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

Summary

Behind the Bastards: Part One – The Vioxx Scandal: How Big Pharma Killed More Americans Than Vietnam

Released: December 10, 2024 by Cool Zone Media and iHeartPodcasts

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Introduction

In the premiere episode of "Behind the Bastards," hosts Robert Evans and Dr. Kaveh Hoda dive deep into one of the most egregious scandals in pharmaceutical history: the Vioxx debacle. Through an engaging and meticulously detailed narrative, they unravel how Big Pharma's relentless pursuit of profit led to widespread harm, surpassing even the tragic toll of the Vietnam War.

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The Crucial Role of Painkillers and NSAIDs

The episode opens with a comprehensive overview of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), highlighting their importance in managing pain and inflammation. Robert and Dr. Hoda trace the origins of common painkillers like acetaminophen and aspirin, emphasizing their vast usage and inherent risks. Dr. Hoda underscores the dangers associated with these medications, noting, “Acetaminophen is one of the biggest causes of liver failure” ([14:06]).

Key Points:

• Acetaminophen: Widely used but a leading cause of liver failure when misused.
• Aspirin: Effective in reducing heart disease risk but can cause severe stomach issues.

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The Quest for Super Aspirins: Understanding COX Enzymes

The narrative then shifts to the scientific breakthrough in understanding prostaglandins and cyclooxygenase (COX) enzymes. The discovery of COX2 marked a pivotal moment in pharmaceutical research, presenting an opportunity to develop painkillers that could mitigate the severe side effects of traditional NSAIDs.

Dr. Hoda explains, “Prostaglandins have important functions for human well-being, but they make nerve endings more sensitive to pain” ([16:11]). This insight fueled the pharmaceutical industry's race to create the so-called "super aspirin."

Key Points:

• Prostaglandins: Chemicals that mediate inflammation and pain.
• COX Enzymes: COX1 protects the stomach lining, while COX2 targets pain and inflammation.

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Merck's Strategic Shift and the Birth of Vioxx

Facing the impending expiration of patents on blockbuster drugs like Zocor and Pravachol, Merck was under immense pressure to innovate. Enter Raymond Gilmartin, Merck’s new CEO with a strong business background but limited medical expertise. Gilmartin spearheaded the development of a COX2 inhibitor, aiming to create a painkiller devoid of the gastrointestinal side effects that plagued existing NSAIDs.

Robert emphasizes the high stakes, stating, “Vioxx could have been the oil and gas industry-level fortune Merck was aiming for” ([19:44]).

Key Points:

• Patent Cliff: Loss of exclusivity on major drugs threatened Merck’s profitability.
• COX2 Inhibitors: Targeted specifically at reducing pain without harming the stomach lining.

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Internal Warnings and Flawed Clinical Trials

Despite mounting internal concerns, Merck proceeded aggressively with Vioxx's development. Dr. Garrett Fitzgerald, a consultant and professor of cardiovascular medicine, voiced early fears that Vioxx might damage blood vessels, increasing the risk of heart attacks. Unfortunately, Merck overlooked these warnings, conducting flawed clinical trials that compared Vioxx to Naproxen instead of a placebo. This manipulation skewed the results, making Vioxx appear safer than it actually was.

Robert criticizes the methodology, remarking, “They compared it to a drug that reduced heart attacks, making Vioxx look riskier by comparison” ([41:27]).

Key Points:

• Dr. Fitzgerald's Warning: Indicated potential cardiovascular risks.
• Manipulated Trials: Comparing Vioxx to Naproxen concealed its true dangers.

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Aggressive Marketing and Celebrity Endorsements

To catapult Vioxx into the market, Merck launched an unprecedented marketing campaign featuring figure skating superstar Dorothy Hamill. Her heartfelt endorsements on platforms like Larry King Live portrayed Vioxx as a miraculous solution for chronic pain, resonating deeply with the public.

Hamill shared her transformative experience: “Thanks to Vioxx, I just felt old. I felt depressed, tired all the time. It was like being given a new life” ([58:43]).

Dr. Hoda points out the effectiveness of this strategy, noting, “Dorothy Hamill's innocence made her the perfect spokesperson” ([66:38]).

Key Points:

• Dorothy Hamill: Leveraged her fame to build trust and drive Vioxx sales.
• Emotional Appeal: Personalized stories made the drug seem indispensable.

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FDA Oversight and Regulatory Failures

Despite internal memos and emerging evidence of Vioxx's risks, the FDA approved the drug in 1999. Dr. Vilalba, an FDA reviewer, had flagged potential cardiovascular issues, but Merck downplayed these warnings. Additionally, the FDA's limited resources and potential conflicts of interest may have contributed to the inadequate scrutiny of Vioxx's safety.

Robert asserts, “The FDA is understaffed and often influenced by future job prospects in the private sector” ([64:35]).

Key Points:

• Insufficient Regulation: Limited FDA oversight allowed Vioxx to enter the market despite red flags.
• Conflict of Interest: Potential biases within the FDA hampered effective monitoring.

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The Aftermath and Path Forward

Vioxx quickly became a bestseller, generating billions in profits for Merck. However, the lack of efficacy compared to older painkillers and the hidden cardiovascular risks meant that millions of Americans were unknowingly exposed to life-threatening side effects. This mismanagement not only jeopardized countless lives but also eroded public trust in pharmaceutical companies and regulatory bodies.

Robert concludes, “Vioxx was Merck's savior, but it was also the death knell for thousands of lives” ([46:56]).

