13 ms·
McKinsey Advised Johnson and Johnson on Increasing Opioid Sales
- dpflan 7y agoSure, 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. """
- bob33212 7y agoReminds me of the tosh.o episode where he interview parents of kid actors
- cwkoss 7y agoThe 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.
- gringoDan 7y agoTo play Devil's Advocate - without pharmaceutical companies developing and marketing drugs, how do we set up an incentive structure that encourages R&D and innovation?
- creaghpatr 7y agoAnother Devil's Advocate argument- make patients aware of drugs that could solve XYZ health problem that they weren't previously aware of. They just want you to "ask your doctor about..."
- Retric 7y agoI can see advertising that a condition exists and or a treatment for it exists. But, I have no idea why naming a specific drug benefits the public.
- the8472 7y agoSubmit them to a central, vendor-independent database so doctors (or consumers for non-prescription) can find available ones based on their ailments.
- refurb 7y agoI think the takeaway is that is already available and doctors don’t consistently use it.
- SolaceQuantum 7y agoFrom what I understand the vast majority of innovative pharmaceuticals are funded by academia.
- ls612 7y agoThe vast majority got their start in academic settings. Most of the R&D money (in particular the expensive phase 3 clinical trials) is spent by pharmaceutical companies.
- SolaceQuantum 7y agoYes, so the actual innovation occured in academic settings, as was the query.
- sgt101 7y agoNo, that isn't the case. The fundamental research occurs in academia, but early development which includes working out how to deliver it, how to mitigate side-effects and then the clinical trials. Getting a drug into use is very distant from finding compounds in a lab.
- tathougies 7y ago> so the actual innovation occured in academic settings, as was the query. Well no not at all. Innovation is both the process itself + the supporting requirements necessary to make it work on a massive scale. We cannot minimize the cost of investment in making sure treatments are effective and non-harmfulu in the general population. That is a critical part of medical innovation.
- refurb 7y agoAbsolutely not. That’s like saying Apple didn’t invent the iPhone because Shockley discovered transistors.
- deogeo 7y agoWhy attach all of developing and marketing, when it's only the advertising that's in question? Doctors/hospitals can learn about new drugs through dry, informative leaflets - TV ads or salesmen talking directly to doctors distorts the demand.
- dooglius 7y agoWhy do you think advertising promotes innovation? I would see it as the other way around, why innovate when you can just invest more into advertising an inferior product?
- davidivadavid 7y agoBecause consumers aren't stupid and that doesn't work, probably? Because your competitor will gladly advertise their more innovative and better product, and yours will look inferior?
- dooglius 7y agoCan you discern the quality of two different drugs based on their respective ads? I certainly can't, if you have a way, I'd be interested to hear it.
- UnFleshedOne 7y agoIf you drug looks inferior to competitor's ad, you will get better return by hiring a better ad agency, not a researching a better drug (that's a crap shot at best times).
- cwkoss 7y agoI find the argument that humans will stop studying pharmacology if they can't monopolize their results quite unconvincing. Current pharma co R&D and innovation only effectively investigates the benefits of drugs with recent patents (with enough years remaining to monetize). There is moral validity to profit-seeking investment in drug trials which find effective treatments, but the current system enables this only with great amounts of inefficiency.
- sgt101 7y ago>I find the argument that humans will stop studying pharmacology if they can't monopolize their results quite unconvincing. agree >Current pharma co R&D and innovation only effectively investigates the benefits of drugs with recent patents (with enough years remaining to monetize). Can you elucidate the connection to your first statement - I don't see how that follows.
