Dreamland (5 page)

The town was a cradle of professional football. Jim Thorpe coached the Portsmouth Shoe-Steels. Later, the Portsmouth Spartans joined the National Football League. The Spartans moved to Detroit during the Great Depression and became the Detroit Lions.

Some say Portsmouth’s long trip down began with the flood of 1937, when the Ohio River rose seventy-four feet after forty days of rain. What is true is that by the 1970s, Portsmouth was collapsing, along with the rest of what was becoming the American Rust Belt—a region unprepared for globalization, competition, and the cheaper labor in countries like Mexico. The shoe factories began closing. Selby Shoes was long gone. Williams Shoes hung on longer, trying to compete with Italy and Taiwan and Mexico. But soon Williams left, too, and the factories’ empty shells remained as reminders of what had been.

Detroit Steel departed in 1980, the year Portsmouth was named an All-American City for the second time. Thousands of jobs went with it. The city didn’t recover from that. The brickyard closed, too. So did the atomic energy plant up in Piketon. The coke plant that supplied Detroit Steel, meanwhile, closed in stages and finally gave up in 2000. A Walmart replaced them both. Near the retailer still stands the coke plant’s smokestack.

Families fled to Columbus or Cincinnati or Nashville. A group of artists moved to Austin, Texas. Portsmouth’s population deflated to twenty thousand. Unsellable houses were rented out or stood empty after landlords moved away. Stores on Chillicothe Street closed one by one until there wasn’t much left there at all.

Remaining behind was a thin slice of educated people. They found work in the schools or the hospitals, in some way or other tending to those for whom factory closings were the beginning of an American nightmare.

About the only new folks who came to Portsmouth then were merchants of the poor economy. Portsmouth got its first check-cashing places and its first rent-to-owns. Pawnshops and scrap metal yards opened. And David Procter expanded his practice.

Many swore by Procter. Hard work was part of life in the area, and by then so was unemployment. The region slumped and the numbers of people applying for disability or workers’ compensation shot up. Federal disability became long-term unemployment insurance for many in the Ohio River valley. Some were legitimately hurt or disabled; some weren’t. But they all needed a doctor’s diagnosis. Procter processed workers’ comp paperwork fast. At Portsmouth’s small Southern Hills Hospital, where Procter had privileges, nurses remembered him as the top admitter to the psych ward—mostly in an attempt to make patients eligible for disability.

Procter was married, with two sons living in Kentucky. He was also a flirt, and staff saw him out in the parking lot at times in a lovers’ quarrel with a nurse.

At Southern Hills, Procter ran through his rounds—literally ran. He was at high speed, animated. A new attitude was taking hold in American medicine at the time. The patient, it held, was always right, particularly when it came to pain. The doctor was to believe a patient who said he was in pain. David Procter embodied this new attitude, and then some. He had a folksy style, with a little of the evangelist in him.

“His patients loved him because he had the ability to figure out what that person believed or needed or wanted,” said Lisa Roberts, who was a hospital nurse at the time. “He was brilliant in that way, to forensically identify vulnerable people and figure out what they needed or believed. He would tell them they had all these things wrong with them.”

Procter was paid in cash at his South Shore clinic. In the mid-1980s, the medical world wrestled with how to use the new opiates that pharmaceutical companies were developing to treat pain. David Procter was an early and aggressive adopter. He prescribed opiates for neck, leg, and lower back pain, arthritis, and lower lumbar spine pain. He combined them with benzodiazepines—anxiety relievers, of which Valium and Xanax, Procter’s favorite, are the best known. In Portsmouth, people had anxiety and they had pain. Appalachia had a long history of using benzodiazepines—dating to the release of Valium in the early 1960s. Little old ladies used it. In this part of the country, anything that relieved pain was welcome. But opiates and benzos together also led quickly to addiction.

By the mid-1990s, Procter was also known to prescribe a lot of diet pills and stimulants, even to those who weren’t fat. A modest industry evolved in and around Portsmouth of scamming prescriptions for diet pills from willing docs like Procter, then selling the pills for a profit. His Plaza Healthcare clinic boomed.