Key Points:

• Massive Profits vs. Public Health: Vioxx's financial success overshadowed its devastating impact.
• Erosion of Trust: The scandal deepened skepticism towards Big Pharma and regulatory agencies.

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Conclusion and Tease for Part Two

As the episode wraps up, Robert and Dr. Hoda hint at the extensive fallout from the Vioxx scandal, including legal battles, Merck's eventual response, and the broader implications for the pharmaceutical industry. They promise a deeper exploration of these consequences in the forthcoming second part of the series.

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Notable Quotes:

• Dr. Kaveh Hoda [01:57]: “Ginger's my magic thing. My little magic creation in my mind that works more than it really does.”
• Robert Evans [16:49]: “NSIDS, the cool kids call them.”
• Robert Evans [41:27]: “This misleading presentation of the evidence made it look like Naproxen was protecting patients from heart attacks and that Vioxx only looked risky by comparison.”
• Dorothy Hamill [58:43]: “Thanks to Vioxx, I just felt old. I felt depressed, tired all the time. It was like being given a new life.”

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Final Thoughts

"Behind the Bastards" presents a compelling and meticulously researched account of the Vioxx scandal, shedding light on the dark underbelly of pharmaceutical practices. Through eloquent storytelling and critical analysis, Robert Evans and Dr. Kaveh Hoda expose how corporate greed and regulatory failures can lead to catastrophic consequences for public health.

Listeners are left with a profound understanding of the complexities surrounding drug approvals and the paramount importance of ethical standards in medicine. Stay tuned for Part Two, where the full extent of Vioxx's impact and Merck's eventual reckoning will be unveiled.

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For those who haven't listened, this summary provides a comprehensive overview of the episode's critical discussions and insights. To explore the full narrative and detailed analyses, tune into "Behind the Bastards" on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

Transcript

[Robert Evans]

Call Zone Media. Welcome back to behind the Bastards, a podcast where Sophie is not in the room right now. So Dr. Kavehota and I are the foxes watching the hen house. That is also. We're also the hens.

[Dr. Kaveh Hoda]

I am the producer. I am the captain now.

[Robert Evans]

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

[Dr. Kaveh Hoda]

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

[Robert Evans]

Were probably too young for that cartoon. I was the right age for it, yes. Dr. Hoda, my healthcare expert. Legally my doctor.

[Dr. Kaveh Hoda]

Oh, God.

[Robert Evans]

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

[Dr. Kaveh Hoda]

About health? Yeah, Yeah, I got a lot. That's good. As a doctor, I feel like I should. 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 effect is so strong for me that, you know, you gotta adopt the placebo. Yeah. Ginger's my magic thing. My little magic creation in my mind that works more than it really does.

[Robert Evans]

Yeah. I'm not big on supplements. I do take. My doctor advised me to take for blood pressure, calcium and potassium. So I do some of that, which I've noticed I don't get cramps as much as I used to, so I guess I'll call that a win. I do love looking into the different potential side effects. I love going onto biohacking subreddits and seeing people talk about the side effects they're having with various weird supplements they're taking to never die. 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 brain. Right. Like, 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 that, like, a huge dose of psilocybin mushrooms Might have like mind altering effects. And it's like, man, everyone, 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.

[Dr. Kaveh Hoda]

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.

[Robert Evans]

Yeah.

[Dr. Kaveh Hoda]

And you know, it's medication we're talking about today. Lots of risks. That's true. They all do. Some more than others I think we're probably going to discuss here. But yeah, I don't know if lion's mane, which I'm not familiar with really.

[Robert Evans]

So I shouldn't say it's a mushroom. Some mushrooms have neurological impacts and stuff on people. But my particular favorite medical theory, Dr. Dr. Hoda, is that obviously cigarettes are bad. They're terrible for almost everyone, nearly always horrible. But I think there's 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 sometimes in little corners of the world or whatever, I've met little old ladies in Japan who 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. There's some minority of the population that cigarettes make invulnerable.

[Dr. Kaveh Hoda]

I feel like this is that meme of the plane that returns from war with the bullet holes in it. You're never gonna hear me say cigarettes are okay. They know what they've done.

[Robert Evans]

They know I know 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 90 year old woman who smokes four packs a day and she's doing fine. So clearly science doesn't understand everything about the maligned. Cigarette. No, don't smoke cigarettes.

[Dr. Kaveh Hoda]

Okay, fair enough.

[Robert 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 got to be doing something, right? Like it's got to do something.

[Dr. Kaveh Hoda]

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

[Robert 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 going to 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 financial interest in finding that this thing worked. Today we're talking about Viox, 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. That's the story we're getting into today. What do you know about Vioxx?

[Dr. Kaveh Hoda]

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 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 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 I think doctors were always skeptical of pharmaceutical companies. 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 and Vioxx.

[Robert Evans]

I think it's also important, like Vioxx, the scandal hits kind of right as before. We're really starting to realize what has gone down with the 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 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? In part because, like, as soon as I turned 18, 19, I was hanging out with a lot of hippies, but in part because there were a lot of 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 and well regarded in a lot of cases, in part because the generation that was kind of running the world in the 80s and 90s had largely lived through, like. And were still close to. Oh, polio is this nightmare that just sweeps through and devastates like a generation. You have these flus and then suddenly you have half as many friends after the flu passes and that stops being a thing. And they're really the first generation, kind of the later boomer that didn't have to deal with that, but were close enough to it to, like, really appreciate. Like, wow. Medical science did us a solid.

