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McKinsey Advised Purdue Pharma How to ‘Turbocharge’ Opioid Sales, Lawsuit Says (nytimes.com)
230 points by seapunk 20 days ago | hide | past | web | favorite | 68 comments



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.


Two things can be bad at once.


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


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


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


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


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.


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.


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.


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.


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.


The legal documents reveal that they are pretty terrible people. It's not that oxi doesn't work; it's that they pushed doctors to get their legit patients to be on higher doses for longer times, making addicts and overdose victms.

It's precisely because this was directed at legit pain patients that it is worse. The opioid crisis wasn't caused by recreational drug users stealing grandma's pills. It was caused by the very rich people who ran Perdue and their never-ending quest to increase people's dose and number of refills.


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.


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.


> 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.


”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”

Are you talking about Facebook? There’s no proof of this happening and bundling it with legitimate concerns makes it easy to dismiss all of the arguments.


Worth reading what McKinsey did in South Africa: https://www.nytimes.com/2018/06/26/world/africa/mckinsey-sou...

Considering they took that deal even over the objection of some of their partners seems to me that not everyone, even the top firms, are as craven.


I knew of one ex- Morgan Stanley quant, who I purposely don't talk to anymore, because his department's product was economically strip-mining West African agriculture for a certain crop, while claiming to be helping. They helped themselves and cheated farmers and brokers with all sorts of BS.


McKinsey invented the category in many ways and is the gold standard to some. It’s like how anything Apple is a thing.


A book called "Lords of Strategy" tracks the consulting "apple" thing. It is a good read. Sorry for duplications. I think overall management consulting is a world ready to be distrupted (if not already). Regurgitation sold as overpriced thoughtware


It’s tough (speaking as a consultant at a smaller company). Large company procurement/legal basically limits the viable pool of competing consulting firms to those with sunk capital in their own big legal/procurement. And the big 4 management consulting firms have all perfected getting that large company’s client relationship and landing contract after contract.

It’s the same reason the same big 4-5 federal contractors win most of the work. The sunk cost in needed bureaucracy is large, it’s hard for a small player to compete.

The root issue is big co procurement has taken accountability away from the people who actually use and understand the services. So in my company’s case it’s common to start a relationship with a counterpart at a firm very willing to invest in our services. Sadly the procurement bureaucracy really gets in the way of progress making everything more expensive for both sides. If you’re Accenture and McKinsey you just (unethically in my opinion) sink the cost but then milk the relationship for all it’s worth.


It’s really dilution of blame. Actually doing anything in a corporation is hard, paying McKinsey to do what they do makes it easier, therefore there is value.


>"... 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?

Your comment is little more than "whataboutism." The post is commentary on the nytimes story about how the Massachusetts Attorney General suing McKinsey and specific instances of McKinsey targeting a doctor's practice in their state. So yes there is good reason to single out McKinsey here as they are the defendant in a lawsuit.

>"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)?"

This is just an ad-hominem. Informing the public and reporting on issues affecting their society and community is exactly the role of journalism.


I have noticed that most accusations of whataboutism are somewhat misplaced. It is not whataboutism to question why a certain company gets the brunt of journalistic targeting while similar other companies do not. If you disagree on the material claims, sure, feel free to point out your reasons, but accusing of whataboutism with just a vague defence of 'journalism', when it's clear that the field is rife with partial truths and outright deception, hardly puts your argument in good light.


My comment is very clearly in response to the OP's questioning:

>"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?"

This is literally asking "what about the other big 4 consulting companies?" There is nothing "misplaced" about my usage of the term here.

The article is about a lawsuit in which a specific company - Mckinsey is named as a defendant which I also stated. So clearly I have actually provided a reason for my assertion.

Lastly disproportionality of media coverage - of which the OP's does not provide any evidence of, does not make the lawsuit any less credible.


I think you’ve totally missed the definition of “whataboutism”. When questioning the ethics of a specific firm in an industry, it’s relevant if they are behaving exactly the same as everyone else in the same industry.

“Perdue chickens are kept in cages!” is flimsy journalism if every large scale chicken farm also keeps their chicken in cages, and the article fails to explain why Perdue is being singled out.

Reporting on air pollution by cars and how it’s changed over the years, and responding that coal power also pollutes, is whataboutism because there’s no expectation of why the pollution level of one would be relevant to the other.

Singling out BMW and talking about how much pollution those specific cars produce because they are more likely to be driven by white collar workers, without explaining if those cars are actually producing more pollution per mile, it would not be “whataboutism” to question - what about the pollution from other brands? Is BMW actually worse or do the people who drive them just make a juicy target?


>"I think you’ve totally missed the definition of “whataboutism”."

Not at all. Whataboutism is a variation on "tu quoque", the idea being an attempt to establish an equivalence between two disparate actions. The disparate actions here being McKinsey's active role in the opioid epidemic - the focal point of this article and the consulting industry's questionable moral compass. PWC, Deloitte and KPMG are not "also" pushing opiods.


They are consulting on other projects that are equally shitty and immoral, whether it be how to structure some financial instrument to screw someone over, or how to implement software to variably price some product based on protected factors, or how to price pharmaceuticals to maximize subscriber copays, or how to design a product with better obsolescence, etc. etc. etc.

Saying that McKinsey is uniquely shitty is perhaps a case study in missing the forest for the tree.

If they could be found criminally liable for all these things that they help their customers


we’ll considering the tremendous damage the opioid crisis has wrought I think it’s fair to say it’s not a triviality.


No they’re about the same. The NYTimes seems to have a bone to pick with McK for some reason.

Not to discredit any individual points, but the targeting seems odd.


