listed as an achievement of the Arthur D. Little company, but it is. He worked as the CEO at a medical device company after that, until he was hired by Merck as their first outside CEO for the express purpose of seeing them through the looming patent cliff scenario. So he is brought in as kind of like an emergency guy, right? Now, it was Raymond who decided that Merck's future would be in super aspirin, alongside their chief scientist, Dr. Edward Skolnick. He launched a crash program to bring a COX-2 inhibitor pain medication to market. The name they picked for the wonder drug that did not yet exist,

• 30:37Robert Evans?

  but they were going to that they were going to hang the company's future on was Vioxx. Now, time was of the essence here. Dr. Needleman, the guy who had failed to discover COX-2, but had gone ahead and named it anyway, worked at a company called G. D. Searle, which was a division of Monsanto and was leading research into a new insight that would eventually be called Celabrex. And while Celabrex was under development, Pfizer bought Searle from Monsanto and started. Throwing money into Celebrex as part of what was turning into a vicious competition to be the first pharmaceutical company to bring one of these new super aspirants to market. And there's probably a lot to be said about Celebrex. I am not competent to say it. I will

• 31:18Robert Evans?

  say that it is currently a medication that the FDA says there's not evidence of significant harms for. There is debate about that to this day, but that's all I can say on the matter because I'm not a not an expert on this. There are some activists who are very angry that Celebrex is still on the market. The FDA has said it's it's more or less fine. That's where we are with Celebrex.

• 31:40Speaker 01

  Yeah, it's in the same family. And it does have that comes with a warning on it. That's more striking than most other NSAIDs. I don't know. Actually, it's a good question. I don't know how often it's used these days. I assume it's pretty, pretty rare. Not as often as it was, for sure.

• 31:59Robert Evans?

  It's one of those things where a few years ago, there was a very scary study about heart effect, like heart problems that it could cause. And then a few years later, there was a study that suggests like, well, no, maybe we got that one wrong. And maybe it's no worse than other drugs in this class. Again, that's all I can really say about Celebrex because I'm not qualified to judge a medication that there's still a lot of debate over.

• 32:21Speaker 01

  I don't have a lot more to add to it either. But it feels like there's other NSAIDs out there that we that we use a little more frequently and seem a little safer.

• 32:29Robert Evans?

  Yeah, yeah. But what you need to know is that Pfizer is putting their is putting their money into Celebrex after they acquire Merle. And, you know, Vioxx is going to be the attempt made by Merck to do the same thing. So throughout the mid 1990s, Cabot, Merck scientists worked on Vioxx, rushing it through stages of medical testing, harassed by the knowledge that any delay or bad finding, and when I say bad, not in a scientific sense, it's not bad scientifically to find out a drug doesn't work, but bad for the company if this drug doesn't work because they're on a timetable, would stop them from beating Pfizer. And unfortunately for everybody, there were signs right from the beginning that Vioxx might be dangerous. The first evidence of this was presented in the mid

• 33:14Robert Evans?

  1990s by Dr. Garrett Fitzgerald, a Merck consultant, who was also professor of cardiovascular medicine at the University of Pennsylvania. He warned the company that Vioxx might harm the walls of the blood vessels protecting the human heart. I'm going to quote again from the book Poison Pills by Tom Nessie, which if you're looking for like a really good exploration of how a pharmaceutical company does evil, Poison Pills is very well written. He suggested that Merck set up a series of experiments to test this theory. Few of them were ever performed. Other scientists cautioned that Vioxx was related to kidney damage, an increase in blood pressure that could be linked to heart problems. Dr. Fitzgerald also found similar problems with the drug in the same class as Vioxx, called Celebrex, made by rival drug company Pfizer. Like Merck, Pfizer denied the finding of any cardiovascular problems with its drug,

• 33:59Robert Evans?

  but cleverly began its own campaign to portray Vioxx as the more dangerous of the compounds.

