Opening remarks:
Throughout the ages, from the myth and legend of "Shennong tasting hundreds of herbs" to the 523 project that achieved the legend of artemisinin, human beings have been constantly striving to promote medical progress. Like all natural science developments, the development of medicine is full of hardships and ups and downs, and behind the good medicines that cure diseases and save people, there are often countless failed research and development stories, and even tragic drug accidents. There are two sides to everything, and so is medicine.
Written by | Fang Jingyu
Source | "Medical Community" public account
In December 2013, the memoirs of former wall Street veteran Jordan Belfort were adapted into the noir comedy film The Wolf of Wall Street, which was released in the United States. The film, which was later critically acclaimed, truly recreated Belfort's life of "success and failure", and also vividly depicted the life of a drunken fan after Belfort's death— including a large number of shots of Belfort abusing the drug methelone ("Quaalude").
In the late 20th century, drug abuse became a common practice in the United States. Methaquone is not the "only focus" in this storm. In that era when the pressure of life increased with the accumulation of wealth, a large number of drugs were packaged as "wonderful means" to solve life troubles and pressures, and appeared on the market one after another. The medical and social problems they cause have not yet been fully solved.
Medical advertising of "customer pain points"
"This is the best of times, and this is the worst of times," is the perfect way to describe the pharmaceutical industry in the 20th century in Dickens' Tale of Two Cities.
The development of chemistry, medicine and pharmacy has spawned countless new drugs and companies that rely on new drugs to survive. Like other commodities, pharmaceuticals need to be marketed to achieve excellent market results. However, the applicable population of drugs is quite special, and it is a rare commodity linked to human life, so its marketing is often subject to many restrictions by regulatory authorities.
However, "there are policies at the top and countermeasures at the bottom." From ancient times to the present, these restrictive policies have diversified drug marketing, allowing pharmaceutical companies to successfully "exert customer pain points" and make a lot of money in the market.
An advertisement for the antiemetic Mornidine (picopitazine) of G.D. Searle, published in 1959. Photo: Can Med Assoc J
One of the marketing tools used is to use patient names and images to create drug advertisements – which is not illegal in the United States, and the US Food and Drug Administration (FDA) does not prohibit such behavior.
As early as the early 20th century, there were a large number of patient images in drug advertising in the United States (and this is still the case today). Integrating the patient image into an attractive situation to satisfy the appetite of patients and doctors was a typical feature of print drug advertising at that time.
For example, in an advertisement for G.D. Searle for its newly developed antiemetic mornidine, the main image is of a housewife cooking breakfast. The company used this scenario to imply that the drug was "safe and effective in treating morning sickness."
Ironically, the ad didn't generate good sales for Mornidine. The drug was quickly abandoned clinically due to its susceptibility to hypotension. Even at that time, many doctors did not know that such a drug had existed in the world.
Want to "decompress"? Let's take a pill
More aggressive marketing is seen in sedative sleeping pills.
This type of drug has a long history, and the speed of evolution can be called a "must" in medicine.
In the 20th century, barbiturate sedatives were all the rage. It's not an ideal sedative — hyperstation and under-efficacy are common, and overdose or taken with alcohol can be fatal — but that doesn't stop its rapid market expansion. Companies aiming at the timing of the production of barbiturate-type sedatives abound.
At that time, the United States did not have strict controls on addictive drugs such as barbiturates [the Controlled Substances Act was issued in 1971], and ordinary people could obtain a large number of controlled drugs from doctors. Doctors are also happy to prescribe such drugs, earning consultation fees and rebates from pharmaceutical companies.
Even so, pharmaceutical companies are still not satisfied with the status quo. After all, throughout the 20th century, the market for barbiturate sedatives was in a situation of "more monks and less porridge" - according to statistics, during this period, the medical community synthesized more than 2500 kinds of barbiturate sedatives, and 50 of them eventually entered the clinic.
To expand the market, you can only target those who do not need a strong sedative, such as office workers with only mild anxiety.
After the end of World War II, the U.S. economy developed rapidly and people's lives greatly improved. But the enormous pressure of work has left most office workers at a loss.
Once again, print advertisements with the image of patients as the "protagonist" have become the main force of the "propaganda war". In an ad created by McNeil for its barbiturate-like sedative, Butabisol, a middle-aged man in a suit and leather shoes is accompanied by the slogan "Thank you Butiso, he can now cope with it..." to highlight Butisol's main use - decompression (to combat daily anxieties related to the environment).
Advertisement for The sedative Butisol of the McNeil company, published in 1969. Pictured: JAMA
Relying on "drugging" to decompress, an almost crazy idea, but at a time when the degree of "inner volume" increased unabated compared to today, there was quite a market. There are many people who rely on drugs to maintain their work energy. This has also achieved many sales records of "decompression" drugs "bright and blind".
In addition to "decompression", some sedatives also use the guise of "improving sleep quality" to attract a large number of normal people who only have a slightly poor sleep quality but do not meet the standard of insomnia, and pay for them.
Qualude, mentioned in The Wolf of Wall Street, is one of them.
