Last Week Tonight with John Oliver (2014–…): Season 2, Episode 1 - Marketing to Doctors - full transcript

John Oliver discusses the growing issues of pharmaceutical companies marketing directly to and through doctors.

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Welcome to Last Week Tonight !
I'm John Oliver.

It is so great,
o great to be back with you.

Clearly, we have been gone
for the last three months,

and you're probably thinking
I was on vacation.

That was not in fact the case.

Much like Brian Williams,
I voluntarily took myself off the air

after it emerged I presented
false information to you last year.

Roll the clip !

My theory always was that Hemingway
was hung like a hamster,

not that there's anything wrong
with that.

There's absolutely nothing
wrong with that.

We Googled "hamster penis,"
and this is what you find ! Adorable !

I'm embarrassed
to say that it turns out

that is not, in fact, a hamster penis,
it is a hamster tail.

I would like to truly apologize
to you the viewers,

to the editorial staff here,
and most of all to that hamster

because you deserved better,
Niblet, you deserved much better.

So with that out of the way,
with trust we built,

let's move on
to a quick recap of the week.

It began with a glorious looming
scandal in the US Congress.

Illinois Congressman Aaron Schock
being asked a lot of questions,

after redecorating
his Capitol Hill office suite

in the style of the PBS TV
series Downton Abbey.

What better way to show you're
in touch with your constituents

than decorating your office in the
manner of a 1920s British aristocrat ?

I'm intrigued. How Downton Abbey-ish
is his office ?

This is Schock's office.
Bright red, a gleaming chandelier.

Just like on television.
And a vase of pheasant feathers.

Pheasant feathers !

Somewhere in Illinois there is a
pheasant freezing his ass off going,

you couldn't just pick
something up at West Elm ?

Have you ever heard
of a eucalyptus bundle ?

Unbelievable !

The Congressman had some explaining
to do. And explain he did.

What do people back home
in Peoria think of this ?

I've never been a old,
crusty white guy.

You know as Taylor Swift says,
haters are gonna hate.

Ok, a couple of things there.

You are definitely
an old crusty white guy

if you think Taylor Swift was the first
person to say "haters gonna hate".

But, to be fair to him,
quoting "Shake It Off"

is probably as close as a congressman
can come to saying

"Go fuck yourself,
my office is magnificent."

Haters gonna hate, shake it off !

Moving on, to what may have been
the most spectacularly

ill-advised moment
in diplomacy this week.

Argentina's embattled
President Cristina Fernandez

under fire for a tweet
during a state visit to China

after meeting
with the Chinese President.

If you're thinking, "How bad could
a tweet from a world leader be ?"

This bad...

Fernandez tried to mimic
a Chinese accent

by switching R's with
what appeared to be maybe L's ?

In a tweet that translates
as did they only come

for lice and petloleum
instead of rice and petroleum.

Holy Shit !
"Lice and petloleum."

That is a level
of clueless racism on the internet

you'd expect
from a Dartmouth sorority pledge.

And perhaps... You're the worst !

And perhaps
the most amazing thing

is that she tweeted this during a
vitally important four-day state visit.

They're negotiating
15 major agreements,

which include two huge
hydroelectric dams in Patagonia,

investment in ports
through which Argentina

exports thousands
of tons of soil to China

and military hardware.

I have to say it's actually pretty big
of China to just go ahead

with their negotiations
like nothing had happened.

If I were them, I would've served
President Kirchner a bowl of lice,

saying "here's your food,
here's that funny joke you said,

why don't you eat your funny joke.

You still owe us
billions of dollars by the way."

Finally this week, there was sad news
for a true American icon.

RadioShack the 94 year old
consumer electronics chain

has filed
for bankruptcy protection.

Half of its 4,000 stores
will be turned into Sprint locations.

The others will be shut down.

You know it's a rough day when
"2,000 new Sprint locations"

is the happy part of a sentence.

RadioShack has not been
in great shape in recent years.

But it's easy to forget it
once ran ads like this.

So much more than just a store,

the best in America,

nobody compares to RadioShack.

That is a catchy song my friends !
If they had left that on the air,

they'd be the most powerful
company on earth today.

The death of RadioShack
in itself is not surprising.

What is surprising is the glib,
jokey tone

with which its demise has been
discussed over the past year.

If you have the name Radio
in your corporate name,

that's not a good sign in 2014.

Is RadioShack doomed
to remain a punch line ?

I actually like RadioShack
I go there a few times a year

and I kinda like it,
I'm an old school guy.

