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McKinsey Advised Purdue Pharma How to ‘Turbocharge’ Opioid Sales, Lawsuit Says

230 points by seapunk 8y ago

dpflan 8y ago
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 8y ago
  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 8y ago
    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.
- alalp 8y ago
  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.
dawhizkid 8y ago
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.
- spamizbad 8y ago
  we’ll considering the tremendous damage the opioid crisis has wrought I think it’s fair to say it’s not a triviality.
- Spooky23 8y ago
  McKinsey invented the category in many ways and is the gold standard to some. It’s like how anything Apple is a thing.
  - pklee 8y ago
    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
    - Spooky23 8y ago
      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.
    - softwaredoug 8y ago
      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.
lixtra 8y ago
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 8y ago
  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.
amsilprotag 8y ago
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 8y ago
  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 8y ago
    This is worth drilling down on. What types of errors should one expect and what are their causes?
    - amsilprotag 8y ago
      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.
      - yeahitslikethat 8y ago
        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.
danieltillett 8y ago
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.
- xxpor 8y ago
  Two things can be bad at once.
- bitL 8y ago
  What if that was done on purpose to reduce cost/long-term crime, masquerading itself as stupidity?
  - mpweiher 8y ago
    Then it's not criminal stupidity, but "just" criminal?
    - ptd 8y ago
      When you make the laws, is becoming a criminal ever a fear?
      - kolbe 8y ago
        I think by definition, they'd fail to be a criminal, and simply be immoral.
fefe23 8y ago
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.
- anigbrowl 8y ago
  * 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.
- Treegarden 8y ago
  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.
  - b_tterc_p 8y ago
    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.
- jlarocco 8y ago
  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
onetimemanytime 8y ago
>>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?
code4tee 8y ago
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 8y ago
  Maybe McKinsey hasn’t kept up its media buys in the NYT lately.
b_tterc_p 8y ago
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.
mimixco 8y ago
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 8y ago
  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 8y ago
    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 8y ago
      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 8y ago
        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.
heyjudy 8y ago
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."

230 points by seapunk 8y ago

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 8y ago
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 8y ago
  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.
alalp 8y ago
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.

dawhizkid 8y ago

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.

spamizbad 8y ago
we’ll considering the tremendous damage the opioid crisis has wrought I think it’s fair to say it’s not a triviality.
Spooky23 8y ago
McKinsey invented the category in many ways and is the gold standard to some. It’s like how anything Apple is a thing.
- pklee 8y ago
  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
  - Spooky23 8y ago
    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.
  - softwaredoug 8y ago
    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.

lixtra 8y ago

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 8y ago
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.

amsilprotag 8y ago

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 8y ago
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 8y ago
  This is worth drilling down on. What types of errors should one expect and what are their causes?
  - amsilprotag 8y ago
    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.
    - yeahitslikethat 8y ago
      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.

danieltillett 8y ago

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.

xxpor 8y ago
Two things can be bad at once.
bitL 8y ago
What if that was done on purpose to reduce cost/long-term crime, masquerading itself as stupidity?
- mpweiher 8y ago
  Then it's not criminal stupidity, but "just" criminal?
  - ptd 8y ago
    When you make the laws, is becoming a criminal ever a fear?
    - kolbe 8y ago
      I think by definition, they'd fail to be a criminal, and simply be immoral.

fefe23 8y ago

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.

anigbrowl 8y ago
* 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.
Treegarden 8y ago
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.
- b_tterc_p 8y ago
  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.
jlarocco 8y ago
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

onetimemanytime 8y ago

>>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?

code4tee 8y ago

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 8y ago
Maybe McKinsey hasn’t kept up its media buys in the NYT lately.

b_tterc_p 8y ago

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.

mimixco 8y ago

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 8y ago
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 8y ago
  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 8y ago
    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 8y ago
      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.

heyjudy 8y ago

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."