
McKinsey Advised Johnson and Johnson on Increasing Opioid Sales - acalmon
https://www.nytimes.com/2019/07/25/business/mckinsey-johnson-and-johnson-opioids.html
======
agiri
"How Management Consultants Steal Your Watch and Then Tell You the Time"

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3xblah
Cha-ching. (Sound of analog cash register closing.)

[http://www.news.com.au/finance/business/states-want-their-
cu...](http://www.news.com.au/finance/business/states-want-their-cut-of-
australias-growing-opium-poppy-industry/story-fnda1bsz-1226880076728)

"There is an enormous need in developing countries who don't have access to
pain relief, _it 's a human right_ to have access to pain relief."

Are we supposed to believe demand was being fueled by "developing countries"?

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jnmandal
I cant imagine how much Johnson&Johnson regrets their decision to take this to
court. This is gonna hurt their reputation for decades. Its basically the
second opium wars, except they went to war against their own country

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ttldr
there are a lot of comments on this thread about the moral hazard of
pharmaceutical advertising. i think the arguments against such advertising
largely hold water, but i’m curious; what are the arguments for it?

can anyone substantiate an argument for why consumer advertising for
prescription medications is good for patient outcomes?

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cwyers
I'm like, isn't this old news? But no, that was Purdue:

[https://www.motherjones.com/politics/2019/01/report-
mckinsey...](https://www.motherjones.com/politics/2019/01/report-mckinsey-
consulting-purdue-pharma-opioid-crisis/)

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bayesian_horse
"It's almost like these people were addicted to this stuff. Oh wait, they
are!"

Was an actual quote from distributors...

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bob33212
Reminds me of the tosh.o episode where he interview parents of kid actors

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dpflan
Sure, sell more of a product that _kind of_ sells itself without proper
advising. Some of these allegations seem predatory. How does this affect the
reputation of McKinsey and its future business? Would there actually be any
impact? They are good at their job. Is McKinsey attracting the same talent it
historically has or are other kinds of companies getting what would be their
talent?

""" McKinsey recommended “targeting and influencing” doctors who specifically
treat back pain in the elderly and those in long-term care. The consultants
also advised the company to move physicians who were “stuck” in prescribing
less potent opioids into prescribing stronger formulations. """

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albertshin
I wonder if it's just McKinsey is the bad apple in the mgmt consulting
industry or if NYT just has more inside sources there than at other firms.

[https://www.nytimes.com/2018/12/15/world/asia/mckinsey-
china...](https://www.nytimes.com/2018/12/15/world/asia/mckinsey-china-
russia.html)

[https://www.nytimes.com/2019/02/19/business/mckinsey-
hedge-f...](https://www.nytimes.com/2019/02/19/business/mckinsey-hedge-
fund.html)

[https://www.nytimes.com/2018/12/30/world/mckinsey-bribes-
boe...](https://www.nytimes.com/2018/12/30/world/mckinsey-bribes-boeing-
firtash-extradition.html)

~~~
mettamage
\--- table via google ---

Firm Employees (Year) Revenue (Year)

McKinsey & Company 21,000 (2017) $10.0 B (2017)

Boston Consulting Group 18,500 (2018) $7.50 B (2018)

Bain & Company 8,000 (2017) $3.8 B (2017 est.)

\--- end table ---

BCG is the only one that should have as much headlines provided they are
similar in nature to McKinsey. If they are, then your hypothesis might be
correct that the NYT has a lot of McKinsey sources. But how could you rule out
that newspapers simply like to bash the #1 instead of the #2 or #3 if the
industry leading companies are behaving in a similar fashion?

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khawkins
As someone currently dealing with chronic pain, suits like this are highly
aggravating. It's just another front of the failed drug war.

People who need pain relief get screwed as doctors, hospitals, and
pharmaceutical companies treat every single patient like they're a drug addict
waiting to happen. The real drug addicts will continue to get their pills,
while the upstanding members of society writhe in pain.

~~~
bob33212
I see comments like this on every single opioid news thread.

I'm sure that you are being honest about feeling that you need to take opioids
every day, but I'm sure that you understand the addictive nature of the pills
and why we should avoid making more people addicted.