You must have a very
full junk drawer is all I can say.

This is a dying
94-year-old business !

It's like you're sitting across
from your grandfather saying:

"I don't really see the point
of Grandpa Fred in 2015.

Frankly, I'm sort of surprised
he still exists."

RadioShack would be
well within its rights

to be a little hurt
at this level of disrespect.

We've prepared
a farewell message for them,

that they should feel free to use.

For nearly a century,

we at RadioShack
have proudly served America,

providing you with the highest quality
home electronics at the best prices.

And now, sadly,
it's time for us to say goodbye.

So we would like to offer this special
farewell message to America.

Go fuck yourselves.
That's right.

Take a thirty pack of batteries
and shove them up your ass.

Who sold your parents
that remote control car

you got for Christmas in 1993
that you loved so damned much ?

RadioShack motherfuckers !

Remember in 1989 when you needed a
cable to plug your Nintendo in the TV ?

Who was there for you ? That's right.
RadioShack again assholes.

And now look at you,
laughing at our slow, painful death.

Laugh while you still can,
shit heads.

Because one day,
you too will be obsolete.

You too shall be left behind in the
wake of time's ceaseless onslaught.

And when that day comes, we'll be
standing over your goddamned grave,

laughing our asses off.

So America,
from all of us here at RadioShack,

goodbye and go to hell
you filthy animals.

Moving on ! Our main story tonight:
prescription drugs.

The only ovals that can bring people
in the Seattle area joy anymore.

Too put it mildly,
America takes a lot of these things.

70% of Americans take
at least one prescription drug,

more than half of us take two.

Researchers say a record 4 billion
prescriptions were written in 2011.

Total drug spending
jumped last year by 3 percent

to nearly 330 billion dollars
with a "B."

That works out to 1 000 dollars
per person on prescription drugs.

Kind of makes you feel
like Walter White

could've made more money cooking up
rheumatoid arthritis medication.

But should this really be
that surprising ?

It's impossible
to escape pharmaceutical ads.

You can't turn on the TV
without being subjected

to an endless stream
of sleep-inducing moths,

old men getting boners
while varnishing chairs, or this.

If your bladder
is calling the shots,

you may have a medical condition
called overactive bladder or OAB.

Again ? But we just went.

What that woman
really needs is a pill

to stop her hallucinating
anthropomorphic bladders.

You're locked inside a prison
of your own mind, Susan !

Be gone demon bladder !

But that's only one small part
of pharmaceutical marketing.

Drugs aren't like
most other products,

because you need someone's
permission to buy them.

Which is why all drug ads
end with the same catchy phrase.

Ask your doctor if Lunesta
is right for you.

- Ask your doctor about Myrbetriq.
- Ask your doctor.

Three words you're either hearing in a
commercial or saying to your coworker

when he asks you if the mole
on his back looks cancerous.

"I don't know ! Ask your doctor !
All I said was "how was your weekend ?"

It's probably fine.

Drug companies know

doctors hold all the real power
in the prescription drug business.

Which is why, while they spend
nearly 4 billion dollars a year

marketing directly to us,

they spend 24 billion dollars
a year marketing directly to doctors.

One analysis claimed that, in 2013,
9 out of the top 10 drug makers

spent more on marketing
than they did on research.

Drug companies are a bit
like high-school boyfriends:

they're much more concerned
with getting inside you

than being effective
once they're in there.

So we thought,
okay, don't think about that too much.

We thought we'd take a look,

we thought we'd take a look at how
all that marketing money gets spent.

Which turns out
to be surprisingly difficult.

It's a secretive world you usually
only get tantalizing glimpses into

during lawsuits,
years after the fact.

In 2012,

the government settled a case with the
makers of asthma medication Advair

over allegedly irresponsible
marketing practices.

We were able to see this video
of a 2001 Advair sales meeting.

Ladies and gentleman,
please welcome Darrell Baker,

Simon Jones, Rob Yacht
and Ken Tyba.

What the fuck !
That was for an asthma medication !

And they were treating it
like an NBA pregame show !

"Please welcome ! He's 59, white,

he likes turkey sandwiches
and his wife's name is Karen,

Say hello to Daryl
boom-boom Baaaaaaaker !"

The audience in that room
were pharmaceutical reps.

The foot soldiers in every
company's drug-marketing efforts.

Drug companies will tell you, their
reps are there to educate doctors,

but behind closed doors,
that message can be different.

There are people in this room

who are going to make an ungodly
sum of money selling Advair.

You know who you are.

