The hard sell Crime and punishment at an opioid startup

Evan Hughes, 1975-

Book - 2022

"The blistering inside story of a startup that made millions pushing opioids-until its cutthroat tactics were exposed and its executives put behind bars John Kapoor had amassed a small fortune in pharmaceuticals when he conceived of a new product. It was the 2000s, and opioids were big business. If Kapoor, an immigrant and the billionaire founder of Insys, could find a new way to administer the highly potent fentanyl, he could patent his invention and sell it to those in need-at a steep pri...ce. The only problem: There weren't enough people in need. Kapoor's drug was approved for breakthrough cancer pain. If Subsys was going to turn a profit, the company would need to persuade doctors to prescribe it "off-label," for other, lesser forms of pain. This is the story of how Insys turned a niche drug into big business. With executives leading the charge, Insys sales reps seduced doctors with charm, money, and sex. Its administrators lied to health care providers, claiming recipients had cancer when they did not. It pushed drugs onto patients that would have benefited from safer options, or no drugs at all. The strategy worked: When Insys went public, it notched the biggest IPO of its year. But several employees reached their limit and quietly blew the whistle, bringing the full force of the justice system upon the drug maker. In The Hard Sell, author and National Magazine Award-finalist Evan Hughes lays bare the pharma playbook. He shows how drug makers like Insys, fueled by greed and a hunger for market share, turn deception into profit. The book represents a stunning vindication, but also a cautionary tale. As Hughes shows, Insys didn't do anything its competitors weren't also doing. It was simply worse at covering its tracks"--

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Subjects
Published
New York : Doubleday [2022]
Edition
First edition
Language
English
Physical Description
x, 273 pages ; 25 cm
Bibliography
Includes bibliographical references (pages [237]-273).
ISBN
9780385544900
0385544901
9780525566328
0525566325
Main Author
Evan Hughes, 1975- (author)
  • The mentor and the protégé
  • The big bet
  • The playbook
  • The rookies
  • The ecosystem
  • The salesman
  • The program
  • The stand-off
  • The performer
  • The spiel
  • The whistleblower
  • The whales
  • An interloper
  • 'Let's get a few more'
  • Fall guy
  • 'It's going down'
  • The pyramid
  • The marks
  • Dirty little secret
  • The verdict
  • No safety net.
Review by Booklist Reviews

*Starred Review* John Kapoor, an industrious immigrant and founder of the pharmaceutical company Insys Therapeutics, lost his wife to cancer in the early 2000s. Her suffering inspired him to create a new treatment for breakthrough cancer pain, Subsys, a powerful fentanyl spray. Grief soon gave way to greed. Kapoor curated a corrupt crew of executives that would do anything to make a profit. Sales reps were encouraged to lie, bribe, and flirt their way onto doctors' prescription pads. Very few patients prescribed Subsys suffered from cancer, as doctors on Insys' payroll encouraged off-label use of the heavily potent opioid. As money started rolling in, financial success became as addictive to the Insys staff as the product they shilled. The company's Wolf of Wall Street—style antics and flagrant disregard for compliance laws finally caught up to them, resulting in a bombshell courtroom drama worthy of prime-time television. Hughes' compact retelling of the Insys saga unfolds like a blockbuster film. Fans of Bad Blood by John Carreyrou (2018) will be captivated by this story of unbelievable greed and hubris. A must-read. Copyright 2021 Booklist Reviews.

Review by Library Journal Reviews

Having reformulated the powerful painkiller fentanyl, ambitious scientist John Kapoor founded Insys Therapeutics in the early 2000s and pushed his sales staff to market it aggressively, especially to shady or outlier doctors. The start-up boomed, but whistleblowing led to an investigation, a trial, and the government's determination to make the drug industry accountable for opioid addiction. From National Magazine Award finalist Hughes. Copyright 2021 Library Journal.

Review by Library Journal Reviews

An account of the inner workings of a pharmaceutical company could have been dull in the hands of another author, but Hughes (Literary Brooklyn) brings it to life beautifully. He weaves together a vivid cast of characters—doctors, sales reps, and executives—with key commentary illustrating the connections between a relatively small drug company named Insys Therapeutics and the broader opiate epidemic. As compelling as a true crime documentary, the book details Insys's relentless quest to corner the drug market with its version of fentanyl and chronicles the resulting federal trial; in 2019, Insys founder John Kapoor and several executives were convicted of bribing doctors to prescribe the addictive drug Subsys. Even readers with little background on the topic will find themselves riveted by the narrative—and disgusted by the tactics and mindset of Kapoor and his colleagues. Hughes perfectly captures the human impact of pharmaceutical sales and corporate greed. VERDICT Anyone who picks up this title will be left reflecting on how the U.S. medical system and drug companies have recklessly destroyed countless lives. A book readers will not soon forget.—Sarah Schroeder, Univ. of Washington Bothell Copyright 2021 Library Journal.

