> On Tuesday, Purdue pleaded guilty to criminal charges, including defrauding federal health agencies and paying illegal kickbacks to doctors. The company also faces roughly $8.3 billion in penalties. As part of the settlement, members of the Sackler family will pay $225 million in civil penalties.
They made over $12 billion in profit as of last year[0], so they still came out ahead...
You're saying they made 12bn dollars that they would not have if they didn't do all of this stuff? I kind of doubt it. I'm not expert on Purdue Parma, but I'm guessing this whole escapade will be EV negative for them.
>Those records show that McKinsey was helping Purdue find a way “to counter the emotional messages from mothers with teenagers that overdosed” from OxyContin.
I feel like this isn’t the first time McKinsey has been caught encouraging or enabling some pretty horrific stuff. It’s probably time they get some prosecutorial attention.
Seriously, they have taken a real nose dive. I wonder if they still have MBAs competing for their jobs or if this has taken out the top level talent (and shipped it over to SV)
Top level talent never joined consulting in the first place. Wall St is considered by most a more desirable and prestigious career path. It's also usually more lucrative.
Traders and investment bankers especially consider consultants to be major losers (including me).
Top-level talent never did either of the miserable jobs of mgmt consulting or ibanking. They can make as much (or more) doing something more enjoyable with fewer hours and a better culture.
Arguably consultants help clients (obviously not in this case), traders are just facilitators of capital and executing on behalf of higher ups. They make money on large volumes of flow but provide no great service aside from liquidity or to line their clients pockets.
iBankers on the buy side at least have to understand where the markets are going. Or have I missed what value the traders do? :)
~10 years ago I was visiting the Bay Area (I live in EU), and developed knee pain (rather strong). I went to the emergency room in a city hospital, and long story short, I was given a prescription for paracetamol or ibuprofen and something called Norco, which is apparently some kind of opioid.
In the pharmacy (CVS i think), the pharmacist was calling somewhere to confirm the prescription and my identity and was trying to understand hard my foreign-issued driving license. After an hour of this identity verification circus, I left the pharmacy with this opioid drug and a pack of Paracetamol/Ibuprofen. Back in the hotel I read about it, and seeing something about opioids I threw it away (I guess, for no reason except that it sounded like it sounded like it's related to drugs) and treated myself with paracetamol (which worked). The experience in the hospital: 6h waiting and check-up straight in the reception room with 20 people watching, plus a doctor whose biggest concern was that I remember that his name is Lim and not Lime, plus being treated like a potential drug abuser in the pharmacy was a bit surreal.
After getting back to EU, the hospital and my international insurer started negotiating price for this 6h waiting and 10 min check-up and an xray. It started with 2000 USD, in the end they settled on 1000 USD or so. Fortunately, I didn't pay anything cause international insurance.
After a few years, when playing football in Switzerland, I stomped badly and sprained my ankle. I went to the local orthopedic clinic, where I was treated at once in doctor's office. Cost: 250 CHF (~250USD), xray included.
That we have to know and navigate the intricacies of healthcare and the nuances between urgent and emergent care is ridiculous in my opinion. Then you have to worry about whether the dr on shift is in network even though you’ve verified the facility is
Could be, though it was ~2010 - so internet information wasn't that good and it was a late hour, 9pm or so - I was looking for an open at that hour orthopedician IIRC, and I barely walked and thinked.
Relevant anecdote - my friend here in Switzerland developed a kidney stone (resulting in an "interesting level of pain" according to him) and went to ER b/c also a late hour. He was actually given some opioid, but he had to take it directly in the hospital (strictly controlled substance I guess), and the doctor told him jokingly that he should be happy, because the amount of people who are prescribed heroin-derivative drugs in Switzerland are very very small.
I don’t really understand the rebate strategy here. They told Purdue to literally go to CVS and tell them “we are going to pay you a bonus for every overdose you cause?”
How does CVS interplay with the doctors who are doing the actual prescribing? I guess I don’t understand how a rebate change anything at CVS. Aren’t they just filling the prescription?
isn’t CVS just doing whatever the doctor is prescribing without any judgement? i don’t see how CVS would be liable here unless they failed to verify the authenticity of a prescription or something on purpose.