Ungodly, that would barely
be an appropriate tone

if they were trying to get cereal
into people's bodies, let alone drugs.

You don't need to see
the people whooping in that room

to know what they look like.

Pharmaceutical sales reps
are famously young, attractive people.

This is so widely known, it's become
a sitcom punch line for years.

Today's the day the pharmaceutical
reps show up to peddle new drugs.

And at Sacred Heart,
that means one thing: Julie's here.

If something is a joke on "Scrubs",
you know it's common knowledge.

That show did not do a lot of arcane,

"What is it with phlebotomists
and French cuisine, am I right ?"

You are right Turk,
we're great friends.

The problem comes
if those reps don't understand

the effects of the drugs
they're pushing.

Listen to one former rep
describe his first training session.

I was in a room with
21 classmates and 2 trainers

and I was the only one
with a science background.

In fact on the first day of training
I taught my class and my instructors

the very basic process
by which 2 brain cells communicate.

So essentially, pharma reps
are like the cast of Grey's Anatomy:

they're young, hot and they have
virtually no medical training.

To be fair, most doctors will probably
take that into consideration.

The problem
comes when some don't.

I even had one physician who
would often bring out a patient chart

if she was having
a difficult patient,

she'd bring out a patient chart
and be like, okay Kathleen,

I've tried this, what do you recommend
in terms of tweaking ?

And I'm sitting here thinking,
I'm a political science major.

You're asking me
what to prescribe for this patient.

Because the only question a Poli Sci
major is really qualified to answer is:

"Was it weird having to move back in
with your parents after college ?"

Now if you're thinking,
if you're thinking at this point,

why do doctors let drug reps
into their offices at all ?

They don't come empty handed,
they'll show up with free samples.

And, even better,
free chicken parm.

Whoever said there's
no such thing as a free lunch,

hasn't worked
in a doctor's office.

There are some offices that advertise
in the front desk job description,

free lunch everyday.

Because the drug reps
are bringing it everyday.

Free lunch every day !

That might not seem like a big deal,
but think about it: lunch is awesome.

If Charlie Manson brought me
a free lunch every day,

I'd at least listen to his sales pitch
on forehead swastikas.

I don't think it's for me, Charlie,
but that's delicious.

Drug companies do it
because they know it works.

They know a terrifying amount

about nearly every prescription
coming out of a doctor's office.

Every time a patient goes into a
pharmacy to get a prescription filled.

The information
is sold to drug companies

who send it to laptops
out in the field.

So we see everything
that the doctor does.

How many prescriptions he prescribes
of our medication and the competitor's.

If the computer shows a doctor's
not prescribing as promised...

You say: "You're banging out
a lot of prescriptions"

"for the competitor's drug
and not mine.

Carl, you seem
to be making medical decisions

based on your best judgment.

I brought you a meatball sub with
chips, Carl, don't fuck me on this !

Don't fuck me Carl.

With this level of pressure,

unsurprisingly, drug companies
have crossed the line,

pushing doctors to prescribe pills
for non-FDA-approved uses.

That's called "going off label".

Here is a horrifying example
involving Astrazeneca,

the government charged
with going "off-label" with Seroquel,

an anti-psychotic
with dangerous side effects.

The allegations,
which were very troubling,

were that they were taking a drug
approved for fairly narrow uses

bipolar disorders and schizophrenia
and marketing it for everything

from sleeplessness
to depression and dementia.

You can't give people

potentially dangerous drugs
and see what happens !

You're a fortune 500 company,

not a white guy
with dreadlocks at burning man !

Astrazeneca denied any wrongdoing,

but it paid half a billion dollars
to settle the lawsuit.

If you're thinking,
"One company with one drug",

know that just about
every major drug company

has paid money
to settle similar charges.

Johnson & Johnson paid 2.2 billion.
Eli Lilly paid 1.4 billion.

Pfizer and its subsidiary
paid$2.3 billion.

And Glaxo Smith Kline paid out
a record 3 billion dollars

to settle accusations that it had
pushed Wellbutrin, an antidepressant,

as a cure for weight gain
and sexual dysfunction.

Or, as one former drug rep
describes the pitch.

It was a quick zinger for your doc
to tell your doctor:

"Remember Wellbutrin ?
The happy, horny, skinny drug."

That's not just irresponsible,
that's copyright infringement.

There is only one happy, horny,
skinny drug, and that is crystal meth.

That's a fact,
so that's a fact right there.