• 34:04Speaker 01

  That's smart.

• 34:05Robert Evans?

  At this point, when he initially warns them, the drug is not on market, he is trying to stop it from getting to market by saying like, there's some real evidence this is sketchy, you should carry it more studies. And Merck is just kind of like, but what if we didn't?

• 34:20Robert Evans?

  It's like when you've been like spending like crazy all month and you know you probably, like you might be running down to the limit, but you're just like going to the grocery store, hoping that like your card works this one more time or something. So now at this point, there was no hard evidence of harm to the human heart, in large part because Merck had refused to do the studies that Dr. Fitzgerald advised. This changed in 1996, when an internal Merck study showed that people who took Vioxx in high doses suffered more heart problems than people given a placebo. A memo was issued internally that noted, "The treatment period was six weeks versus placebo. The initial dose of Vioxx was 175mg, but in mid-study, the dose was lowered to 125mg. Adverse events of most concern were in the cardiovascular system,

• 35:05Robert Evans?

  i.e. heart attack, unstable angina, rapid-fallen hemoglobin, and hematocrit, dangerous blood problems in some subjects." So that's bad. Those are all really bad results.

• 35:15Speaker 01

  Yeah. You're you're almost officially a doctor because that is correct. That is the appropriate diagnosis is that it's all bad.

• 35:23Robert Evans?

  Not good.

• 35:24Speaker 01

  Not good.

• 35:24Robert Evans?

  Not good. It is important to underline the severity of these results, though. These extremely serious side effects were present after just a few weeks of medication for doses that were just about twice the approved amount for treating acute pain, which was 50 milligrams. Now, twice sounds like a lot, but when we are talking about the way people use medicines, it's really not. People take way more, especially pain medicine, than they ought to.

• 35:52Speaker 01

  This keeps me in business that people do this. This is like almost, you don't even have to take it more than is recommended to run into problems because sometimes people only take a little and they run into problems in the GI system, for example, or other issues like kidneys that can be affected or the heart. But it is a sole underlying known fact that whatever we think people are going to be taking, likely it'll be more.

• 36:21Robert Evans?

  And that is why it's standard in tests like the one they were conducting, actually to test 10 times the effective acute dose when doing studies like this to check for side effects, which they didn't do because they knew that the results would be even worse. One doctor who analyzed these results noted, "I recall very clearly many occasions where Merck scientists and doctors working with Merck were claiming that Vioxx was safe as placebo, which we've already seen it's not." Now, the reality is that results like this were a big warning sign and should have been taken as evidence that Vioxx might not be viable as a medication and certainly needed more testing. But Merck went full speed ahead. In November of 1998, they asked the FDA to approve Vioxx after testing the drug on 5,400 patients.

• 37:04Robert Evans?

  They bragged that they had conducted eight different studies, which had shown Vioxx's efficacy. Now, this is where we get into a complicated and uncomfortable topic: medical studies and why they often don't work the way that they should. In theory, the process of conducting medical studies should identify dangers in new drugs and accurately measure their efficacy. But theory envisions a situation in which drugs are researched by Interested parties who have no vested interest in anything but the truth. The reality is that studies are often funded by pharmaceutical companies who, like Merck, might be sweating the arrival of an upcoming patent cliff and headed by a new CEO who lacks the same commitment to medical ethics as his precursor. I'm going to quote now from an article on this in the Union of Concerned Scientists.

• 37:48Robert Evans?

