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The Hard Sell: Crime and Punishment at an Opioid Startup
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.
John 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.
John 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.
288 pages, Hardcover
First published January 1, 2022
120 people are currently reading
4813 people want to read
About the author
Evan Hughes
16 books7 followersLibrarian Note: There is more than one author in the GoodReads database with this name.
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August 1, 2022
Apparently the Insys Therapeutics fraud case made a splash when the trial was going on, but I somehow missed it, so this story, of a small pharmaceutical company that defrauded insurance companies and paid off doctors to get people hooked on their opioid product, was new to me. What wasn't new to me is the way people will rationalize hideous behavior in order to make money and avoid having to be adults about anything. I felt immense anger while reading this, but the book was well-written and Hughes told the story in a compelling way, so I never wanted to abandon it. I listened to the audiobook, and the reader did a good job; there was a proper amount of inflection but he never got in the way of the story.
The Insys case was one of the few times individuals at a pharma company (including the founder) actually stood trial for their actions and got punished. The much larger pharmaceutical companies apparently have federal cases brought against them all the time, and they just make a settlement payment and everyone gets on with their lives as if nothing happened. Of course, this is even more enraging. I'm about to start Empire of Pain: The Secret History of the Sackler Dynasty and should probably start meditating again to deal with the feelings it's sure to bring up.
The Insys case was one of the few times individuals at a pharma company (including the founder) actually stood trial for their actions and got punished. The much larger pharmaceutical companies apparently have federal cases brought against them all the time, and they just make a settlement payment and everyone gets on with their lives as if nothing happened. Of course, this is even more enraging. I'm about to start Empire of Pain: The Secret History of the Sackler Dynasty and should probably start meditating again to deal with the feelings it's sure to bring up.
January 23, 2022
Upon typing Insys Therapeutics in the Google search bar, the searcher is lead to a website that is couched in legalese. In addition to informing the reader that the company she is looking for has gone bankrupt, the website also offers an option to lodge a third party claim against the company, in the event she has suffered adverse consequences post using the company’s products. While the how and where of the claims themselves are dealt with by the website, the intriguing parts relating to the who, why and what of a now defunct entity and its buccaneering stewards, are revealed in a jaw dropping manner by reporter Evan Hughes in his rip roarer of a book “The Hard Sell”.
Hobnobbing with doctors of a suspect character doling out prescriptions from virtual ‘pill mills’, recruiting exotic dancers from strip tease clubs to double up as medical representatives to gain speedy and beneficial access to medical practioners, hoodwinking insurance agencies by misrepresenting both the nature and severity of the patients’ illnesses, and sponsoring sham ‘speaker programmes’ which were brazen euphemisms for bribe, the top brass at Insys Therapeutics consistently and liberally pushed the envelope of greed and chance.
An ebullient founder (John Kapoor), in cahoots with an enigmatic CEO (Michael Babich), an eccentric vice president of sales (Alec Burlakoff) and an enthusiastic vice president of marketing (Matthew Napoletano) formed an unlikely quartet at Insys Therapeutics. Buoyed by the FDA approval for their blockbuster pain medication Subsys, the Four Musketeers wanted their company to be the unquestioned colossus in its domain. Subsys itself represented a very niche product falling under the category of rapid-onset opioids. Technically termed, “TIRF” (an abbreviation for transmucosal immediate-release fentanyl), Subsys was to be used solely to treat ‘breakthrough’ pain (pain that breaks through all layers of protection) experienced by cancer patients. To be prescribed with immense discretion and care, fentanyl was an opioid capable of causing untold physical and mental damage. Hundred times as powerful as morphine and approximately fifty times as influential as heroin, fentanyl represented one of the prime reasons behind the opioid epidemic roiling the United States.
Let the opioid crisis be damned, Kapoor and his cronies found themselves gripped in the throes of an ambition that was as suicidal as it was fantastical. Spending hundreds of thousands of dollars as an incentive for prescribing Subsys as part of a sham speaker’s program, Insys employees identified the top ‘decile’ doctors specialising in pain management and dubbed these medical practioners, “whales.” The identification of the whales itself was a laughable administrative charade of Shakespearean proportions. Due to its dangerously unique properties, the distribution of TIRF drugs had to adhere to a protocol named REMS (Risk Evaluation and Mitigation Strategy). Every prescriber of a TIRF drug had to enroll in the TIRF REMS access programme and pass a “knowledge assessment” quiz. Incredulously, this REMS programme was sponsored and administered by the very manufacturers producing the TIRF drugs! Talk about appointing a fox to guard the chicken coop!
