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'In-Depth Narcotics Experience': McKinsey Advised US Pharmas on How to Turbo Sell Opioids_我的网站
A | 妈宝男真是给男娃当妈的一大难题。 Global consulting giant McKinsey & Company advised several painkillers producers for 15 years on how to "turbocharge" prescription drug sales largely to blame for starting the opioid epidemic in the US, The New York Times has revealed citing over 100,000 documents.,The docs emerged as a part of a settlement deal that McKinsey signed with several state attorneys that sued the company.,Apart from working with Endo, Purdue, and Mallinckrodt, the company also provided "in-depth experience in narcotics" for Johnson & Johnson subsidiaries producing controlled substances. Meanwhile, hundreds of thousands of US citizens died from overdose, often linked to these very drugs.,How It All Started,According to the disclosed documents, McKinsey helped both Endo and Purdue, the creators of two of the most widespread opioid-based drugs for severe chronic pain, to launch their products Opana and OxyContin in 2006-2008. The firm even advised one of the companies on how to overcome a Food and Drug Administration (FDA) block which it had encountered in 2008.,The FDA blocked Purdue's attempt to release an upgraded version of its OxyContin, which was more difficult to snort or dilute and inject in bloodstream – two methods of the prescription drug's abuse that already had been devised by some of its recipients. In order to help Purdue get the license, McKinsey interviewed an ex-drug dealer on the medication's abuse, prepared docs and even coached the drug firm's officials for meetings with the FDA as the pharmaceutical company knew its drug had been widely abused, the docs suggest.,Crack Pipes: Biden Administration's Handling of US Opioid Crisis Raising Questions, Journo Says15 February, 13:00 GMT,Purdue's main competitor, Endo, also released a new version of its painkiller and tried to get it marked as resistant to crushing (for snorting) and diluting (for injections), but the FDA did not allow the latter citing lack of such properties. Nonetheless, the drug's release was a success and coincided with a drop in abuse-resistant OxyContin's sales.,This came, however, at a cost of local epidemics of previously unseen blood disorders in several US states in 2012 – patients were found to be anemic and suffered from kidney failure. Many of them admitted to abusing updated Opana – the new formulae indeed discouraged from snorting it, but still allowed injection abuse. However, the same component that prevented crushing took a great toll on those who tried to inject the drug to get a better high, leading to red blood cells' destruction and organ damage.,Going on the 'Offensive',The consulting company's involvement in the opioid crisis did not stop at helping the companies to launch their products – it also helped them to boost the sales.,While the pills like the ones produced by Endo, Purdue and Mallinckrodt were originally advertised as not causing additions, US doctors were not always prone to prescribing them, especially when a patient's pain was neither severe nor chronic. According to the revealed documents, McKinsey's consultants helped Purdue, and several other companies, including two J&J subsidiaries, to overcome this "problem".,Starting in 2009, McKinsey developed a "segmentation" strategy for