  "To increase the likelihood of FDA approval for its anti-inflammatory and arthritis drug ViOx, Merck used flawed methodologies biased towards predetermined results to exaggerate the drug's positive effects. Internal documents made public in litigation revealed that a Merck marketing team had developed a strategy called ADVANTAGE, assessment of differences between ViOx and Naproxen to ascertain gastrointestinal tolerability and effectiveness, to skew the results of clinical trials in the drug's favor. As part of the strategy, scientists manipulated the trial design by comparing the drug to Naproxen, a pain reliever sold under brand names such as Aleve, rather than to a placebo. The scientists then highlighted the results that Naproxen decreased the risk of heart attack by 80%

• 38:29Robert Evans?

  and downplayed the results that ViOx increased the rate, the risk of heart attack by 400%. This misleading presentation of the evidence meant it looked like Naproxen was protecting patients from heart attacks and that ViOx only looked risky by comparison. So instead of comparing this drug to a placebo, in which it would have been like, wow, the rate of heart attacks is much higher, they compared it to a drug that reduced the risk of heart attacks? And we're like, well, of course, people have more heart attacks on this drug. This other drug reduces heart attacks, but that doesn't mean this is danger. Like, that's so fucking shady.

• 39:00Speaker 01

  It is. It's a bit tricky how they're doing it too, because, you know, so far, a lot of what they have done sounds very, I mean, sounds sound from a distance. You know, the whole idea of like looking at COX2 inhibitors, like looking at medications specifically for this and comparing it, you know, say, hey, look, at least we're better than the other medications. To some degree, from a high, from your way back vantage point, it all makes sense. It's when you start to like, look a little bit more closely that it's questionable, especially given that they seem to know early on that there was high risk of these cardiovascular injuries and that the whole narrative is being shifted to try and. Take focus away from that.

• 39:44Robert Evans?

  Yeah.

• 39:45Speaker 01

  It's, it's, it's all, this is why it's a difference between marketing and between like a scientist running the program.

• 39:51Robert Evans?

  Yeah, yeah. And that's like, that's, that's really the whole story here, right? So Merck's fuckery extended to the hiring of ghostwriters to write scientific articles reporting on clinical trials of Vioxx to try and convince doctors and regulators that the medication was safe. Internal Merck documents later revealed that in 16 out of 20 papers reporting on early Vioxx clinical trials, a Merck employee was listed as the lead author of the first draft, but in the published versions, credit for authorship was given to an outside academic. To continue in that, from that piece by the Union of Concerned Scientists, in one draft of a Vioxx research study that did not yet have a prominent outside name attached, Merck officials listed the lead author only as "external author?"

• 40:34Robert Evans?

  A Merck scientist was also found to have removed the evidence of three heart attacks among patients in a data set from the results presented. So great, great stuff.

• 40:46Speaker 01

  And when, I mean, and I don't know what numbers were in that paper, but removing three can make a huge difference.

• 40:51Robert Evans?

  Yes, yes. Especially if you're not talking about a huge study, you know?

• 40:55Speaker 01

  Yeah. Did it say anything about how many people were in that study?

• 40:58Robert Evans?

  I, you know what? I'm sure I could have looked into it, but I did not.

• 41:03Speaker 01

  And I'm wondering if in these studies, they were talking about the rates of peptic ulcer bleeding, gastric bleeding as well. Cause I mean, that's ostensibly the whole reason that they're doing this.

• 41:13Robert Evans?

  That was the whole thing that Advantage was supposed to show, right? Is that it reduced the rate of like peptic ulcer bleeding and stuff. And yeah, just the whole, the fact that we have drafts of them just being like, we'll figure out who the author of this piece is later. Once we find a science, once we find an outside doctor who, you know, wants some cash. And a lot of, these aren't direct bribes. These are like, okay, you'll stick your name on this and then this research project you want will get a little bit of funding from, uh, from, from old Papa Merck, you know?

• 41:40Speaker 01

  And not even just that. These are all being published in decent journals. I'm sure that just people want to be in good journals. They want to have another publication in, you know, New England Journal of Medicine or the Lancet or whatever.

• 41:53Robert Evans?

