Note: I’m not much of a reader of true crime: the motives are always the same and perps and their enablers display only slightly varying blends of cowardice, appetite, anger or thrill-seeking. When I do, I try to be selective. See Classic Crimes (William Roughhead), Small Town D.A (Robert Traver), For the Thrill of It: Leopold, Loeb, and the Murder That Shocked Jazz Age Chicago (Simon Baatz), and The Spy in The Russian Club: How Glenn Souther Stole America's Nuclear War Plans & Escaped to Moscow (Ronald Kessler)
The Hard Sell: Crime and Punishment at an Opioid Startup – Evan Hughes
I could not put down this book about an opioid startup called Insys. They used strong techniques to market their FDA-approved drug, Sybsys, a powerful pain killer made of fentanyl. Since some of their sales techniques were illegal, the top executives were busted and went to trial. The trial was the opportunity for Hughes to take a deep dive to examine how these drugs are marketed and sold. In a tight overview of this trial, Hughes makes clear the fact the nobody gave a shit about the people addicted, harmed, and killed by the narcotic, not the drug makers or its sales agents nor the defense attorneys nor the federal prosecutors.
Readers and patients who are not aware of how drug companies influence doctors’ prescribing will find this an eye-opening book. It is an aggressive sales technique to target the top ten percent of opioid prescribing doctors in a state. It is iffy indeed to push doctors to prescribe higher dosages of any medication, much less the most powerful pain killer in the market, during an epidemic of opioid overdose deaths.
Out of their lane, sales staff urged the doctors to prescribe the medication even in cases when it was not indicated (so-called “off label”). Subsys was approved for breakthrough cancer pain, not aching joints. Going way outside the guard-rails, Insys inserted themselves into the pre-authorization process by out and out falsehoods and massaging the facts to persuade insurance companies to approve coverage.
Most egregiously, Insys paid doctors to give talks on the medication as a pretext to set up a ‘this for that.’ In other words, the company pays for presentations even to attendee-free meetings and the doctors prescribe the drug. Later federal prosecutors summed up the business model as one plus one equals two: “bribing doctors, conning insurers, making money.”
Under pressure from the market and the imperative to make money, the big bosses want all the market share. Under pressure from the bosses, the sales staff want the exhilaration of landing big accounts and money. Under gimme-gimme pressure from sales agents and patients in pain, harried doctors write hundreds of scripts for an opioid painkiller, adverse effects on trusting naïve patients be damned. It takes courage to resist pressure. As a humble minion a large public bureaucracy, I gently opine there have to be easier, less stressful ways of making a living.
And staying out of jail.
Also, as a part-time compliance operative myself, the other take-away I got from this book is that companies had better not be cheap like Insys when it comes to hiring in-house lawyers and compliance specialists. The federal regulations are many and convoluted. It’s very easy to make mistakes and run afoul of regs even with the best intentions. Companies need experts to navigate regulatory swamps properly.
Finally, more government oversight is needed over drug
companies marketing and distributers between the drugmakers and doctors and
pharmacies. Drug company bosses ought not to get coddled when it comes to fines
and jail.