Manufacturer Roser launched the advertising slogan of "Sleeping a Good Night brings a good morning", accompanied by a picture of a family having a warm breakfast, implanting Qualude's "safe and reliable" cognition.
In order to compete with the same period of products such as Butisol, which is mainly composed of barbiturates, Rorer also advertised another major selling point of Qualude, "no barbiturates".
Qualude's marketing strategy of "playing the family card" has been quite successful. In 1972, Quaalude was "named" the sixth best-selling sedative in the United States.
An advertisement for Rorer's sedative Qualude(methaquolone), released in the 1970s. Photo: Newsweek
Although both McNeil and Rorer are complacent about their "success," in the eyes of some pharmaceutical companies, these marketing tactics are still "almost meaningless."
Rather than "making a fuss" about existing diseases, it is better to "invent diseases" yourself: this is being used to the extreme in the marketing of Wallace's new sedative, Miltown( mepropanol).
In 1955, Miltown was put on the market. Wallace combined normal life, work, and family stresses to launch a new concept of "60s syndrome" and ran a series of ads in the 1960s.
At the same time, Wallace put "titles" such as "crash parent syndrome" and "computer age syndrome" to the anxieties and frustrations in daily life - these "new problems" can be solved by Miltown.
Miltown soon became a household name for "miracle drugs" and the "darling" of the fashion industry, and many actors, singers and hosts favored it.
Miltown thus began its "celebrity marketing" strategy. The famous actor Milton Berle has repeatedly stood for it on his television programs. This gives the public the impression that "drug safety is guaranteed by celebrities", further fueling unnecessary drug use.
This madness did not end until the 1970s, when it was affected by the Controlled Substances Act.
Sedative Miltown's "CrashIng Parent Syndrome" series of ads, released in the 1960s
How deeply you love, how deep you hate
Compared with drugs that simply produce sedative effects, Qualude, which can induce hallucinations in large doses, has also become the "originator" of party drugs in this crazy marketing.
In rock singer David Bowie's work Time, Quaaludes and Red Wine became a sign of nighttime revelry. Composer Frank Zappa mentions scenes of sleeping on Qualude in his work Pygmy Twylyte.
But whether it's Buttisol, Quaalude, or Miltown, or many of their contemporaries' overmarketed drugs, their "good times" came to an end in the 1970s with a series of vicious events.
The "most powerful" Qualude, the most miserable end.
In 1977, the famous Hollywood director Roman Polanski was involved in a sexual assault case, and Polanski fled. According to relevant records, Polanski "fed" Quaalude to the other party, and after his unconsciousness, he was attacked.
In 1978, The Rorer Company, which felt itself in trouble, sold qualude's production and sales rights. Its leaders said Qualude "makes up less than 2 percent of its sales and gets 98 percent into trouble."
The Lawrence Daily Journal-World, May 28, 1981, reported on the negative impact of Qualude on pharmaceutical companies
The following year, according to the Associated Press, 87 people died in the United States alone for misuse of Qualude. By 1980, the number of deaths from the abuse of Qualude had risen to 117.
Previously, the infamous sulfonamide poisoning incident in American history that gave birth to the Federal Food, Drug and Cosmetic Act of 1938 killed 105 people.
Of course, drugs outside of Quaalude aren't much better either. In 1962, the famous movie star Marilyn Monroe died of barbiturate poisoning. That same year, according to authorities, about 250,000 people in the United States were addicted to barbiturates. At that time, sedative and hypnotic drugs have therefore played the "barbiturates-free" sign.
Meprothionate was also discovered in the 1960s to cause drug dependence. Further studies have shown that it is related to hematologic diseases such as thrombocytopenia and aplastic anemia. This led to meprothan in the late 1960s being kicked out of the major clinical guidelines and becoming an outcast of the times.
News of Marilyn Monroe's death, and later revealed Monroe's death certificate
In 1983, Qualude, which "created an era," was discontinued in the United States. Shortly thereafter, the U.S. Drug Enforcement Administration (DEA) moved methaquol (not just qualude as a commodity) to List I of the Controlled Substances Act. Since then, methaquone has been treated in the United States as a compound with "very high potential for abuse and no proven medical value", and its production, transportation and use have been severely restricted.
But Qualude hasn't completely disappeared in this world. Illegal drug workshops (clandestine laboratories) roamed the night, and methaquol tablets modeled after Qualude's design began to appear in many countries.
To this day, Quaalude is reportedly one of the most popular drugs of abuse in South Africa. On 14 September 2020, South African police successfully cracked down on a drug trafficking gang, in which as many as 3.9 tons of methaquol powder alone were seized.
Where the boundaries of drug marketing are have always been one of the hot topics discussed in the medical field. In that era of barbaric growth of drug marketing, pharmaceutical companies can make profits in all kinds of unimaginable ways, but the social problems caused by them also deserve our attention. Quaalude's story shows that "laissez-faire" pharmaceutical companies to promote their drug products by any means is likely to trigger a social crisis, which is naturally not what we want to see.
Resources:
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Source: Medical community
Editor-in-charge: Xu Liyan
Proofreader: Zang Hengjia
Plate making: Xue Jiao