Cult of Irresponsibility: Is ‘Sweeping the Dust Under the Carpet’ a New Norm in Health and Pharma?

Face and Embrace

One of the first and most important lessons many learn – or re-learn – in recovery is to take responsibility for their actions. Own up to what you have done. Face the music and accept consequences, no matter how uncomfortable, inconvenient, or challenging.  Don’t run and hide.  Try to keep your side of the street clean.

What many practicing a program of recovery also soon learn, often with no small measure of disappointment, is that not everyone is guided by this same key principle.

In Other News

Last week, at the apex of the opiate epidemic and at a time when fentanyl-laced heroin is producing previously unheard-of overdose rates, billionaire drug company executive John Kapoor stepped down as CEO of Insys Therapeutics, a leading manufacturer of fentanyl-based opioid medicines and also a producer of medical marijuana.

Kapoor’s resignation occurred just a month after six Insys executives were arrested for their efforts to bribe medical professionals in several states to prescribe, with regularity and with clear preference over other drugs, Insys’s under-the-tongue spray form of fentanyl.

Who is John Kapoor?

Kapoor is a multi-billionaire who heads another generic pharma company, Akorn, and he has a record of allowing marketing techniques at his companies that often push the bounds of ethics and law.  Most notably, Kapoor is not quitting the company.  Not by a long shot.

He will remain a powerful member of the board and a 67% majority stockholder in Insys. In short, he is distancing himself from what promises to be an ugly and aggressive lawsuit, while continuing to collect a healthy paycheck and maintain influence over the two pharma companies that have put him on Forbes’ Richest People in America list. He’s worth about 2.1 billion, incidentally.

The Industry

Kapoor’s companies’ practices – and his own maneuvering – may seem unsavory, but it’s not unique in the healthcare and pharma industries these days. At the beginning of this year, McKesson – the largest drug distributor in the U.S. – agreed to pay a $150 million fine for violating federal law by failing to effectively monitor and prevent suspicious, often large-scale orders, of powerful painkillers such as oxycodone.

The company paid a more than $13 million dollar fine to settle similar charges in 2008.  And in December, Cardinal Health – another “Big 3” drug manufacturer – paid $44 million in fees to settle allegations that it had failed to maintain adequate systems to control the diversion of opiates.

So what’s the deal?

All of these developments, or financial settlements more appropriately, come at a time when more than 2 million people (in 2014 alone) reported abusing or being dependent on prescription painkillers. The death rates due to opiate overdoses have quadrupled since 1999, and roughly one in four people who are prescribed opioids long-term end up struggling with addiction.

Federal agencies have, out of appropriate concern but likely equal measures of panic issued new guidelines for prescribing and have recommended aggressive drug monitoring programs to stem the tide of misuse and abuse.  But clearly, malpractice, which of course literally translates to “bad practice,” has continued.

And it’s not just been big drug companies. Doctors have played a role too. Some were simply not careful enough in monitoring patients or failed to be forward-thinking enough to alter their recommendations for the treatment of chronic pain. But some continued to be swayed by big pharma and took significant payment to endorse and prescribe drugs that were dangerous.

What is perhaps most unsettling about all of this is that the public rarely sees real contrition, remorse, or apology expressed in the wake of such actions.

Purdue Pharmaceuticals

Purdue Pharmaceuticals, who is a 1997 landmark case and settlement ($635 million) paid dearly for its misleading claims about the non-addictive properties of its signature drug OxyContin, may have come closest to trying to do something right or at least better, in light of the problem they had caused.

In 2010, they released a reformulation of Oxy that made it far more difficult to crush or dissolve in an effort to stave off abuse. But that had the unintended consequence, along with rising prescription pill street values, of driving opiate-dependent users to heroin.

News Article

A newspaper released this month by the RAND Corporation and Wharton School makes that connection even more clear. Indeed, instead of taking any direct measures to say we’ve played a big role in a huge problem that has negative consequences for the public, drug companies have lobbied and made political contributions in excess of $900 million dollars to protect their business interests in a market that not only doesn’t go away – but most certainly gets worse – when the biggest players put big money behind keeping pain meds in serious play.

Profits $$$

So, it often seems like the pattern is that CEOs take cover and companies write checks to contain, or manage, their problems. And protect their interests. The New York Times recently highlighted a report by Oxfam pointing out that global financial inequity is at an all-time high, and that that trend runs parallel to increasing distrust in American businesses and institutions.

We’ve seen these kinds of patterns since before the 2008 economic crisis when big banks were bailed out in the midst of a sub-prime mortgage crisis that was leveraged to the hilt in large part due to their lack of self-regulation and company executives notoriously scrambled to secure multi-million dollar severance.

So what’s really fueling the fire?

But it was not just big money and abuse of power that inspired a feeling of anger and disappointment among many citizens then. And it’s not just those things that irritate or discourage us when we see them happening in the healthcare industry today.

No, it’s that we don’t recognize in any of this something very basic that most Americans, most adults, have come to value: namely, taking real responsibility for what we’ve done and owning up to – and even trying to right – our wrongs.

Most of us have been taught this since we were kids, but it certainly takes on a new significance when we work in substance abuse treatment and see the importance of the principles of honesty and integrity in recovery.

So let’s hope as we head into 2017 that we see a change in the tides. That we see more to make us feel connected in our common mission to improve and often save, lives. And that, at least at the bare minimum, we all can feel that we live up to the oath of “do no harm.”  The stakes are higher than ever before.