I have had a total of two opioid pills in my life and I could feel exactly how
it could take over.

~~~
awakeasleep
The attitude towards prohibition that your parent comment described is
_exactly_ what set the stage for the recent opioid epidemic.

We were just coming out of another era where opioids were restricted to the
inhumane point where people with serious problems were left in debilitating
pain - to the point where Purdue's lies were accepted because doctors felt
genuine sympathy towards the suffering they saw.

There is a happy middle ground. There are people who benefit from opioid
medications.

It was bad moral choices by this generation's pharmaceutical companies that
caused this outbreak. That is where the fault lies.

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jormungand
Management Consultants: A bunch of 20 sth year olds with fancy degrees and
zero experience in growing a business helping huge companies grow by whatever
means possible. I always found this hugely ironic.

~~~
perspective1
And yet these consultants created a plan so successful NYT is writing about
it.

~~~
chaosite
20-year-olds are also quite good at selling addictive drugs.

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gringoDan
For better or for worse, consulting companies exist to:

1) Enrich their partners

2) Lend credibility to their clients

Consulting firms are hired based on an "appeal to authority" fallacy.
Companies don't want to make hard/unpopular decisions, so they outsource them
to consultants. Data point: management consulting is one of the industries
that is hit hardest by a recession. [0] If consultants truly provided value,
this is _exactly when they would be most needed_.

The people actually doing the work on these deals are 22-25 year olds. They
are highly incentivized to make their firm look good (thus enriching the
firm's partners). Anything else is gravy. Anecdotally, I have many friends who
worked in the industry, and when asked if they would hire consultants for
their own hypothetical businesses, the answer was always "No".

I highly recommend this article on McKinsey's work restructuring Puerto Rico's
debt - it pulls back the curtain on the industry:
[http://nymag.com/intelligencer/2019/04/mckinsey-in-puerto-
ri...](http://nymag.com/intelligencer/2019/04/mckinsey-in-puerto-rico.html)

[0]
[https://www.ft.com/content/1a229d54-4548-11de-b6c8-00144feab...](https://www.ft.com/content/1a229d54-4548-11de-b6c8-00144feabdc0)

~~~
harperlee
Overly cynical.

 _All_ companies exist to provide profits to their owners.

Your argument about the datapoint can also be argued for lending: credit
disappears when it’s most needed. It must be completely and utterly useless,
then.

Or perhaps when a crisis strikes, if you want to minimize spending, you first
eliminate consultant bills, instead of, idk, firing internal employees?

Part of the value of a consultant is that they are more mobile than an
employee, so they get to see the same problem in different companies, and get
expertise on that issue more quickly that if you stay on the first company in
which you solved that issue. I’ve dealt with the same very-specific software
on about 20 different banks, for example (disclaimer: I’m a consultant :) ); I
have people under 25 on the team that are real experts on very specific
things, and run cicles around people with 2x - 5x their experience if you
count it in days and not problems solved.

And then of course consultants are sometimes hired for the wrong reasons and
asked to do obvious recommendations. Politics were there before the
consultants arrived.

~~~
chibg10
>All companies exist to provide profits to their owners.

Management consultants nearly always have a conflict of interest though (i.e.
the preoccupation of consultants is almost always "sell, sell, sell" rather
than "help the client make money") due to the nature of their work and their
short-term contact-based engagements mean they rarely have to stick around and
deal with the messes that they create.

Large management consulting firms IME tend to hire (or develop maybe) people
who are smart and ambitious but highly conformist and reluctant to challenge
authority. Combined with nature of the work I described above (and ofc
existing to make owners /partners rich), this is sort of a perfect storm for
lots of "semi-unintentional" unethical behavior and sometimes fully
intentional unethical behavior.

Fwiw, from what I observed this dynamic actually makes the consulting work
environment terribly exploitative and miserable for non-partner consultants
but consultants tend not be the personality types who would leave consulting
(and the prestige/"potential to become a partner") over it --unsurprisingly,
else the industry wouldn't exist as it does now.

~~~
harperlee
> Management consultants nearly always have a conflict of interest though
> (i.e. the preoccupation of consultants is almost always "sell, sell, sell"
> rather than "help the client make money") due to the nature of their work
> and their short-term contact-based engagements mean they rarely have to
> stick around and deal with the messes that they create.

Not my experience at all. If you show value to the client and you build a
trust relationship then you enter into a relational mode that is fruitful for
both sides, and you skip/streamline all the tedious commercial topics (RFPs,
competitors, beauty contests, the purchasing department demanding a 3%
discount...). On the other hand, if you want to milk the cow dry then you end
up on a very transactional relationship and you need to start cold selling
from scratch after every project, which takes a lot of effort, time and
energy.

