APExclusive: OxyContin maker paid $600 million in legal penalties for misrepresenting addiction risks in the U.S. Its foreign affiliate is making the same claims to sell the drug in China. By ekinetz.
Tony Chen, a former OxyContin sales representative who spoke on condition that he only be identified by his English name, for fear of retribution, said Mundipharma required sales staff to upload copies of patients' private medical records, obtained without consent, to a company group chat, in apparent violation of Chinese law, during an interview in China on Sept. 19, 2019.
These tactics mirror those employed by Purdue Pharma in the U.S., where more than 400,000 people have died of opioid overdoses and millions more became addicted. An avalanche of litigation over the company’s marketing has driven Purdue Pharma into bankruptcy in the U.S.In China, Mundipharma managers have required sales representatives to copy patients’ private medical records without consent, in apparent violation of Chinese law, current and former employees told AP.
Mundipharma said it was taking immediate action to investigate the allegations uncovered by AP. In a statement, the company did not respond to specific allegations but said it has rigorous policies in place “to ensure that our medicines are marketed responsibly and in accordance with China’s strict regulatory framework governing analgesics.”
These seeds of philanthropy and political alliances would bear fruit for the Sacklers just as opioid prescriptions began to fall in the U.S. Two decades ago, as stories of OxyContin abuse began to circulate in the United States, foreign pharmaceutical companies helped spread a new gospel of pain treatment across China, recasting pain as the fifth vital sign—alongside blood pressure, heart rate, respiratory rate, and temperature—and pain treatment as a human right.
“In China, doctor’s groups, especially the young doctors, show their respect to American doctors or the European doctors,” Yu said. “What they say, that’s truth. What you say, that’s interfering.”In 2007, Purdue and three executives pleaded guilty in U.S. court to misrepresenting OxyContin as less addictive than other opioid painkillers, and paid $635 million in penalties, one of the largest settlements in pharmaceutical company history.
Two years later, the Chinese government launched the campaign nationwide. On February 22, 2011, Mundipharma won a contract to implement the program with an initial target of establishing model GPM wards in 150 key hospitals within three years.Mundipharma was responsible for helping train doctors and educate patients, as well as distributing pamphlets and placards to raise awareness about pain.
The oncology society declined to answer questions. China’s Ministry of Health, which was reorganized as the National Health Commission, said it hadn’t designated a company to provide assistance for the program. During that same period, sales of morphine, widely considered an affordable “gold standard” for pain treatment, remained flat at those same hospitals. By early 2017, OxyContin had captured roughly 60 percent of the cancer pain market in China, up from just over 40 percent in 2014, company documents show.HTML tag. Try viewing this in a modern browser like Chrome, Safari, Firefox or Internet Explorer 9 or later.
Chen knew he had no legal right to copy personal information, and at first scribbled over patients’ names before uploading the documents. He and his colleagues said they used to discreetly snap photos of patient records during the night shift, or during lunch breaks. The key to this access was good relationships with doctors. Just as Purdue was accused of doing in the U.S., Mundipharma cultivated doctors with paid speaking gigs, dinners, event sponsorships and expense-paid trips to meetings, sometimes routing payments through third parties, sales reps said. Speakers, who sometimes delivered presentations created by or with Mundipharma sales staff, could earn 500 yuan to several thousand yuan per speech, current and former employees said.
But as pain treatment expanded in China, with the establishment of pain clinics beginning in 2007 and the rollout of GPM, more doctors became certified to prescribe opioids. Pain management ceased to be the purview of anesthesiologists like Ruijin Hospital’s Dr. Yu. It became a matter for surgeons, pain clinicians and cancer doctors.
Yu said he tried to persuade colleagues that some of the new notions about pain were silly, even risky. “I remember I argued with them, muscle pain or joint pain is not a good indication for opioid drugs,” he said. “But they said, it’s a human right. You have to relieve the pain.”When Chen started work at Mundipharma, he was taught that OxyContin was a good drug, and widely used in America.
“Purdue accepted responsibility for the misconduct in 2007 and has since then strived never to repeat it,” the company said again in a legal filing in September. Dr. Fan has spoken at Mundipharma-funded conferences and appeared in a pain awareness video alongside Mundipharma China’s general manager, other prominent doctors and celebrities. The China-Japan Friendship Hospital was among the first to obtain certification under the Good Pain Management program in Beijing.When AP told Fan about Purdue’s 2007 guilty plea, he seemed shocked.
The Mundipharma sales reps told AP they had a pitch for doctors worried about addiction: If used properly, the risks of addiction to opioid painkillers are virtually non-existent. Patients who seem addicted may just need more drugs to control pain, staff PowerPoints explained.He said patients could slip into addiction within a few days. “They came to you and started talking repeatedly about pain and asked you to prescribe medicine,” Yu said. “We call this drug-seeking behavior.
As Chen looked back over his training documents, he found presentations touting opioid painkillers as a safe and effective treatment for chronic pain, citing outdated studies with authors linked to Mundipharma and other companies.
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