Long Before OxyContin®, the Sacklers Perfected the Art of Monetizing an Addiction
More than 60 years ago, they made bank by marketing Valium®. The ensuing wave of addiction was a national scandal.
In 1955, a new sedative medication unexpectedly took America by storm. It was called Miltown® (chemical name meprobamate). Executives at Carter-Wallace, the pharmaceutical company where it had been discovered, had doubted there’d even be a market for it. But they released it anyway, and to their delighted surprise, and without any real advertising, it became the fastest-selling drug in American history.
Miltown® became an overnight obsession of the movie and entertainment industry, to the point that Los Angeles was dubbed by one wag as “Miltown®-by-the-sea.” The Hollywood trade press ran stories on the so-called “don’t-give-a-damn pills” — which promoted relaxation and relieved anxiety, but in a lighter-seeming way than the other available options (such as barbiturates, which would so infamously wreck the lives of actresses like Marilyn Monroe and Judy Garland).
All such pills “were frequently handed out at parties and premieres, a kind of pharmaceutical appetizer for jittery celebrities,” writes Andrea Tone in her excellent history of this era, The Age of Anxiety:
Frances Kaye, a publicity agent, described a movie party she attended at a Palm Springs resort. A live orchestra entertained the thousand-odd guests while a fountain spouted champagne against the backdrop of a desert sky. As partiers circulated, a doctor made rounds like a waiter, dispensing drugs to guests from a bulging sack. On offer were amphetamines and barbiturates, but guests wanted Miltown. The little white pills “were passed around like peanuts,” Kaye remembered.
Overnight, Miltown® was everywhere. It was available to journalists and editors at a Los Angeles daily newspaper, on request to the head copy boy. It was displayed in Cartier and Tiffany jewelry accessories specifically designed to hold these “emotional aspirin” pills. A stash was kept on hand at the “I Love Lucy” show, and Lucille Ball’s assistant once offered the actress a coffee-and-Miltown® after an argument with husband Desi Arnaz. Playwright Tennessee Williams and author Norman Mailer relied on the tranquilizer (among other addictive substances). Salvador Dali’s wife loved it so much that she urged the drug company to commission a huge art installation from her husband: Crisalida, a 60-foot-long tunnel of parachute silk, set up at the American Medical Association’s convention that year. The tunnel was supposed to be a caterpillar, down the bowels of which visitors could walk past figures becoming butterflies of Miltown®-induced tranquility. Or something like that.
Aldous Huxley’s dystopian novel “Brave New World” was more than 20 years old by the time Miltown® hit the scene. That novel had depicted a horrifying future where, among other things, the population was pacified by a government-issued sedative called “Soma”. Yet Huxley himself had strangely moved on over the years. He now welcomed meprobamate and other lighter sedatives as potentially revolutionary.
[Side note: the Miltown® team also developed carisoprodol, a medication that, once ingested, eventually metabolizes to meprobamate. So, the carisoprodol depresses the nervous system some, and then as the body breaks it down, it briefly becomes meprobamate, which also presumably exerts some further “Miltown®” relaxation effect. The brand name they chose for carisoprodol was … Soma®. Yes, they chose that name after the publication of “Brave New World.” Today, it’s rare for anyone to prescribe Miltown®, which we now know is highly addictive, miserable to withdraw from, and has an ugly side-effect profile. But Soma® still gets prescribed as a muscle relaxant.]
It’s strange how completely Miltown® has been forgotten, given how ubiquitous it once was. Comedian Jerry Lewis worked it into more than one year’s Oscar presentations, quipping for example that “buttered Miltowns®” would be available in the lobby for losers. Comedian Bob Hope worked Miltown® references into his bits as well, for example joking that Soviet leader Nikita Khrushchev’s peace overtures meant the Russians “must be spiking their vodka with Miltown®.” And Miltown®-spiked vodka was indeed a thing: cocktails appeared with names like the Miltini — a martini that replaced the olive with a little white pill — or the Guided Missile, a double shot of vodka and two Miltowns®.
