1. Power and Knowledge in Drug Marketing

1 This is true even in nearly ideal circumstances – for example, as part of the close communication between teachers and students who have incentives respectively to teach and to learn, and who have books and articles to support their communication. Much knowledge moves only with difficulty.

2 For a general overview of the field, see Sergio Sismondo, An Introduction to Science and Technology Studies, 2nd edn (Chichester: Wiley, 2010).

3 For a few key early works adopting this view, see David Bloor, Knowledge and Social Imagery, 2nd edn (Chicago: University of Chicago Press, 1991); H. M. Collins, Changing Order: Replication and Induction in Scientific Practice, 2nd edn (Chicago: University of Chicago Press, 1990); G. Nigel Gilbert and Michael Mulkay, Opening Pandora’s Box: A Sociological Analysis of Scientists’ Discourse (Cambridge: Cambridge University Press, 1984); Karin D. Knorr-Cetina, The Manufacture of Knowledge: An Essay on the Constructivist and Contextual Nature of Science (Oxford: Pergamon Press, 1981); Bruno Latour and Steve Woolgar, Laboratory Life: The Construction of Scientific Facts, 2nd edn (Princeton, NJ: Princeton University Press, 1986); Steven Shapin and Simon Schaffer, Leviathan and the Air-Pump: Hobbes, Boyle, and the Experimental Life (Princeton, NJ: Princeton University Press, 1985).

4 In a fascinating study, Harry Collins shows that technical knowledge moves much more easily when attempts at transmission include face-to-face contact than when they are conducted purely through written texts. This resonates with the pharmaceutical industry’s use of key opinion leaders and sales representatives, as seen in Chapters 5 and 6 of this book. See H. M. Collins, Changing Order: Replication and Induction in Scientific Practice, 2nd edn (Chicago: University of Chicago Press, 1990). Bruno Latour argues that models of the movement of information in terms of ‘translation’ tell us much more than do models in terms of ‘diffusion’. His point is essentially the same as mine on the quasi-substantiality of knowledge. See Bruno Latour, Science in Action: How to Follow Scientists and Engineers through Society (Cambridge, MA: Harvard University Press, 1987).

5 Even Wikipedia is not as egalitarian as it seems, though. See Heather Ford and Judy Wajcman, ‘“Anyone Can Edit”, Not Everyone Does: Wikipedia’s Infrastructure and the Gender Gap’, Social Studies of Science 47, no. 4 (2017): 511–527.

6 These terms are borrowed from the sociologist Pierre Bourdieu, for example in ‘The Specificity of the Scientific Field and the Social Conditions of the Progress of Reason’, Social Science Information 14, no. 6 (1975): 19–47. There is no escaping the sciences’ social structures, even as they remain within the sciences. As Bourdieu says, ‘The “pure” universe of even the “purest” science is a social field like any other, with its distribution of power and its monopolies, its struggles and strategies, interests and profits’. Even the production of ‘objective truth’ requires social conditions. Moreover, action in a field is competitive, a struggle for limited capital among its members. This will be accentuated when some parties have access to considerably more resources for establishing scientific knowledge than have others. See also Pierre Bourdieu, Language and Symbolic Power (Cambridge, MA: Harvard University Press, 1981).

7 Antonio Gramsci, Selections from the Prison Notebooks, ed. and trans. Quinton Hoare and Geoffrey Nowell-Smith (New York: International Publishers, 1971). Gramsci’s central concern was strategic: to displace conservative (in particular Fascist) hegemony over key institutions in favour of socialist hegemony. I hope that people will be able to use my work in this book in strategic ways, too: to displace pharmaceutical industry hegemony over key aspects of the medical world, in favour of a more democratic medicine.

8 Antonio Gramsci, Selections from the Prison Notebooks, ed. and trans. Quinton Hoare and Geoffrey Nowell-Smith (New York: International Publishers, 1971), 5 (emphasis in the original).

