How Medicine Became Big Business: The Hidden Roots of America’s Pharma Addiction

The modern world expects a pill or supplement for every complaint, from daily aches to fleeting worries. This culture didn’t simply emerge—it was built, layer by layer, through visionary reform, vast philanthropy, and eventually masterful marketing. Key players from the Rockefeller Foundation, Carnegie endowments, and Abraham Flexner transformed American medicine into a respected, centralized, science-focused profession. Decades later, Arthur Sackler leveraged this trusted system with marketing strategies that made pharmaceuticals and supplements a daily part of American life.

Laying the Foundation: The Reform of American Medicine

The Era of Reform

At the turn of the 20th century, American medicine was a jumble of proprietary schools, inconsistent standards, and questionable practices. Many practicing doctors lacked sound scientific training, and “patent medicines”—often unregulated and hazardous—were freely sold to the public.

The Flexner Report and Philanthropy’s Influence

This began to change in 1910, when educator Abraham Flexner published his landmark report, financed by the Carnegie Foundation and enthusiastically adopted by the Rockefeller Foundation. Their vision was clear: unify medical education around university-based, research-driven standards, close inadequate schools, and shift care away from folk remedies toward scientific medicine.

• Rockefeller Philanthropy:

  The Rockefeller Foundation poured millions into medical schools and teaching hospitals, establishing institutions like Johns Hopkins, University of Chicago, and the Rockefeller Institute for Medical Research.

  
  

• Flexner’s Lasting Impact:

  Medical training became rigorous and laboratory-focused, producing generations of physicians grounded in a scientific world view. These reforms turned medicine from a patchwork trade into an elite, respected profession.

By the mid-20th century, doctors held significant authority in the healthcare field, with patients largely deferring to their expertise. The U.S. healthcare sector was organized in a highly structured manner, focusing on professional, institutional, and scientific principles. These reforms made the medical profession more exclusive and emphasized the scientific nature of medicine. They also established high-cost structures that continue to influence healthcare today.

From Patent Medicines to Marketing Machines

Medicine’s Early Days:

In the late 1800s and early 1900s, “patent medicines” were advertised everywhere, promising miracle cures but often delivering little more than alcohol or opiates. These cure-alls were promoted directly to the public with flashy ads and fake testimonials. Public outrage and investigative reporting eventually led to the 1906 Pure Food and Drug Act, which forced truth in labeling—but didn’t end marketing excess.

With new rules in place, drug companies shifted focus. The main advertising audience became doctors, the gatekeepers to treatment.

The Master of Medical Marketing

Arthur Sackler emerged after the transformation wrought by Flexner and Rockefeller. With formalized, centralized medicine as his stage, Sackler saw fertile ground for aggressive, sophisticated marketing. He was more than a psychiatrist; he was the marketing pioneer who transformed how drugs were sold worldwide. In the 1940s, Sackler joined and later owned William Douglas McAdams, a top medical advertising agency. Sackler recognized that now, with medicine’s new authority and professionalism, doctors were the ultimate consumers—trusted by the public and insulated from the wildest days of patent medicines.

Sackler’s Playbook

• Influence Through Authority:

  Sackler didn’t just advertise; he embedded promotional material in peer-reviewed journals, sponsored “educational” conferences, and paid thought leaders to endorse new drugs. Like a brand making sneakers fashionable through celebrity athletes, Sackler made drugs popular by recruiting influential doctors.

  
  

• Blurring Ethical Lines:

  This is Sackler’s most controversial move. While running his ad agency, he simultaneously shaped strategies for several top drug companies. Behind the scenes, Sackler influenced the sales of competing drugs, making his agency appear neutral while actually controlling messaging from multiple sides. In reality, he coordinated campaigns and swapped marketing insights, allowing him to drive industry standards and norms—no matter which “competing” company paid the bill. What is not commonly known is that Sackler was also the majority owner of the competing ad agency L.W. Frohlich and IMS Health, Inc. now known as IQVIA.

IMS was a market research company that monitored physicians prescribing patterns, drug sales trends, and regional market dynamics.

Sackler used these analytical tools to design highly targeted and effective advertising and sales campaigns for his pharmaceutical clients, including Pfizer (Terramycin) and Roche (Librium, Valium).

