American Medicine God: Starting by Inheriting a Pharmaceutical Company and Selling Medicine

If a Yale University acceptance letter is a ticket to high society, then a paper published in a top medical journal is a "certificate of truth" personally awarded by God.

In the summer of 1992, this certificate was being mass-produced in Boston.

On the banks of the Charles River in Boston, the red-brick buildings of Harvard Medical School appear solemn and dignified under the blazing sun. This is the Mecca of global medicine, where every brick is imbued with the brilliance of reason and science. Countless Nobel laureates have been born here, and countless drugs that have changed the course of humankind have been developed here.

In Kendall Square, less than two miles from the medical school, the air conditioning is blasting in an unremarkable gray office building.

This is Praxie Medical Education and Communication Company.

The name sounds impressive and academic. But in reality, according to its business registration documents, it is a wholly-owned "independent subsidiary" of Wotech Pharmaceuticals. And among industry insiders, it has a more straightforward name—"the ghost factory."

The conference room was filled with smoke. Slides were constantly changing on the projection screen, and the light and shadow danced on everyone's faces.

"We don't need 'probably,' we need 'absolutely.'"

The speaker was Saul Goodman. He unbuttoned his suit jacket, loosened his tie, and pointed to a set of data bar charts on the projection screen.

"If the conclusion states 'may have a low risk of addiction,' doctors will be hesitant to prescribe the drug. We need to reassure them, a reassurance coated with scientific sugar."

Sitting opposite him were three medical doctors wearing plaid shirts.

They are the "senior medical writers" here, commonly known as "ghostwriters." Most of them graduated from Ivy League schools and have solid academic backgrounds, but because they cannot get research funding or are tired of the poverty in the laboratory, they eventually choose to sell their brains and become hired writers for pharmaceutical companies.

“But, Mr. Goodman,” one of the older gunmen pushed up his glasses and pointed to a thick stack of raw data reports beside him, “in the expanded group of the Phase III clinical trial, there were indeed 12 patients who showed obvious symptoms of drug dependence. These included increased tolerance, withdrawal symptoms, and seeking drugs through non-medical channels.”

"If we take all this data into account, according to the intention-to-treat (ITT) principle, the addiction rate is 4.5%."

4.5%. If this figure were released, OxyContin would be classified as a Class II controlled drug, and its sales would be halved.

"Then why do these 12 people have dependency symptoms?" Saul asked rhetorically, his tone carrying the interrogative pressure typical of a lawyer.

"Because...the investigation showed that they did not strictly follow the doctor's instructions to take the medication, or they had a history of alcoholism and drug abuse."

"Then let's eliminate them!"

"Scientific research requires controlled variables, right? These people belong to the 'poor compliance' sample, or the 'distractors.' Their behavior contaminates the purity of the data."

He picked up a red marker and drew a sharp cross on the whiteboard.

"Just kick them out of the denominator. That's data cleaning. It's statistically legal, right?"

The ghostwriters exchanged bewildered glances. In statistics, this is called "cherry-picking," a serious academic misconduct. But when faced with the client's check, academic ethics are negotiable. (The Qin Hui Method of Paper Writing)

"If...we use a per-protocol set for analysis and exclude patients with a history of addiction..."

The gunman quickly pressed a few keys on the scientific calculator, and a new number appeared on the screen.

He hesitated before saying, "The addiction rate is 0.8%."

"Less than 1%." Saul snapped his fingers, a satisfied smile spreading across his face. "This is the headline we wanted: 'Iatrogenic addiction to long-term opioid therapy under strict medical supervision is extremely rare.'"

"Remember, 'Rare.' That's the key word."

He picked up the printed draft of the paper on the table and felt the thickness of the paper.

The article is beautifully written.

It cites numerous biochemical mechanism diagrams to explain in detail how OxyContin's "slow-release mechanism" avoids peaks and troughs in blood drug concentration, thus theoretically eliminating the basis for addiction.

The wording is meticulous, the logic rigorous, and it exudes an academic austerity and authority. Every footnote points to a genuine reference, and every p-value is less than 0.05.

The only downside is that it's a lie.

It's like a meticulously made-up corpse, looking lifelike, but rotting inside.

"Alright, the paper's done." Saul slammed the paper back onto the table. "Now, we need a name. A name that can turn this lie into the truth."

...

Harvard Medical School, main teaching building.

Dr. Russell Porter is no longer the professor who desperately sought funding at Massachusetts General Hospital.

As the originator of the "fifth vital sign" theory, he is the godfather of the global pain medicine community. His name is printed on every textbook on pain management, and his schedule is filled with speaking invitations from all over the world.

His office was spacious and bright, with walls covered with various certificates and awards. Huge oak bookshelves were filled with professional books, symbols of knowledge and totems of power.

At this moment, he was sitting in a genuine leather office chair, toying with an exquisite crystal trophy in his hand—the Lifetime Achievement Award just awarded by the American Association for the Study of Pain.

When Saul entered, led by his secretary, Potter did not rise, but merely nodded slightly. This was the tacit understanding between old acquaintances, and also the restraint of a superior towards their "butler."

"How's Victor?" Porter put down the trophy, his tone as if he were greeting a distant relative. "I heard he's been making quite a splash in Washington. He's got the FDA under control, and now he's acquired Sakura Pharmaceuticals. His appetite is growing bigger and bigger."

"Mr. Victor is well." Saul pulled out a chair and sat down, pushing a thick document in a black cover in front of Potter. "But he's a little worried about you."

"Worried about me?" Porter raised an eyebrow, a mocking smile playing on his lips. "What do I have to worry about? My new book just hit the New York Times bestseller list, my clinic appointments are booked until next year, and even the White House health advisor is consulting me on pain management policies."

"But someone is trying to topple your statue, Doctor."

"Because OxyContin holds 90% of the opioid market share, other pharmaceutical companies are getting restless. Johnson & Johnson, Purdue... because they have no comparable competitors, they've started resorting to dirty tricks."

Saul pointed to the document, his expression turning serious.

"In recent months, some discordant voices have emerged in academia. A pharmacology professor at Yale and an addiction medicine group at Stanford have begun publishing papers questioning the scientific validity of the 'fifth vital sign.' They claim that long-term opioid use can lead to receptor downregulation, triggering a serious addiction crisis."

"They even implied in The Lancet's letter-to-the-reader section that your theory is 'pharmaceutical-funded pseudoscience'."