The whales identified by Insys were all enrolled into the infamous ‘speaker programme’ from where began to grind the finely lubricated levers of an unabashed quid pro quo arrangement. As Insys ingratiated itself in a myriad number of abominable ways to the doctors (sales reps even took the doctors’ dogs out on walks, brought in their cars to the mechanics and picked up relatives from airports), the satiated and unscrupulous doctors began prescribing Subsys as if there was no tomorrow. A drug that was to be solely and stringently administered to make the last days of terminally ill patients as painless as possible was being administered to treat back pains, migraines and everything in between. Astonishingly, Insys also maintained a spreadsheet that exhibited the return on investment, that the company received from each “speaker” for every dollar expended by the company on a doctor or a nurse.
As Evan Hughes illustrates in a vindictive and eviscerating fashion in the closing chapters of his book, the rot of corrupt practices has its roots, an intransigent system ringfenced by an insouciant set of rules. The gall and temerity showcasing the misdeeds of the executives at Insys, had their genesis in the allure of past precedents. Purdue Pharma, a company owned by the ignominious Sackler family was singularly responsible for the devastation wrought by the abuse of the powerful opioid, Oxycontin. As a punishment for engaging in reckless behaviour and imperiling the lives of millions of innocent patients, Purdue Pharma barely got a rap on its knuckles and was let off by paying a significant sum as ‘penalties’. Not a single member of the Sackler family saw the confines of a prison.
It is not just Purdue that has gotten away lightly for all its excesses. As a 2018 research report by the consumer advocacy group Public Citizen, disconcertingly illustrates pharma companies pled guilty to federal crimes at least forty-eight times from 1991 to 2017. Household names such as Pfizer, GlaxoSmithKline, Novartis, Bristol Myers Squibb, Teva, Merck, Johnson & Johnson, AstraZeneca all paid to settle Justice Department investigations between 1991 and 2017.
The prosecutors therefore decided to make an ‘example’ out of Insys. It is left to the readers to decide whether judgment in Insys was a trail blazer and a sign of things to come or the defenestration of an easily accessible scapegoat. An absolutely callous attitude towards documentation practices and an inexplicable reluctance to appoint a legal compliance team made it convenient for the law enforcement authorities to apply the dreaded provisions of the Racketeer Influenced and Corrupt Organizations Act (“RICO”) against Insys and its chieftains. A powerful weapon to penalize and prosecute the mafia, RICO is a persuasive tool when wielded with vigour.
Babich, and Burlakoff escaped with light sentences after striking a deal with the Department Of Justice and testifying under immunity against Kapoor. Both were sentenced to around thirty months in prison. Kapoor copped a jail time of 5 years and at the time of writing is serving his sentence.
The two biggest whales, Dr. John Patrick Couch and Dr. Xiulu Ruan were sentenced to 240 months and 252 months, respectively, in federal prison for running a massive pill mill in Mobile, Alabama. The two doctors and owners of C&R Pharmacy, split 75% of the profits attributable to the prescription drug reimbursements. Approximately 91% of the prescriptions written by the two doctors cost patients’ insurance anywhere between $1,000- $24,000 per month. Dr. Couch even permitted one of his nurse practitioners, Justin Palmer, to forge Dr. Couch’s name on prescriptions for Controlled Substances more than a dizzying 25,000 times!
Even Hughes, “The Hard Sell”, along with Patrick Radden Keefe’s “Empire of Pain” (a book chronicling the hubristic fall of Purdue Pharma), represents two of the finest books written about the miasma plaguing the inner workings of the pharmaceutical industry.
Hobnobbing with doctors of a suspect character doling out prescriptions from virtual ‘pill mills’, recruiting exotic dancers from strip tease clubs to double up as medical representatives to gain speedy and beneficial access to medical practioners, hoodwinking insurance agencies by misrepresenting both the nature and severity of the patients’ illnesses, and sponsoring sham ‘speaker programmes’ which were brazen euphemisms for bribe, the top brass at Insys Therapeutics consistently and liberally pushed the envelope of greed and chance.