For that increasing number of doctors
who will refuse even to see drug reps,

the companies have one
other trick up their sleeve:

simply paying doctors
to talk to other doctors

about their products over dinner.

And that sounds ridiculous.

But not as ridiculous as the special
ego-boosting title they use.

I essentially say to a doctor,

our company has identified you
to be a thought leader.

Would you like to be
a thought leader for our company ?

The doctor will normally
almost every time say yes.

Of course they say yes ! Doctors like
to be called "thought leaders"

the same way that Brendan Fraser
likes being called

"two-time academy award
winner Brendan Fraser."

Not true, but it's got a lovely ring
to it and look how happy it makes him.

Look it, give the guy a go,
look how happy he is.

For a position described
as "thought leader,"

not a lot of thought
goes into the job.

In many cases the slides
and the content and the script

are prepared
by the drug company.

It's not always clear to the audience
that this is material that was scripted

completely by the drug company that
was paying the doctor to give the talk.

So if you're a doctor
just regurgitating a script,

you're not a "thought leader"
so much as you are "thought sayer."

Abraham Lincoln
was a "thought leader."

You're more like the animatronic
Lincoln at Disneyland.

To be fair: Glaxo Smith Kline will
no longer pay for "thought leaders".

And the industry in general claims
they're reforming.

A spokeswoman for Pharma,
the drug industry's trade group,

has even bragged about the tough new
restrictions they put in place.

In our Pharma code, we say
that pharmaceutical representatives

can bring an occasional meal,
a modest meal.

Turkey sandwiches, pizza,
I don't want to focus on turkey,

maybe we could have
ham sandwiches.

But modest meals,
not steak in a restaurant.

No, not in a restaurant !

Although we'd probably allow
a steak at an Outback Steakhouse.

That's a chunk of horsemeat with grill
marks drawn on it with a Sharpie.

So no one's getting ethically
compromised by that.

This voluntary Pharma code is I guess
a step in the right direction.

So let's see how one of their members
have been abiding by it.

The justice department
filed a civil fraud lawsuit

against the Swiss
drug maker Novartis,

accusing it of paying kickbacks
and lavishly spending on doctors,

including taking some out to Hooters
in exchange for prescribing its drugs.

Don't worry, research has shown
the best medical decisions

are always made with an
Arizona State College football game

blasting in the background.

But at least Hooters
qualifies as a "modest meal".

They also paid doctors to speak
at places like L-2-0 in Chicago,

a restaurant whose Zagat
review reads, and I quote,

"Tabs may bring tears to your eyes,
so many say it's for special occasions

unless, of course,
you go on someone else's dime."

I'm guessing at the end of the meal,
the waiter came over and asked

"Separate checks ? Or one person
is buying your influence ?

Just one is it ? That's very nice
of him, there you go."

And at least
they were there for that one.

Many doctors took payments
for speeches they never even gave.

All of which Novartis has denied,

saying that everything they did
had a legitimate business purpose,

and besides,
speaker programs like theirs

are an accepted and customary
practice in the industry.

Which is kind of the whole point:
even in its best form,

hiring doctors as paid spokesmen
seems like a conflict of interest.

And multiple reports have found
that many drugs' top prescribers

are also often getting money
from that drug's company.

Which is worrying.
Because we trust doctors.

When you see Rihanna trying
to get you to drink coconut water,

you know
she's getting money to do that,

and you take that into account...

"I'm glad you're getting paid, Ri-Ri.
But I'm not going to drink that.

Because you and I both know
that coconut water

tastes like cereal milk
mixed with bull semen.

We both know that,

so I'm going to take that into account
when I make this decision for myself."

I know this has all been disheartening,
but luckily,

there is actually
some good news here.

A new clause in the affordable
care act will for the first time ever,

allow average citizens
to search a federal website

to see the perks given to physicians
by pharmaceutical companies.

I know what you're thinking:
what a federal web site ?

Made up of a list of doctors ?
Let me command T up a new tab !

This website
is actually kind of fascinating.

The first batch of numbers are online,
covering the last five months of 2013.

You can, and should go online and
look up your doctor at this address.

Maybe you'll find your doctor did
a little research for a drug company.

Or maybe, as Pro Publica did when
they looked at Pharma payments,

you'll find a doctor who's earned
more than a million dollars

delivering promotional talks
and consulting.

Or maybe you'll find a doctor who got
food and beverages worth four cents.

I have to know
what that meal was !

The only way a four-cent meal makes
sense is if that doctor is a mouse.

That's the only way
it makes sense.