  And you, you also have to remember, people think, a lot of people think this is the next big miracle drug. So yeah, you want, you want, you want to have a, you want to have a little bit of play in that, right? Of course. So yeah, the worst piece of evidence against Vioxx of this period came out the same year Merck asked for FDA approval, 1998. Merck Study 090 involved 978 patients and showed that people on Vioxx experienced serious cardiovascular events six times as often as patients taking a different drug or a placebo for arthritis pain. Merck shelved the study and never published it. Later that same year, a group of medical researchers at the University of Pennsylvania, and by the way, thanks to that doctor we named earlier, U of Penn really tried to stop Vioxx from being a thing, published a study that showed

• 42:38Robert Evans?

  that COX2 inhibitors might interfere with other enzymes that help prevent heart disease. Warnings were sent to Merck and Pfizer, who quickly shoved them off into the circular file and kept right on begging the FDA to say yes. And say yes, the FDA did. They approved Vioxx for use as a painkiller in results in adults in 1999, menstrual pain medication, and an anti-inflammatory for people with osteoarthritis. Despite approving the drug, FDA reviewer Dr. Villalba warned in his memorandum that there was evidence suggesting Vioxx caused more frequent cardiovascular events in patients. So, Vioxx goes to market, it immediately becomes a bestseller. Celabrex also goes to market, it drives massive profits for Pfizer.

• 43:22Robert Evans?

  And this is in spite of the fact that particularly Vioxx is not great at, I mean, neither drug is really all that good at fighting pain. And I'm going to quote from the New York Times here. "When studies on Vioxx and Celabrex became available in 1998, 1999, many doctors were disappointed. Neither drug alleviated pain any better than the old medications, and the drugs cost close to $3 a pill. Over-the-counter pain relievers, in contrast, cost pennies a dose." And by the way, they weren't all that much better at preventing ulcers. Some studies suggest like Vioxx was no better at preventing ulcers, although that seems to be unclear. Now, analysts say that the success of Vioxx was critical to Merck. The patents on those popular Merck drugs aspire, started expiring in 2000 and 2001, which

• 44:06Robert Evans?

  opened them up to generic competition. And Vioxx comes through and is, I mean, almost immediate. Billions of dollars a year in profits for the company. Michael Krint Savage, a drug industry analyst at the investment bank Raymond James and Associates, says Vioxx was Merck's savior. It's as simple as that. Like, he puts it down as the company might have gone owner under, at least, you know, probably been acquired if it hadn't have been for Vioxx.

• 44:30Speaker 01

  I mean, I remember at the time, it was huge. It was, I'd never seen a campaign like it. I don't remember. I think it was one of the first times I remember really having like, being conscious of like how much a medicine was being marketed. Yeah. You know, and, you know, I think it's one of these medicines where it's like, you know, maybe five to 10% of the people who are using it maybe had some benefit, real benefit where they maybe, it did help them from a gastric ulcer perspective. Maybe they didn't have the option of taking another medicine. But for the other 90% of people that were taking it, it wasn't necessary for them. It wasn't something that they needed. And it was just increasing their risk of, of heart attack or stroke.

• 45:15Speaker 01

  And, and I think that this is, I bet you, I mean, you probably know this, but I bet, up to this point, this was the most that had ever been spent on direct marketing.

• 45:24Robert Evans?

  Yeah. I mean, and that is what we're actually about to talk about is the marketing campaign, which, surprise, surprise, involves beloved figure skater Dorothy Hamill. But

• 45:33Speaker 01

  I knew it.

• 45:34Robert Evans?

  Mm hmm. Yes. She, she's the great monster in this, in all of our episodes. Every episode we've ever done, Dorothy Hamill.

• 45:41Speaker 01

  Been building up to this. She's the Thanos of the behind the bastards world.

• 45:44Robert Evans?

  That's right. Joseph Stalin would never have accomplished his greatest crimes without Dorothy Hamill's assistance. That's obvious, though.

• 45:52Speaker 01

  Evil haircut.

• 45:52Robert Evans?

  Historians have been talking about that for decades. Anyway, you know who's not Dorothy Hamill? I don't know why I'm shitting on Dorothy Hamill. None of this is really her fault. Anyway, here's that.

