Medical Reference Tools and Pharmaceutical Promotion: A History of Entanglement

Reference tools are often uncritically accepted as balanced, objective, definitive, and evidence-based guides to medical knowledge. Yet for centuries textbooks and manuals have been entangled in various ways with industry interests. This essay shows how reference tools have served as sites of pharmaceutical promotion. Focusing on 2 reference tools, The Merck Manual and The Management of Pain, the authors sketch the complex and dynamic ways that Merck & Company and Purdue Frederick Company used medical reference texts to advance their market interests over the 20th century. Merck leveraged its eponymous Manual initially to promote its own products and later to elevate its brand name amid a public relations storm. Purdue's influence on pain medicine textbooks and prescribing manuals was less direct: By subsidizing the creation of pain medicine's flagship textbook and cultivating goodwill from key leaders, the company shaped the direction of many of the field's reference tools. As reference tools evolve over the 21st century, combining in new ways with machine-learning models, a historical perspective alerts us to the enduring influence, and vulnerabilities, of these aids to thought.