Purdue: its analysts divided the company's customers into groups based on their potential thoughts of the product and then formed distinct messages for each group. The customers in this case were doctors prescribing painkillers and the product was opioid drugs. The strategy targeted even doctors who resorted to opioids only in most extreme cases, ensuring them of OxyContin's safety and trying to convince them that there was no point in making their patients suffer.,The consulting company proposed to achieve this by "[raising] physician comfort levels through appropriate education and support". Purdue tried to convince these doctors that their colleagues had no issues prescribing OxyContin.,By 2014, the US government started to realize a nascent opioid drug problem was underway and introduced new labeling requirements for such drugs as well as instructions to use them only in cases of severe of chronic pain. Around the same time, OxyContin sales started to decline, prompting Purdue to ask for McKinsey's help once again – this time to overcome the government's policy and precautions.,The consultants identified the problem as the company promoting its drug as a less potent opioid amid rampant drug abuse and advised to shift to the "offense" instead, the documents show. They namely advised focusing the salesmen efforts on doctors, who were likely to prescribe OxyContin to a new client not previously taking opioid drugs.,"Physicians with higher OxyContin NBRx to Rx ratio may be more likely to initiate a patient on OxyContin", an extract from a McKinsey presentation for Purdue from January 2014 said.,Around the same time and amid the 2015 HIV concentrated outbreaks in several states linked to the opioid drugs abuse via injections, McKinsey consulted Endo on promoting its Opana. The company was not concerned about what the CDC named "explosive transmission" of HIV and the Opana's role in it, according to the documents. On the contrary, in summer 2015, it helped Endo rededicate most of its salesmen from other products into a "Sales Force Blitz" – the company almost solely dedicated to selling Opana to around 3,000 physicians in the US.,One of McKinsey's consultants was excited over the creation of the "Force", claiming in correspondence with the head of Endo’s painkiller unit that the "fun [begins] on Monday!" with the latter responding "agreed, the fun is just beginning".,Playing Both Sides,One of the strangest revelations in the documents uncovered by the New York Times is that McKinsey managed to play both sides of the opioid crisis tragedy – helping pharmaceutical companies sell more of "not-so-addiction-resistant" drugs, while also assisting the FDA, other government agencies and state governments, in the fight against the epidemic.,In 2017, the FDA finally decided to pull one of the drugs, the more potent Opana, from the market, but not until it made $844 million in revenue with help from McKinsey and played a role in the deaths of thousands of Americans, considered to be the victims of the opioid epidemic. Paradoxically, the same year, McKinsey Senior Partner Tom Latkovic lamented about doctors prescribing opioid painkillers left and right at a health care conference.,"Why do we continue to prescribe, dispense, pay for opioid prescriptions to people that we know, or at least we could know, have an incredibly high propensity to abuse them?" Latkovic