• 46:03Speaker 05

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• 47:14Robert Evans?

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• 49:24Robert Evans?

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• 50:23Robert Evans?

  Do ask your doctor about fewer medicines. Visit devato.com or call 1-877-844-8872.

• 50:30Speaker 06

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• 51:04Robert Evans?

  Uh, we're back. Okay, so we're talking the Vioxx marketing campaign. How do you sell America on this drug that is going to get a decent percentage of America killed? And the answer is figure skating superstar Dorothy Hamill. So yeah, this is, this is where the real villain of the story comes into it.

• 51:25Speaker 01

  The haircut is a problem for me.

• 51:27Robert Evans?

  Haircut, Dorothy Hamill's haircut?

• 51:29Speaker 01

  My first girlfriend, the first girl that really smashed my heart into like a billion pieces, scattered them across the globe.

• 51:37Robert Evans?

  Was Dorothy Hamill? Wow, she's really taken some strays in this episode.

• 51:40Speaker 01

  Whoa, she just, she had Dorothy Hamill's haircut.

• 51:43Robert Evans?

  Oh.

• 51:44Speaker 01

  Which I don't know why at the time, didn't bother me. But, um, so now when I see that haircut, I'm like, oh yeah, that reminds me of that, that.

• 51:53Robert Evans?

  Lost love, lost love.

• 51:55Speaker 01

  Yeah, painful, painful.

• 51:57Robert Evans?

  So for those of you who don't know what we're talking about, back in the 1970s, an incredible athlete named Dorothy Hamill became one of the most famous people in the world when she was just 19. She performed at the 1976 Innsbruck Olympics and won the gold. Time declared her America's sweetheart, and as is customary for world-class athletes, corporations began offering her embarrassing piles of money to endorse their products. Hamill's first run as a famous person didn't go great. She married Dean Martin's kid, and then he died in a plane crash. She fell out with her coach. She spent all of her money buying the ice capades and then wound up burning out and developing a bleh- ulcer. She had another marriage that ended badly and wound up, well, not broke, you wouldn't say, but no longer rich. And she suffered from a substantial amount of pain

• 52:43Robert Evans?

  from a lifetime of pushing her body to athletic excess. The pain was bad enough that at the worst, Dorothy could no longer even play with her daughter. Some days she could barely get out of bed. And then her doctor told her to try Vioxx. She would later claim that it was effectively a miracle cure for her, not only soothing her pain, but bringing back her ability to perform on the ice in a way she hadn't in years. In August of 2000, Hamill made an appearance on Larry King Live with Caitlyn Jenner. And Jenner is also talking about Vioxx in this. This Jenner is also claiming that like, this, this really helped her arthritis. She told the audience a heart wrenching story about loss and pain and her miraculous return to the world of the living thanks to Vioxx. Quote, "I just, I felt old. I felt

• 53:27Robert Evans?

  depressed, tired all the time. I mean, having chronic pain is exhausting. And I got to the point this year, I was on tour and I couldn't skate. And so I went to a doctor and we finally got to the bottom of it. And my doctor prescribed Vioxx for me. And it's as if I've been given a new life. It's just, it's been amazing. I feel 20 years younger. I don't look it and I don't skate it, but I feel that way."

• 53:47Speaker 01

  Was this when Larry King still had some credibility?

• 53:50Robert Evans?

  Oh, yeah. He was big at this point. This is like, right around the turn of the century. He's, he's still a big, a major, major.

• 53:57Speaker 01

  This is like before infomercial Larry.

• 54:00Robert Evans?

  Yes, yes. And this is, I mean, maybe this is part of his downfall. But people still take the show seriously and they take this very seriously. And to be clear, I'm not saying that, you know, even Caitlyn or, or Hamill were lying about their experiences on Vioxx, because some people did gain benefits of this. And, you know, I, so I'm not doubting that. The problem again is that a single person's having a good reaction to a drug is not evidence that the drug is safe. You know, for example, I know some people in their 70s who have been doing heroin for 50 straight years and are, and are fine. That doesn't mean heroin is safe. It means some people are lucky. Right? Yeah.