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/

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


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.


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


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?”


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/

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.


> 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.


Looking closer at the data, almost everyone is receiving small travel, lunch payments. Many of the higher earners are receiving large sums for "Promotional Speaker/Other", "Consulting Fee" or "Current or prospective ownership or investment interest".

Comparing 10 or so names in the source data with the Propublica data, often Propublica has identical amounts and trasactions as the Open data, a few times Propublica's dollar amounts and transactions are higher. This might be evidence to support arkades's claim, but I can't be sure since I don't know the exact methodology.


They also get paid to speak about drugs. Thousands of dollars per lecture and interestingly the only people in attendance at said lectures are the physician and a drug rep and the venue is a restaurant.


> propublica deserves deep skepticism

Seconded. One of their journalists, Jesse Eisinger, quoted a paper to back a particular claim. I found the paper and discovered it said the opposite. Figuring a skimming mistake, I e-mailed Mr. Eisinger. The response was a brief dismissal, nothing more.


Very often "Gell-Mann amnesia effect" is invoked to mean "this story is complete rubbish" when what is actually meant is "I have a different, not necessarily correct, and very possibly self-interested interpretation of the facts"


In the interest of not getting unnecessarily combative:

I can't tell whether your comment was stated in a tone of "I generally think Gell-Man amnesia effect is misused on HN," or whether you meant it to directly criticize my comment.

Please clarify, if you don't mind.


Also deserving of skepticism: doctors who accept money from big Pharma.

It motivates over prescription. That's a scientifically proven fact.


One of my doctors refused to give me a prescription for a 25mg version of a medication over a 5mg version (pill could be cut in pieces and still as efficient), as the lower dosage was classified as "cosmetic", commanding 50x higher prices/mg, whereas the higher dosage was "life-saving", therefore cheap. Then I went to another doctor and experienced the same. The same doctor was recommending me to buy the higher dosage and split it into pieces just 2 years ago.


He probably got burned at some point and got scared. We get reviewed a lot more these days.

"You prescribed a 5x higher dose than he needed!"

"But I told him to cut it in five."

"That's not what you wrote in your documentation?"

"Well, if I wrote that in the documentation, it would have been documenting my own insurance fraud. I had to write that it was for (condition that requires 25 mg)."

"Did he have (condition that requires 25 mg)?"

"No, he had (condition that requires 5 mg)."

"So, which is it? Did you commit insurance fraud, or did you write him the wrong dosage?"

One is insurance fraud, the other is malpractice.

Why is it the doctor's fault that we're stuck in the middle of this shit system? Do people not understand that we aren't in control? The insurers, the federal regulators, the combination of the two, (Medicare), the state regulators, the combination of those two (Medicaid), congress, etc. They're in control. It's a happy day when our hands aren't bound from the start of our day to the finish. Don't blame us because we're the face you interact with.


Are doctors doing anything to end the requirement that patients get prescriptions for drugs? What are you doing to change the system? The AMA lobbies congress to keep it broken in the favor of doctors and detriment of patients.

Doctors control our right to live. It's contrary to life, liberty, and the pursuit of happiness, because we must get your permission to live.


> Are doctors doing anything to end the requirement that patients get prescriptions for drugs?

(A) Physicians are not some monolithic block. Whatever ones stance on the AMA, they are a single lobbying group. They are not the collective noun for “doctor.”

(B) I, personally, do plenty. I left health insurance for clinical work because I saw how few healthcare leaders understood how to forge more effective care models in the current landscape, and I wanted to do better for people.

(C) I am unaware of any movement among physicians to give people unfettered access to prescription medications (not to say that I’m omniscient - such a movement may exist outside my knowledge.) I would not support such a movement if it existed; it would do massive harm to the public.


What evidence supports your claim it would do massive harm to the public?

My evidence for the contrary is any of the countries in the world where prescriptions aren't required.


The explanation I've received was that they don't get any money from the higher dosage from insurance company and as I use it for "cosmetic" reason, I won't get the cheaper one.


Doctors don’t get money from insurers for drugs one way or the other, barring infusions (think: chemo.) An explanation that involves the doc not getting more money from the insurance company sounds like it may have lost something in translation.


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.


Having worked for McKinsey myself, I can assure you they are/were not. Client confidentiality is holy and you normally do not talk to your colleagues about the work you do. McKinsey oftentimes serves clients on both sides of an M&A deal for example and has strict procedures in place to keep teams separate.


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.


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.


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.


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.


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.


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?


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


>>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?


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."


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.


Ok, we changed the URL to the NYT from https://threader.app/thread/1091690262718496768.

Submitters: the HN guidelines say "Please submit the original source. If a post reports on something found on another site, submit the latter."

https://news.ycombinator.com/newsguidelines.html


* McKinsey may be a horrible company, but they didn't make opioids.*

For a nice fee, I'll draft you an actionable plan to commit the perfect murder. But hey, I'm not committing any myself and I can't help what people do with the things they learn from my super-specific and reliable murder consultancy services.


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/submitted?id=seapunk


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


I dont know too much about McKinsey (besides from the obvious) but I would like to know what why they might be a horrible company.


It’s probably better to say that all major consulting companies are complicit with all aspects of major markets. Almost every large company employs McKinsey or one of its competitors. Most people involved will not be working on “horrible” content. Some people will, largely driven by the area they work in.

Projects could range from making insurance more profitable (broadly speaking bad for society) to improving diversity and inclusion (a good thing).

Consulting firms are rental shops for talented workers.


> 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.

The "dude" on Twitter is an ex-columnist for the NYT. His perspective matters. By the way, the thread links to the author.




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