McKinsey Proposed Paying Pharmacy Companies Rebates for OxyContin Overdoses
nytimes.com
nytimes.com
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...
He didn’t say they made $12b in illegal profits.
Why would you try twisting his words like that?
>Those records show that McKinsey was helping Purdue find a way “to counter the emotional messages from mothers with teenagers that overdosed” from OxyContin.
Traders and investment bankers especially consider consultants to be major losers (including me).
iBankers on the buy side at least have to understand where the markets are going. Or have I missed what value the traders do? :)
Typically IB and consulting at the top 3 are both very prestigious.
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.
An urgent care clinic would have gotten you quicker results at a lower cost.
Typically I've waited under 30 minutes, and now days some have online wait time estimators, and at larger facilities x-rays are right down the hall.
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.
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?
CVS put some limits on opioid prescriptions:
https://www.statnews.com/2017/09/21/cvs-opioid-prescription-...
It is a murder bonus; it proceduralized a public health crisis.
That's the theory. In reality it's just as you say.
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.
If you have a doctor who writes prescriptions by hand try taking it to different pharmacies, you'll find the procedures are rather different.
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.
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.”
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.
It really is us the people that they are afraid of.
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.
With a corporation or politician? Not so much.
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.
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?
[0] https://www.helpguide.org/articles/mental-disorders/narcissi...
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.
"relieve personal distress (e.g. discomfort from the situation),
avoid self-punishment (e.g. feelings of guilt),
avoid social-punishment (e.g. looking bad to others),
obtain rewards from self or others (e.g. praise, pride),
gain a mood-enhancing experience (e.g. feel glad someone was helped)."[1]
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.
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.
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.
Consumer
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?
It's really disappointing to see this bullshit.
I keep hearing about the opioid deaths and the crisis but what exactly happens that these people overdose on it?
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.
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.
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.
Meanwhile, Kalief Browder was jailed without trial for three years — for allegedly stealing a backpack. We truly do have two justice systems.
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.
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.
Or do you mean prosecuted for coming up with an idea that is in poor taste but was never actually implemented?
• 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.
> 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!
None of what you just said is going to happen.
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?
[0] https://www.hainesandlagerquist.com/understanding-utilizatio...
[1] 'Quality' in this context is generally defined as "achieving whatever result the client desires."