While delivering a recent medical ethics speech keynote speech, I was asked, as a medical ethics speaker, and medical ethics consultant, what the biggest ethical abuse of the system might be?
In my opinion, if there is a Medical Ethics Hall of Shame, the top award – or at least near the top, is the opioid crisis and how unscrupulous drug companies, physicians and sales reps, conspired to create a crisis of epidemic proportions.
The purveyors of opioids, working in tandem with unethical healthcare providers, launched a snowball down a hill that annually swallowed up tens of thousands of lives, directly and indirectly. Virtually every major and mid-sized city or town in America boasts homeless camps. A large percentage of the “residents” are opioid-addicted. Millions of families and their friends have “lost” people who were caught in the web of addiction. How did it start? Where did it start?
The kickback schemes
In a Reuters article by Nate Raymond (May 25, 2022), an all-too familiar scenario played itself out.
The Insys Therapeutics company is now out of business (bankrupt in 2019), but the damage continues. The Arizona company manufactured a fentanyl spray (tradename Subsys), both addictive and deadly. Its intended use, presumably, was to relieve the awful pain of patients in the last phases of terminal cancer. However, unethical individuals from the top down saw the opportunity to make millions.
The latest conviction involves a Tampa, Florida M.D. and an Insys Therapeutics sales representative who “facilitated” nearly $280,000 in kickbacks to the M.D. from the company. A jury convicted the physician, Steven Chun and a pharma sales rep, Daniel Tondre for conspiracy and receiving kickbacks. They may be the last of the Insys convictions, but they are not alone. More than 40 healthcare providers and company employees were convicted in the deadly mess. They are poster children for medical ethics abuse.
The kickback scheme was straightforward and sinister. Insys Therapeutics held fancy luncheons and “paid doctors” to speak on medical topics relating to the miracle Subsys drug. Except. The doctors knew it was a sham, the drug reps certainly knew it was a sham and paid doctors’ kickbacks by arranging for them to participate in “sham” speaker programs ostensibly meant to educate medical professionals about Subsys. No one was educated about anything.
Over and over, Chun sometimes showed up to speak and each time he did, close to $3,000 came into his account, and all he had to do was to write prescriptions. In fact, crank them out for just about any ache or pain. To really entice the operation, Insys “hired” Chun’s girlfriend to help him enable insurance form submissions. It was largely an honorarium.
While it is arguable, I suppose, that one physician has little impact, we must remember it was as many as 40, then office assistants, then pharmacies became involved, then their clerks. It spread into hospitals and clinics, then ultimately “out back doors.” There was simply too much money to be made with drugs that were more addictive than heroine.
The opioid crisis was not only on the shoulders of one pharma company, but several, and now, of course, the millions of pills being illegally manufactured off-shore.
From the start, Dr. Chun has maintained his innocence. It is a difficult argument to make, especially as the former chief executives of the company both wound up in jail.
Along with the jail sentences, of course, men like Dr. Chun will undoubtedly lose their licenses. At some point on the way, even though he is adamant he never prescribed the drug, to someone who didn’t need it, he must have thought “how come I’m getting paid $3,000 just to show up at a lunch?” For the more he prescribed, the more free lunches were provided.
As a medical ethics speaker, and medical ethics consultant, I can safely say (pun intended) there is no free lunch. He took the money as did 40 other physicians, all presumably exposed to medical ethics in medical school.
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