An ebullient founder (John Kapoor), in cahoots with an enigmatic CEO (Michael Babich), an eccentric vice president of sales (Alec Burlakoff) and an enthusiastic vice president of marketing (Matthew Napoletano) formed an unlikely quartet at Insys Therapeutics. Buoyed by the FDA approval for their blockbuster pain medication Subsys, the Four Musketeers wanted their company to be the unquestioned colossus in its domain. Subsys itself represented a very niche product falling under the category of rapid-onset opioids. Technically termed, “TIRF” (an abbreviation for transmucosal immediate-release fentanyl), Subsys was to be used solely to treat ‘breakthrough’ pain (pain that breaks through all layers of protection) experienced by cancer patients. To be prescribed with immense discretion and care, fentanyl was an opioid capable of causing untold physical and mental damage. Hundred times as powerful as morphine and approximately fifty times as influential as heroin, fentanyl represented one of the prime reasons behind the opioid epidemic roiling the United States.
Let the opioid crisis be damned, Kapoor and his cronies found themselves gripped in the throes of an ambition that was as suicidal as it was fantastical. Spending hundreds of thousands of dollars as an incentive for prescribing Subsys as part of a sham speaker’s program, Insys employees identified the top ‘decile’ doctors specialising in pain management and dubbed these medical practioners, “whales.” The identification of the whales itself was a laughable administrative charade of Shakespearean proportions. Due to its dangerously unique properties, the distribution of TIRF drugs had to adhere to a protocol named REMS (Risk Evaluation and Mitigation Strategy). Every prescriber of a TIRF drug had to enroll in the TIRF REMS access programme and pass a “knowledge assessment” quiz. Incredulously, this REMS programme was sponsored and administered by the very manufacturers producing the TIRF drugs! Talk about appointing a fox to guard the chicken coop!
The whales identified by Insys were all enrolled into the infamous ‘speaker programme’ from where began to grind the finely lubricated levers of an unabashed quid pro quo arrangement. As Insys ingratiated itself in a myriad number of abominable ways to the doctors (sales reps even took the doctors’ dogs out on walks, brought in their cars to the mechanics and picked up relatives from airports), the satiated and unscrupulous doctors began prescribing Subsys as if there was no tomorrow. A drug that was to be solely and stringently administered to make the last days of terminally ill patients as painless as possible was being administered to treat back pains, migraines and everything in between. Astonishingly, Insys also maintained a spreadsheet that exhibited the return on investment, that the company received from each “speaker” for every dollar expended by the company on a doctor or a nurse.
As Evan Hughes illustrates in a vindictive and eviscerating fashion in the closing chapters of his book, the rot of corrupt practices has its roots, an intransigent system ringfenced by an insouciant set of rules. The gall and temerity showcasing the misdeeds of the executives at Insys, had their genesis in the allure of past precedents. Purdue Pharma, a company owned by the ignominious Sackler family was singularly responsible for the devastation wrought by the abuse of the powerful opioid, Oxycontin. As a punishment for engaging in reckless behaviour and imperiling the lives of millions of innocent patients, Purdue Pharma barely got a rap on its knuckles and was let off by paying a significant sum as ‘penalties’. Not a single member of the Sackler family saw the confines of a prison.
It is not just Purdue that has gotten away lightly for all its excesses. As a 2018 research report by the consumer advocacy group Public Citizen, disconcertingly illustrates pharma companies pled guilty to federal crimes at least forty-eight times from 1991 to 2017. Household names such as Pfizer, GlaxoSmithKline, Novartis, Bristol Myers Squibb, Teva, Merck, Johnson & Johnson, AstraZeneca all paid to settle Justice Department investigations between 1991 and 2017.
The prosecutors therefore decided to make an ‘example’ out of Insys. It is left to the readers to decide whether judgment in Insys was a trail blazer and a sign of things to come or the defenestration of an easily accessible scapegoat. An absolutely callous attitude towards documentation practices and an inexplicable reluctance to appoint a legal compliance team made it convenient for the law enforcement authorities to apply the dreaded provisions of the Racketeer Influenced and Corrupt Organizations Act (“RICO”) against Insys and its chieftains. A powerful weapon to penalize and prosecute the mafia, RICO is a persuasive tool when wielded with vigour.
Babich, and Burlakoff escaped with light sentences after striking a deal with the Department Of Justice and testifying under immunity against Kapoor. Both were sentenced to around thirty months in prison. Kapoor copped a jail time of 5 years and at the time of writing is serving his sentence.