In 1996, one who went to visit him was a man named Randy, a guard at the state prison in Lucasville ten miles north of Portsmouth. Randy suffered deep bruises to his back in a fight with an inmate. He was given a list of approved doctors to see. One was David Procter.

“Several guys from the prison went there because his office could take care of the [workers’ compensation] paperwork,” Randy remembered.

Procter took him off work for six months and, sure enough, handled all the paperwork, charging him two hundred dollars cash. He also prescribed a drug called OxyContin—40 mg, twice a day, for thirty days. The drug was a new painkiller, he said, and they were having good results with it.

“Looking back on it, [the injury] was nothing that warranted that harsh of a drug,” Randy recalled. “But at the time, you’re thinking this is great because I don’t feel my back.”

Thirty days later, Randy figured he was better and didn’t return to Procter for a refill. Soon he was gripped by what he thought was the worst flu of his life. He ached, couldn’t get out of bed, had diarrhea, and was throwing up. He talked to some friends. One suggested he might be going through withdrawal.

Then it hit him: You’ve got to go back.

Procter prescribed him more of the same. Randy returned every month, paying two hundred dollars cash for a three-minute visit with Procter and an Oxy prescription. Procter’s waiting room overflowed. People fought over space in line. Only a handful of patients were there for injuries. The rest were feigning pain, scamming prescriptions, with the doctor’s connivance. Randy saw six fellow prison guards in the waiting room. He kept his head down, got his Oxy prescription, and left.

“You’re seeing people who you know are probably going to be locked up in one of your cellblocks,” he said. “It really humbles you. You think you’re doing stuff the way it’s supposed to be done. You’re trusting the doctor. After a while you realize this isn’t right but there really isn’t anything you can do about it. You’re stuck. You’re addicted.”

Before long, he found street dealers he could go to if he ran out during the month. He returned to his prison job. But by then fully addicted to an opiate, he began arriving late and making excuses. Desperate, he finally went to a deputy warden. He got into treatment and got clean. Three and a half years after going to David Procter the first time, the addiction was over for Randy.

For the Ohio River valley and America, it was just beginning.

The Adman

New York, New York

In 1951, an adman named Arthur Sackler from a little-known marketing firm met with the sales director of a small hundred-year-old chemical concern named Charles Pfizer and Company in New York City.

Arthur Mitchell Sackler was thirty-nine and already had a career of achievement as a psychiatrist behind him.

He and his brothers, Raymond and Mortimer, had grown up in New York, the sons of eastern European Jewish immigrants. They attended college during the Depression and all three passed briefly through the Communist Party, according to Alan Wald, author of
American Night: The Literary Left in the Era of the Cold War
. Arthur Sackler began his publishing career on his high school newspaper. During the Depression he printed single-handedly what Wald called a “crude strike bulletin” for the Communist Party. Sackler took art classes at night and paid for his schooling with odd jobs.

Finishing his medical studies, Sackler became a psychiatrist at Creedmoor, a New York mental hospital. There, he wrote more than 150 papers on psychiatry and experimental medicine, and identified some of the chemical causes in schizophrenia and manic depression. He was an antismoking crusader long before it was popular, and prohibited smoking at the companies he would later own. At Long Island University, he started Laboratories for Therapeutic Research, which he later directed and supported with large donations. Meanwhile, he established the first racially integrated blood bank in New York City.

Sackler watched medicine change radically during the postwar years. Scientific advances were allowing companies to produce life-altering drugs—antibiotics and vaccines in particular. It was an effervescent time, though less so for medical advertising, which remained plodding and gray even as the new drugs it promoted were changing the world. Sackler saw no reason this should be. He switched careers in the 1940s and hired on at William Douglas McAdams, a small, rather staid medical advertising firm.