Review by Publishers Weekly Reviews

Journalist Hughes (Literary Brooklyn) takes a revelatory deep dive into the ignominious history of the pharmaceutical manufacturer Insys Therapeutics, the leadership of which was convicted in 2019 of federal racketeering and conspiracy charges. John Kapoor, the founder of the Arizona company, and others had bribed doctors to prescribe their fentanyl-based pain medication Subsys even when medically unnecessary. Insys also persuaded physicians to delegate seeking prior authorizations for insurance coverage to an Insys contractor, a practice that Hughes notes is tantamount to a kickback ("If you write our product instead of the other one, we'll pay for the grunt work").Hughes does an excellent job of illuminating the inner workings of Big Pharma's malicious practices; for example, it was routine practice for sales reps to document their pitches, and some of those notes referenced lies about the medications being pushed (such as OxyContin being less addictive than other opioids). To avoid legal jeopardy, several major drug manufacturers altered their record-keeping systems so as to eliminate the risk of an employee recording incriminating information. While the arc of this story won't surprise readers familiar with the recent Purdue Pharma headlines, this is a powerful indictment of abhorrent industry practices. It's a worthy complement to Gerald Posner's Pharma: Greed, Lies, and the Poisoning of America. Agent: David Halpern, Robbins Office. (Jan.) Copyright 2021 Publishers Weekly.

Review by Publisher Summary 1

A National Magazine Award finalist, drawing on unprecedented access, presents the inside story of entrepreneurial upstart John Kapoor who founded Insys Therapeutics, making millions selling painkillers until whistleblowers put him at the center of a landmark criminal trial.

Review by Publisher Summary 2

"The blistering inside story of a startup that made millions pushing opioids-until its cutthroat tactics were exposed and its executives put behind bars. John Kapoor had amassed a small fortune in pharmaceuticals when he conceived of a new product. It was the 2000s, and opioids were big business. If Kapoor, an immigrant and the billionaire founder of Insys, could find a new way to administer the highly potent fentanyl, he could patent his invention and sell it to those in need-at a steep price. The only problem: There weren't enough people in need. Kapoor's drug was approved for breakthrough cancer pain. If Subsys was going to turn a profit, the company would need to persuade doctors to prescribe it "off-label," for other, lesser forms of pain. This is the story of how Insys turned a niche drug into big business. With executives leading the charge, Insys sales reps seduced doctors with charm, money, and sex. Its administrators lied to health care providers, claiming recipients had cancer when they did not. It pushed drugs onto patients that would have benefited from safer options, or no drugs at all. The strategy worked: When Insys went public, it notched the biggest IPO of its year. But several employees reached their limit and quietly blew the whistle,bringing the full force of the justice system upon the drug maker. In The Hard Sell, author and National Magazine Award-finalist Evan Hughes lays bare the pharma playbook. He shows how drug makers like Insys, fueled by greed and a hunger for market share, turn deception into profit. The book represents a stunning vindication, but also a cautionary tale. As Hughes shows, Insys didn't do anything its competitors weren't also doing. It was simply worse at covering its tracks"--

Review by Publisher Summary 3

The inside story of a band of entrepreneurial upstarts who made millions selling painkillers—until their scheme unraveled, putting them at the center of a landmark criminal trial.“A fast-paced and maddening account.... Until I read The Hard Sell, about the outrageous behavior of an obscure drug company, I hadn’t appreciated the full extent of the filth or the dark stain the opioid sector has left on the entire industry.... What’s most surprising and powerful about The Hard Sell is not one company’s criminality—we’ve grown inured to corporations behaving badly—as much as how institutionalized these practices were across the modern drug industry.” —New York Times Book ReviewJohn Kapoor had already amassed a small fortune in pharmaceuticals when he founded Insys Therapeutics. It was the early 2000s, a boom time for painkillers, and he developed a novel formulation of fentanyl, the most potent opioid on the market. Kapoor, a brilliant immigrant scientist with relentless business instincts, was eager to make the most of his innovation. He gathered around him an ambitious group of young lieutenants. His head of sales—an unstable and unmanageable leader, but a genius of persuasion—built a team willing to pull every lever to close a sale, going so far as to recruit an exotic dancer ready to scrape her way up. They zeroed in on the eccentric and suspect doctors receptive to their methods. Employees at headquarters did their part by deceiving insurance companies. The drug was a niche product, approved only for cancer patients in dire condition, but the company’s leadership pushed it more widely, and together they turned Insys into a Wall Street sensation. But several insiders reached their breaking point and blew the whistle. They sparked a sprawling investigation that would lead to a dramatic courtroom battle, breaking new ground in the government’s fight to hold the drug industry accountable in the spread of addictive opioids. In The Hard Sell, National Magazine Award–finalist Evan Hughes lays bare the pharma playbook. He draws on unprecedented access to insiders of the Insys saga, from top executives to foot soldiers, from the patients and staff of far-flung clinics to the Boston investigators who treated the case as a drug-trafficking conspiracy, flipping cooperators and closing in on the key players. With colorful characters and true suspense, The Hard Sell offers a bracing look not just at Insys, but at how opioids are sold at the point they first enter the national bloodstream—in the doctor’s office.