For a man with a name that sounds like a vintage Italian motorcycle, Peretti runs pretty smooth. The creator of The Men Who… documentaries – The Men Who Made Us Fat (about the food industry), The Men Who Made Us Thin (about the weight loss industry) and the surely inevitable but yet to come The Men Who Made Us Fart (about fashionable diets) – recently presented his latest mini-series, The Men Who Made Us Spend, about marketing. Tooling around the globe in vest and V-neck (how about The Men Who Made Us Shirtless, about bankers?), Peretti kicked off by exposing the hidden suicide pact engineered into products to ensure they go pop before their time, and we buy a new one. First up was Osram, who a hundred years ago put the blow back into bulbs, thus ensuring that when the lights went out for the consumer, the profits went up for the manufacturer. More recently, we have the doomsday counters hidden in printer consumables that announce game over even when there is still plenty ink in the cartridge. A picture emerged of a world where cynical industries push kamikaze products on gullible punters to keep the manufacturers in profit. Had Oscar Wilde been in the manufacturing line, he would have known what to say. Either the product goes, or I go.
The next episode focused on fear. Fear is why hockey moms drive the urban school run in tanks, and the rest of us use ant-bacterial hand-washes when good old fashioned Imperial Leather mostly works just as well. The blue-print is to generate a fear, and then offer a solution. Listerine was the solution to eternal spinsterhood caused by bad breath. The odour situation got worse as Peretti pulled more stinking rabbits out of smoking hats, or it may have been smoking rabbits out of stinking hats, as the marketing miasma was by now making Dr No’s eyes water. But the really interesting example, which turned a late-coming drug that almost never made it to market into the most commercially successful drug ever, turned fear based marketing on its head. Instead of presenting illness as something to be afraid of, Parke-Davis/Warner Lambert and their partner-then-owner Pfizer made illness fun. Out went downers like sudden cardiac death and paralysed stroke victims, and in came fun. Lipitor – a statin – was marketed on the back of a light hearted campaign that urged Americans to ‘know your number’, their blood cholesterol level, and the fun was to compete, to get the score lower, much as one might with a golfing handicap. Lipitor was sold as the game changer, the dope that best lowered the number.
The campaign was extraordinarily effective. Because Pfizer’s advertising focused on a blood test result, rather than a real disease, it could sell direct to consumers. Fit healthy Americans were urged to take a blood test and visit their doctor – often a doctor primed by Pfizer reps on how great Lipitor was – for a Lipitor prescription. By selling to the masses, as well as doctors, Pfizer achieved massive sales, and the rest, as they say, is history.
Only it isn’t. Statins for fit healthy people are highly controversial. Earlier this week, BMJ editor Dr Fiona Godlee once again rightly defended her decision not to retract two opinion articles that called mass statin prescribing into doubt. The statin daleks once again lined up to fire their pharmaceutical rays: statinate, Statinate, STATINATE! Yet the extraordinary thing is the best research we have to date is quite clear: statins are of no overall benefit to fit healthy people with a low risk of cardiovascular disease. They may very occasionally prevent a heart attack or a stroke, but that rare benefit is wiped out by other harmful effects. Overall mortality is the same, whether these people take a statin or not.
The bizarre notion that masses of fit healthy people should take a drug that isn’t going to benefit them doesn’t have it’s origins in science, but in marketing. Pfizer’s Lipitor marketing didn’t just put statins on the map, it all but got them put in the water. The coup relied on removing fear and replacing it with a bit of harmless – only it isn’t harmless – fun. Know your number, take the pill. A triumph of marketing over medical science, and a bad day for the rest of us.