
McKinsey Advised Purdue Pharma How to ‘Turbocharge’ Opioid Sales, Lawsuit Says - seapunk
https://www.nytimes.com/2019/02/01/business/purdue-pharma-mckinsey-oxycontin-opiods.html
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danieltillett
The people I really think should be held to account are those that suddenly
cut off all the prescription opioid addicts by changing the rules without
putting in place treatment options first. To expect millions of addicts to not
switch to street Fentanyl and end up dying in large numbers after being cut
off from prescription opioids is criminal stupidity.

~~~
bitL
What if that was done on purpose to reduce cost/long-term crime, masquerading
itself as stupidity?

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mpweiher
Then it's not criminal stupidity, but "just" criminal?

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ptd
When you make the laws, is becoming a criminal ever a fear?

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kolbe
I think by definition, they'd fail to be a criminal, and simply be immoral.

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mimixco
The legal papers linked at the start of this article make for a great read.
The Sacklers are monsters who got people hooked on ever increasing doses they
couldn't quit. It's not just about diverting and using the drug
recreationally; most of the addicts started out with legit pain needs.
Thousands of them are now dead.

~~~
dannylandau
It is easy to scapegoat the founders, but I know quite a few people, including
myself, where OxyContin was the only pain reliever that really worked. In my
case, took it after surgery. Not sure that Purdue Pharma is any worst or
better than other Big Pharma.

~~~
goldenkey
Same here. All these god-damned opiate laws made it so hard to get renewals of
medication for my chronic pain. And insurance stopped covering Tapentadol
which was by far the most effective and safest drug. In 2011 I was pummeled
and then tortured in LA by police/jail officials, which caused cervical spine
damage.

So I switched to kratom. Its a shame but kratom is much healthier anyhow. It
has vitamins and minerals and fiber, cant be overdosed on, doesnt cause
massive constipation, isnt as physically addictive, its an all around better
drug for daily pain management.

~~~
YjSe2GMQ
It's a well known fact for anyone practicing palliative medicine that often
you have to shuffle around opioids to see which one works. And there is really
nothing special about oxycodone, it's just another opioid that's been known
for over 100 years.

It's great that it worked for you guys (for real, it's fantastic), but the
whole concept of systematically pushing a particular opioid is disturbing.

~~~
goldenkey
Tapentadol isnt a standard opioid. Its an upgraded version of Tramadol that
required millions of dollars in funding to research and discover. It is by the
same company, Depomed, who discovered Tramadol. Tapentadol is an amazing drug
with better pain relief than actual standard opioids like morphine or oxy.

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dawhizkid
Is it really just McKinsey, or are these articles focused on McKinsey because
they are the most schadenfreude-inducing among big management consulting firms
(akin to the media outrage directed at Facebook)?

e.g. are BCG, Bain, the consulting arms of the Big 4 any more ethical in what
they will or won't do for a paying client? The story would be more interesting
if everyone outside of McKinsey refused to do consulting work for Purdue, but
that is something we'll probably never know.

~~~
will_brown
Yes it is news worthy for the same reasons facebooks role in the election was
news worthy, the same reason Goldman Sachs behavior was news worthy in the
2008 great recession.

People hold these companies and their employees in such high esteem (to the
point some people don’t thing articles should be published about their bad
behavior, rather articles should be published about other firms hypothetically
engaging in the same behavior if the companies in question didn’t).

At the end of the day the worlds biggest companies are willing to knowingly
take money from foreign governments to illegally spread propaganda to
influence elections, help firms sell drugs that literally end up killing
people, and sell their own investment clients toxic assets while offloading
their own position on the same assets.

You are right others may have engaged in the same behavior, but: 1. That’s not
news worthy and 2. other firms likely would have actually suffered real
consequences. Certain firms like Facebook and others continually receive bad
press because they continually engage in bad behavior but keep on like it’s
business as usual. In other words, the article is focused on McKinsey not
because there is a grand conspiracy against McKinsey, but because McKinsey
actually committed the bad acts the articles is about.

~~~
Alex3917
> help firms sell drugs that literally end up killing people

Keep in mind that's actually the best practice and it's what they were
supposed to be doing. The problem isn't that they were selling drugs that were
killing people, and it's that they were marketing them illegally and trying to
get people hooked on them who didn't even need them in the first place.

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amsilprotag
I guess McKinsey erred in accepting the work from Purdue, but it seems like
the consulting provided was obvious and likely overpriced. More at fault, in
my estimation, is the AMA and other physician standards bodies. Propublica
released a search tool [0] last year based on Open Payments Data [1] and the
numbers are ridiculous. My small state shows 10s of physicians receiving over
$100k over the recorded 2013-2016 period and a very long tail. Many on the
list are orthopedic surgeons and psychiatrists.

[0]
[https://projects.propublica.org/docdollars/](https://projects.propublica.org/docdollars/)

[1] [https://openpaymentsdata.cms.gov/](https://openpaymentsdata.cms.gov/)

~~~
arkades
Know that Gell-Mann amnesia effect that comes up all over Hn?