wondered.,The bizarre divergence between what McKinsey was advising to the pharmaceutical companies and Latkovic's rhetoric is explained by the fact that he was not a member of the consulting company's pharmaceutical practice, which worked with pharma.,Instead, he and his team worked with state governments and health systems to pin down the ways of tackling the opioid crisis, The New York Times said citing two local officials, who used to work on the issue. Their work, however, was partly complicated by McKinsey's pharmaceutical wing, which wanted to greenlight their draft publications in case they could damage their clients.,North Carolina Rep. Claims Opioid Crisis 'Affects Every Community' in US Amid Drug Trafficking Surge19 December 2021, 01:36 GMT,Eventually in 2019, McKinsey finally stopped advising its top client, Perdue, but not until their ties became public during one of the litigations related to the opioid epidemic and initiated by US authorities. One such litigation eventually had McKinsey pay $600 million in settlement without admitting guilt, as well as release the documents related to its work with the pharmaceutical companies.。 特别是小时候，又得呵护，又得注意不能养成什么都找妈的习惯。 图图是在伦敦出生的。我和我老公自己带。
B | 他一岁前，光是吃喝拉撒睡觉冷暖这些问题，我就感觉到国内外的方式完全不同。 我个人感觉，国内对孩子的养护真是极致到了宇宙的尽头。 特别是短视频里那些过分警告孩子会怎样怎样的傻叉论述，导致热爱看这些的祖父母，跟我们这一代父母，经常因为带娃的小事起争执。
C | 哭一会就会有情感阴影，坐久了伤脊椎，吃任何东西都会呛着，冬天裤子露脚踝了就会感冒，摸摸脸蛋就会脸颊发炎…... 图图10个月的时候，我带他回家拍全家福，有一幕特别逗。进影棚之前，有好几家一起在等。 我老公双手抓着娃小手玩，举高高了一下。一瞬间包括工作人员在内，一起惊呼“He!” 一边惊呼还集体向后退，像水花炸开了一样。
D | 他们估计觉得，我娃的脊椎这么一下，就要断了。
E | 我老公是东欧人，家里说俄语为主，养育方式比较tough，特别是男娃。他们更在乎养成普京那样的男子，七十多岁泡冰水里养生那种。 我老公三岁就开始被锻炼做很多家务。即使有阿姨，他的房间一定是自己打扫。
F | 很多体育运动，很多下田的农活，培育体格和性格。 图图小时候，到了冬天也不会穿很多，我老公偶尔还给他洗洗冷水澡，上一上普京那种提高免疫力的东欧方法。 一岁前的大冬天，我自己带他去上游泳课，两个人从泳池出来了也没啥人帮忙的，洗洗擦干盖上保暖的大衣就回家，没法太细致。 我个人的体验是国内遇见的妈宝男真的很多，我真的好奇是不是跟近年的养育文化有关。 男娃被当成了特别稀奇的物种。
G | 可是温室养法，养不出能经历风雨的树。 越稀奇越绝种啊，你看看大熊猫。 可是，每个人一定会经历风雨，没有父母能帮助挡一辈子。 当然，英国我也待得不长，我也没有严格的统计数据来比较。
H | 全球化之后的流动性也大——我纯属个人吐吐槽。 英国也一定有妈宝男。 我有个之前的合作伙伴，还是我老乡，就base伦敦。看起来各种光鲜的金融男，可真的事事费妈。大事找妈，小事找老婆。 当这位妈宝男的妈妈代表他来找我吃饭，替他三十多岁的儿子谈合作和分账方式，以及规划人生的时候，我真的震惊了。 立马停止合作。 我感觉英式教育里养出妈宝男的概率小，只是个人这五年在英国上学工作，待人接物的感受。 西方文化里，大多数老外会觉得经常找妈是一个很丢脸的事情，特别男娃。 图图干妈说，在伦敦路上，往往看见老外家庭是一带五。中国家庭反过来，五带一。 最近给图图看学校，也有不少心得。
I | 从幼儿园开始，很多学校都会强调接触户外和大自然。从小学开始，很多学校就强调如何培育独立性（Independence）和独立思考，学习之外还有非常多的运动项目和俱乐部。 从小就做题家的我，听到这些是很新鲜的。我接受的中式教育更重视知识的灌输，很少强调要走出去，很少强调玩的重要性。 剑桥的人类学教授麦克法兰研究英式教育和英国社会，有好几本著作。 他说，英式教育中团队运动比数学更重要，因为团体运动“teach you the centre art of life”。 大家不会崇拜数学考得好的人，而是会跟着足球队队长去打拼。 因为在一个团队运动里当队长，需要很强的交往能力和平衡精神。
J | 比如足球，一个孩子需要学习去平衡，自己要踢多久的球，什么时候把自己脚上的球传给别人。 这种能力正是解决各种人生难题的核心——麦克法兰说，这种教育设计体现了亚当斯密对于一个人平衡“self love”和“social love”的思考。 这种教育设计其实根源于英国殖民时代，英国需要通过公学系统（boarding school)，培养能去全球范围殖民的外交和政治人才。
K | 这种传统英式教育的核心，在于让未来能力成为全球领导人的孩子，在离开家的情况的下去自己解决问题（solve problems away from home)。 英国这么小一个岛国，有全球这么多殖民地，是懂点全球化领导的艺术的。 麦克法兰自己就是外交官的后代。
L | 我印象特别深，他说从小他在英国的学校就是自己和同学们玩各种游戏（all kinds of games)，室内游戏和室外团体运动。 Netfilx的剧《王冠》第一季里，就有女王老公菲利普小时候在苏格兰的公学里上学的故事。环境那叫一个苦，成天在森林泥地里跑爬打滚— 他还是王室身份。 他自己很感激这段经历，试图把儿子查尔斯送过去。查尔斯从小养尊处优惯了，几乎被父亲深爱的同一个学校击垮。结果就是转回更现代化（舒服）的学校。 话说回来，英国学校也是很在乎读书和学习的，特别是阅读写作还有数学能力在national curriculum里是核心。 但绝不会只强调书本学习，或者针对考学的能力培养。 麦克法兰系统研究过英国工业革命的历史。很有意思的是，工作革命之前，日本的识字率比英国高，但工业革命这种历史级别的创新，并不发生在日本。 他说，英式教育比较遵从人性和自然，对人的干预少。“一味的知识灌输，只会扼杀人性”。 当然，这也只是我这个做题家妈妈的反思。
M | 不养出妈宝男的这条路，还很长。 不仅是因为希望，我儿子童年可以真的快乐一些。
N | 关键如果长大了还妈宝，真是会一辈子费妈。 共勉。 本文来自微信公众号：糖总总，作者：糖总总。
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