There is a pharmaceutical marketed under the tradename of Subsys, that was approved for sale by the U.S. Food and Drug Administration (FDA) about five years ago. The drug has inherent problems as it contains fentanyl which is a powerful opioid and 
opioids are under close scrutiny. Its use is for patients who are dealing with serious illnesses such as cancers where chronic pain markedly affects quality of life. It is manufactured by Insys Therapeutics.
The Insys product is meant as a sublingual product, it is sprayed under the tongue. The opioid is quickly taken up by the body and helps to alleviate pain. Insys felt that when it was being developed that it would be a very popular pain-killing medication. It failed to live up to its sales potential, so Insys devised a scheme.
Insys – The shell game
When a sales rep walks into an office, a typical question asked of the rep might be, “How many patients are using the drug?” The more patients using a pharmaceutical such as Subsys, the more likely it is to gain the attention of a physician. So the company in its infinite “unethical wisdom” decided to produce (on paper) “fake” cancer patients. In order to create the scam Insys recruited three physicians to develop a “marketing plan.”
The Arizona Attorney General Mark Brnovich claimed the scheme was emblematic of “the unethical and greedy behavior in the pharmaceutical industry that is fueling the opioid crisis in our state.”
The senate committee investigating the Insys scheme as part of a national investigation into opioids said their investigation revealed that the company had been pressuring its employees to increase use of the drug. Under most circumstances the drug was used when the patients who were prescribed had active cancers with chronic pain that could not be controlled with milder pharmaceuticals. The reps provided kickbacks to doctors to prescribe the drug, to fake medical records and lie to insurance companies. The kickbacks were covered up as marketing costs and payments to doctors as speaker’s fees.
In December 2016, six former Insys executives including the former CEO had been indicted.
The doctors who received kickbacks were guilty in their own way as well. What was worse, is that they knew better in terms of their medical, ethical training. For example, the so-called speaking engagements were nothing more than fancy dinners Insys sales reps bought for their families and friends where money was exchanged “under the table.”
Insys – Faking it
When the “cancer community” caught wind of what Insys had done, they were logically outraged. Cancer patients are in a life and death struggle, there are no gray areas. However, when a company like Insys is caught it underscores the complex world fueled by a profit motive between patients, oncologists, researchers, and various organizations. It is often all gray and it erodes trust. It is very difficult (and understandably so) for patients to trust pharmaceutical companies.
While pharmaceutical companies, especially those in the “cancer space” now claim that they are behaving within the highest ethical standards, it is difficult for the community of cancer patients to accept. Even Insys, which has new management and an almost completely revamped sales force is doing all it can do to convince us that they are working to within the highest ethical standards.
Here’s the problem: no one really knows what those standards mean. If a pharmaceutical manufacturer claims that they are adhering to high standards, are they saying that they have an on-going, third party, ethical training process? Who is administering those programs, who is measuring the success of those programs and most importantly, what are the measurable expectations from the ethics training?
It would be wrong to look simply at “Big Pharma” as being culprits. There are oncologists and other medical specialties all too willing to stick out their greedy hands and accept “marketing payments,” for altering patient records and prescribing unnecessary drugs. Then again, they must have had a sense that the payments are one of many causative factors to raise the ever, upwardly spiraling healthcare costs.
We are taught that physicians are trained to adhere to the highest ethical standards, but again, who teaches them those standards and how are they measured? The questions outweigh the answers, but one thing is certain: the teaching of ethical standards to pharmaceutical companies and physicians has failed the patient.
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