[Dr. Kaveh Hoda]

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

[Robert Evans]

And, I mean, part of the problem is that shit like the Vioxx scandal and like, the Purdue pharmaceutical scandals are closer to us than, for example, fucking 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 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. Let me take a sip of my Kratom tea. Mm. And since all the health cops out there don't like people pill popping, like Dr. House, even though he made it look incredibly sexy. Did he? Did he fucking hate that show? Oh, man. You're not a House fan, huh?

[Dr. Kaveh Hoda]

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

[Robert Evans]

Scrubs? Really? Yeah. I mean, I did rewatch. I like to imagine that the movie Platoon is like a. Like the whatchamacallit.

[Dr. Kaveh Hoda]

The prequel.

[Robert Evans]

The prequel to John C McGinley's in it. Because John C McGinley said it. Yeah. That's why Dr. Cox is the way he is. He had to spend that night hiding under his friends bodies in a trench line.

[Dr. Kaveh Hoda]

Everyone ran away.

[Robert Evans]

He had to watch Willem Dafoe die.

[Dr. Kaveh Hoda]

Yeah.

[Robert 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, so because of, you know, health cops don't like people becoming horrible pill addicts and destroying their lives. There's 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. Acetaminophen 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 then it's really worth getting into. Because of how it was discovered, acetaminophen could never be patented. Right. Which means pharmaceutical companies are not super attracted to acetaminophen. Right. Because like, well, 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 acetaminophen in the US initially framed it as a painkiller for children. And the way the ad campaign that they use 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 with pills of Tylenol. And that was their marketing ploy to get little parents to buy Tylenol for their.

[Dr. Kaveh Hoda]

Kids always love fire trucks.

[Robert Evans]

Kids love Tylenol too.

[Dr. Kaveh Hoda]

They love their Tylenol, they love their liver damage and they love their fire trucks.

[Robert Evans]

That's the thing about this is why I'm going to try to make the chief Christmas toy of this season, the little doctor House Pill Popper set. Where cause kids, you can take as much Tylenol as you want, right.

[Dr. Kaveh Hoda]

It'll be like a big cane, just a big cane container at the top dispenser. Right. And that's your little house toy for kids.

[Robert Evans]

It's your little house toy for kids. Yeah. 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 child, which is 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, we're so.

[Dr. Kaveh Hoda]

Jaded now that's a problem. We're jaded.

[Robert Evans]

We're jaded. And 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. They literally sold it as a cough medicine for children. So the firetruck plan worked well. 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 Johnson, which for whatever reason is a great name. I don't know why. Doesn't make much sense to me.

[Dr. Kaveh Hoda]

Easy, remember?

[Robert 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 salicylic 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. 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 non addictive and helps with a lot of things. But there's some hard limits based on what this does to people's stomachs and livers.

[Dr. Kaveh Hoda]

I mean, acetaminophen, that's worldwide. One of the biggest causes of liver failure is from people taking too much acetaminophen 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 somebody who's swallowed too much advil or something like a leve or something.

[Robert Evans]

Yeah. And I think that probably 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're all focused at least on the ulcers. But yeah, 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 codeine is the nicest thing you've ever encountered, your life is good.

[Dr. Kaveh Hoda]

You've had a hard life.

[Robert Evans]

Shit, you have had a bad life. 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 call these hypothetical medications super aspirins because research pharmacologists aren't great at naming things. Terrible, terrible, terrible, 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 doctors don't precisely know why it does what it does. We have some idea, but a lot of this is still being fulfilled.

[Dr. Kaveh Hoda]

More than you want to know. Yeah, there's a lot of things we do in medicine that we just. They seem to work.

[Robert Evans]

It doesn't. It definitely helps. We're not sure why, but in this case, the research bore fruit, as authors Tom Nessie describes in his excellent book Poison. 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 can potentially block an artery. Prostaglandins actually make nerve endings more sensitive to pain. NSAIDS. NSAIDS.

[Dr. Kaveh Hoda]

NSAIDS.

[Robert Evans]

NSIDS, the cool kids call them. 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 cyclooxygenase, or cox, was produced as part of the mobilization of prostaglandin and was the enzyme that actually Controlled pain and inflammation.

[Dr. Kaveh Hoda]

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

[Robert Evans]

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

[Dr. Kaveh Hoda]

Yeah, yeah, in his honor. 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.

[Robert Evans]

We try to be complete. Also, Dr. Cox is in born on the 4th of July, which you can consider a stealth sequel to Platoon if you assume that Willem Dafoe actually survived his injuries in Platoon.

[Dr. Kaveh Hoda]

Was he in Wilmington, 8th of July?

[Robert Evans]

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. So these researchers began to theorize that cocks 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 the 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 doesn't actually find it, but he's confident enough in its existence for reasons that I'm sure make sense to biochemists, that he gives it an A. Cox 2 research goes on. And in July of 1992, several teams of researchers in Montreal announced that they have isolated two enzymes, COX2, and one of which, COX2 seems to be the causal agent behind the side effects NSAIDs provoke in some patients, right? So 1992, they found finally this thing they've been looking for for like 20 years, right? This is the reason they believe why your aspirin or whatever can cause stomach ulcers. So the researchers mused 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. 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, 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?

[Dr. Kaveh Hoda]

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

[Robert Evans]

Yes. This is like an unfathomable fortune. We're talking like an oil and gas industry level fortune is on the table here. And so a fucking race begins, right? And the two major companies that are going to wind up really throwing their hats into the table 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 missions 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 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, hey, maybe there's a company that actually believes what it's. They gave up money, you know, a lot of it. So that sounds pretty great. But coming into the 90s, Merck is also staring down the barrel of a. 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 Prayechol, 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 researching a new medicine. Right? If you've only got a decade or so before your two big profit engines are going to take a long time from research to get to market.