In any case, again, the conflict of helping the client vs. overselling is
hardly a consultant-specific topic; I’d say the smaller the shop, and the
closer the ownership to the sales team, the more pressure there will be, in
general. Case in point: the actual doctors that overprescribe opioids!

~~~
chibg10
>If you show value to the client and you build a trust relationship then you
enter into a relational mode that is fruitful for both sides, and you
skip/streamline all the tedious commercial topics (RFPs, competitors, beauty
contests, the purchasing department demanding a 3% discount...). On the other
hand, if you want to milk the cow dry then you end up on a very transactional
relationship and you need to start cold selling from scratch after every
project, which takes a lot of effort, time and energy.

This is greatly at empirical odds with the near ubiquitous distrust for
consultants among almost everyone who has worked with them.

And there is certainly no shortage of willingness to repeatedly cold sell in
order to advance one's own career in consulting.

~~~
harperlee
> near ubiquitous distrust for consultants among almost everyone who has
> worked with them

Perhaps this empirical observation doesn’t have enough unbiased samples.
Consulting in general, more in particular management consulting, and even more
in particular strategy consulting (where MMB, McKinsey, Boston, Bain are
leaders; and the kind that sparkled this discussion), are 3 different, huge,
mature, global industries. So there are empirical odds enough to say that
people trust them enough to pay them, which is at odds with that universal
distrust you state.

Perhaps that “ubiquitous distrust” is just more prevalent in HN or in the IT
industry.

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cwkoss
The marketing of medicine in inherently unethical because it seeks to override
doctors and consumers information-based evaluations, and instead make a choice
based on emotional propaganda.

The harm caused by any given medical advertisement is directly proportional to
its effectiveness. Every pharmaceutical sales rep is an immoral cancer on our
society.

~~~
refurb
This may come as a shock to you, but marketing pharmaceuticals is really no
different than marketing other products. It really comes down to educating
consumers about your product.

Doctors as decision makers are not some monolithic block of individuals who
are super educated about every product on the market and every piece of data.
Just developing awareness of new drugs is a huge job. I'd say less than 5% of
doctors are cutting edge enough that they require no additional education on
new drugs.

The best story I can tell was from a friend who worked at a drug company that
sold a hepatitis C drug. Once Gilead's drug came out, this company basically
decided to discontinue their drug. Incredibly, there were doctors out there
still ordering the old drug. The company had to send reps out to these doctors
to _tell them to stop ordering it_. Continuing to use it made zero sense at
all.

~~~
mr_crankypants
The problem here is that pharmaceutical companies' marketing departments have
a deep conflict of interest. They're incentivized to encourage doctors to use
the drug that makes their company the most profit, not the drug that is best
for the patient.

And there is plenty of research demonstrating that this is exactly what they
do, and that doctors are indeed swayed by it, because, as you say, they don't
have the time to do keep up with it all on their own.

And yes, there is a fundamental difference to consider here: My doctor has a
fiduciary responsibility to do what's best for my health, to the best of their
ability, and drug marketing compromises that. By contrast, nobody has any
fiduciary responsibilities related to which brand of toilet paper I use.

~~~
refurb
My counter to your comment, and my own personal experience, is that doctors
are fully aware of the manufacturers conflict of interest. They know that the
drug companies will present everything in the best possible light.

Other things that exist to counter this bias are competitors, who will provide
a different perspective and most importantly, the FDA that regulates all
pharmaceutical promotion for accuracy and will quite swiftly drop the hammer
on a company that bends the rules.[1]

[1][https://www.fda.gov/drugs/warning-letters-and-notice-
violati...](https://www.fda.gov/drugs/warning-letters-and-notice-violation-
letters-pharmaceutical-companies/warning-letters-2019#OPDP)

~~~
theaustinseven
Yeah, but this starts to break down when the pharmaceutical representatives
can give laundered incentives(fancy "educational" dinners, "educational" yacht
parties, etc.) to prescribe their product. In the US, pharma reps can see the
prescription amounts of doctors to verify that they are actually prescribing
their product(last I heard from a pharma CRM company in 2016). This seems
deeply and fundamentally unethical.

Then you bundle all that up with the various studies that show that doctors(as
with all professions) do a poor job with continuing education so that they are
further inclined to take the recommendation from the pharma reps(which can be
seen in the roots of the opioid crisis), I don't think we're in a very good
place from a regulatory standpoint.

~~~
refurb
The practice of greasing the skids with lavish events ended a while back. Drug
companies can't even give free pens to their doctors now.[1]

[1][http://phrma-
docs.phrma.org/sites/default/files/pdf/phrma_ma...](http://phrma-
docs.phrma.org/sites/default/files/pdf/phrma_marketing_code_2008.pdf)