• Creating New Needs:

  He made everyday issues sound like medical conditions—turning stress into “psychic tension,” tiredness into something only a pill could cure. These tactics mirrored the beauty industry’s campaigns convincing people they have flaws only special products can fix. By popularizing vague conditions or magnifying mild symptoms—they were able to turn minor complaints into treatable diseases, and making medication the go-to solution for an ever-growing list of problems.

Direct-to-Consumer Revolution

By the 1980s, Sackler’s tactics had spread far and wide. New regulations allowed TV drug ads, and suddenly medicines like Claritin or Prozac became household names. Companies spent billions ensuring the public believed they needed pills—prodding patients to demand their doctors prescribe specific brands. The “ask your doctor” message was everywhere. Prescription ad spending shot from $47 million in 1990 to over $5 billion by 2007.

This explosion made prescription drugs household names. Patients started walking into appointments asking for specific medicines by brand—much like a child asks for breakfast cereal from commercials.

Supplements caught on, especially after a 1994 law relaxed rules. Marketing campaigns for vitamins and herbal pills leaned heavily on the strategies Sackler made famous: emotional appeals, authority figures, and creating a sense of daily necessity—despite little scientific proof.

Tactics That Hooked a Nation

• Playing on Fear and Hope

  Many ads use the “what if” scenario—what if you don’t get enough vitamin A, or what if that ache is something serious? It’s much like a weather channel exaggerating a small storm, just to keep you tuned in. Fear sells.

  
  

• Creating Problems, Selling Solutions

  Companies will name a vague feeling, like “low testosterone” or “lack of focus,” and pin it to a pill. This is called “disease mongering.” They turn everyday ups and downs into apparent medical conditions—then offer the fix.

  
  

• Authority by Association

  Doctors in lab coats, celebrity endorsements, and scientific jargon make products seem credible. It’s like toothpaste brands saying “8 out of 10 dentists recommend...” The appeal to authority makes us trust the product.

  
  

• Repetition and Normalization

  Constant ads make pill-taking seem like part of daily hygiene. “Don’t forget your vitamins” sounds as normal as “don’t forget your toothbrush.”

How It Changed Us

Today, Americans are more likely than ever to pop a pill for any ache, worry, or tired day. Our doctors, heavily marketed to, may be more likely to prescribe branded drugs or recommend supplements. The message—crafted over decades—is that health is something you purchase and manage through products, not something you support through lifestyle.

Americans now take more pills, more often, than any nation in the world.

This shift has quietly altered not just individual habits but the entire healthcare system. Doctors, pressured by patient requests, are more likely to prescribe what’s popular. Insurance and industry money flow into new drugs, while low-cost solutions like diet and exercise get less attention.

The Perfect Storm

Sackler’s genius was only possible because of the groundwork laid by Flexner, Rockefeller, and Carnegie. Their reforms gave medicine unified authority, scientific legitimacy, and public trust. The field became insulated from the chaos of unregulated medicine—but also receptive to influence campaigns that trusted in the profession’s unbiased expertise.

Sackler exploited this prestige, guiding doctors, consumers, and even regulatory systems with tactics honed in advertising. He blurred the lines between education and promotion, science and sales, ensuring pharmaceuticals and supplements became daily fixtures in American life. His marketing strategies normalized the blending of science and promotion. As a result, skepticism regarding the motives of pharmaceutical companies has become a lasting aspect of public opinion.

Tragic Examples of the Playbook in Action

OxyContin: Selling Relief, Ignoring the Risks

The most pointed example of Sackler’s marketing brilliance—and its dangers—came with Purdue Pharma’s launch of OxyContin in 1996. Following his classic playbook, Sackler’s family pushed aggressive promotion, minimized addiction risks, and incentivized doctors nationwide. OxyContin sales soared, but so did opioid addiction rates—a crisis now recognized as one of the great public health failures.

Doctors, patients, and regulators trusted the polished message—and with widespread adoption came soaring addiction rates and a public health disaster. The OxyContin story revealed how influence could steer even a cautious, educated profession toward dangerous blind spots.

Accutane and the Retinoid Revolution

Accutane (isotretinoin), introduced by Roche in the 1980s, was heralded as a breakthrough for severe acne. Doctors who remembered the havoc of cystic acne embraced this new “miracle pill.” Marketing zeroed in on the medication’s transformative results, while side effects—birth defects, depression, gut issues, and immune system effects—were minimized or dismissed in training and advertisements.