- cwkoss 7y agoDefenders of drug monopolies often argue that removing the monopoly will reduce our intensive drug research spending. This may be true. However, I'd argue that the focus of this intensive drug research spending is perverted by economic incentives and overinflated because of the artificially constrained scope. For-profit Pharma companies have a fiduciary obligation to only invest in research which they can profit from. This leads them to only invest in research in the tiny proportion of "interesting drug candidates" that can be monopolized. Ex. - Imagine scientists find that saffron can be an effective antidepressant with few side effects. They research the active molecule and find that adding a bromine atom would make the molecule patentable, but it is slightly less effective and has more side effects. The drug company has an incentive to spend great amounts developing the less-effective patentable drug, and no incentive to research the other. Drug company has incentive to try to convince the public that their inferior molecule is actually preferable. Now, we have a lot of data about the safety of saffron - people have included in their diets for hundreds or thousands of years. If this can be used to treat depression, it will likely have a much better safety profile than a novel molecule which has never been ingested by humans before. The therapeutic index of saffron (delta between effective dose and aversive side effect dose) is huge! Likelihood of getting it through safety trials has very high bayesian prior. (Saffron as antidepressant is an area of recent research - all papers I've seen published by academics https://scholar.google.com/scholar?hl=en&q=saffron+antidepressant https://scholar.google.com/scholar?hl=en&q=saffron+antidepre..., I made up the bromine part for the example. Saffron may also be useful as anti-tumor and in ADHD treatment) Pharma Co's may be investing intensely in researching a tiny fraction of drugs, but this fraction is less likely to contain the safest candidates and thus I don't think those dollars are being spent very effectively.
- inflatableDodo 7y ago>how do we set up an incentive structure that encourages R&D and innovation? Well, there's disease, death, suffering and injury. If you need more of a structured incentive than that, then I am not sure really what to suggest.
- cryoshon 7y agoprovide big bounties for drug development. from the government. we're gonna pay for the drugs either way, so we may as well create our own incentive structures to ensure that it's done right.
- mirimir 7y agoIt ought to be government-funded. What the current system gives us isn't "R&D and innovation". It's mostly ~equivalents of top-selling products. Plus new stuff that's actually less effective than old products that went generic so long ago that there's ~no promotion.
- wpietri 7y agoIf there is any devil that doesn't need your help, it's the pharma industry. It's important to realize that to a first approximation, advertising prescription drugs is pure waste. The main case is pharma companies battling for fixed market share. That is, there are N people who have the problem, and companies X, Y, and Z are spending money trying to maximize their share of the market. The ad spend changes which pharma company does the best, but that money comes from the sick people, who would be better off without it. The other case for advertising is demand generation, and for drugs I think it's mostly waste as well. I definitely know a couple people who are not sick enough to really need drugs (or perhaps not sick at all), but advertising-induced hypochondria means they badger their doctor until they get a prescription. That's an expensive boondoggle. I'm sure there are some people who hear an ad and realize they have an actual problem. But if that's a significant issue, I'd rather we just paid for public service announcements for disease awareness, rather than hoping the very profitable drugs are the same ones people have the biggest medical need for. And theory aside, advertising prescription drugs to the public was illegal for decades and we still did fine on the medical innovation front.
- refurb 7y agoYou realize there are a handful of therapeutic areas where they are really competitive? It’s inaccurate to suggest that’s the only market for drugs.
- wpietri 7y agoAs I said, I see two basic cases. In one, they're competitive. In the other, they aren't. I think general audience advertising is even less justifiable in the latter case.
- DoreenMichele 7y agoIt would be nice if we tried to shift our focus away from drugs. We generally over emphasize the importance of drugs and surgeries to so-called healthcare and downplay or outright pooh-pooh more basic things, like hygiene, exercise and good nutrition.
- im3w1l 7y agoAd supporters will sometimes say that ads are meant to get the word out about a product so people know its an option. How can we prove that this is false or that the benefits are smaller than the drawbacks?
- kleer001 7y agoHow? Find a natural experiment where two very similar populations, chosen at random, were placed into two different cohorts. I'm sure there's one somewhere in the recent and well documented past.
- chipperyman573 7y agoThis study tested kids but it supports the argument you made, and it's pretty reasonable to assume it applies to adults as well. https://www.cbc.ca/news/kids-think-food-in-mcdonald-s-wrapper-tastes-better-study-1.635688 https://www.cbc.ca/news/kids-think-food-in-mcdonald-s-wrappe...
- henryfjordan 7y agoI would like to see a compromise where new drugs are allowed to be advertised to the public for say 1 year following their release then never again. People need agency in their own medical choices, and knowing there is a drug for your medical condition is very empowering. Especially as we talk more and more about moving to a single-payer system, it's important to make sure patients have the power to question their doctors and explore their own health instead of essentially being dictated to by the state.