CVS can choose to set metrics and implement systems to discourage noticing that one person is pulling multiple scripts, for example.
Also remember that CVS is basically a monopoly wholesaler as well as a retailer — so they can play games at that level as well like stuffing the channel to favor the manufacturer that pays them more on the backend. Railroad trusts and standard oil did the same thing in the 1900s.
This is especially true in places where states have hobbled regulatory power. Little towns in West Virginia were dispensing more opioids than counties in other places. In places with more robust regulation, the pharmacists will lose their license.
The whole thing is disgusting and really illustrates how amoral and evil outfits like McKinsey are, and how their way of thinking is a more in your face vision of what many corporate leaders believe.
yeah I guess the wording of the story is confusing. I think it’s less “here’s a reward for literally killing people” and more “here’s a little something to soften the blow of an OD so that you continue to fill Oxycotin without judgement or heavy restrictions”
I’m trying to imagine this 45 year old CVS VP of Product stuffing the channel with opiates & hiding the analytics on one hand. And on the other hand feeling real bad somebody somewhere ODed.
These emotions - they belong to two very different people. Who don’t like each other at all.
“Your pharmacists get paid $150k to count pills and assess risk. They failed to assess risk, here’s a bonus for continuing to hire people who don’t do their job.”
Pharmacies have to handle the possibility that a patient is collecting multiple prescriptions from multiple doctors to get more quantities than they need or can safely have.
No, it’s not. Pharmacists are tasked with refusing to fill prescriptions they believe are harmful, and routinely reject combinations of medicines if they are harmful. And the DEA is putting pressure on pharmacies to refuse prescriptions for suspected opioid abusers, so many large pharmacy companies have many limits in place regardless of what the doctor writes.
If you walk into a pharmacy with just an opioid prescription, and you’re not a regular or something seems off such as it’s hand written, chances are you’re going to get denied or at least won’t get your medication until they call the doctor and discuss why you need it.
All the states even have a PDMP - prescription drug monitoring program - that pharmacies have to check before dispensing opioids to confirm the person’s prescription history.
ok, so a rebate is less “here’s a reward for OD’ing people” and more “we’ll soften the blow if you continue filling Oxy with no judgment if someone ends up dying” I guess
No, it’s more Purdue and McKinsey modeled the overdose rates based on market performance of OxyContin. Overdoses were a metric, provided for free by the county health departments, that was a proxy for sales performance.
It is a murder bonus; it proceduralized a public health crisis.
Whenever someone says “liable” I know they’ve stopped arguing about justice and begun arguing about proper application of laws lobbyists purchased from Congress.
Same question. They decided to INCENTIVIZE overdoses? (And "opioid use disorders" too, they were paying rebates for those too).
I don't understand either the ethical OR business sense of this. Very confused.
I haven't been paying too too much attention to this stuff, and I never before felt like saying anyone should face prison over any of this -- but incentivizing overdoses, are you serious? I feel like anyone involved in that decision is a horrible human being, at the least.
Yup. So much this. If everyone can realize this. We all are nothing but resources for companies, politicians and law enforcement is there to help the prior two.
It really is us the people that they are afraid of.
If you’re cynical enough, you could easily argue that every relationship that any person has is based on nothing more than resources. Somebody claims to love their wife? Unlikely. They’re just looking for some love and fulfilment resource. Do you really like your friends? Or do you just like the way friendship makes you feel?
There's a difference between getting something out of a relationship, or even having the relationship contingent on that benefit, and doing absolutely everything short of what will land you in prison to get the maximum benefit for the minimal cost.
My favorite local breakfast place only serves me because I pay, but I forgot my wallet one time and they just waived the charge. There's a spectrum between altruism and exploitation, and it's important we put pressure on large organizations to stay away from the exploitation end because it's clear some won't do it on their own.
You've redefined resource to be literally anything, in an attempt of coming to a materialist worldview.
There's three important attributes of resources. Firstly, resources of a same type, defined by their use, are fungible. Secondly, resources are a means to an end. Lastly, resources are valuable either because of their uses or because they can be exchanged.