[Dr. Kaveh Hoda]

Yeah, you got to start cooking, you.

[Robert Evans]

Got to start moving. In addition to that, five of their best selling medications, including Pepcid, were set to lose patent protection even sooner in 99. They are looking at a looming, very serious problem for their profitability.

[Dr. Kaveh Hoda]

This is such a recurring theme with pharmaceutical companies. I just did an episode about a medication called Zygris which was the Tigris. 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. It 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.

[Robert Evans]

Yeah, yeah, yeah. And that's like, that is the story here. That'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 there's so many little things that are fucked up about even the things that seem like they make sense that also lead to fucked up outcomes because of how much money is at stake in these businesses and how expensive it is to be a pharmaceutical company. Right. It's not cheap. And most of the medications that they. 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.

[Dr. Kaveh Hoda]

Right.

[Robert Evans]

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've got shareholders to please.

[Dr. Kaveh Hoda]

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

[Robert Evans]

More, I'm assuming really happening in the.

[Dr. Kaveh Hoda]

90S, I'm assuming that's the problem here.

[Robert Evans]

Yep, that's a big part of it. Yes. So Merck is coming into the 90s. Not quite a five alarm fire yet, but definitely 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? Cabe?

[Dr. Kaveh Hoda]

The people who deserve to. The people are the people who sponsor this podcast. They're the ones that deserve the most of the money.

[Robert 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. Hand your children over to our sponsors. They'll take care of them. They'll raise them as their own.

[Dr. Kaveh Hoda]

Better than we would.

[Robert Evans]

Better than you would. Yeah, exactly. Just trust them. This podcast is sponsored by BetterHelp. There's some dark stuff going on in the world right now, but it's also the holiday season. This is my favorite time of the year. I love going out to Christmas markets. I love going on cold hikes. And when the weather gets crummy, I like staying inside and watching movies. But when you're cooped up inside, sometimes in these long, dark winters, it can be easy for some of the stuff in our heads that's dark and less pleasant to bubble up and trouble us. Therapy is a great way to bring yourself some comfort that never goes away. It can help you work through some of those problematic things in your head. It can help you learn positive coping skills and how to set boundaries. So if you're thinking of starting therapy, you should consider giving BetterHelp a try. It's entirely online. It's designed to be convenient, flexible, and suited to your schedule. Just fill out a brief questionnaire to get matched with a licensed therapist, and you can switch therapists anytime for no additional charge. Find comfort this December with BetterHelp. Visit betterhelp.com behind today to get 10% off your first month. That's BetterHelp. H E L P.com behind.

[C]

All right, we're all set for the party. I've trimmed the tree, hung the mistletoe, and paired all those weird shaped knives and forks with the appropriate cheeses. And I plugged in the Partisan.

[Robert Evans]

Partisan.

[C]

It's a home cocktail maker that makes over 60 premium cocktails, plus a whole lot of seasonal favorites too. I just got it for 50 off, so how about a Cosmopolitan or a mistletoe margarita?

[Robert Evans]

I'm thirsty.

[C]

Watch. I just pop in a capsule, choose my strength, and wow.

[Robert Evans]

It's beginning to feel more seasonal in here already.

[C]

If your holiday party doesn't have a bartender, then you become the bartender. Unless you've got a Bartesian, because Bartesian crafts every cocktail perfectly in as little as 30 seconds. And I just got it for $50 off.

[Robert Evans]

Tis the season to be jolly or.

[Dr. Kaveh Hoda]

Add some holiday flavor to every celebration with the sleek, sophisticated home cocktail maker Bartisian.

[Robert Evans]

Pick up your phone and shake it.

[Dr. Kaveh Hoda]

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[Robert Evans]

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[C]

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[Robert Evans]

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[C]

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[Dr. Kaveh Hoda]

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[C]

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[Dr. Kaveh Hoda]

In the quiet town of Avella, Pennsylvania, Jared and Christy Akron seem to have it all. A whirlwind romance, a new home, and twins. On the what no one knew was that Christy was hiding a secret so shocking it would tear their world apart.

[Robert Evans]

911 response.

[Dr. Kaveh Hoda]

What's your emergency?

[Robert Evans]

My babies. Please. My babies.

[Dr. Kaveh Hoda]

One woman, two lives, and the truth more terrifying than anyone could imagine. They had her as one of the suspects, but they could never prove it.

[Robert Evans]

You're going to go to jail if.

[Dr. Kaveh Hoda]

You don't come with us right now.

[C]

Throughout this whole thing, I kept telling myself, nobody's that crazy.

[Dr. Kaveh Hoda]

Uncover the chilling mystery that will leave you questioning everything. A story of the lengths we go to protect our darkest secrets. She went batshit crazy. Shot and killed all her farm animals, slaughtered them in front of the kids, Tried to burn their house down. Audio presents the unborn on the iHeartRadio app, Apple Podcasts or wherever you get your podcasts.

[C]

We want to speak out, we want to raise awareness, and we want is to stop.

[Dr. Kaveh Hoda]

Wow. Very powerful.

[C]

I'm Ellie Flynn and I'm an investigative journalist. When a group of models from the UK wanted my help, I went on a journey deep into the heart of the adult entertainment industry. I really wanted to be a Playboy model. Lingerie topless. I said, yes, please. Because at the center of this murky world is an alleged predator. You know who he is because of his pattern of behavior. He's just spinning the web for you to get trapped in it.

[Dr. Kaveh Hoda]

He's everywhere and has been everywhere.

