So Purdue Pharma finally pled guilty. The company CEO, one Steven Miller (no, not that one), formally acknowledged this before a judge. An update:

Somehow, just when I think this mess has reached its end, something else emerges that makes me wonder if the company’s conduct wasn’t even more self-serving than we thought. Take this article, which appeared just a few days later:

For those of you who aren’t familiar with the world of high-profile consulting, McKinsey is perhaps the best-known of its ilk — serving governments and big corporate interests at the highest levels. They played key roles in both the Enron (2001) and Wall Street (2007) financial crises. And it turns out they were heavily involved with Purdue in the prescription painkiller epidemic, too.

They get around.

An earlier NYT piece described McKinsey’s role in convincing Purdue Pharma management to deal with growing evidence of Oxycontin abuse by launching an aggressive promotional campaign intended to revitalize sales of the drug despite the bad news. The idea was to somehow turbocharge opioid prescribing in the face of opposition. They offered advice on how to push back against law enforcement, as well as negate the impact of media stories about grieving families of overdose victims. One method was to recruit chronic pain patients to act as advocates for continued access to Purdue’s products.

I guess they wanted people to believe that the potential benefits for pain control justified the rising death toll?

Aargh. I thought I was pretty cynical but this surprised even me. It’s “Merchants of Death” type stuff (see Chris Buckley’s satire Thank You For Smoking).

Then again, we don’t ordinarily look to highly-paid spin doctors for ethical guidance. They exist for a different purpose entirely.

I think most of us realize by now that when ethics comes into conflict with corporate financial interests, money often wins the day. Those dazzling CEO bonuses aren’t paid out for strictly ethical business practices.

I found myself wondering about the thought processes that go on when the two sides, management and consultants, get together to plan. In my imagination, it goes something like this:

Corporate: “Hey, our products help people. It’s not our fault if some people abuse them. We have a right to make a profit. We’re the good guys here.”

Consultants: “It’s not our job to make decisions for the client. We advise on various options. The final responsibility is not ours.”

On some level, I figure both parties know it could end badly. Still, at the time it probably feels like it’s worth the risk. Especially to a company worried about its revenue. An expert is willing to tell them there’s hope yet. When you want badly enough to believe…

Problem is, with healthcare? There are lives at stake.