Ads for unrelated products — Baskin-Robbins ice cream, Ford motor cars — riffed off the Miltown® craze, by claiming that ice cream or a luxury sedan would give more peace of mind than any silly pill. And the celebrity endorsements, or at least associations, continued. Lauren Bacall remembered being prescribed Miltown® for grief and insomnia after the death of husband Humphrey Bogart. Jayne Mansfield scoffed at the pill: “Miltown®, schmiltown. Who needs Miltown® when I’ve got Mickey Hargitay?” (Her bodybuilder fiancé.)
No one more aggressively touted Miltown® than Milton Berle, the comedian and host of the widely watched Milton Berle Show. His constant patter about the drug included a running joke he wanted to be called Uncle Miltown®. (His worried wife made a public statement that she wanted “more Milton and less Miltown®”, wanted him to take less of the drug, and thought he should stop boosting it to others. “Most of the comedians in television are taking it now,” she added.)
Elvis Presley made a famous 1956 appearance on the Milton Berle show: his rendition of “Hound Dog” that day was controversial for being too sexually suggestive, although that seems laughable watching it today. But when Presley told Berle he was looking for “a quiet type of girl,” Berle replied, “You don’t want a girl, you want a Miltown®.”
And the Miltown® money rolled in, by the tens of millions. Within just two years of launch, a billion Miltown® pills had been sold.
The Sacklers Get a Taste
Executives at rival pharmaceutical companies were envious of this roaring success. It is a dirty, open secret of the pharmaceutical business that the business people in charge — not the physicians or chemists or researchers, but the business people who allocate the resources — often don’t want to innovate. Make some completely new drug? Sounds risky.
But if one can create a very similar drug to an existing blockbuster, there’s a known market to muscle in on. So, at Roche, they told their chemists to come up with something as chemically close to meprobamate as possible without violating the patent.
Instead, a Roche chemist actually was innovative. He isolated a notably different new sedative: the first benzodiazepine, chlordiazepoxide. Roche branded it Librium® (to suggest “liberation” and “equilibrium”). It was similar-acting to meprobamate — a nervous system depressant that among other things eased anxiety — but that similarity was a good thing: There was a known market, just waiting. By 1957, a third of all prescriptions in America were already tranquilizers like Miltown®.
Librium® hit the market in 1960, and to sell it, Roche turned to Arthur Sackler.
Sackler, a physician-turned ad man, had made a name for himself as someone willing to revive — and improve upon — the lost tradition of aggressive medical marketing. In the bad old days, America was plagued with charlatans who would stand on street corners or public squares and hawk “snake oil” or other fake medicines. By contrast, modern medicine in the 1950s was rightly proud of its scientific triumphs. These included penicillin (discovered in 1928 but only ramped up for mass production during World War II) and other antibiotics, from streptomycin for tuberculosis to sulfa antibiotics for malaria, as well as the first defibrillator, the first dialysis machines, and more. Modern medicine preferred a demeanor of dignity and reserve. Many physician leaders would be horrified to think of being part of something as crass as a business project.
Sackler saw a way around that. Tasked with helping the young company Pfizer sell some of its earliest antibiotics, he became a pioneer of “detail men”: well-dressed, well-spoken, and highly educated young gentlemen, who would visit doctors in their offices bearing promotional literature and an articulate familiarity with medicine and science. The doctors received these men almost as scientific colleagues. But they weren’t. They were less interested in truth than sales. Pfizer’s internal marketing documents referred to the doctors at that time as “prey.” The detail men were urged to hunt down doctors prescribing the antibiotics of a competitor, and to browbeat them into “switching to our side of the fence.”
As part of the marketing of the antibiotic Terramycin® (chemical name oxytetracycline), Sackler convinced Pfizer to go from a team of eight detail men to more than 2,000 (!). They also bought advertising in medical journals, and sent “Dear Doctor” postcards to the homes of physicians across the nation. “High-prescribing physicians might receive two or three Pfizer mailings every day year-round,” according to John Kallir, an ad executive from those days.