• 54:45Robert Evans?

  Or the aforementioned 90 year old women doing.

• 54:48Speaker 01

  Who are these ancient people who do drugs and smoke that you hang out with all the time?

• 54:53Robert Evans?

  Little Burning Man regionals, you run into a lot of elderly people who have been doing drugs for forever.

• 54:59Robert Evans?

  Some of them are very good at it.

• 55:02Robert Evans?

  I've been gas station sober for years now, Kaba.

• 55:05Speaker 01

  Yeah, that's responsible. California sober, but you can only get inebriated with things you buy at the gas station.

• 55:11Robert Evans?

  I don't mess with that marijuana. That shit's dangerous. I just take those trucker yellow jackets that they give to keep lot people driving long haul awake, you know? I don't know what's in them. They're big and yellow. That means they're safe.

• 55:23Speaker 01

  It would be red if it was dangerous.

• 55:26Robert Evans?

  It'd be red if it was dangerous. They can't put dangerous drugs in a yellow and black pill and call it yellow jacket.

• 55:31Speaker 01

  Caution, it doesn't mean danger.

• 55:33Robert Evans?

  Yeah. So I never take more than like 12 in a day. Yeah. Thank God for yellow jackets.

• 55:39Speaker 01

  I just, I some, I some, I sometimes don't know if you're kidding and I just hope in my heart that you are. And I'm just going to pretend that this is all part of a bit.

• 55:50Robert Evans?

  I do the safe thing. I like open the pill and I pour all the powder in the pill into a glass and then I pour in a bunch of my kratom into the glass and then I add a banana for the potassium. Cause that's good for your heart.

• 56:00Speaker 01

  Level, this level of detail is what bothers me.

• 56:05Speaker 01

  It's the part I don't like.

• 56:06Robert Evans?

  Mm-hmm. It's fine. It's mostly just B12 and caffeine and God knows what else because there's absolutely no, no agency that looks into what gets put into substances that are sold in gas stations in this country.

• 56:18Speaker 01

  Oh my God. And what little oversight there is, is gonna be gone.

• 56:22Robert Evans?

  Yes, thank God. Thank God. Look, RFK Junior might ban the HPV vaccine, but we could get legal heroin.

• 56:33Speaker 01

  It's all one big organized end of humanity cash grab. The, the next couple of years, any drug you want to get through is gonna get through.

• 56:44Robert Evans?

  God willing. Look, if, if the world's ending, do you want heroin to not be legal?

• 56:51Speaker 01

  That's fair, but it's not gonna be even heroin. It's gonna be like, you know, blood pressure pills that the company just gets through and then it makes people's hearts explode. And then the company will just say, hey, we're bankrupt and then they're fine. And then they just move on with their lives and then people are gonna be left in the wake. And then-

• 57:10Robert Evans?

  No, you're right. They're gonna ban Prozac and replace it with like Polarare liver pills. It's just gotta be a disaster.

• 57:18Speaker 01

  He was always doing research that, RFK.

• 57:21Robert Evans?

  He's always trying something new.

• 57:24Robert Evans?

  So the fact that this beloved celebrity athlete has gone on Larry King and said exactly what Vioxx PR would want her to say was a godsend. You know, that's the kind of PR no money can buy. Although I have to tell you now, that moment was in fact bought and paid for by Merck. They had found out that Dorothy was a customer. They had reached out to her with an idea and a pile of money. Her life story had been used as the basis for an entire marketing campaign and her appearance on Larry King was just the first step in launching it. Tom Nessie writes, "The day after Dorothy Hamill's appearance, even Merck's CEO Raymond Gil-Martin was smitten. He received heart-wridding letters from arthritis sufferers saying they were going to immediately ask their physicians for Vioxx. Gil-Martin personally congratulated the Public Relations Department.