[C]

It's so much worse and so much more widespread than I had anticipated. Together we're going to expose him and the rotten industry he works in. It's not just me. We're an army in comparison to him. Listen to the Bunny trap on the I Heart radio app, Apple podcasts, or wherever you get your podcasts.

[Robert 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 that?

[Dr. Kaveh Hoda]

Much better.

[Robert Evans]

They've never yelled at me. Never yelled at me, never even spanked me. And I deserved it sometimes. So you paid money for that sort of thing? I have. No. We don't even be saying shit like that. The subreddit's gonna get real uncomfortable. Very f. Okay, so super aspirin seems like it could be the solution to Merck's problems. In 1994, a new CEO takes over at Merck. And 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 Gilmartin. Now, the previous CEO, Raymond, is an MBA from Harvard. Right. Which means he doesn't know anything about anything but making money in the most sketchy ways possible. Whereas the previous CEO, CEO of Merck had been Dr. Roy Vagelos, an actual medical scientist with a research background.

[Dr. Kaveh Hoda]

Very famous.

[Robert Evans]

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

[Dr. Kaveh Hoda]

Yeah. The Vagelos Award is this award that's still given out to people who are doing humanitarian work for, like, in the pharmaceutical world. So this is a major shift, a major shift away from somebody who was, I think, ostensibly a very good person, from all accounts a very good person, good researcher, to something very different.

[Robert Evans]

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

[Dr. Kaveh Hoda]

Rotation in the hospital.

[Robert Evans]

I keep thinking about, like, fucking the polio vaccine guy who he was like. I think his direct quote when asked if he was going to patent it was like, would you patent the sun? Yeah. Sulk. Yeah. Real G. Real chad. So Raymond's career up to that point this is the business guy new CEO of Merck had included eight years as a consultant for Arthur D. Little, which lists as one of its great achievements. 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, I'm 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 COX2 inhibitor pain medication to market. The name they picked for the wonder drug that did not yet exist, but that they were going to hang the company's future on 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 insaid that would eventually be called Celebrex. And while Celebrex 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 aspirins market. And there's probably a lot to be said about Celebrex. I am not competent to say it. I will 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.

[Dr. Kaveh Hoda]

Yeah, it's in the same family and it does have. It 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 rare or not as often as it was, for sure.

[Robert 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.

[Dr. Kaveh Hoda]

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

[Robert Evans]

Yeah, but what you need to know is that Pfizer is putting their money into Celebrex after they acquire Merle. And Vioxx is going to be the attempt made by Merck to do the same thing. So throughout the mid-1990s, Kavat 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-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, but cleverly began its own campaign to portray Vioxx as the more dangerous of the compounds.

[Dr. Kaveh Hoda]

Hmm, that's smart.

[Robert 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 out more studies. And Merck is just kind of like, but what if we didn't? It's like when you've been spending like crazy all month and you know, you probably, like, you might be running down to the limit, but you're just going to the grocery store hoping that 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, that is heart attack, unstable angina, rapid fall in hemoglobin and hematocrip. Dangerous blood problems in some subjects. So that's bad. Those are all really bad results.

[Dr. Kaveh Hoda]

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

[Robert Evans]

Not good, not good, not good, 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. 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 specially pain medicine than they ought to.

[Dr. Kaveh Hoda]

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.

[Robert 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 test 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. 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 disinterested 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. To increase the likelihood of FDA approval for its anti inflammatory and arthritis drug Vioxx, Merck used flawed methodology, bias 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 Vioxx 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% and downplayed the results that Vioxx increased the risk of heart attack by 400%. This misleading presentation of the evidence made it look like Naproxen was protecting patients from heart attacks and that Vioxx 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 attack, 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 dangerous. Like, that's so fucking shady.

[Dr. Kaveh Hoda]

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 medication specifically for this and comparing it, you know, say, hey, look, at least we're better than the other other medications to some degree. From your way back vantage point, it all makes sense. It's when you start to 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. This is why it's a difference between marketing and. Between scientists running the program.

[Robert 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 academ to continue 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. 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. That's great stuff.

[Dr. Kaveh Hoda]

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

[Robert Evans]

Yes, yes. Especially if you're not talking about a huge. You know. Yeah.

[Dr. Kaveh Hoda]

I wonder, did it say anything about how many people were in that study?

[Robert Evans]

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

[Dr. Kaveh Hoda]

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

[Robert 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. Find an outside doctor who wants some cash. And a lot of times 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 old Papa Merck.

[Dr. Kaveh Hoda]

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 New England Journal of Medicine or Valance or whatever.

[Robert Evans]

And you also have to remember people think, a lot of people think this is the next big miracle drug. So, yeah, 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, the U. Of Penn really tried to stop Vioxx from being a thing, published a study that showed 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 adults. In 1999, a menstrual pain medication and an anti inflammatory for people with osteoarthritis. Despite approving the drug, FDA reviewer Dr. Vilalba 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. Celebrex also goes to market. It drives massive profits for Pfizer. 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 Celerex became available in 1990, 8 and 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. 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 that seems to be unclear now. Analysts say that the success of Vioxx was critical to Merck. The patents on those popular Merck drugs expire, started expiring in 2000 and 2001, which opened them up to generic competition. And Vioxx comes through and is, I mean, almost immediately, 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. He puts it down as the company might have gone under, at least probably been acquired if it hadn't have been for Vioxx.

