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People don’t read about the well documented case of Purdue Pharma and OxyContin and decide they will never take any painkillers again. Bizarrely, they are more likely to turn their ire towards vaccines, says Peter Kelly…

Two regular patients were sitting down having a chat while waiting for their prescriptions. I ask them both if they would like to get the flu vaccine. One of them said no and one said yes.

The patient who said no was stunned to hear the other patient say yes and his jaw dropped as he turned to him and said: “You don’t get that, do you?” The other patient replied: “Always.”

Then, the first patient proceeded to tell him that he once heard of someone who “got it” and then died. And then he asked him if he trusted drug companies.

This appeared to be a trickier question and the second patient thought long and hard before giving his answer. He didn’t trust them but he was still getting the vaccine. Both gentlemen were waiting for their prescriptions which consist of medication produced by drug companies.

Why do people not trust drug companies? Drug discovery and production is big business. The five biggest drug companies in the World are Eli Lilly and Company, Johnson and Johnson, AbbVie Inc., Roche Holding AG and AstraZeneca plc.

Unscrupulous characters making extremely questionable decisions

Respectively, these companies are worth approximately $740 billion, $458 billion, $403 billion, $273 billion and $259 billion and they are more powerful than most countries.

These companies are structured in such a way that the number one priority of its executive employees is to boost shareholder value. This pressure can lead some unscrupulous characters to make extremely questionable decisions. Here are some examples of instances when drug companies have been caught being incredibly untrustworthy.

In the 1980s, Bayer sold blood-clotting products contaminated with HIV to haemophiliac patients even after discovering the contamination. This led to thousands of infections and deaths which in turn led to multiple lawsuits and hundreds of millions in settlements. However, there were no criminal convictions for executives.

Johnson and Johnson illegally promoted Risperdal, an antipsychotic for use in children and elderly dementia patients (unapproved populations). Children developed side-effects such as gynecomastia (breast growth in boys) and paid over $2 billion in fines and settlements. No criminal charges were brought against specific executives.

Merck marketed Vioxx, a painkiller, despite evidence it increased the risk of heart attack and stoke. Internal documents later showed the company knew about these risks but continued selling it.

It is estimated there were tens of thousands of deaths before it was pulled from the market in 2004. Merck paid around $4.85 billion to settle lawsuits. No executives were criminally charged.

Probably the most famous and devastating case of a drug company acting unlawfully is Purdue Pharma. They aggressively marketed the painkiller OxyContin as non-addictive despite knowing it had a high risk of dependency.

This created an opioid epidemic in the US that led to the deaths of hundreds of thousands of people due to overdose. Purdue pleaded guilty in 2020 to federal criminal charges and agreed to an $8.3 billion settlement. The owners later agreed to pay several billion more in civil settlements. However, once again, nobody went to jail.

These stories justifiably cause some patients to distrust drug companies. People think their sole motivation is profit and they will do and say anything to turn a profit. They also lose faith in a system that never fully holds anyone accountable. Sure, some large funds are thrown out but no individuals ever go to jail.

Overall, most people who work for the big drug companies are honest, decent people and most of the drugs they produce are more useful than dangerous. But, as with all industries and systems, it is imperfect. And when bad characters find themselves in ethically questionable positions and they pursue profit over patient safety, they give the whole industry a bad name.

It puts us pharmacists in a difficult position to try and defend the promotion of medication use. And at some level, you just have to accept there will always be a cohort of patients who will not trust drug companies and will make ad hoc decisions based on that lack of trust.

I will never fully understand why vaccines mainly seem to be the class of medication that gets rejected because of this lack of trust.

People don’t read about the disaster of Purdue Pharma and OxyContin, which has been well documented on Netflix in various drama series and documentaries, and decide that’s it, they will never take any painkillers again as drug companies cannot be trusted. Bizarrely, people are more likely to turn their ire towards vaccines.

In conversations with patients, I usually say that while drug companies have been caught out doing horrific things and there is always some degree of risk trusting anyone, the flu vaccine is worth getting.

Peter Kelly is a pharmacist based in London and a stand-up comedian.