The two biggest whales, Dr. John Patrick Couch and Dr. Xiulu Ruan were sentenced to 240 months and 252 months, respectively, in federal prison for running a massive pill mill in Mobile, Alabama. The two doctors and owners of C&R Pharmacy, split 75% of the profits attributable to the prescription drug reimbursements. Approximately 91% of the prescriptions written by the two doctors cost patients’ insurance anywhere between $1,000- $24,000 per month. Dr. Couch even permitted one of his nurse practitioners, Justin Palmer, to forge Dr. Couch’s name on prescriptions for Controlled Substances more than a dizzying 25,000 times!
Even Hughes, “The Hard Sell”, along with Patrick Radden Keefe’s “Empire of Pain” (a book chronicling the hubristic fall of Purdue Pharma), represents two of the finest books written about the miasma plaguing the inner workings of the pharmaceutical industry.
October 25, 2025
Раптово дочитала "Продавці болю" Евана Г'юза. Чому раптово, бо додаток показував десь 86% і я думала, що там ще буде на якійсь час перед сном почитати, а виявилося, що там вже були суцільні посилання на джерела (літературні і не сильно).
💫 Поставила 4 зірочки, хоча по правді це десь 3,5.
▫️ Так, це доволі захопливе чтиво, як на нонфік, і доволі цікаве в плані геть нової інформації про всі ті "нутрячкові" процеси в фармацевтичних компаніях, регулювання ринку, бій дженериків та жабогадюкінг страхових та лікарів.
▫️ Але особливої любові не сталося, бо жоден з фігурантів справи так до себе автора й не підпустив, і він фактично конструював їхні характери з виключно слів інших, часто далеких, людей, а також відкритих судових процесів потім.
🐈⬛ Спроба додати більше людського в оповідь була одна, невміла й корява, але зарахую вже як спробу.
🐈⬛ А в цілому, звісно, абсолютно трешова ситуація із тим, як кількох фраєрів жадоба згубила™, про що й буквально виснує автор в останньому розділі, уточнюючи, що якби компанія мала юридичний супровід з самого початку, то й досі продовжувала б впарювати свою наркоту на законних підставах 💀
✅ Цілком #Дафа_радить, читається як трилер, хоча образ жертви вийшов змазано-непевний. А, забула ще додати, що поки читала, то постійно згадувала книгу "Дурна кров: Таємниці та брехні стартапу Кремнієвої долини" Джона Керрейру, яка написана набагато краще за цю.
💫 Поставила 4 зірочки, хоча по правді це десь 3,5.
▫️ Так, це доволі захопливе чтиво, як на нонфік, і доволі цікаве в плані геть нової інформації про всі ті "нутрячкові" процеси в фармацевтичних компаніях, регулювання ринку, бій дженериків та жабогадюкінг страхових та лікарів.
▫️ Але особливої любові не сталося, бо жоден з фігурантів справи так до себе автора й не підпустив, і він фактично конструював їхні характери з виключно слів інших, часто далеких, людей, а також відкритих судових процесів потім.
🐈⬛ Спроба додати більше людського в оповідь була одна, невміла й корява, але зарахую вже як спробу.
🐈⬛ А в цілому, звісно, абсолютно трешова ситуація із тим, як кількох фраєрів жадоба згубила™, про що й буквально виснує автор в останньому розділі, уточнюючи, що якби компанія мала юридичний супровід з самого початку, то й досі продовжувала б впарювати свою наркоту на законних підставах 💀
✅ Цілком #Дафа_радить, читається як трилер, хоча образ жертви вийшов змазано-непевний. А, забула ще додати, що поки читала, то постійно згадувала книгу "Дурна кров: Таємниці та брехні стартапу Кремнієвої долини" Джона Керрейру, яка написана набагато краще за цю.
February 13, 2022
4.5, rounding up
January 27, 2022
This was a great read from beginning to end. That simple, not going to kick off this review with any setup or introduction. If you are at all interested in the Opioid crisis and its fallout among the corporate sleaze then this is another must-read. I bought this on the heels of finishing 'Empire of Pain' on the Sacklers while my appetite was still whet. This turned out to be a great compliment to that excellent book as well. While telling a much different story of corporate intrigue, the same objective still remains: Sell at all costs, no matter who gets hurt. (Spoiler: a lot of people get hurt) I actually in many ways liked this book even more then 'Empire' as this had a more interesting cast of characters and how the conspiracy unfolded quickly and fell apart almost as fast. Goes without saying that I highly recommend this, I knocked it out in one day, a personal record for a book this size (not huge, but still long). Start with 'Empire' if you haven't read that yet, and then move here. InSys wasn't as well known as Purdue Pharma, but was playing by a similar playbook. Then go watch 'Crime of the Century' on HBO to complete the circle, great way to really let you look behind the curtain on the ickiness of the pharmaceutical industry.