9 Therefore, my approach is quite different from that of, say, Ben Goldacre, who tends to focus on issues of truth and falsity in claims about efficacy and safety. This is not to dismiss his fine work: Ben Goldacre, Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients (Toronto: McClelland & Stewart, 2012). See also, for example, John Abraham and Courtney Davis, ‘Drug Evaluation and the Permissive Principle: Continuities and Contradictions between Standards and Practices in Antidepressant Regulation’, Social Studies of Science 39, no. 4 (2009): 569–598; Jon N. Jureidini, Leemon B. McHenry, and Peter R. Mansfield, ‘Clinical Trials and Drug Promotion: Selective Reporting of Study 329’, International Journal of Risk & Safety in Medicine 20, no.1–2 (2008): 73–81; Bruce M. Psaty and Richard A. Kronmal, ‘Reporting Mortality Findings in Trials of Rofecoxib for Alzheimer Disease or Cognitive Impairment: A Case Study Based on Documents from Rofecoxib Litigation’, Journal of the American Medical Association 299, no. 15 (2008): 1813–1817.

10 Industry-sponsored studies appear to be as rigorous as other studies, even while sponsorship strongly shapes reported outcomes. For a recent meta-analysis, see Andreas Lundh, Sergio Sismondo, Joel Lexchin, Octavian A. Busuioc, and Lisa Bero, ‘Industry Sponsorship and Research Outcome’, Cochrane Database of Systematic Reviews 12 (2012). Two earlier meta-analyses came to similar conclusions: Joel Lexchin, Lisa A. Bero, Benjamin Djulbegovic, and Otavio Clark, ‘Pharmaceutical Industry Sponsorship and Research Outcome and Quality: Systematic Review’, British Medical Journal 326, no. 7400 (2003): 1167–1170; Justin E. Bekelman, Yan Li, and Cary P. Gross, ‘Scope and Impact of Financial Conflicts of Interest in Biomedical Research: A Systematic Review’, Journal of the American Medical Association 289, no. 4 (2003): 454–465.

11 Political economy has been an important lens through which the field of Science and Technology Studies has viewed biotechnology and pharmaceutical trials. See, for example, Melinda Cooper, ‘Experimental Labour – Offshoring Clinical Trials to China’, East Asian Science, Technology and Society 2, no. 1 (2008): 73–92; Jill Fisher, Medical Research for Hire: The Political Economy of Pharmaceutical Clinical Trials (New Brunswick, NJ: Rutgers University Press, 2009); Kaushik Sunder Rajan, Biocapital: The Constitution of Postgenomic Life (Durham, NC: Duke University Press, 2006); Catherine Waldby, Tissue Economies: Organs and Cell Lines in Late Capitalism (Durham, NC: Duke University Press, 2006). I am expanding that to pharmaceutical knowledge. Like economic markets, major knowledge markets have definite histories, are actively made, and are shaped by circumstances. For economic markets, see Naazneen H. Barma and Steven K. Vogel, eds, The Political Economy Reader: Markets as Institutions (New York: Routledge, 2008). Among those who have explicitly extended the point to knowledge markets is Steve Fuller, The Knowledge Book: Key Concepts in Philosophy, Science and Culture (New York: Routledge, 2014).

12 Alfred Chandler, Jr., The Visible Hand: The Managerial Revolution in American Business (Cambridge, MA: Harvard University Press, 1977).

13 Peter Gøtzsche has a similar attitude, but he sees the hidden actors in terms of organized crime. In a book structured around a great many anecdotes, he also explores how the pharmaceutical industry attempts to dominate medicine. See Peter C. Gøtzsche, Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare (London: Radcliffe Publishing, 2013).

14 See, for example, Stephan Erhardt, Lawrence J. Appel, and Curtis L. Meinert, ‘Trends in National Institutes of Health Funding for Clinical Trials Registered in ClinicalTrials.gov’, Journal of the American Medical Association 314, no. 23 (2015): 2566–2567.

15 Sergio Sismondo, ‘Ghost Management: How Much of the Medical Literature is Shaped Behind the Scenes by the Pharmaceutical Industry?’ PLoS Medicine 4, no. 9 (2007): e286.

16 MD NetGuide, ‘The ‘e’volution of Pharmaceutical Marketing’ <http://www.mdnetguide.com/specialty_editions/marketer/v1n1/pharmmarket.htm> [accessed 13 August 2004].

17 Susanne L. Rose, Janelle Highland, Matthew T. Karafa, and Steven Joffe, ‘Patient Advocacy Organizations, Industry Funding, and Conflicts of Interest’, JAMA Internal Medicine 177, no. 3 (2017): 344–350.