[Dr. Kaveh Hoda]

I mean, I remember at the time it was huge. I'd never seen a campaign like it. Not that I remember. I think it was one of the first times I remember really having like being conscious of like, how much of medicine was being marketed, you know, and, you know, I think it's one of these medicines where it's like, you know, maybe 5 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 would just increase increasing their risk of heart attack or stroke. 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 ever been spent on direct marketing.

[Robert Evans]

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

[Dr. Kaveh Hoda]

Oh, I knew it.

[Robert Evans]

Yes. She's the great monster in this. In all of our episodes, every episode we've ever done, Dorothy Hamill been building up to this.

[Dr. Kaveh Hoda]

She's the thanos of the behind the Bastards world.

[Robert Evans]

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

[Dr. Kaveh Hoda]

Evil haircuts.

[Robert 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.

[C]

All right, we're all set for the party. I've trimmed the tree, hung the mistletoe, and paired all those weird shaped knives and forks with the appropriate cheeses. And I plugged in the Partisan.

[Robert Evans]

Partisan.

[C]

It's a home cocktail maker that makes over 60 premium cocktails, plus a whole lot of seasonal favorites too. I just got it for 50 off. So how about a Cosmopolitan or a Mistletoe margarita?

[Robert Evans]

I'm thirsty.

[C]

Watch. I just pop in a capsule, choose my strength and wow, it's beginning to.

[Robert Evans]

Feel more seasonal in here already.

[C]

If your holiday party doesn't have a bartender, then you become the bartender. Unless you've got a Bartesian, because Bartesian crafts every cocktail perfectly in as little as 30 seconds. And I just got it for $50 off.

[Robert Evans]

Tis the season to be jollier.

[Dr. Kaveh Hoda]

Add some holiday flavor to every celebration with the sleek, sophisticated home cocktail maker Bartesian.

[Robert Evans]

Pick up your phone and shake it.

[Dr. Kaveh Hoda]

To get $50 off any cocktail maker. Yes, you heard me.

[Robert Evans]

Shake your phone and get $50 off. Don't delay.

[C]

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[Dr. Kaveh Hoda]

The creators of Stephen King's Strawberry Spring comes the Unborn. A shocking true story.

[Robert Evans]

My babies. Please.

[C]

My babies.

[Dr. Kaveh Hoda]

One woman, two lives and a secret she would kill to protect. She went crazy. Shot and killed all her farm animals. Slaughtered.

[Robert Evans]

Slaughtered them in front of the kids.

[Dr. Kaveh Hoda]

Tried to burn their house down. Listen to the unborn on the iHeartRadio app, Apple Podcasts or wherever you get your podcasts.

[C]

We want to speak out and we want this to stop.

[Robert Evans]

Wow. Very powerful.

[C]

I'm Ellie Flynn, an investigative journalist, and this is my journey deep into the adult entertainment industry. I really wanted to be a Playboy model. He was like, I'll take you to the top. I'll make you a star. To expose an alleged predator and the rotten industry he works in. It's honestly so much worse than I had anticipated. We're an army in comparison to him. From novel Listen to the Bunny trap on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

[Robert Evans]

Hey everyone, it's John, also known as Dr. John Paul. And I'm Jordan or Jo Ho. And we are the Black Fat Film Podcast, a podcast where all the intersections of identity are celebrated. Oh, chat.

[C]

This year we have had some of.

[Robert Evans]

Our favorite people on, including Kid Fury, T.S. madison, Amber Ruffin from the Amber and Lacey Show, Angelica Ross, and more. Make sure you listen to the Black Fat Femme podcast on the iHeartRadio app, AVA podcast, or wherever you get your podcast girl.

[C]

Oh, I know that's right. All right, we're all set for the party. I've trimmed the tree, hung the mistletoe, and paired all those weird shaped knives and forks with the appropriate cheeses. And I plugged in the Bartesian Bartesian. It's a home cocktail maker that makes over 60 premium cocktails, plus a whole lot of seasonal favorites too. I just got it for 50 off, so how about a Cosmopolitan or a Mistletoe Margarita?

[Robert Evans]

I'm thirsty.

[C]

Watch. I just pop in a capsule, choose my strength and what?

[Robert Evans]

Wow, it's beginning to feel more seasonal in here already.

[C]

If your holiday party doesn't have a bartender, then you become the bartender. Unless you've got a Bartesian, because Bartesian crafts every cocktail perfectly in as little as 30 seconds. And I just got it for $50 off.

[Dr. Kaveh Hoda]

Tis the season to be jollier. Add some holiday flavor to every celebration with the sleek, sophisticated home cocktail maker Bartija.

[Robert Evans]

Pick up your phone and shake it.

[Dr. Kaveh Hoda]

To get $50 off any cocktail maker. Yes, you heard me.

[Robert Evans]

Shake your phone and get $50 off. Don't delay.

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[Dr. Kaveh Hoda]

In the quiet town of Avella, Pennsylvania, Jared and Christy Akron seem to have it all. A whirlwind romance, a new home, and twins on the way. What no one knew was that Christy was hiding a secret so shocking it would tear their world apart.

[Robert Evans]

91 One Response what's your emergency? My Babies. Please. My babies.

[Dr. Kaveh Hoda]

One woman, two lives. And the truth more terrifying than anyone could imagine. They had her as one of the suspects, but they could never prove it.

[Robert Evans]

You're going to go to jail if.

[Dr. Kaveh Hoda]

You don't come with us right now.

[C]

Throughout this whole thing, I kept telling myself, nobody's that crazy. Crazy.

[Dr. Kaveh Hoda]

Uncover the chilling mystery that will leave you questioning everything. A story of the lengths we go to protect our darkest secrets. She went batshit crazy. Shot and killed all her farm animals, slaughtered them in front of the kids, tried to burn their house down. Audio represents the unborn. On the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

[C]

We want to speak out, we want to raise awareness, and we want this to stop.

