This case study discusses the ethical dilemmas faced by the pharmaceutical industry, to which Purdue Pharma and Johnson & Johnson belong, over the years. It looks into how Opioids evolved and were used in medicines. It also deals with substance abuse in the U.S. and the dilemma these pharmaceuticals face in launching opioid-based painkillers.
Erik Snowberg, Trevor Fetter, Amy W. Schulman
Harvard Business Review (720420-PDF-ENG)
December 16, 2019
Case questions answered:
Provide a complete analysis of the ethical dilemmas facing the pharmaceutical industry, to which Purdue Pharma and Johnson & Johnson belong, over time. Discuss the actions they have taken in the face of these challenges and your personal assessment of the situation, and the advice you would give to the board of directors moving forward.
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Case answers for The Business of Pain: Johnson & Johnson and the Promise of Opioids
The Business of Pain: Johnson & Johnson and the Promise of Opioids
This case study deals with how Opioids evolved and were used in medicines. It discusses the conflict between effective opioid treatment and substance abused in the U.S. Pharmaceutical companies, such as Purdue Pharma and Johnson & Johnson, are challenged on whether to launch opioid-based painkillers and medicines amidst the issues.
Is the Pharmaceutical Industry Responsible for the Opioid Crisis?
One of the major qualms facing the pharmaceutical industry is the unethical marketing and distribution of opioid drugs. To generate profit from opioid treatments, which were typically only used in severe cases and the limited end-of-life care industry, the pharmaceutical industry began marketing opioids as solutions to chronic pain, downplaying negative side effects such as addiction.
Beginning in the late 1990s, by 2018, 2 million people were suffering from an opioid-use disorder. This behavior of the companies involved was extremely unethical due to their use of manipulative marketing, blatantly false medical claims, and lack of action when faced with the onset of the opioid crisis.
Manipulative marketing by pharmaceutical companies played a huge role in causing the severity of the opioid crisis. Purdue Pharma, the creator of the infamous opioid medication Oxycontin, marketed the drug as a less addictive option that could be used to treat non-severe conditions such as backaches and knee problems. They stressed Oxycontin as a vehicle for quick pain relief, diverging from the prior use of opioids in the narrow end-of-life care industry.
This is clearly unethical as conclusive evidence that Oxycontin is less addictive does not exist. Instead, this was based on a hypothesis that it would be less appealing to drug addicts since the drug is long-acting.
This behavior is also unethical as Purdue likely created Oxycontin to expand opioid demand by creating a need for it in the pain-care industry rather than helping people suffering from chronic pain.
By doing so, they could transform the opioid business into a much larger industry, one in which they could generate profit far more greatly. To enhance this message, Purdue distributed inspirational videos stressing the positive effects of Oxycontin on people suffering from chronic pain.
However, when the patients featured in these videos were interviewed years later, 2 had died while abusing opioids, while others shared many problems brought on by their Oxycontin use.
Thus, Purdue used these patients’ stories to market the benefits of Oxycontin without following up on the long-term effects of the drug, suggesting to potential users that it was a safe long-term option.
Additionally, to persuade doctors to prescribe Oxycontin as much as possible, Purdue representatives began delivering an onslaught of Oxycontin-related merchandise, including stuffed animals, hats, and CDs.
This marketing extended even to frequent physicians’ offices to convince them to prescribe the drug, provide expensed meals and travel, and provide funds for pain treatment groups strongly encouraging opioid use.
However, this behavior was not limited to Purdue, as other pharmaceutical companies such as Cephalon and Insys Therapeutics engaged in similar tactics. They amplified the message that opioids should not only be used for acute pain such as cancer and surgery but all sorts of chronic pain, including arthritis. Again, these suggestions were made without conclusive evidence from research studies suggesting the expansion of opioid treatments.
Additionally, sales representatives marketing the drugs often lacked medical education and did not discuss the possibility of addiction when speaking to physicians. Insys has also been charged for pushing opioids for non-cancer patients, despite opioid treatment having only been approved for patients with cancer at the time.
To combat this ‘issue,’ representatives were instructed to lie about patients having cancer to insurance companies by providing unclear, deceiving answers. This behavior is extremely unethical, as it demonstrates that these corporations utilized deceit and bribery to generate profit.
While a company needs to sell its product to exist, doing so in the above ways is unethical and endangers patients suffering from chronic illnesses. Despite evidence of this behavior, Cephalon maintains those practices were in the past, while Insys has denied wrongdoing.
However, in 2019, Insys founder John Kapoor was sentenced to 5 years in prison due to his part in providing kickbacks to doctors prescribing their opioid products.
Likewise, Purdue has been forced to pay $634 million in fines in a lawsuit for misleading marketing. They have also promised to terminate their aggressive opioid marketing and have launched campaigns detailing how they deal with the opioid epidemic.
My advice to the board of directors moving forward would be to discontinue all opioid products and development and to donate annually to foundations working to combat the opioid crisis and help affected families.
Another example of pharmaceutical companies’ unethical behavior in the distribution of blatantly false information to promote opioid sales. Purdue and others claimed that less than 1% of patients taking the drugs became addicted. This was based on a non-peer-reviewed article in the New England Journal of Medicine, extracted from an editor’s note referencing short-term drug use.
Based on this inconclusive evidence, which does not support long-term use of opioids, Purdue has used this to their advantage to bolster their statements that Oxycontin lacks addictive properties.
This is extremely unethical as the short segment in the article cited does not provide conclusive grounds to recommend long-term opioid use for pain treatment. Purdue also claimed that Oxycontin would not attract addicts, as its long-acting and long-term effects would not be appealing.
Again, these statements are not backed by facts – it is morally wrong to claim otherwise. Purdue further introduced the existence of ‘pseudoaddiction,’ which they defined as a patient who appears to be a drug addict because they are pursuing pain relief.
This suggests that company leaders expected Oxycontin abuse and introduced the concept of ‘pseudoaddiction’ to cover up their tracks temporarily.
Even more shockingly, when marketing the drug, Purdue trained sales representatives to inform doctors that Oxycontin was superior to other opioids on the market, including false information that it was less addictive and far less likely to be abused.
Johnson & Johnson, another player in the opioid market, has also recently been exposed…