18 David S. Hilzenrath, ‘In FDA Meetings, “Voice” of the Patient Often Funded by Drug Companies’, Project On Government Oversight, 1 December 2016 <http://www.pogo.org/our-work/reports/2016/in-fda-meetings-voice-of-the-patient-often-funded-by-drug-companies.html>.

19 For the television ad figure see Beth Snyder Bulik, ‘With a Month Left to Go, Pharma’s $3.2B TV Ad Spending Has Already Topped 2016’, FiercePharma <https://www.fiercepharma.com/marketing/pharma-tv-ad-spending-tops-2016-total-one-month-left-led-by-abbvie-and-pfizer>[accessed 12 December 2017]. For approximate ratios of TV to other advertising see Julie Liesse, ‘Healthcare Marketing’, Advertising Age, 17 October 2016 <http://gaia.adage.com/images/bin/pdf/KantarHCwhitepaper_complete.pdf> [accessed 12 December 2017]. Medical journal ad spending is reported in Larry Dobrow, ‘Medical Journal Ad Spend in H1 2017: All the Data in One Place’, Medical Marketing & Media, 4 October 2017 <http://www.mmm-online.com/campaigns/medical-journal-ad-spend-in-h1-2017-all-the-data-in-one-place/article/696599/>.

20 There have been many studies of pharmaceutical advertising. For a few examples of different kinds of analyses, see: Peter Conrad and Valerie Leiter, ‘From Lydia Pinkham to Queen Levitra: Direct‐to‐Consumer Advertising and Medicalisation’, Sociology of Health & Illness 30, no. 6 (2008): 825–838; Barbara Mintzes, Morris L. Barer, Richard L. Kravitz, Arminée Kazanjian, Ken Bassett, Joel Lexchin, Robert G. Evans, Richard Pan, and Stephen A. Marion, ‘Influence of Direct to Consumer Pharmaceutical Advertising and Patients’ Requests on Prescribing Decisions: Two Site Cross Sectional Survey’, British Medical Journal 324, no. 7332 (2002): 278–279.

21 See, for example, Statista, ‘Revenue of the worldwide pharmaceutical market from 2001 to 2016 (in billion U.S. dollars)’ <https://www.statista.com/statistics/263102/pharmaceutical-market-worldwide-revenue-since-2001/> [accessed 5 May 2018].

22 As long noted, firms rely on hierarchical organizations, rather than always outsourcing. In a classic paper, Ronald Coase argues that the reason for this was the possibility of reducing transaction costs within an organization, compared with between independent actors. See Ronald Coase, ‘The Nature of the Firm’, Economica 4, no. 16 (1937): 386–405. Coase’s account has been challenged and supplemented by a number of others that emphasize other factors relevant to the rise and stability of firms. See, e.g. Demetri Kantarelis, Theories of the Firm, 2nd edn (Geneva: Inderscience Publishers, 2014).

23 David J. Teece, Gary Pisano, and Amy Shuen, ‘Dynamic Capabilities and Strategic Management’, Strategic Management Journal 18, no. 7 (1997): 509–533.

24 Quoted in Stephen P. Dunn, ‘Galbraith, Uncertainty and the Modern Corporation’, in Michael Keaney, ed., Economist with a Public Purpose: Essays in Honour of John Kenneth Galbraith (New York: Routledge, 2001), 157–182.

25 I was introduced to the idea of channel marketing, and to the pharmaceutical industry as engaging in channel marketing, by Kalman Applbaum, ‘Getting to Yes: Corporate Power and the Creation of a Psychopharmaceutical Blockbuster’, Culture, Medicine, and Psychiatry 33, no. 2 (2009): 185–215.

26 There is a sense in which this is not unusual. The perceived validity of most knowledge, scientific and otherwise, ultimately rests on trust in its sources. See, e.g. Steven Shapin, ‘Cordelia’s Love: Credibility and the Social Study of Science’, Perspectives on Science 3, no. 3 (1995): 255–275. However, medical practitioners may be more removed from core medical evidence than are many other experts.

27 Definition of Marketing’, American Marketing Association <https://www.ama.org/AboutAMA/Pages/Definition-of-Marketing.aspx> [accessed 22 December 2017].