Now, love, fulfillment, and the feeling of friendship realize neither of the three properties. Neither does a wife or a friend.
Because of that, I don't think one can say that every relationship a person has is based on nothing more than resources. Personal relationships are categorically different.
Additionally, unlike material relationships, personal relationships are most healthy and effective when they are between equals.
There are many abstract concepts included in the definition of the word resources. You’re trying to argue that it means computable wealth and absolutely nothing else. Which is very obviously ridiculous, and it’s hard to see this comment as anything other than an attempt to start some pointless semantic debate.
I'm certainly not saying that it is equivalent to comptable wealth. Political power fits all three criteria and is not comptable wealth, so does any other kind of resource one could think of.
Only if you define resource so broadly as to constitute anything, at which point the statement becomes “all relationships are based on things” ... which, like, yes of course
You’re right, and I think this is a good point against the root comment. Nobody can argue against the claim that we are all just resources to politicians, corporations, and law enforcement because it is vacuously true. It’s like saying we are all just atoms. It doesn’t tell us whether many or most in those industries are good people who are in it for the right reasons. And of course, this story about a particular repugnant act can’t prove such a blanket statement.
Whether resources are material or not isn’t relevant. The attention, care, kindness, compassion that a person has to offer others is a resource (and a finite one at that). The basis of the claim is that these entities are viewing other people as nothing more than what those people have to offer them. If you prescribe to the doctrine of psychological egoism, then that is how every single person views every single relationship they have (intentionally or otherwise).
I would say that’s a rather cynical way to view the world (others would say it’s just a factual perspective). But if you view this scenario from that perspective, there’s no logical reason that you shouldn’t also view the relationships you have with your own spouse/parents/children/friends... the same way.
>But if you view this scenario from that perspective, there’s no logical reason that you shouldn’t also view the relationships you have with your own spouse/parents/children/friends... the same way.
Absolutely. And while such attitudes are not incredibly widespread, there are enough folks who do so that we have a name for exhibiting such behavior. We call it Narcissistic Personality Disorder[0].
Which is a terrible thing to do of course, as it stigmatizes a whole group of people that just want to live their lives and use the the objects in their environment to their advantage. What's bad with that?
Your wrong about this. The actual term for this (as I mentioned above) is psychological egoism. This topic has been publicly debated for a very long time. You can look at the history of the debate between egoism and utilitarianism (and the further debate about whether there’s a meaningful difference between those two ideas) if you want to learn about it.
People have debated for a very long time whether a person who derives satisfaction from benefitting others is truely motivated by the benefit of others, or simply the benefit of themselves by way of that satisfaction. A narcissist is a completely different thing. They would not derive satisfaction from benefitting others, for reasons such as their narcissistic lack of empathy.
The views in my comments are no more reductionist than the parent comment I was replying to. I would also suggest that rejecting psychological egoism as reductionist is a rather blatant anti-science point of view.
However whether reciprocity was involved doesn’t at all change the existence of a self-interested motive. It’s simply irrelevant.
Furthermore, in this case there was reciprocity. In this instance the big corporate interests were selling a product for which doctors had a demand to treat their patients. You’re welcome to have an opinion about the integrity and value of that reciprocity, but that goes for anybody in regards to any relationship. A cynical person could come to that conclusion about any relationship, and offer you a justification for it supported entirely by a leading thesis from the field of ethics.
I would suggest that projecting evil motives onto others implies a far greater sociopathic tendency. Keep in mind that all of the worst things we’ve managed to accomplish as a species tended to start with dehumanization as the first enabling step.
I’d also suggest that this comment would also necessarily include dismissing just about every psychologist, philosopher or ethicist who studies the nature of self-interested motives as being a sociopath as well.
If you really wanted to be cynical however, I’d suggest you start by asking who’s benefitting from us having this conversation. I’d say it’s the regulators, and to a greater extent the executives who have been in charge of those regulators, who are the people statutorily responsible for these failures. I can’t imagine how happy they’d be with us debating how culpable big pharma and their management consultants are for it.