Wipe Cheez-it dust off your whiskers
before you prescribe me anything.

There is information
on this database you should know.

This should be the beginning.

If drug companies
want to regain our trust,

maybe they should let us know
the effect their money has on doctors

in the only way they know how.

Have you noticed
anything strange about your doctor ?

Does he seem happier
than usual these days ?

Is he quick to prescribe drugs
you think you might not need ?

One more actually.

Does his waiting room
frequently feature

surprisingly attractive,
not sick looking people ?

That may be because your doctor
has been taking pharmaceutical money.

Pharmaceutical money takes forms
from free lunches to speaking fees.

Here's how it works:

money combines with the cash
receptors in your doctor's wallet

to create
fast acting financial relief

so your doctor
can rest easy and enjoy life.

Common side effects
of doctors taking money

may include
chronic over prescription,

unusually heavy cash flow,
dependency on free samples,

inflammation of confidence,

and an increased tendency to suggest
off-labeled prescriptions,

which in turn
can cause heart attack, stroke,

loss of feeling in arms and legs,

blurred vision, grinding of the teeth,
temporary deafness, total blindness,

numbness, sudden bursts of rage,
reduction of trust,

angry erections lasting
over 17 hours, and death.

Ask your doctor today if he's taking
pharmaceutical company money

then ask your doctor
what the money is for.

Ask your doctor
if he's taken any money

from the companies who made
the drugs he just prescribed for you.

Then ask yourself
if you're satisfied with that answer.

Pharmaceutical money, ask your doctor
if his taking it is right for you.

Finally tonight:
a quick word about Ecuador.

Ecuador's President is Rafael Correa
a charismatic leader

who once a week does an address
to the nation he calls "Citizen Link",

where some amazing things
can happen.

Yes ! That is how a president
should address a nation !

Every presidential speech from now
on should have somewhere within it,

in brackets, "clown enters."

These addresses
can clearly be pretty fun.

they can also take a darker turn.

Yes, darker even than a clown

because Correa frequently
uses them as a platform

to attack people
he feels insulted by.

He's ripped up newspapers
that have criticized him.

He doesn't realize that newspapers
tend to print more than one copy.

Last week, it got even worse,
when for some reason,

he decided to start calling out
individuals, by name,

who had been abusing him
on twitter.

Another little angel,
he is @tuiterovendido.

His real name
is Johan Arturo Caicedo Rovira.

So young. What a shame.
He's 18 years old, very young.

18... so young, so immature !
Unlike me,

the 51-year-old head of state who
is currently attacking him in public."

To be fair to him that 18 year old had
expressed a hope that Correa would die.

Correa should have people who take
care of that sort of thing for him.

Rather than spending,
like he did,

nearly 15 minutes
calling out online trolls.

Even attacking
one individual's Facebook page.

The little angel,
and I didn't even know his name.

He was just Crudo Ecuador.

He's got a whole bunch
of trash on his page.

Of course he has,
that's what Facebook is !

It's pages full of trash !

Stop Googling yourself,
you're president of Ecuador !

He explicitly encouraged his supporters
to tweet back at his attackers.

We are more. We will respond
in the exact same way my friends.

If they send 1 tweet, we'll send
10,000 because we are 10,000 to 1.

How are you now
getting involved in a Twitter war ?

You do know no one
has ever won one of those, right ?

It's impossible.
Look, President Correa:

if you're this sensitive, then Twitter
and Facebook might not be for you.

And to be honest, being a world leader
might not be for you,

unless you can build up
your tolerance for personal abuse.

Trust me: I've been through this.
I used to be very sensitive,

then I became a comedian,

and I got insulted so much
I can't feel anything anymore.

It's made me stronger as a person.
Emptier and stronger.

So you don't need less abuse,
you need more,

you need more abuse
to tip you over the edge.

So allow me
to help you right now !

President Correa:
nice smug smile you've got.

You look like a used
Jeremy Piven salesman.

You look like every
real housewife's third husband.

You're the only president
for whom this might be

the single most dignified moment
of your presidency.

By the way,
what the hell is happening here ?

That's a necklace
made out of penises.

That's not even a joke !
That's a dicklace around your neck !

And don't get offended by this,
President Correa.

Because if your skin was any thinner,
you'd be a taint.

So don't get offended !

I think we all know
what that music means:

a psychotic clown is about
to tell me my time is up !

But I would encourage
all of you to tweet insults

directly to President Correa's
Twitter handle

all this week to help him
get over his oversensitivity.

That's our show, thank you so much
for watching, good night !