28 The term ‘marketing era’ and the starting point of my stance here are owed to Kalman Applbaum, The Marketing Era: From Professional Practice to Global Provisioning (New York: Routledge, 2004).

29 The theorist of marketing Peter Drucker, writing in the early 1970s, recognized the new marketing era: ‘Selling and marketing are antithetical rather than synonymous or even complementary. There will always be, one can assume, a need for some selling. But the aim of marketing is to make selling superfluous. The aim of marketing is to know and understand the customer so well that the product or service fits her and sells itself. Ideally, marketing should result in a customer who is ready to buy’. Peter F. Drucker, Management: Tasks, Responsibilities, Practices (New York: Routledge, 1974), 64–65.

30 As many readers will recognize, the term ‘assemblage’ is taken from Gilles Deleuze and Félix Guattari, for example in their A Thousand Plateaus: Capitalism and Schizophrenia (London: Bloomsbury Publishing, 1988). However, my account of assemblage marketing owes more to Actor-Network Theory, perhaps because the construction and stabilization of actor-networks have been more clearly described than have the construction and stabilization of assemblages. For early articulations of Actor-Network Theory, see Bruno Latour, Science in Action: How to Follow Scientists and Engineers through Society (Cambridge, MA: Harvard University Press, 1987); Michel Callon, ‘Some Elements of a Sociology of Translation: Domestication of the Scallops and the Fishermen of St. Brieuc Bay’, in John Law, ed., Power, Action and Belief (London: Routledge & Kegan Paul, 1986): 196–233; John Law, ‘Technology and Heterogeneous Engineering: The Case of Portuguese Expansion’, in Wiebe E. Bijker, T.P. Hughes and Trevor Pinch, eds. The Social Construction of Technological Systems: New Directions in the Sociology and History of Technology (Cambridge, MA: The MIT Press, 1987): 111–134.

31 There has been some fascinating work in Science and Technology Studies on the creation and development of markets. For example, markets require infrastructure to allow communication and exchange, as seen in the carefully constructed material and electronic structures of stock and commodity exchanges: e.g. Devin Kennedy, ‘The Machine in the Market: Computers and the Infrastructure of Price at the New York Stock Exchange’, Social Studies of Science 47 no. 6 (2017): 888–917; Caitlin Zaloom, Out of the Pits: Traders and Technology from Chicago to London (Chicago: University of Chicago Press, 2006). In particular, there is a thriving research programme studying how academic economics contributes to and shapes real markets. This is relevant to Chapter 5 of this book. See, e.g. Donald MacKenzie, Fabian Muniesa and Lucia Siu, eds, Do Economists Make Markets? On the Performativity of Economics (Princeton, NJ: Princeton University Press, 2007); Daniel Breslau, ‘Designing a Market-Like Entity: Economics in the Politics of Market Formation’, Social Studies of Science 43, no. 6 (2013): 829–851. Even demand has to be constructed, as shown in Franck Cochoy, On Curiosity: The Art of Market Seduction (Mattering Press, 2016). Other fields that study markets as institutions make some related points about the contingent structures of markets: See Naazneen H. Barma and Steven K. Vogel, eds, The Political Economy Reader: Markets as Institutions (New York: Routledge, 2008).

32 For example John Abraham, ‘Pharmaceuticalization of Society in Context: Theoretical, Empirical and Health Dimensions’, Sociology 44, no. 4 (2010): 603–622; Simon J. Williams, Paul Martin and Jonathan Gabe, ‘The Pharmaceuticalisation of Society? A Framework for Analysis’, Sociology of Health & Illness 33, no. 5 (2011): 710–725.

33 For a good overview of what is often called ‘disease-mongering’ or ‘selling sickness’, see Ray Moynihan and Alan Cassels, Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All into Patients (Vancouver: Greystone Books, 2005).

34 ExL Events, ‘Disease Awareness Campaigns Forum’ <http://exlevents.com/disease-awareness-campaigns-forum/> [accessed 6 April 2018].

35 David Healy, ‘Shaping the Intimate: Influences on the Experience of Everyday Nerves’, Social Studies of Science 34, no. 2 (2004): 219–245.