They don't call it the human resources department for no reason...
If you look at cities/modern civilization, it's really no different from an industrial farm. People who run industrial farms are focused on the production of the livestock - aka the productive value of each head of cattle, each chicken, etc. People who run cities are focused on the production of every head of human.
Notice the uptick in "How do I get more productive", "I've had a productive day today", etc? Doesn't it seem like it's all about productivity? Are you meeting your potential - have you been as productive as you could be today?
Nobody I was friends with could afford to overdose on legitimate oxycodone due to its cost, so many overdosed on much cheaper heroin after not being able to afford oxy pills anymore. I've also read about people overdosing on counterfeit oxy pills containing fentanyl (for example, the musician Prince if I remember correctly) though that's not happened in my former friend group as far as I know.
Forgive me for sounding daft. I feel reluctant taking one Tylenol pill nevermind anything close to this - how exactly have you had at least eight friends die? Was it accidental? Uncontrolled dosage? Suicide? Do you forget that you had taken it already?
I keep hearing about the opioid deaths and the crisis but what exactly happens that these people overdose on it?
Heroin (an opioid) is known to bring quite literally the happiest euphoria known to man. You can read this sentiment of it just about everywhere. For simplicity - take it as exactly that: a drug that induces the feeling of the happiest warmth imaginable
Then, realize, some people come from absolutely fucked and broken lives. Being beaten and raped by their own family members they have to live with (sometimes for years) - if you're not aware that things like this go on - I'm mostly happy for you. But yeah, this is very much a thing.
Then put together what it has to be like being a person coming from an absolutely broken place and having never had the slightest emotional warmth and happiness in your entire life, and finding something relatively cheap and easily sourced that takes away all of that pain for some amount of time.
Then, realize, that tolerance to this euphoria inducing drug grows rather quickly, what you find on the street gets laced with shit like fentanyl, etc - and it's not hard to see why countless deaths occur.
Also, somewhat unrelated, but you sound like you've never had much of a bout with extreme lasting physical pain. Shit can get unfathomably intense.
For better answers perhaps, look to the bluelight forums.
Heroin. Every single time. It's of wildly varying strength (and price) these days apparently. My first couple friends dying are what led to me getting clean around nine years ago.
The vast majority of them (if not all) also took oxy before/during their stints with IV heroin. This is obviously anecdotal but that's what I've seen!
Edit to clarify:
Generally it's been accidental as far as I can tell, there have been two instances where it might've been suicide. Generally one way to think about the heroin problem would be:
Imagine wine (which is normally 14% abv and costs let's say, $20) but sometimes it's 100% abv and costs $20, or 5% abv and costs $30, or 7% abv and $100, or 75% abv and $0.99 and you can't tell until you buy it and try it.
heroin can be of greatly varying strength, especially nowadays when you sometimes/often get fentanyl. I used to be addicted to opiates for a period of 2 years (with maybe 3 years of recreational use before things got bad), ending in 2017.
I have had a very close friend die from a heroin/fentanyl overdose, getting a PhD at the time. I say this to emphasize that even very smart, careful, and reasonable people can overdose and die. I've come close myself a couple times.
I would imagine accidental death from pharmaceuticals is much rarer, as the potency is consistent.
I'm convinced if we just completely legalized all of this stuff a better outcome would ensue. After all, there are two primary negative effects of illicit opiates in our current system: high stdev of potency, and high cost. Under legalization, the stdev could be reduced to 0 and the cost could be brought down 10 or 100 fold.
And George Floyd got the death penalty. Seems like if someone makes $46 million (arbitrary figure) from something as shitty as this, they ought to lose $46 million, either by paying back $46M, or by losing something that's worth $46M to them. A leg? A child? Hey offer them some choices.
Getting a bit Saudi-Arabia-ish here, but seems like the law would look, if not like this, then more like this, if it weren't written by the guy who made the $46 million.
Legally, I'm guessing manslaughter. With enough count (thousands!) the distinction fades.