November 3, 2022
TITLE: The Hard Sell: Crime and Punishment at an Opioid Startup
AUTHOR: Evan Hughes
PUB DATE: 01.18.2022 Now Available
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.
REVIEW:
As a nurse, I see the aftermath of the opioid epidemic - the overdose, cardiac arrest, and many, many deaths of young people. In THE HARD SELL, Evan Hughes exposes the hard truths of the pharmaceutical industry specifically the brilliant marketing and business kind of John Kapoor, founder of Insys Therapeutics, the manufacturer of a novel form of fentanyl, an opioid responsible for overdoses leading to death.
Hughes wrote about the marketing schemes to deceive insurance companies and unsuspecting doctors who fell for their methods of prescribing turning this company into a money making corporation.
Evan Hughes captured the insiders scoop on the investigation after whistle blowers reported which lead to a dramatic courtroom drama, and eventually holding this company accountable.
Be sure to add this to your TBR!
AUTHOR: Evan Hughes
PUB DATE: 01.18.2022 Now Available
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.
REVIEW:
As a nurse, I see the aftermath of the opioid epidemic - the overdose, cardiac arrest, and many, many deaths of young people. In THE HARD SELL, Evan Hughes exposes the hard truths of the pharmaceutical industry specifically the brilliant marketing and business kind of John Kapoor, founder of Insys Therapeutics, the manufacturer of a novel form of fentanyl, an opioid responsible for overdoses leading to death.
Hughes wrote about the marketing schemes to deceive insurance companies and unsuspecting doctors who fell for their methods of prescribing turning this company into a money making corporation.
Evan Hughes captured the insiders scoop on the investigation after whistle blowers reported which lead to a dramatic courtroom drama, and eventually holding this company accountable.
Be sure to add this to your TBR!
March 14, 2022
Here is a good book. It reads like a great mystery thriller. The author does a great job of developing the major players and moving the story along in a fast paced coherent manner. Highly recommended.
August 31, 2025
A+ reporting and storytelling. Hughes doesn't oversell the action or rely on gimmicky cliff hangers to maintain the reader's interest. This isn't an edge-of-your-seat thriller but it's well-paced, the action is compelling and it's solid in every respect. I'm afraid an excellent book like this gets lost in the deluge of books about the opioid crisis.
The story isn't about the biggest or first culprit, it doesn't talk much about the victims and it doesn't speak of societal damage or provide any general statistics. It's not sweeping or grand in scope. It's entirely focused on a small pharmaceutical company; its founder; its executives and sales reps; the doctors over-prescribing Subsys; and the fallout.
The prologue offers a sample of the trouble ahead and then the book builds from the beginning and works chronologically to the conclusion; there's no jumping around in time. The chapters aren't particularly long and there are breaks along the way so it's easy to read in bits and pieces. I read it a little quicker than I normally would because I enjoyed the experience so much.
The Notes section cites the selected court cases and an alphabetical listing of people mentioned in the book along with a brief description of their role in the story along with the years they were involved. The names never seemed to get to be too much but the references at the end are a nice touch.
I'd happily read a book of this quality about any subject.
The story isn't about the biggest or first culprit, it doesn't talk much about the victims and it doesn't speak of societal damage or provide any general statistics. It's not sweeping or grand in scope. It's entirely focused on a small pharmaceutical company; its founder; its executives and sales reps; the doctors over-prescribing Subsys; and the fallout.
The prologue offers a sample of the trouble ahead and then the book builds from the beginning and works chronologically to the conclusion; there's no jumping around in time. The chapters aren't particularly long and there are breaks along the way so it's easy to read in bits and pieces. I read it a little quicker than I normally would because I enjoyed the experience so much.
The Notes section cites the selected court cases and an alphabetical listing of people mentioned in the book along with a brief description of their role in the story along with the years they were involved. The names never seemed to get to be too much but the references at the end are a nice touch.
I'd happily read a book of this quality about any subject.
January 21, 2022
More about the litigation than the actual crimes, this is in a similar vein to Empire of Pain or Dopesick. File under "enlightening but enraging". The things these people do for profit, ugh.