Before long one of his clients was Charles Pfizer and Company, then the world’s largest manufacturer of vitamin C. The company’s newly formed pharmaceutical research department had developed a synthetic antibiotic, first derived from soil bacteria, that it called Terramycin and that had proven effective on more than fifty diseases, including pneumonia. The company was moving from chemical manufacturing to pharmaceuticals. Instead of licensing it to a drug company, Pfizer wanted to sell the antibiotic itself.

In the office that day, Sackler told the company’s sales director, Thomas Winn, that with a large enough advertising budget for Terramycin, he could turn Charles Pfizer and Company into a household name among doctors.

Winn gave him a budget larger than any company had ever spent to advertise a drug. Sackler “plastered the media with what would be called now a teaser campaign,” said John Kallir, a copywriter at William Douglas McAdams at the time.

The Terramycin campaign aimed at frequent contact with individual doctors—a radical new concept. Sackler put large color ads in medical journals with plays on the word “terra” (Italian for earth): “Terra Bona” and some others. When the drug was finally released in America, he placed ads in the same font and color, saying “Terramycin.”

Meanwhile, Sackler’s ad writers in New York wrote thousands of postcards meant to appear as if they were from Egypt, Australia, Malta, and elsewhere. They mailed these cards, addressed individually to thousands of U.S. family doctors, pediatricians, and surgeons, describing how Terramycin was combating diseases in these exotic locales—“milk fever” in Malta, “Q fever” in Australia. The cards were signed “Sincerely, Pfizer.” Doctors already known to prescribe a lot of drugs got extra direct mail.

Then Sackler sent salesmen on visits to doctors’ offices. “They were intensive drives,” Kallir said. “At the same time, we had a very heavy schedule of direct mailings, several mailings at a time to these doctors, along with journal ads.”

Kallir remembered that Sackler paid to have a Pfizer
Spectrum
, an eight-page glossy house organ, inserted in the monthly
Journal of the American Medical Association
for a year.

All that combined with the drug’s efficacy to make Terramycin a blockbuster—with forty-five million dollars in sales in 1952. Based on its Terramycin success, Charles Pfizer and Company expanded to thirteen countries, and eventually changed its name to Pfizer.

Sackler’s campaign marked the emergence of modern pharmaceutical advertising, a field that up to then, in the words of one executive, “existed but it didn’t.” Seeing the future, Sackler bought the firm he worked for, William Douglas McAdams.

As an aside, he and his brothers also purchased an unknown drug company: Purdue Frederick, formed in the 1890s, during the days of patent medicines, by John Purdue Gray and George Frederick Bingham. The company had limped along since then, and until our story begins to unfold in the 1980s, it was still known mainly for selling antiseptics, a laxative, and an earwax remover.

Arthur Sackler, meanwhile, continued to transform drug marketing. In 1963, he licensed from Hoffman-La Roche the right to import and sell a new tranquilizer called Valium. Sackler again emphasized direct doctor contact to promote the drug. “Detail men”—salesmen—frequently visited doctors’ offices bearing free samples of Valium. He put booths at medical conventions, and frequent multipage color ads in medical journals. He published another glossy monthly magazine with stories about what well-known doctors were up to, along with other news, and Valium ads.

Part of the campaign aimed to convince doctors to prescribe Valium, which the public saw as dangerous. Ads urged doctors to view a patient’s physical pain as connected to stress—with Valium the destresser. If a child was sick, maybe her mother was tense. Valium was marketed above all to women, pitched as way of bearing the stress of lives as wives and mothers. Before the feminist movement, women were presumed to need that kind of help for the rest of their lives, thus there was no worry then about its addictiveness.

Among Arthur Sackler’s many talents was that he thought like a family practitioner. Docs were barraged with patients who were tense, worried. “The patient would walk in, ‘I’m nervous all day long, doctor.’ Or ‘My son’s in the army,’” said Win Gerson, who worked for Sackler for years and later became president of William Douglas McAdams. “People were walking around nervous, worried, and this drug absolutely calmed them. It worked for certain types of back pains. It kind of made junkies out of some people, but that drug worked.”