There are laws on the books to charge individual officers for corporate actions, practically never used. They could have been used on paint company executives, who had forestalled a ban, in the '40s, on a promise to phase out lead, and absolutely did not, and tobacco executives, who actively sought to addict children. Arguably, sugar industry executives merit such treatment for actively suppressing research indicating sugar has been directly responsible for millions of deaths, and for heavily marketing to children.
But any bozo who shoots up a bus station apparently merits overwhelmingly more attention, so the executives directly responsible get to retire unbothered to their yachts.
You say "doing research, thinking about it, and bothering to come up with a proposal" as if the only obstacle is that no one has figured out how to bring these people to justice.
That's not what's happening here. These are people who use their immense power and resources to warp our bureaucracy to protect and enrich themselves. They don't face real consequences because the system is designed to shield them from accountability.
It's so easy to hand-wave about "them" and "the system," but I don't see how you're helping people unless you're helping to make concrete proposals or helping to identify specific policies by specific people that need to be punished and/or prevented in the future.
the board and corporate governance of companies should be held criminally liable for actions they oversee. You can get locked up for life under the kingpin act. Let's make that applicable here.
> As for actually doing research, thinking about it, and bothering up to come up with a proposal... I guess nobody actually cares THAT much.
Spare us the snark, it's not helpful. You should know that one cannot just draw up a proposal to bring criminal charges; only a very small number of people have the legal authority and resources to do that.
Well I mean that pretty sincerely. I think people find it fun to be outraged. I don't think people genuinely care enough to learn who the involved parties are, and make a sincere proposal on what went wrong.
Honestly, I have no idea why you would think that, or why you would expect "why don't you come up with a proposal?" to be met with anything other than incredulous fury.
People come up with proposals on how to fix the system all of the time. If you haven't heard of them, that's due to a gap in your reading, not because proposals don't exist. The issue comes down to actually getting people in power who want to make these kinds of changes, something that doesn't happen very often.
Richard Sackler, for starters. He's the former chairman of Purdue Pharmaceuticals, and investigative journalists have uncovered a boat load of paperwork showing that he personally pushed for marketing tactics that would result in addiction and death. The sudden exit of the entire Sackler family from the board and executive positions in 2018 reeks of wrongdoing too, especially since reports indicate that Richard continued to call the shots after resigning. Given that Purdue Pharma recently pleaded guilty to criminal charges, I suspect that various proprietorial offices should have enough evidence to get a subpoena of his personal records.
But again, tons of people have researched this stuff. The problem is that I cannot personally bring a criminal charge against Richard Sackler. Which is why your "people just want to be mad on the internet" attitude is extremely obnoxious. The problem isn't that what needs to be done in these cases isn't known, the problem is that the people who have the power continue to do what we don't want them to do.
Well personally I've never heard of Richard Sackler before, but that's exactly what I was asking for.
>> the problem is that the people who have the power continue to do what we don't want them to do.
If an outraged public has clear alignment on what needs to happen, a lot of times this can force the hand of government.
On the other hand, being unspecifically frustrated isn't enough. A lot of issues are very complex (e.g. bailout), and culpability is spread thin, and laws are limiting. If there isn't alignment on the facts, then some irrelevant figure will be scapegoated to sate the public anger.
And here’s the crux of the problem; plenty of people have done the research on this stuff. You just never bothered to read any of it, and instead you had the gall to imply that the real problem is that a bunch of people on HN were too lazy to put together a proposal on what to do. A tad bit ironic, since you apparently don’t even know the names of the core actors in this problem, don’t you think?
Yes, people are angry. Yes, people often scapegoat on complex issues. No, the actual problem is not that we just want to get angry without actually doing any of the work to propose a solution.
>>> And here’s the crux of the problem; plenty of people have done the research on this stuff. You just never bothered to read any of it
Exactly, thank you for proving my point. I, like 90% of Americans, do not care enough about the opioid epidemic to do any research. We care so little, that we don't even know Richard Sackler's name. I have a million things to care about in my personal life, and a million other pieces of news I could worry about instead.
It's not a personal attack, I'm not sure why you're getting so offended about it, it's simply human nature.
The other thing you seem not to grok is that if 90% of Americans said Richard Sackler needs to be prosecuted it would happen. However, maybe 10% of the population knows that name.