September 3, 2025
4,25 🌟
цікава книга-розслідування, що легко читається. проте мені, мабуть, не вистачило історій пацієнтів.
зусилля автора щодо збору інформації заслуговують поваги.
цікава книга-розслідування, що легко читається. проте мені, мабуть, не вистачило історій пацієнтів.
зусилля автора щодо збору інформації заслуговують поваги.
March 13, 2022
To me, the most enthralling part of the book happened when a top Insys executive went on the stand during a trial, and the lawyer asked him, "Do you tell lies?" and he answered, "Of course I do. I'm in sales. And I work for Dr. Kapoor."
Before I read this book, all I really knew about fentanyl is that it killed Prince and that there aren't many recovery programs specific to fentanyl (as opposed to alcohol or meth or heroin) because fentanyl addicts die so quickly on average. This is a book about selling Subsys, a form of fentanyl that you can spray under your tongue. It starts to work in about five minutes, almost as fast as IV fentanyl. And if you don't calibrate the dose correctly, it can kill you the first time you take it.
People at Insys got in trouble because they did stuff that other drug companies did, but more blatantly. Such as . . .
• Instead of hiring ex-cheerleaders to sell to doctors, they hired an ex–exotic dancer.
• Instead of paying prescribers to give talks about drugs and calling it speaker fees, they sometimes used the word "bribe." The president of the company talked about return on investment for these bribes and demanded to see the results for each speaker.
• Instead of the occasional secret affair, Insys was a hotbed of affairs. One executive had romantic or sexual encounters with at least five coworkers. Why didn't HR intervene? Because the head of HR was one of the coworkers he was having an affair with.
• Subsys is supposed to be for breakthrough cancer pain only. Mercifully, very few people ever experience this type of pain. So to increase the number of prescriptions written, Insys created an internal department that committed insurance fraud all day long. As a result, some people with back pain and migraines got a highly addictive painkiller that ruined some of their lives and killed some of them. People working in this department knew what they were doing was wrong, but they sometimes got $200 per week in bonuses, and they needed the money. One of them was so stressed that she routinely vomited before work.
The thing I find most baffling is that Dr. Kapoor, who founded and owned the company, was already extremely rich before Insys. He didn't need to take the risks or sweat out the crises.
Before I read this book, all I really knew about fentanyl is that it killed Prince and that there aren't many recovery programs specific to fentanyl (as opposed to alcohol or meth or heroin) because fentanyl addicts die so quickly on average. This is a book about selling Subsys, a form of fentanyl that you can spray under your tongue. It starts to work in about five minutes, almost as fast as IV fentanyl. And if you don't calibrate the dose correctly, it can kill you the first time you take it.
People at Insys got in trouble because they did stuff that other drug companies did, but more blatantly. Such as . . .
• Instead of hiring ex-cheerleaders to sell to doctors, they hired an ex–exotic dancer.
• Instead of paying prescribers to give talks about drugs and calling it speaker fees, they sometimes used the word "bribe." The president of the company talked about return on investment for these bribes and demanded to see the results for each speaker.
• Instead of the occasional secret affair, Insys was a hotbed of affairs. One executive had romantic or sexual encounters with at least five coworkers. Why didn't HR intervene? Because the head of HR was one of the coworkers he was having an affair with.
• Subsys is supposed to be for breakthrough cancer pain only. Mercifully, very few people ever experience this type of pain. So to increase the number of prescriptions written, Insys created an internal department that committed insurance fraud all day long. As a result, some people with back pain and migraines got a highly addictive painkiller that ruined some of their lives and killed some of them. People working in this department knew what they were doing was wrong, but they sometimes got $200 per week in bonuses, and they needed the money. One of them was so stressed that she routinely vomited before work.
The thing I find most baffling is that Dr. Kapoor, who founded and owned the company, was already extremely rich before Insys. He didn't need to take the risks or sweat out the crises.
September 9, 2021
This is a well written and fascinating look at the world of Insys, a pharmaceutical company. It was formed by eccentric immigrant John Kapoor, who became a millionaire looking to get even richer. He developed a new form of fentanyl delivery called Subsys, and hired a bunch of shady people to push it to some iffy doctors. They found ways to target doctors that wrote a lot of opioids and went about trying to get them to switch to their new drug.