As a physician, former health insurance exec, and guy with a graduate degree
in health policy: propublica deserves deep skepticism.

~~~
dhbradshaw
This is worth drilling down on. What types of errors should one expect and
what are their causes?

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arkades
Largely they lack context to interpret what they’re seeing. One that jumped
out at me a while back:

They were showing physician payouts from Medicare and presenting them as
though they were salaries. Problem: some specialties carry overhead in their
Medicare payout.

When your cardiologist prescribes you a blood pressure medication, that money
goes to a pharmacy, not to the doctor. So your physician payout is X (cost of
visit.)

An oncologist prescribing you a chemo infusion, however, has to buy that
infusion from the pharmacy. Medicare then reimbursed doc Z (cost of the drug
plus a couple of percentage points). Docs Medicare payout looks like Z; his
take-home salary is actually about 0.03*Z.

The failure to distinguish between these meant that PP’s data massively over-
inflates these specialties’ salaries. PP just presents them at face value.

Or another: hospitals rarely charge their publicly posted prices. The vast
majority of their pay comes via rates negotiated with insurers. PP loves to
post their public numbers and go on about high variance numbers without any
recognition that those numbers are in no way pegged to the actual negotiated
rates. PP presents them at face value.

Largely, PP just doesn’t ever seem to dig deeply enough to find the nuances
and caveats in their data, to find how they relate to the actual underlying
questions that they -superficially- seem to answer, like “how much are
hospitals charging people for this procedure?” or “what kind of money are
doctors taking home?”

~~~
klenwell
Here's the introduction at the top of the ProPublica page cited by the GP:

 _Pharmaceutical and medical device companies are required by law to release
details of their payments to a variety of doctors and U.S. teaching hospitals
for promotional talks, research and consulting, among other categories. Use
this tool to search for general payments (excluding research and ownership
interests) made from August 2013 to December 2016._

[https://projects.propublica.org/docdollars/](https://projects.propublica.org/docdollars/)

That seems like pretty fair context. You seem to be referencing a different
article about Medicare reimbursement without actually citing it. That's a
dodge.

If the medical industry requires reams of context to understand its practices
and pricing, it's largely because pharma, insurers, medical groups, and
individual providers often go to obscene lengths to obscure their practices
and pricing.

I'm not going to waste skepticism on ProPublica that could better directed at
the American medical-industrial complex.

~~~
arkades
> That seems like pretty fair context. You seem to be referencing a different
> article about Medicare reimbursement without actually citing it. That's a
> dodge.

I'm not dodging anything. I'm pointing out that when I bother to read their
articles, they repeatedly get things wrong. The whole point of the Gell-Man
effect is: "I read things I'm an expert on. They get those things really
wrong. I am skeptical when they continue to write (on that topic) and (other
topics), because why would they get other things any more right?"

I'm not an expert on the nuances of the pharma payout reporting. I am an
expert on health care policy, health insurance, and clinical practice.
Everything they write related to that, that I have read, tends to be off-base.
If they regularly get healthcare stuff wrong, then yes, I apply skepticism to
them writing about closely related topics which I may not have the same
expertise in.

> If the medical industry requires reams of context to understand its
> practices and pricing, it's largely because pharma, insurers, medical
> groups, and individual providers often go to obscene lengths to obscure
> their practices and pricing.

(a) Any data of any complex, multi-component system requires reams of context
to understand. This is why "domain expertise" is considered one of the key
components of a competent data scientist.

(b) Our system is complex in part because >60% of our healthcare dollars
derive from either federal programs, state programs, or an intersection of the
two, which means they come with piles of regulatory things that complicate the
issue.

(c) Our system is complex in part because we have a free market system, which
is a fractured, multi-actor system (as opposed to a single-party-system). This
means cash-flow gets complicated by the fact that reimbursement flows to lots
of different interacting groups with dis-aligned interests.

(d) Our system is complex because we have a privatized insurance system, which
puts a for-profit actor between the consumer and the physician - and one who,
in partnering with certain provider groups, specialty pharmacies, etc.
effectively channels the demands of the consumers into preferred paths -
preferences determined by negotiated rates.

(e) Pricing tends to lack transparency because the vast majority of healthcare
dollars are via these third-party insurers, who each negotiate separate rates
with providers. Everyone involved in these negotiations has an incentive to
not let their negotiated rates become widely public.

If your need to point a finger of blame undermines your willingness to
understand the complexity of the system, you only do a disservice to yourself.
The system doesn't get _simpler_ just because you don't like its outcomes -
and attempting to modify it without understanding the interacting components
is doomed to massive unintended consequences. Or, in short, don't tear down
the fence until you understand why it was built.

>I'm not going to waste skepticism on ProPublica that could better directed at
the American medical-industrial complex.

That's a false dichotomy.

People providing inaccurate reporting that is critical of an industry don't
become more accurate because you are also critical of that industry. That's
just rationalization: "these guys must be above criticism because they
validate beliefs I already hold."

You _could_ be skeptical of _both_ parties. You could be skeptical of the
medical industry _and_ shitty reporting on the medical industry. You could be
skeptical of FB _and_ NYT's recent obsession with it. You could be skeptical
of etc. etc.

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dpflan
FTA: “If you’re complicit in causing a major social problem, it has become
very fashionable to also be engaged in solving that problem. And, in fact, in
trying to lead the solution chase.“

This is interesting, I wonder if teams within McKinsey working on different
sides of the issue were aware of each other.