- mikeash 7y agoHow about we periodically publish a big book that lists all approved drugs, their uses and side effects, and send it to every residence in the country like we (used to?) do with phone books.
- TheOtherHobbes 7y ago
- happytoexplain 7y ago>Every pharmaceutical sales rep is an immoral cancer on our society. This seems like one of the most cleanly horizontally divided opinions in all of the US - where nearly everybody agrees loudly and strongly with it except the wealthy and powerful. I wish a presidential candidate would have the balls to echo this severe but obviously popular thought and fix the fucking system with extreme prejudice.
- foolbiter 7y agoThere are at least two currently-running candidates who do seem have the balls to directly confront the pharma industry! Why do you think there aren't?
- slenk 7y agoThere are 20-some people running...I wouldn't call them a presidential candidate yet...more like presidential hopefuls. And because big pharma seems to always win.
- mars4rp 7y agothey win because not enough people care!
- r00fus 7y agoThey are technically all candidates. The winner of the primary is a nominee. Pharma gets what they pay for. Vote for someone who isn't beholden to them.
- slenk 7y agoYeah, but after continuing to vote for people that don't have backing and therefore never have a chance to start really is starting to feel like I am wasting my vote. Hell, because of the Electoral College, my vote ultimately doesn't count if it isn't what the whole state picks.
- blaser-waffle 7y ago
- perspective1 7y agoPretty strong opinion to posit about 1000s of people without any supporting evidence.
- cwkoss 7y agoMorality is not objective, determining it is not an evidentiary process.
- sokoloff 7y agoMarketing can provide information to aid in an information-based evaluation of the best course to take. IMO, that means it’s not inherently unethical, only that done wrong it can be unethical.
- cwkoss 7y agoI agree that there is, theoretically, the possibility for moral advertising/marketing/promotion in medicine, but the status quo has dropped so low I'm not sure any companies today only use moral methods. I think the key is that moral marketing only serves to inform, and must deliberately avoid any bias or intentional persuasion. - Supply your molecule for free to all researchers without any strings attached. - Maintain an inclusive directory of research people have performed with your molecule. Publish a journal of all research and redistribute it for free. - Commission impartial fact sheets that are surveys of treatments for a given condition - what objective measures of outcomes can be made between treatments, both positive and negative?
- refurb 7y agoThis 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.
- enraged_camel 7y ago>> This may come as a shock to you, but marketing pharmaceuticals is really no different than marketing other products. Really? You don't see the difference between marketing, say, a car or a smartphone, and marketing a drug that treats a life-threatening condition? Perhaps you should think about this subject a bit more deeply. >> I'd say less than 5% of doctors are cutting edge enough that they require no additional education on new drugs. What do you base this on? Do you have some citations to support it?
- dsfyu404ed 7y agoI'm not a fan of drug advertising (I want it regulated, not banned) but I don't see how it's categorically different than other advertising. Chronic pain (and a whole host of other issues) aren't life threatening. Until the mid 20th century people just lived with chronic pain and tons of other things. Look at the kinds of TV ads you see, they're for drugs that minimize the symptoms of some some negative, but not life threatening thing. These are not essential products. They're luxuries of modern life that we consider to be nearly essential. Depending on one's specific situation having a smartphone or car may actually be more "essential" to daily life than having one's condition treated. As an aside, drugs that actually save lives don't seem to get marketed much.
- sicromoft 7y agoI don't like the current system of pharma sales reps either, but black and white thinking like this is not healthy or productive. Your final sentence isn't conveying any objective information -- in fact, it seems pretty close to emotional propaganda itself. Does that make you an immoral cancer on our society? (No.)
- mirimir 7y agoNot to mention, outright bribery.
- _the_inflator 7y agoYep. You do not earn by not prescribing something.
- lordnacho 7y agoWhy restrict this to medicine? It would seem that anything that takes people away from just informed reason is bad.
- umvi 7y agoI think society would benefit immensely from banning the advertising of drugs. This includes both medicinal and recreational drugs. Make all drugs legal, but mandate they have boring text/information-only labels, put the more dangerous ones behind the counter in smaller quantities, and let the only thing influencing their purchase be doctor recommendations/prescriptions or personal research. It should apply evenly from ibuprofen to allergy pills to marijuana to cocaine to alcohol.