[Dr. Kaveh Hoda]

Wow. Very powerful.

[C]

I'm Ellie Flynn, and I'm an investigative journalist. When a group of models from the UK wanted my help, I went on a journey deep into the heart of the adult entertainment industry. I really wanted to be a Playboy model, lingerie topless. I said, yes, please, because at the center of this murky world is an alleged predator. You know who he is because of his pattern of behavior. He's just spinning the web for you to get trapped in it.

[Dr. Kaveh Hoda]

He's everywhere and has been everywhere.

[C]

It's so much worse and so much more widespread than I had anticipated. Together, we're going to expose him and the rotten industry he works in. It's not just me. We're an army in comparison to him. Listen to the bunny trap on the I Heart Radio app, Apple Podcasts, or wherever you get your podcast losses.

[Robert Evans]

Hey, everyone, it's John, also known as Dr. John Paul. And I'm Jordan or Joho. And we are the Black Fat Film Podcast, a podcast where all the intersections of identity are celebrated. Oh, chat.

[C]

This year, we have had some of.

[Robert Evans]

Our favorite people on, including Kid Fury, T.S. madison, Amber Ruffin from the Amber and Lacey Show, Angelica Ross, and more. Make sure you listen to the Black Fat Femme podcast on the iHeartRadio app, AVA podcast, or wherever you get your podcast, girl.

[C]

Ooh, I know that's right.

[Robert Evans]

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.

[Dr. Kaveh Hoda]

The haircut is a problem for me.

[Robert Evans]

I had Dorothy Hamill's haircut.

[Dr. Kaveh Hoda]

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

[Robert Evans]

Now she's really taking some strays in this episode.

[Dr. Kaveh Hoda]

Whoa. Just. She had Dorothy Hamill's hair.

[Robert Evans]

Oh.

[Dr. Kaveh Hoda]

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

[Robert Evans]

Lost love, yeah.

[Dr. Kaveh Hoda]

Painful, painful.

[Robert 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 bleeding 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, 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 and this, this. Jenner's also claiming that 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, I just. I felt old. I felt 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.

[Dr. Kaveh Hoda]

Was this when Larry King still had some credibility?

[Robert Evans]

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

[Dr. Kaveh Hoda]

This is like before infomercial Larry.

[Robert Evans]

Yes, yes.

[Dr. Kaveh Hoda]

Okay.

[Robert Evans]

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 even Caitlin or Ham were lying about their experiences on Vioxx because some people did gain benefits of this. And 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. For example, I know some people in their 70s who have been doing heroin for 50 straight years and are fine. That doesn't mean heroin is saf. It means some people are lucky. Right. Or the aforementioned 90 year old women.

[Dr. Kaveh Hoda]

Doing these ancient people who do drugs and smoke that you hang out with all the time.

[Robert Evans]

Little Burning man regionals. You run into a lot of elderly people who have been doing drugs for forever. Some of them are very good at it. I've been gas station sober for years now. Cava that's responsible for California sober.

[Dr. Kaveh Hoda]

But you can only get inebriate the things you buy at the gas station.

[Robert Evans]

I don't mess with that marijuana. That shit's dangerous. I just take those trucker yellow jackets that they give to keep 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.

[Dr. Kaveh Hoda]

It would be red if it was dangerous.

[Robert 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 caution.

[Dr. Kaveh Hoda]

It doesn't mean danger.

[Robert Evans]

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

[Dr. Kaveh Hoda]

I just, 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.

[Robert 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 because that's good for your heart.

[Dr. Kaveh Hoda]

This level of detail is what bothers me. I don't like.

[Robert Evans]

It's fine. It's mostly just B12 and caffeine and God Knows what else? Because there's absolutely no agency that looks into what gets put into substances that are sold in gas stations in this country.

[Dr. Kaveh Hoda]

Oh, my God. And what little oversight there is is gonna be gone. Yes, in the next seven years.

[Robert Evans]

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

[Dr. Kaveh Hoda]

It's all one big organized end of humanity cash grab the next couple years. Any drug you want to get through.

[Robert Evans]

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

[Dr. Kaveh Hoda]

That's fair. But it's not gonna be the 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 going to be left in the wake, and then.

[Robert Evans]

No, you're right. They're going to ban Prozac and replace it with like polar bear liver pills. It's just got to be a disaster.

[Dr. Kaveh Hoda]

He was always doing research that rfk.

[Robert Evans]

He's always trying something knew. 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. 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 Merc. 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 launch launching it. Tom Nessie writes, the day after Dorothy Hamill's appearance, even Merck CEO Raymond Gilmartin was smitten. He received heart ridden letters from arthritis sufferers saying they were going to immediately ask their physicians for a Vioxx. Gil Martin personally congratulated the public relations department. One marketing executive wrote that with Dorothy telling our story, Vioxx sales were going to soar and overtake Celebrex, an obsession within the company.

[Dr. Kaveh Hoda]

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

[Robert Evans]

I love it, I love it, I love, 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 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 Merc, 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, 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.

[Dr. Kaveh Hoda]

Right.

[Robert Evans]

So the FDA gets kind of unhappy with this. And Merck replied, she just slipped, 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 12, 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 Vioxx. 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. I was gonna. I was just like, did I just go over September 12th and not make.

[Dr. Kaveh Hoda]

I feel like you would have caught that. No, no, it's fine.