~~~
pjc50
I've often heard people make this complaint about public services existing to
perpetuate the problem they're supposed to solve, but the same problem is much
easier to do when you're an amoral consultancy in the private sector.

~~~
yborg
[https://my.mixtape.moe/pvaozn.jpeg](https://my.mixtape.moe/pvaozn.jpeg)

My favorite of all of these.

For an executive, spending money on a brand-name consultant certainly can have
value in that he's able to hand off responsibility for failing to solve a
problem to an entity whose brand is more or less impervious to failure. It's a
win for everyone but the company putting up the money.

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lixtra
To me, McKinsey is so many layers away from the actual problem that I find it
difficult to single them out. The main responsibility lies with the doctor
prescribing the medicine. Then with the company that pushed and produced them,
then with McKinsey that consulted them and finally with the Uber drivers that
brought the sales people and the patients to the doctors.

~~~
danols
At the very top of that pyramid of blame you should place the elected
officials allowing corporations so blatantly to abuse its citizens for profit
for such an extended period of time.

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b_tterc_p
Article runs a weird line. Foremost, was it obvious at the time that opioids
would grow to be highly damaging? Maybe. Was it obvious to the consultants?
Maybe again. Some points here are rough.

“It was that year that Craig Landau, then Purdue’s chief medical officer and
now its chief executive, had an email exchange that included a McKinsey
consultant about how to counter mothers whose teenagers had overdosed on
OxyContin. The solution: bring in patients to emphasize how the drug helps to
relieve pain.“

This really does not feel malicious. It’s not discrediting the losses at all.

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code4tee
There seems to be a continuing chain of these damning stories about McKinsey
and its quesrionable ethics. Seems like the New York Times has one now every
few months. Has the firm lost its way or are lights just being put in places
McKinsey would rather they weren’t?

~~~
i_am_nomad
Maybe McKinsey hasn’t kept up its media buys in the NYT lately.

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onetimemanytime
>> _and “suggested sales ‘drivers’ based on the ideas that opioids reduce
stress and make patients more optimistic and less isolated,”_

Not American style justice, but making them take heroin-like painkillers would
be poetic justice. If it wasn't good for stress reducing and to make you feel
optimistic, McKinsey consultants would not have recommended that line of
promotion, no?

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heyjudy
I've met the acquaintance of some McKinseans: their prime modus operandi most
coincides with do-whatever-you-but-don't-get-caught anr money is personal
value meter. Of the closest ecno-political centroids, I'd say they're on the
spectrum of "free-market" libertarians, neocons and neoliberals who believe
"protect the establishment," "markets solve everything" and "externalities
don't matter."

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fefe23
Please don't take this personally. We have a situation here that I have seen a
few times and I need help understanding it.

We have an article in the New York Times. Some dude on Twitter reacts to it.
You link to the dude on Twitter instead of the Times.

Why?

Even worse, you did not even link to the dude on Twitter. You link to some
unrelated "thread unrolling" service, carefully making sure nobody who did any
of the work gets any of the traffic.

Have they treated you unfairly in the past to deserve this as punishment? I
don't get it.

That aside: McKinsey may be a horrible company, but they didn't make opioids.
Shouldn't we be focusing on the opiod makers here? I'm saying this as a
European who has no skin in the game.

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jlarocco
I agree, not linking to the original source is very annoying and makes it
difficult to understand what's going on and form an opinion.

But, doing a (very) little investigation, "seapunk" is the creator of this
Threader [1] web page, and is apparently spamming the service here [2].

[https://news.ycombinator.com/item?id=18400319](https://news.ycombinator.com/item?id=18400319)

[https://news.ycombinator.com/submitted?id=seapunk](https://news.ycombinator.com/submitted?id=seapunk)

~~~
seapunk
Indeed I’m the creator but I only share content that is relevant for the HN
community.