36 Lucie Gerber and Jean-Paul Gaudillière, ‘Marketing Masked Depression: Physicians, Pharmaceutical Firms, and the Redefinition of Mood Disorders in the 1960s and 1970s’, Bulletin of the History of Medicine 90, no. 3 (2016): 455–490.

37 For example, Robert Whitaker, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (New York: Random House, 2011).

38 Jeremy A. Greene, Prescribing by Numbers: Drugs and the Definition of Disease (Baltimore: Johns Hopkins University Press, 2007); Ray Moynihan and Alan Cassels, Selling Sickness: How the World’s Biggest Pharmaceutical Companies are Turning Us All into Patients (Vancouver: Greystone Books, 2005). In addition, it is widely recognized that diseases change through time, because of interactions among patients, physicians and illnesses; see, e.g. Robert Aronowitz, Making Sense of Illness: Science, Society, and Disease (Cambridge: Cambridge University Press, 1998); Jacalyn Duffin, Lovers and Livers: Disease Concepts in History (Toronto: University of Toronto Press, 2005); Duffin’s elegant account focuses on two very different diseases, lovesickness and hepatitis C.

39 Jeremy A. Greene, Prescribing by Numbers: Drugs and the Definition of Disease (Baltimore: Johns Hopkins University Press, 2007).

40 Anne Pollock, Medicating Race: Heart Disease and Durable Preoccupations with Difference (Durham, NC: Duke University Press, 2012).

41 This description owes much to the work of anthropologist Joseph Dumit, who approaches these changes as part of a new cultural logic around health. See Joseph Dumit, Drugs for Life: How Pharmaceutical Companies Define Our Health (Durham, NC: Duke University Press, 2012). Similar views have come out of the medical world itself, often focusing on over-diagnosis; see, e.g. H. Gilbert Welch, Lisa M. Schwartz and Steven Woloshin, Over-Diagnosed: Making People Sick in the Pursuit of Health (Boston: Beacon Press, 2011).

42 See, for example, Jon N. Jureidini, Jay D. Amsterdam, and Leemon B. McHenry. ‘The Citalopram CIT-MD-18 Pediatric Depression Trial: Deconstruction of Medical Ghostwriting, Data Mischaracterisation and Academic Malfeasance’, International Journal of Risk & Safety in Medicine 28, no. 1 (2016): 33–43; Adriane J. Fugh-Berman, ‘The Haunting of Medical Journals: How Ghostwriting Sold “HRT”’. PLoS Medicine 7, no. 9 (2010): e1000335; Joseph S. Ross, Kevin P. Hill, David S. Egilman, and Harlan M. Krumholz, ‘Guest Authorship and Ghostwriting in Publications Related to Rofecoxib: A Case Study of Industry Documents from Rofecoxib Litigation’, Journal of the American Medical Association 299, no. 15 (2008): 1800–1812.

43 Promises are central to many aspects of business communication, and in some contexts can help to establish the very things promised, as explored in Mads Borup, Nik Brown, Kornelia Konrad, and Harro Van Lente, ‘The Sociology of Expectations in Science and Technology’, Technology Analysis & Strategic Management 18, no. 3-4 (2006): 285–298.

44 Helen B. Schwartzman, The Meeting: Gatherings in Organizations and Communities (New York: Plenum, 1989).

45 Josh Katz, ‘Drug Deaths in America Are Rising Faster Than Ever’, New York Times, 5 June 2017.

46 Centers for Disease Control and Prevention, ‘Prescription Opioid Overdose Data’, 1 August 2017 <https://www.cdc.gov/drugoverdose/data/overdose.html> [accessed 17 June 2017]. However, official statistics appear to underestimate overdose deaths, because death certificates often don’t identify drugs; see Christopher J. Ruhm, ‘Geographic Variation in Opioid and Heroin Involved Drug Poisoning Mortality Rates’, American Journal of Preventive Medicine 53, no. 6 (December 2017): 745–753.

47 One study estimated that prescription opioid abuse cost the US economy roughly $500 billion in 2015 alone, although that figure mixes incompatible kinds of costs. Council of Economic Advisors, reported in: Lucia Mutikani, ‘Opioid Crisis Cost U.S. Economy $504 Billion in 2015: White House’, Reuters, 21 November 2017 <https://www.reuters.com/article/usa-opioids-cost/opioid-crisis-cost-u-s-economy-504-billion-in-2015-white-house-idUSL1N1NP0J7>.