• 58:09Robert Evans?

  One marketing executive wrote that 'With Dorothy telling our story, Vioxx's sales were going to soar and overtake Celebrex,' an obsession within the company."

• 58:17Speaker 01

  You almost slipped into like your 50s radio announcer voice. You're like, you kind of shifted to the 90s. I saw what you did there. It was nice.

• 58:23Robert Evans?

  I love it. I love it. I love it. So yeah, patients are coming in. They're begging doctors to write prescriptions. Doctors are going, "Well, shit, how bad could it be? It's basically just aspirin." You know, and a lot of people are suddenly taking Vioxx. Now, the FDA does push back a little on this campaign because Dorothy's appearance on Larry King counted as an ad and she had not mentioned that she was being paid by Merck, which you're not supposed to do. They also had an issue that she was kind of basically saying she had not told people that Vioxx was extremely dangerous if you prescribed it to patients with a history of bleeding ulcers. In fact, she had stated that she was taking it despite her history of bleeding ulcers,

• 59:07Robert Evans?

  which is kind of telling people this is safe to say in the exact situation that the FDA knows we know it is not safe to tell people to take it in. Right. Um, so the FDA gets kinda unhappy with this and Merck replied, she just slipped up. We taught Hamill the proper way to sell our product, but she went off script. They promised to retrain her before following up with any additional advertisements. This happened on September 12th, 2000. The next day, in violation of their promise to the FDA, Hamill appeared on a local TV station in Atlanta to urge people to consider ViOx. The FDA never found out about this and might not have cared if they had. If you wanted to get away with something, September 12th, well, actually that was 2000. Never mind, everything was still fine.

• 59:50Robert Evans?

  I was gonna, I was just like, did I just go over September 12th and not make a I feel like you would have caught that. No, no, no, it's fine. The research. Didn't happen yet, everything was fine. Plenty of towers in New York still at this point. Now, the unfortunate reality of the FDA is that it is staffed and operated by a lot of people who want to work in the private sector of the pharmaceutical industry someday. And some of these people feel a need to avoid making waves and killing a golden goose that is currently injecting cash into someone they want as a future employer. Or who may have been a past employer that they're hoping will, you know, hire them on for a lucrative consulting gig in the future. Beyond that, the teams at the FDA, who we rely on to monitor food and drug advertising, are hideously understaffed, operating on a shoestring budget. There may not have been anyone watching Dorothy Hamill's ad on local Atlanta TV

• 1:00:35Robert Evans?

  because no one was being paid to do so. Now, Merck did change their TV ads for ViOx based on the FDA's feedback. And you can see one example of that here. We, we gotta play just one of these bad boys. Here is Dorothy Hamill's revised ViOx ad.

• 1:00:51Speaker 07

  When I started skating at eight years old, I never thought I'd experience the thrill of winning a medal. With all the great memories has come another thing I thought I'd never experience, the pain of osteoarthritis. ViOx is here, a prescription medicine for osteoarthritis pain. With one little pill a day, ViOx can provide powerful 24-hour relief. ViOx specifically targets only the COX2 enzyme, a key source of arthritis pain. People with allergic reactions such as asthma to Or other arthritis medicines should not take Vioxx. In rare cases, serious stomach problems such as bleeding can occur without warning. Tell your doctor if you have liver or kidney problems. For more information, talk to your doctor about once daily Vioxx for the relief of osteoarthritis pain.

• 1:01:35Speaker 07

  Perhaps my biggest victory is to be able to plan my day around my life instead of my pain. Ask your doctor if Vioxx is right for you.

• 1:01:43Robert Evans?

  Vioxx for everyday victories.

• 1:01:46Speaker 01

  First of all, I take back what I said about her hair. I think it actually looked really good there. I don't know. Maybe it's just like time and the, the, the cycle of change and, and fashion. I don't know.

