Heaps of ignominy are not in short order for parties that played sketchy roles in fostering the nation’s deadly opioid abuse and drug overdose crisis. The stain has spread now to one of corporate America’s most-favored advisors — the giant McKinsey consulting group.
The firm has issued a rare public mea culpa for its work with Purdue Pharmaceuticals, a family-run drug maker that has gained notoriety, even among Big Pharma companies, for how it hyped its powerful painkiller OxyContin. The relentless push to sell that drug, officials have asserted, provided a ghastly template for peddling opioids, triggering abuse, addiction, debilitation, and death for hundreds of thousands of Americans in recent times.
Purdue was a McKinsey client, and the consultants now are re-examining their advice to the drug maker on how to fire up OxyContin sales and whether these suggestions fell short of the firm’s own standards. The New York Times, to its credit, dug into records to detail the consultants’ unacceptable conduct, reporting:
“McKinsey had discussed ways for Purdue to ‘turbocharge’ sales of its drug OxyContin, proposing that it pay distributors rebates for overdoses linked to the pills they sold. Lawmakers — both Democrats and Republicans — have called for McKinsey to be investigated, and a prominent physician employed by the firm said executives who knew of this work should resign. Two senior partners at McKinsey [also] discussed whether to purge records related to Purdue, according to documents recently filed in connection with the drug maker’s bankruptcy proceedings.”
McKinsey, which earns significant fees for its purported business analysis, acumen, and capacity to whisper in the eager ears of global corporate heavyweights, found itself in an unusual spot, advising Purdue, the newspaper reported:
“McKinsey rarely acknowledges mistakes and has never before accepted responsibility for helping Purdue sell more opioids, even as hundreds of thousands of people were abusing the highly addictive painkiller. The firm said that it had stopped advising clients worldwide on the opioid business and that it was cooperating with ‘opioid-related investigations.’ ‘As we look back at our client service during the opioid crisis, we recognize that we did not adequately acknowledge the epidemic unfolding in our communities or the terrible impact of opioid abuse and addiction on millions of families across the country,’ McKinsey said in a statement published on its website.”
Consequences for consulting
The consequences may be increasing for McKinsey for its Purdue work. The newspaper reported that not only have members of Congress assailed the consultants for promoting risky prescription painkillers and called for investigations of McKinsey, including potential criminal prosecution, lawmakers also are discussing legislative curbs, as suggested by U.S. Sen. Josh Hawley, (R-Mo.):
“’In light of McKinsey’s possible active role in driving the opioid crisis, Congress must consider whether to impose obligations on consulting firms to report criminal activity or specific criminal penalties for consultants playing a role in federal crimes,’ Mr. Hawley wrote [recently to McKinsey’s global managing partner].”
The New York Times made clear the legal standing of the consultant and its client:
“Purdue recently pleaded guilty to criminal charges, including defrauding federal health agencies and paying illegal kickbacks to doctors. McKinsey has not been charged or sued for its work with opioids, and there is no evidence that the rebate program was enacted.”
Still, the newspaper has dogged McKinsey, reporting on internal dissent caused by its Purdue work and for others:
“In the wake of several widely publicized reports involving McKinsey’s work with controversial clients around the world, including authoritarian governments, the firm said it was taking steps to change the way it selected which projects to undertake. ‘There are still numerous investigations and cases pending against the industry, you should not expect this will be the last time McKinsey’s work is referenced,’ several of McKinsey’s top executives, led by Liz Hilton Segel, the managing partner for North America, wrote in a memo to employees, hours after The Times published its article in November. ‘While we can’t change the past, we can learn from it.’”
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them and their loved ones by dangerous drugs, especially opioids. It took a while for Big Pharma, doctors, nurses, hospitals, insurers, and others in health care to stitch together a false picture of how prescription drugs might be used to deal with the common and problematic issue of patient pain. Media investigations and rigorous research, however, has shown how falsehoods and aggressive advertising and marketing flooded the country, especially vulnerable rural and ex-urban areas, with tens of millions of unwanted and unneeded pills. These drugs, along with synthetic painkillers like fentanyl, hooked too many patients, savaging their lives, as well as their families and communities. Further, the meds opened the gates to abuses and overdoses of illicit drugs.
Reining in the hype for drugs
The opioid and overdose crisis has skyrocketed during the coronavirus pandemic, and it may be long past time for policy makers to act with vigor against a key element that has fueled the nation’s problems with prescription drugs — their makers’ aggressive advertising, marketing, and sales. The United States and New Zealand are the only two nations on the planet that even allow direct-to-consumer advertising of these meds. Federal regulators have just warned doctors and Big Pharma that speaker programs, with industry types handing out to clinicians big fees, booze, and expensive meals at posh venues, have veered over the line too often of legal informing of clinicians about pharmaceuticals and medical devices.
Enough is enough. This is a message that doctors, most importantly, must take to heart and act on. It is worth quoting at length these researchers opining on the medical and science information web site Stat, based on their new study on MDs and payments they get from Big Pharma and medical device makers:
“Each year, about half of all U.S. doctors accept money or gifts from drug and device companies, totaling more than $2 billion. These payments range from free meals during which doctors listen to drug reps pitch their latest products, to travel to luxury locales to serve as paid ‘consultants. ‘The conflicts of interest created by these payments are clear. Yet the medical community has resisted stopping this flow of cash, arguing that industry payments do not harm patients and may even have benefits. Few serious efforts have been made to rein in this practice. We believe stronger action — a total ban on drug industry payments to physicians — is needed. Now.
“We are part of a research team at Memorial Sloan Kettering Cancer Center that recently confirmed what drug companies have long known: Industry cash influences how doctors treat their patients. We analyzed all available studies that have asked the question: Do doctors prescribe more of a drug if they receive money from that drug’s manufacturer? The results were unanimous: All 36 studies showed that receiving industry money increases prescribing. This was consistent across all medical specialties and types of drugs. Industry money affects how doctors prescribe cholesterol medications. It affects drugs for Alzheimer’s disease, for multiple sclerosis, and for blood thinners. It even affects which drugs are used to treat cancer. Perhaps most worrisome, it increases how many opioids doctors prescribe.
“These money-fueled nudges harm patients. Accepting industry money leads doctors to prescribe expensive, worthless drugs. It leads them to choose drugs with more severe side effects when treating leukemia. It causes them to deviate from prescribing guidelines. And the increased opioid prescribing resulting from payments leads to increased deaths from opioid overdoses. Industry payments also contribute to rising health care costs by making doctors more likely to prescribe brand–name drugs over cheaper generics. At a time when unchecked drug price increases are straining the Medicare budget and patients’ pocketbooks, industry payments are pushing things in exactly the wrong direction. The reason a federal ban on payments is necessary is that physician-led change is unlikely. The majority of physicians believe that accepting industry payments is appropriate.”
We have lots of work to do to curb Big Pharma’s harmful excesses, and we could take a step in the right direction by curtailing the malarkey the industry and those who abet it manufacture — to the detriment of all the rest of us.