- Erik816 7y agoI think beer should be considered food, but otherwise I can get on board with this.
- cwkoss 7y agoGruits were medicinal herbal meads - funny to think that in not-so-distant history, a doctor may have prescribed one of several "medicinal beers". It's interesting how molecules can be considered 'food', 'medicine' or 'poison' in different contexts.
- sokoloff 7y agoI think that almost immediately ends up in a morass of private information web sites, none of which are as trustworthy as current FDA-regulated labeling. Do you prefer Instagram "influencers" to have more control over what drugs people take than the current regulated advertising? I don't.
- swsieber 7y agoI don't think they would. Do they currently have instagram drug influencer in Europe, where direct-to-consumer drug advertising is illegal? https://en.wikipedia.org/wiki/Direct-to-consumer_advertising https://en.wikipedia.org/wiki/Direct-to-consumer_advertising
- sokoloff 7y agoI would think that pharma companies currently instead just advertise in American media and trust that the word will get over to consumers in Europe...
- themark 7y agoAlways wondered how they get away with it. Every time I hear “Ask your doctor about ____” I cringe. How is this ok?
- tynpeddler 7y ago>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. This is far to simplistic. It's fairly common for doctors to be unaware or poorly informed on new or uncommon treatments. They have a finite amount of time and brainpower and are not all knowing.
- m463 7y agoMaybe the pharmaceutical companies can help by flying these overworked doctors to Hawaii for an informational conference. or possibly just delivering takeout to them at the hospital so they can relax and research new treatments while eating. (seriously, drug companies give doctors free takeout)
- Analemma_ 7y agoMost other first-world countries have banned drug advertisements, and they appear to be doing just fine. Actually, they appear to be doing significantly better than we are: no opioid crisis.
- navigatesol 7y ago>They have a finite amount of time and brainpower and are not all knowing. Yeah, there seems to be this contradiction here that doctors are naive or corrupt and are going to be swayed into prescribing us drugs we don't need, but also that we should be leaving it 100% up to doctors to be informed and prescribe us what we need.
- jormungand 7y agoManagement 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 7y agoAnd yet these consultants created a plan so successful NYT is writing about it.
- tootie 7y agoIt's an interesting business. I've known some management consultants who were serious pros and it's a seriously impressive skill. I've also seen the army of kids who descend on an office and produce nonsense reports to provide the execs with CYA for whatever predetermined decision.
- bayesian_horse 7y ago"It's almost like these people were addicted to this stuff. Oh wait, they are!" Was an actual quote from distributors...
- gringoDan 7y agoFor 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-rico.html http://nymag.com/intelligencer/2019/04/mckinsey-in-puerto-ri... [0] https://www.ft.com/content/1a229d54-4548-11de-b6c8-00144feabdc0 https://www.ft.com/content/1a229d54-4548-11de-b6c8-00144feab...
- harperlee 7y agoOverly 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.
- reaperducer 7y ago
- khawkins 7y agoAs 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 7y agoI 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 7y agoThe 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.
- agiri 7y ago"How Management Consultants Steal Your Watch and Then Tell You the Time"
- cwyers 7y agoI'm like, isn't this old news? But no, that was Purdue: https://www.motherjones.com/politics/2019/01/report-mckinsey-consulting-purdue-pharma-opioid-crisis/ https://www.motherjones.com/politics/2019/01/report-mckinsey...
- 3xblah 7y agoCha-ching. (Sound of analog cash register closing.) http://www.news.com.au/finance/business/states-want-their-cut-of-australias-growing-opium-poppy-industry/story-fnda1bsz-1226880076728 http://www.news.com.au/finance/business/states-want-their-cu... "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"?
- jnmandal 7y agoI 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
- ttldr 7y agothere 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?
- albertshin 7y agoI 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-russia.html https://www.nytimes.com/2018/12/15/world/asia/mckinsey-china... https://www.nytimes.com/2019/02/19/business/mckinsey-hedge-fund.html https://www.nytimes.com/2019/02/19/business/mckinsey-hedge-f... https://www.nytimes.com/2018/12/30/world/mckinsey-bribes-boeing-firtash-extradition.html https://www.nytimes.com/2018/12/30/world/mckinsey-bribes-boe...
- mettamage 7y ago--- 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?