• 1:01:56Robert Evans?

  Maybe it was the Vioxx. You don't know, maybe Vioxx makes your hair look great, everybody. Go out and buy Vioxx.

• 1:02:01Speaker 01

  It's a brilliant strategy. Like the people who grew up watching her and knew who she was and admired her are that age where they were having lots of osteoarthritis and joint pains, looking for medication. It's a, she's the perfect spokesperson.

• 1:02:16Robert Evans?

  Yeah.

• 1:02:16Speaker 01

  And she, and she has that innocence so that you believe, you know?

• 1:02:20Robert Evans?

  Yeah. And the Dorothy Hamill ads are a huge success. Millions of Americans saw their former child sweetheart skating and skiing and living an active, healthy life thanks to this new miracle drug. And millions of them decided, I want that for myself. And ultimately, tens of thousands of them are going to die as a result. And that's the story we're going to tell in part two, Gaba.

• 1:02:40Speaker 01

  Can't wait.

• 1:02:41Robert Evans?

  Yay. But first off, do you have anything to plug before we roll out here?

• 1:02:45Speaker 01

  I do. Plug is my show. That is the plug that I want to plug is my show. I'm plugging it now. It's called The House of Pod. It is a humor adjacent medical podcast. If, if you like the subjects like today's subject, you'll like our show. In fact, one of our most recent episodes is about a sort of similar, a little bit less egregious, but similar pharmaceutical shenanagery. I don't know if that's a word, about the medication Zygris. And, and there's all kinds of fun guests like Robert and Prop and all the, the people you know and love here. Margaret, so check out my show, The House of Pod. And if you want, you can follow me.

• 1:03:29Speaker 01

  At Blue Sky, which I'm giving a shot now, seems a little bit less fascist.

• 1:03:32Robert Evans?

  Yeah, definitely less fascist. It's got its own annoyances, but all of social media has things that annoy me. So what are you gonna do?

• 1:03:39Speaker 01

  Exactly. You can follow me there at CaveMD.

• 1:03:42Robert Evans?

  You can also follow me there at I Write OK, where you can follow me on the other place, too. But you know what you could do that I would appreciate most? Go get off the internet. Feed somebody, you know? Do something good in the world.

• 1:03:56Speaker 01

  Yeah, I like it. I like it. And take the nice-

• 1:03:59Robert Evans?

  Except for to listen to podcasts. Keep listening to podcasts, for the love of God. Keep listening to podcasts.

• 1:04:03Speaker 01

  Do not stop listening to podcasts.

• 1:04:05Robert Evans?

  Under no circumstances stop listening to podcasts.

• 1:04:07Speaker 01

  Will you ever stop? In fact-

• 1:04:08Robert Evans?

  No.

• 1:04:08Speaker 01

  Just for thinking about stopping, you should listen to extra podcasts today.

• 1:04:12Robert Evans?

  Yeah. You know what? I'll say it right now. If you have stomach ulcers, podcasts will knock that right out.

• 1:04:17Speaker 01

  Podcast your way through it. Podcast your way through it.

• 1:04:19Robert Evans?

  That's right.

• 1:04:24Speaker 07

  Behind the Bastards is a production of Cool Zone Media. For more from Cool Zone Media, visit our website, coolzonemedia.com, or check us out on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Behind the Bastards is now available on YouTube. New episodes every Wednesday and Friday. Subscribe to our channel, youtube.com/AtBehindTheBastards.

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  In February of 2024, celebrated illustrator and children's book author Petra Mathers and her husband Michael mailed letters to dozens of friends and family members to let them know they had died by suicide. Dear honeys, this is goodbye. By the time you get this letter, both Petra and I will be dead. Next stop, Wonderland. Why did they do it? And what did it do to the people they left behind? Listen to Death of an Artist on the iHeart Radio app, Apple Podcasts, or wherever you get your podcasts.

• 1:06:48Speaker 05

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