Ethics own goal in opioid epidemic: the role of consultants
Updated: Feb 26
Reading the news that global consulting firm, McKinsey, has just settled law suits with US states for almost US$ 574 million over its role in the opioid epidemic, without admitting liability, left me feeling sad.
I felt sad because the work of many people in the pharmaceutical industry over the years to help set industry standards of behaviour on things like marketing was ignored by external consultants paid by companies to advise on exactly these issues.
The opioid epidemic in the US has had tragic consequences.
One estimate is that between 1999 and 2016 over 453,000 people have died in the US from opioid overdoses.Total overdose deaths in the US reached almost 50,000 in 2017, many of these due to prescription opioids.
Source: United Nations Office on Drugs and Crime. 2020. World Drug Report 2020: 4 – Cross-Cutting Issues: Evolving Trends and New Challenges, p. 32, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf, accessed 20/2/2021.
The impact of the opioid epidemic in the US was so much that it actually affected the country's life expectancy figures, contributing to the overall decline in US life expectancy in recent years.
Morals gone awry
Court filings in the US show that amongst other things McKinsey recommended options to ‘turbocharge’ opioid sales. It also recommended aggressive sales tactics like rebating pharmacy chains for patient overdoses and considered the destruction of its own internal emails and documents.
It makes for grim reading.
The issues were such that in writing about the firm’s activities on opioid marketing, Tom Peters, management guru and former McKinsey partner, said he was “angry, disgusted and sickened”. He laments the company’s dealings with its clients on this issue.
Peters argues that one of the reasons McKinsey got it so wrong was that the firm is filled with too many MBA graduates “addicted to spreadsheets and PowerPoint presentations”.
He says that they are too engrossed in marketing, finance and quantitative issues and not focussed enough on people, organisational and cultural issues.
And yet in healthcare it is these issues that make all the difference.
Knowledge and ethics
Now, don’t get me wrong. I like a good spreadsheet as much as the next person.
But sadly, as well as falling at the first hurdle on ethics it appears that some people didn’t do a great job of doing their research either.
Anyone who has spent time working with pharmaceutical companies on ethics and their engagement with health care professionals will tell you about the amount of work the industry has done on developing best practice standards and frameworks.
This work includes things like:
working with industry leaders to take the industry forward on national codes of conduct with enforcement provisions
developing international codes of practice for the global pharmaceutical industry
developing standard notes for guidance for pharmaceutical companies on a range of ethical issues concerning engagement with health care professionals
collaborating with other health stakeholder groups to develop cross-sectoral codes of practice to align the pharmaceutical industry with health care professionals and patients, and
raising awareness on ethical issues and expanding the reach of industry codes of practice in emerging markets, such as in Latin America and Asia through APEC.
(You can find an earlier article I co-authored on this topic here.)
Despite the critics, the pharmaceutical industry has responded to changing community standards by taking the lead on setting ethical standards in marketing practices.
Alas, McKinsey – apparently unaware of any of this – advised its clients to do the opposite.
I say ‘unaware’ because the alternative – that perhaps the consultants knew about the industry's broader ethics agenda but chose to ignore it anyway – is difficult to contemplate.
The bottom line is that the sales tactics being recommended were probably at odds with everything the pharmaceutical industry has been trying to achieve in the principles, provisions and intent of industry codes of practice.
And, like a lot of people in the pharmaceutical industry, I spent a fair chunk of my professional career working with industry, collaborating with others in the health sector and speaking in front of sometimes sceptical audiences on how the pharmaceutical industry can take the lead in ethical standards.
So, to read about the cavalier way McKinsey approached all of this was hard to swallow.
Ethics and culture important
Across the world, the ethics and culture of various companies and industries are coming under more scrutiny than ever before, and the pharmaceutical industry is no exception.
I can understand that consultants might sometimes get caught up in the enthusiasm to help their clients achieve commercial success.
We all want to help our clients succeed.
But consultants should have the clarity to know when what is being proposed is just wrong and be prepared to advise clients when they think something is not right.
They should also know what the hell the industry has been doing for years on this topic.
For the money McKinsey was getting paid, they could have done better.
At least they have acknowledged as much, expressing their deep regret for their role.
While it won’t solve the problems of the opioid epidemic, at least it’s a step in the right direction.
Declaration of interest: Shawview Consulting consults to pharmaceutical companies that supply opioids to patients.