[Robert Evans]

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

[Dr. Kaveh Hoda]

When I started skating at 8 years old, I never thought I'd experience the.

[Robert Evans]

Thrill of winning a medal.

[Dr. Kaveh Hoda]

With all the great memories has come.

[Robert Evans]

Another thing I thought I'd never experienced. The pain of osteoarthritis.

[Dr. Kaveh Hoda]

Vioxx is here. A prescription medicine for osteoarthritis pain. With one little pill a day, Vioxx can provide powerful 24 hour relief. Vioxx specifically targets only the COX2 enzyme, a key source of arthritis pain. People with allergic reactions such as asthma to aspirin or other arthritis medicines should not take Vioxx. In rare cases, serious stomach problems such.

[Robert Evans]

As bleeding can occur without warning.

[Dr. Kaveh Hoda]

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. 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. Vioxx for everyday victories. 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 like time and the cycle change and fashion. I don't know.

[Robert Evans]

Maybe it was the Vioxx. You don't know. Maybe Vioxx makes your hair look great. Everybody go out and buy Vioxx.

[Dr. Kaveh Hoda]

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. She's the perfect spokesperson and she has that innocence that you believe.

[Robert 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. Copper.

[Dr. Kaveh Hoda]

Can't wait.

[Robert Evans]

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

[Dr. Kaveh Hoda]

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 you like the subjects, like today's subject, you'll like our show. In fact, one of our most recent episodes is about sort of similar, a little bit less egregious, but similar pharmaceutical shenanigry. I don't know if that's A word about the medication Zygris. And there's all kinds of fun guests like Robert and Prop and all 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 at bluesky, which I'm giving a shot now. Seems a little bit less fascist.

[Robert 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 going to do exactly?

[Dr. Kaveh Hoda]

You can follow me there at kavemd.

[Robert Evans]

You can also follow me there at iwriteokay, 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. Do something good in the world. Yeah, like online.

[Dr. Kaveh Hoda]

I like it.

[Robert Evans]

And take a podcast to listen to podcasts. Keep listening. For the love of God, keep listening.

[Dr. Kaveh Hoda]

Do not stop listening to podcasts.

[Robert Evans]

Under no circumstances stop listening to me.

[Dr. Kaveh Hoda]

Will you ever stop. In fact, just for thinking about stopping, you should listen to extra podcasts today.

[Robert Evans]

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

[Dr. Kaveh Hoda]

Not podcast your way through it. Podcast your way through it.

[Robert Evans]

That's right.

[Dr. Kaveh Hoda]

Yep, agreed.

[C]

Behind the Bastards is a production a 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.

[Dr. Kaveh Hoda]

Wherever you get your podcasts.

[C]

Behind the Bastards is Now available on YouTube.

[Dr. Kaveh Hoda]

New episodes every Wednesday and Friday.

[C]

Subscribe to our channel YouTube.com BehindTheBastards all right, we're all set for the party. I've trimmed the tree, hung the mistletoe, and paired all those weird shaped knives and forks with the appropriate cheeses. And I plugged in the barbecue. It's a home cocktail maker that makes over 60 premium cocktails, plus a whole lot of seasonal favorites too. I just got it for 50 off. So how about a Cosmopolitan or a Mistletoe margarita?

[Robert Evans]

I'm thirsty.

[C]

Watch. I just pop in a capsule, choose my strength and wow, it's beginning to.

[Robert Evans]

Feel more seasonal in here already.

[C]

If your holiday party doesn't have a bartender, then you become the bartender. Unless you've got a Bartesian, because Bartel Artesian crafts every cocktail perfectly in as little as 30 seconds. And I just got it for $50 off.

[Robert Evans]

Tis the season to be jollier.

[Dr. Kaveh Hoda]

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[Robert Evans]

Pick up your phone and shake it.

[Dr. Kaveh Hoda]

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[Robert Evans]

Shake your phone and get 50 off. Don't delay.

[C]

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[Robert Evans]

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[Dr. Kaveh Hoda]

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[C]

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[Robert Evans]

Play at home.

[C]

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[Dr. Kaveh Hoda]

So what are you waiting for?

[C]

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[Dr. Kaveh Hoda]

From audio up the creators of Stephen King Strawberry Spring Comes the Unborn. A shocking true story.

[Robert Evans]

My babies. Please.

[C]

My babies.

[Dr. Kaveh Hoda]

One woman, two lives and a secret she would kill to protect. She went crazy, shot and killed all her farm animals, slaughtered them in front of the kids. Tried to burn her house out. Listen to the unborn on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

[C]

We want to speak out and we want this to stop.

[Robert Evans]

Wow. Very powerful.

[C]

I'm Ellie Flynn, an investigative journalist, and this is my journey deep into the adult entertainment industry. I really wanted to be a Playboy model. He was like, I'll take you to the top. I'll make you a star. To expose an alleged predator. And the rotation, what an industry he works in. It's honestly so much worse than I had anticipated. We're an army in comparison to him. From Novel Listen to the Bunny trap on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

[Robert Evans]

Hey everyone, it's John, also known as Dr. John Paul. And I'm Jordan or Joho. And we are the Black Fat Film Podcast, a podcast where all the intersections of identity are celebrated. Celebrated. Oh, chat.

[C]

This year we have had some of.

[Robert Evans]

Our favorite people on, including Kid Fury, T.S. madison, Amber Ruffin from the Amber and Lacey Show, Angelica Ross, and more. Make sure you listen to the Black Fat Femme podcast on the I Heart Radio app, Ava Podcast or wherever you get your podcast girl.

[C]

Oh, I know that's right.