So, in conclusion, back to my original point -- If you ever want more than 10% of the population to know the name, you have to bring him up in your discussions, because 90% of us don't care enough.
> It's not a personal attack, I'm not sure why you're getting so offended about it, it's simply human nature.
You directly told people here that it was their fault they’d not done the effort to do some research and propose something, and that they didn’t really care about this issue. If you don’t understand why people will respond very poorly to that, then my genuine sympathies go out to you, because that was a personal attack.
I agree. However, in the case of the opioid epidemic I think we're way past the stage of identifying that there is a problem.
The next step with any issue (black lives matter, big bank bailout) is to take a complex systemic issue and find specific, realistic changes that can help with the problem, before people get apathetic/resign.
And with all of this, many people seem ready to accept without hesitation a COVID-19 vaccine developed, tested, packaged and distributed at "warp speed", by huge pharmaceutical companies that have been granted immunity from liability.
Moral absolutism has been out of vogue for 50 years, but I encourage everyone to give it a spin. It’s provides such wonderful moral clarity and said clarity is surprisingly effective at rooting out the sort of poisonous people who ruin friendships, companies and societies. I’ve dealt with numerous McKinsey consultants over a 30 year career. I’ve collected enough data points to feel safe in concluding the following:
• McKinsey is a vile organization without any redemption.
• That they are not condemned as such speak volumes about both our societies’ moral failings and more broadly, our individual failure to care about the people McKinsey helped murder.
• That last point bears repeating: McKinsey will happily and knowingly murder people for money. That only seems like a preposterous or exaggerated statement because we are not accustomed to hearing someone be impolite to evil people in a position to pay us well.
• People who work for McKinsey are sociopaths. Not occasionally. Not sometimes. In all cases. The only exception being people recruited directly from college who quit that firm within a few years of joining.
• Many here are in a position to punish McKinsey alumni. If you are asked to interview someone with McKinsey on their resume, I believe you should absolutely state that they performed terribly regardless of what occurred. I personally find it rewarding to repoer that their interview behavior during the interview seemed erratic, to the extent that I questioned their sobriety. If your sense of humor is as dark as mine I highly suggest this approach. If you have hire / fire authority, it’s much simpler. Don’t hire, do fire.
• Organizations like McKinsey exist because we collectively accept their behavior. When we stop doing that, McKinsey will stop addicting broken, damaged and hurting people to opiates.
Stopping McKinsey is up to us. I make an argument from the left. But I think there are also compelling objections to these parasites that can be made from a position far to the right.
This doesn’t and shouldn’t be a left/right thing. Because it is absolutely a parasites vs producers thing. And everyone, regardless of politics, will be healthier freed of this particular tapeworm.
Having spent some years as an employee of several consulting firms (with an IT focus, not management/McKinsey style), I can comfortably say that a primary goal of a professional services organization is to maximize realization[0] and profitability.
When the goal of an organization is maximization of revenue/profit to the exclusion of all else, it's not unusual to see laxity in ethical standards.
The mechanism for doing so is to provide quality[1] service and leave the customer satisfied. The article makes it clear that the Sackler family felt this was true for the services provided by McKinsey.
You'll note that those are similar metrics that are associated with sex workers. The primary difference between consultants and prostitutes is that being the former is usually (but not always) less degrading.
None of the above should be all that surprising to anyone. The question then becomes: "What, if anything, should we do about it?"
I posit that we should make the costs of ethical lapses higher than the potential profit of same.
We certainly don't have that now. Perhaps we should work to change that?
> I encourage everyone to give [Moral absolutism] a spin
> state that they performed terribly regardless of what occurred... [report] that their interview behavior during the interview seemed erratic, to the extent that I questioned their sobriety
Quite some cognitive dissonance you're holding onto there!
They are no more evil than any other business. We live in an era where a certain philosophy has taken root, and government is much weaker than in the past.
They made over $12 billion in profit as of last year[0], so they still came out ahead...
0: https://www.forbes.com/sites/rachelsandler/2019/10/04/the-sa...