Imagine you were a manufacturer of powerful opioid painkillers and your sales representatives discover suspicious activities at the offices of some physicians who prescribed your product. These activities include patients lining up to pay cash for prescription opioids, drug deals going down in the parking lot, people falling asleep from opioid intoxication in the waiting room and physicians being visibly intoxicated themselves. In response would you:

(A) Report these doctors to the authorities?

(B) Insulate yourself by not sending your representatives to these doctors anymore, but continue to pocket the huge profits they generate from writing countless prescriptions for your products?

(C) Keep a secret list of these doctors but publicly promote the idea that painkiller abuse is not driven by wayward doctors but by other sources, such as pharmaceutical robberies?

(D) Reveal the list of doctors to authorities years later only because at that point it could stop a competitor from introducing a new generic medication that might cut into your own sales?

(E) A combination of B, C and D, but certainly not A.

According to Scott Glover and Lisa Girion of the L.A. Times, Purdue Pharma chose option E and thereby preserved its astounding profits from Oxycontin. The company’s lawyer claims that no one would be interested in their list of suspicious doctors, but immediately after the story broke state legislators understandably called on Purdue to turn over the list to the authorities.

Purdue thinks their judgement of what names should and should not release is above reproach, but:

Andrew Kolodny, a New York addiction doctor who is leading an effort to curb narcotic painkillers, said such decisions should not be made by a pharmaceutical company.

“That judgment needs to be made by state medical boards, not a corporation that benefits from overprescribing,” he said. “Purdue should make the list available to state medical boards so that physicians on the list can be investigated.”

Purdue Pharma’s conduct may seem shocking in light of the fact that it was fined $600 million in 2007 for deceptively marketing Oxycontin and understating its addictiveness. But it’s all relative. OxyContin is a multi-billion dollar profit center for Purdue Pharma, and a fine that size is therefore just the cost of doing business rather than a significant deterrent to further unethical behavior.

[Cross-posted at The Reality-based Community]

Keith Humphreys

Keith Humphreys is the Esther Ting Memorial Professor at Stanford University. @KeithNHumphreys