48 For an excellent historical parallel, complete with fascinating analyses, see Nicolas Rasmussen, On Speed: The Many Lives of Amphetamine (New York: New York University Press, 2008). Rasmussen would argue that many of the structures described in this book were already nascent in the 1920s to 1950s, when amphetamines were developed and promoted.

49 Art Van Zee, ‘The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy’, American Journal of Public Health 99, no. 2 (February 2009): 221–227.

50 John Temple, ‘DEA Secretly OKs Killer Quantities of Oxy and Morphine’, Daily Beast, 21 October 2015 <http://www.thedailybeast.com/dea-secretly-oks-killer-quantities-of-oxy-and-morphine>.

51 Patrick Radden Keefe, ‘The Family that Built an Empire of Pain’, The New Yorker, 30 October 2017.

52 United States, Washington. U.S. General Accounting Office, ‘Prescription Drugs: OxyContin Abuse and Diversion and Efforts to Address the Problem’, GAO-04-110, 22 January 2004 <http://www.gao.gov/htext/d04110.html>. See also Art Van Zee, (2009) ‘The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy’, American Journal of Public Health 99, no. 2 (February 2009): 221–227.

53 United States, Washington. U.S. General Accounting Office, ‘Prescription Drugs: OxyContin Abuse and Diversion and Efforts to Address the Problem’, GAO-04-110, 22 January 2004 <http://www.gao.gov/htext/d04110.html>.

54 ‘About The Joint Commission’, The Joint Commission <https://www.jointcommission.org/about_us/about_the_joint_commission_main.aspx>.

55 United States, Washington. U.S. General Accounting Office, ‘Prescription Drugs: OxyContin Abuse and Diversion and Efforts to Address the Problem’, GAO-04-110, 22 January 2004 <http://www.gao.gov/htext/d04110.html>.

56 Theodore Cicero and Matthew S. Ellis, ‘Roots of Opioid Epidemic Can be Traced Back to Two Key Changes in Pain Management’, The Conversation, 17 March 2016 <https://theconversation.com/roots-of-opioid-epidemic-can-be-traced-back-to-two-key-changes-in-pain-management-50647> [accessed 21 July 2017].

57 David Armstrong, ‘Secret Trove Reveals Bold “Crusade” to make OxyContin a blockbuster’, STAT News, 22 September 2016 <https://www.statnews.com/2016/09/22/abbott-oxycontin-crusade/>.

58 Pamela T.M. Leung, Erin M. Macdonald, Irfan A. Dhalla, and David N. Juurlink, ‘A 1980 Letter on the Risk of Opioid Addiction’, New England Journal of Medicine 376, no. 22 (1 June 2017): 2194–2195.

59 Sanford H. Roth, Roy M. Fleischmann, Francis X. Burch et al., ‘Around-the-Clock, Controlled-Release Oxycodone Therapy for Osteoarthritis-Related Pain: Placebo-Controlled Trial and Long-Term Evaluation’, Archives of Internal Medicine 160, no. 6 (March 2000): 853–860.

60 United States of America v. The Purdue Frederick Company, Attachment 8 to Plea Agreement, Virginia, 12-13 (2007) <http://i.bnet.com/blogs/purdue-agreed-facts.pdf>.

61 Harriet Ryan, Lisa Girion, and Scott Glover, ‘“You Want A Description of Hell?” OxyContin’s 12 Hour Problem’, Los Angeles Times, 5 May 2016.

62 Harriet Ryan, Lisa Girion, and Scott Glover, ‘“You Want A Description of Hell?” OxyContin’s 12 Hour Problem’, Los Angeles Times, 5 May 2016.

63 Marion S. Greene and R. Andrew Chambers, ‘Pseudoaddiction: Fact or Fiction? An Investigation of the Medical Literature’, Current Addiction Reports 2, no. 4 (1 October 2015): 310–317 <http://dx.doi.org/10.1007/s40429-015-0074-7>.

64 Marion S. Greene and R. Andrew Chambers, ‘Pseudoaddiction: Fact or Fiction? An Investigation of the Medical Literature’, Current Addiction Reports 2, no. 4 (1 October 2015): 310–317 <http://dx.doi.org/10.1007/s40429-015-0074-7>.