All of this must have felt like flattering attention, coming as it did from people speaking the same language of scientific medicine. In fact, Sackler and his team even coined the term “broad-spectrum antibiotic.” Today, doctors in the hospital often talk about whether a given situation merits “broad-spectrum antibiotics.” I myself used the term for years — thinking it was a scientific term and that I was a doctor. But it began as a marketing term, and apparently I have all along just been a Sackler sock puppet.
(Feeling like a Sackler sock puppet is a recurring theme of my professional life.)
Sackler died in 1987, and was inducted posthumously ten years later to the Medical Advertising Hall of Fame, which said at the time: “No single individual did more to shape the character of medical advertising than the multi-talented Dr. Arthur Sackler.”
This was in recognition of his work flogging Terramycin® — but even more so for his heroics in slinging sedatives.
The Sackler team got a commission on every Librium® pill sold, and sell they did: Just as they’d done with Terramycin®, they set off on the trail of their prey: They sent vinyl phonograph records to primary care offices with recordings of physicians singing Librium®’s praises, sent direct mail to physicians’ homes, visited physicians in their offices, bought spreads in their medical journals.
To get the public clamoring for the drug in parallel, Team Sackler even organized a Life magazine photoshoot of a ferocious lynx at the San Diego Zoo, who suddenly turned “genuinely gentle and friendly” and was shown sniffing a flower after “a new tranquilizer called Librium”.
Soon Librium® would be the most prescribed drug in America, rapidly surpassing Miltown®. In part, that was because the scientist who had discovered Miltown®, Frank Berger, was opposed to selling medicines with aggressive marketing. Out of grudging respect for that fiercely defended moral position, his company Wallace-Carter hired no detail men. The explosion of interest in Miltown® in the 1950s had been a purely organic Hollywood-driven phenomenon, and Berger had earned huge royalties from it — but he would not resort to the deceptions and manipulations of a Roche, or an Arthur Sackler, to hook more people on a sedative just to earn more money.
And so, the company Wallace-Carter faded into obscurity.
From Librium to Valium
Even as the marketing of Librium® was heating up, Roche’s chemists isolated a second benzodiazepine: diazepam. They named it Valium® (from valere, Latin for “strong” or “healthy”).
Valium® hit the market in 1962, just two years behind Librium®, and it raised a business conundrum: Would it just cannibalize the booming Librium® market? It would take the marketing genius of a Sackler to successfully sell both drugs at once. But succeed they did: Valium® eventually blew past Librium®, generating hundreds of millions of dollars in annual sales. Throughout the 1970s, Valium® was the most widely prescribed drug in the entire Western world. But both drugs sold briskly. And a narrative emerged from the advertising circles that helped: It held that while each drug worked wonders for anxiety, Librium® was particularly good for alcohol withdrawal, while Valium® was particularly good for muscle spasms.
Decades later, I was taught exactly this. There’s no convincing evidence for such assertions. The medications can essentially be used interchangeably. But that was the marketing gloss and it has persisted, passed down over the decades as an oral tradition of medical school and residency training.
In other words: my 21st century medical education was, once again, crafted in part by a 1950s Sackler family advertising scheme. This time, however, instead of encouraging use (perhaps overuse) of antibiotics, the goal was to convince the doctor to prescribe addictive substances more broadly.
Next time: The Valium addictions
The Opioid Crisis series:
Part I: A deep dive into the sociopathy of the Opioid Crisis.
Part II: The conspiracy to game the medical literature.
Part III: The conspiracy widens.
Part IV: ‘No family more evil’ fights on
Part V: Welcome to the Tupperware party
Part VI: Dark knowledge
She goes running to the shelter of her mother's little helper. I was happier not knowing there is a "medical advertising hall of fame." Stories like this one cast a sinister shadow on what many consider the "good" old days.