Even after Roche pulled brand-name Accutane off the market due to lawsuits and mounting side effect reports, generic isotretinoin and spin-offs remained. Today, the same retinoid chemicals are still widely prescribed and promoted not only for acne but for aging and other conditions, and similar synthetic vitamin A derivatives (retinyl palmitate, retinyl acetate) are routinely added to processed foods and supplements labeled as “healthy.”

Overlooked Truths: Synthetic Vitamin A and Chronic Stress

What rarely gets discussed—partly thanks to decades of selective marketing—is the downside of daily or high-dose synthetic vitamin A (retinoids):

• Sensory Activation and the Stress Response:

  Modern research shows that retinoids (synthetic vitamin A) activate sensory receptors and the body’s stress pathways. Chronic, repeated activation alters brain signaling, ramps up stress hormones, and keeps the nervous system in chronic alert mode.

  
  

• Chronic Stress, Inflammation, and Disease:

  Low-level, persistent stress responses have been linked to chronic inflammation, which underpins conditions ranging from diabetes to gut disorders and neurological to mental health challenges.

  
  

• Downplayed in Medicine and Marketing:

  Promotional materials and even medical education focus on the visible short-term benefits of retinoids—acne-clearing or “anti-aging”—while underappreciating both the everyday risks and the systemic, slow-building impacts of excess synthetic vitamin A.

The Cycle Continues: Pills, Fortification, and the Supplement Surge

Decades after Accutane’s warning labels and OxyContin’s legal reckoning, Sackler’s playbook endures. Foods are marketed with “essential vitamins” like synthetic vitamin A—despite the downside of chronic dosing. Supplements claim to boost immunity and mood, regardless of existing nutrient status or potential risks.

All the while, the same pattern persists:

• Doctors are regularly shown only benefits in industry-funded education and promotional materials.

  
  

• Side effects—especially subtle, chronic, or psychosocial ones—get less attention.

  
  

• Consumers, aiming for optimal health, ingest retinoid pills, use retinoid creams, or consume synthetic vitamin A fortified foods, often unaware that these very interventions may keep their bodies in a state of mild stress and low-grade inflammation.

Reclaiming Awareness: History, Choice, and Responsibility

The point isn’t to vilify pharmaceuticals or doctors, nor to reject the real pain and suffering these medicines have helped alleviate. It’s to see the full picture: the history of reform and trust that made doctors powerful, the marketing sophistication that shaped medical practice, and the ongoing cycle where selective communication highlights benefits and dims concern over long-term impact.

What Now?

• Cultivate Critical Health Literacy: Learn the history. Question oversimplified claims about “miracle vitamins” and miracle pills—whether prescription or over the counter.

  
  

• Consider the Full Picture: Benefits and immediate relief matter, but so do side effects, chronic exposures, and subtle stressors.

  
  

• Ask, Listen, and Share: Discuss these histories and risks with your providers, family, and community. Push for clear, transparent information about what you’re ingesting.

  
  

• Remember, Health Is Holistic: Robust wellness almost always arises from balanced food, supportive relationships, daily movement, and meaningful rest.

  
  

Conclusion: Beyond the Playbook

We didn’t end up with a pill for every problem by accident. It took bold reforms, public trust, and generations of artful persuasion. The harmful stories of Accutane, OxyContin, and now, vitamin fortification show that influence continues—shaping the way we see health, risk, and even ourselves.

We can honor modern medicine’s advances and still see where the lines of science and sales have blurred. Only with curiosity, open conversation, and a willingness to look beyond the label can we reclaim health as something more than just a bottle on the shelf.

Every bottle tells a story. Make yours an informed one.

References

• Abraham Flexner. “Medical Education in the United States and Canada.” Carnegie Foundation, 1910.

• Stevens, Rosemary. “The Public-Private Division of American Medicine: The Politics of Health Policy.” The Milbank Memorial Fund Quarterly, 1971.

• Donohue, J. (2006). “A History of Drug Advertising: The Evolving Roles...” PMC.

• The Evolving World of Pharma Marketing, Pharmacy Times

• Harvard. Sackler-denaming-report-final.pdf, 2024.

• “The Family That Built an Empire of Pain,” The New Yorker, 2017.

• NCBI Bookshelf, Dietary Supplements: Introduction and Background, 2024.

• Rockefeller Foundation Annual Report, 1982.

• Feierman, Steven. "Rockefeller Medicine Men: Medicine and Capitalism in America." University of California Press, 1979.