65 Sheryl Ubelacker, ‘Pain Course Revised Over Concerns About Drug Company Influence’, The Globe and Mail, 26 March 2017 <https://www.theglobeandmail.com/news/national/pain-course-revised-over-concerns-about-drug-company-influence/article1321037/>.

66 John Fauber and Ellen Gabler, ‘Narcotics Use for Chronic Pain Soars Among Seniors’, Milwaukee-Wisconsin Journal Sentinel, 29 May 2012 <http://archive.jsonline.com/watchdog/watchdogreports/narcotics-use-for-chronic-pain-soars-among-seniors-kg56kih-155555495.html/>.

67 Dora H. Lin, Eleanor Lucas, Irene B. Murimi, Andrew Kolodny, Caleb Alexander, ‘Financial Conflicts of Interest and the Centers for Disease Control and Prevention’s 2016 Guideline for Prescribing Opioids for Chronic Pain’, The Journal of the American Medical Association Internal Medicine 177, no. 3 (March 2017): 427–428.

68 Eric Eyre, ‘Drug Firms Poured 780M Painkillers into WV amid Rise of Overdoses’, Charleston Gazette-Mail, 17 December 2016 <http://www.wvgazettemail.com/news-health/20161217/drug-firms-poured-780m-painkillers-into-wv-amid-rise-of-overdoses>. There were also more than 550 million doses of hydrocodone shipped to West Virginia in this period.

69 Scott Higham and Lenny Bernstein, ‘The Drug Industry’s Triumph Over the DEA’, The Washington Post, 15 October 2017.

70 Barry Meier, ‘In Guilty Plea, OxyContin Maker to Pay $600 Million’, The New York Times, 10 May 2007.

71 Philip J. Wininger, ‘Pharmaceutical Overpromotion Liability: The Legal Battle Over Rural Prescription Drug Abuse’, Kentucky Law Journal 93, no. 269 (2004-2005): 269.

72 David Herzberg argues that the US has had a number of pairs of addiction problems – to do with licit and illicit drugs – going along with pairs of responses. See David Herzberg, ‘Entitled to Addiction? Pharmaceuticals, Race, and America’s First Drug War’, Bulletin of the History of Medicine 91, no. 3 (2017): 586–623.

73 United States, Washington. U.S. General Accounting Office, ‘Prescription Drugs: OxyContin Abuse and Diversion and Efforts to Address the Problem’, GAO-04-110, 22 January 2004 <http://www.gao.gov/htext/d04110.html>.

74 Scott Higham and Lenny Bernstein, ‘The Drug Industry’s Triumph Over the DEA’, The Washington Post, 15 October 2017.

75 Don Winslow, ‘El Chapo and the Secret History of the Heroin Crisis’, Esquire, 9 August 2016 <http://www.esquire.com/news-politics/a46918/heroin-mexico-el-chapo-cartels-don-winslow/>.

76 Harriet Ryan, Lisa Girion, and Scott Glover, ‘OxyContin Goes Global – “We’re Only Just Getting Started”’, Los Angeles Times, 18 December 2016.

77 Abby Zimet, ‘OxyContin For Kids: What Could Possibly Go Wrong?’, Common Dreams, 3 July 2012 <https://www.commondreams.org/further/2012/07/03/oxycontin-kids-what-could-possibly-go-wrong>.

78 Thomas Reuters, ‘6 Ex-Pharma Executives Arrested in U.S. in Fentanyl Bribe Case’, CBC News Health, 8 December 2016 <http://www.cbc.ca/news/health/fentanyl-bribery-1.3887631>. For a rich account published well after this chapter was written, see Evan Hughes, ‘The Pain Hustlers’, The New York Times, 2 May 2018.

79 United States Department of Justice Drug Enforcement Administration, New Orleans Division News, ‘Two Mobile Pain Doctors Convicted After Seven-Week Trial’, 2 March 2017 <https://www.dea.gov/divisions/no/2017/no030217.shtml>.

80 John Hempton, ‘Get Your Opiates for Free: Capitalism Meets the Zombie Apocalypse’, Bronte Capital (blog), 3 February 2014 <http://brontecapital.blogspot.ca/2014/02/get-your-opiates-for-free-capitalism.html>.