The book shows things that went on that were pretty shocking in how Kapoor had things done. Insys, with its drug Subsys joined Purdue Pharma and Cephalon, who both were in trouble over OxyContin and Actiq respectively. Purdue paid $600 million in 2007 to resolve charges, and Cephalon in 2008 paid a $425 million dollar fine over wrongdoing. It’s also about the US Department of Justice investigators from Boston who went after Insys and its executives. An incredible true crime story that shows what some people will try to get away with, given half a chance. Advance electronic review copy was provided by NetGalley, author Evan Hughes, and the publisher.
The book shows things that went on that were pretty shocking in how Kapoor had things done. Insys, with its drug Subsys joined Purdue Pharma and Cephalon, who both were in trouble over OxyContin and Actiq respectively. Purdue paid $600 million in 2007 to resolve charges, and Cephalon in 2008 paid a $425 million dollar fine over wrongdoing. It’s also about the US Department of Justice investigators from Boston who went after Insys and its executives. An incredible true crime story that shows what some people will try to get away with, given half a chance. Advance electronic review copy was provided by NetGalley, author Evan Hughes, and the publisher.
March 27, 2023
A lot of good books have been coming out about the opioid crisis lately.
After Empire of Pain: The Secret History of the Sackler Dynasty, the Hard Sell by Evan Hughes was the perfect follow up. The Hard Sell is about a small pharmaceutical startup that becomes a contributor to the opioid crisis with its spray fentanyl product called SUBSYS and it’s eventual downfall.
It’s very scary to think your doctor might not have your best interest to heart. Are they prescribing this medication because it’s good for me or because a pharmaceutical company is giving them kickbacks? This is the story of The Hard Sell. This books shows how doctors became complicit pushers of Fentanyl by taking kickbacks from pharmaceutical companies for prescribing their drug of choice. Neither the doctors or the pharmaceutical companies cared about the patients taking the drugs. They only cared about their bottom line.
In some ways, the eventual prosecution of Insys was a reaction to the Sackler family (from Empire of Pain) escaping justice. The Justice department saw the opportunity to actually put company executives in jail as an example to other pharmaceutical companies.
I would recommend this book to anyone interested in the Opioid crises or stories about white collar true crime.
After Empire of Pain: The Secret History of the Sackler Dynasty, the Hard Sell by Evan Hughes was the perfect follow up. The Hard Sell is about a small pharmaceutical startup that becomes a contributor to the opioid crisis with its spray fentanyl product called SUBSYS and it’s eventual downfall.
It’s very scary to think your doctor might not have your best interest to heart. Are they prescribing this medication because it’s good for me or because a pharmaceutical company is giving them kickbacks? This is the story of The Hard Sell. This books shows how doctors became complicit pushers of Fentanyl by taking kickbacks from pharmaceutical companies for prescribing their drug of choice. Neither the doctors or the pharmaceutical companies cared about the patients taking the drugs. They only cared about their bottom line.
In some ways, the eventual prosecution of Insys was a reaction to the Sackler family (from Empire of Pain) escaping justice. The Justice department saw the opportunity to actually put company executives in jail as an example to other pharmaceutical companies.
I would recommend this book to anyone interested in the Opioid crises or stories about white collar true crime.
March 22, 2022
So interesting and engaging. I learned so much. Not 5 because it was so clear that it was written by a man and that was annoying.
July 5, 2022
Finally, a book about the opioid crisis where some of the powerful are held to account. Really well-written; taut, to-the-point, and accessible - translates court documents into a powerful narrative.
March 26, 2022
Ugh, made me so mad. People who profit off drugs…
July 8, 2023
The opioid epidemic is so wild to me if you liked books like dopesick and empire of pain this is your book.
December 27, 2022
> Instead of mentioning breakthrough cancer pain, he wanted reps to say Subsys had the same indication as the chief competitors, Cephalon’s Actiq and Fentora. That approach conveniently omitted the word “cancer” and steered clear of the inconvenient fact that Subsys was only approved for a relatively small group of patients. It also implied, without saying so, that Subsys was appropriate for non-cancer pain, because that was in fact the primary use for those two competing drugs, partly owing to Cephalon’s illegal off-label promotion.
> Data analysis had revealed that the patients on the lowest strengths of Subsys were the most likely to stop taking it. Clearly, Kapoor concluded, doctors needed to titrate up—move patients up to higher-strength prescriptions.
> The higher strengths of Subsys were more expensive, so reps naturally earned more on those scripts because their commissions were tied to the dollar amount. On top of that, Kapoor authorized an incentive structure where the bonus percentage was higher on the top two strengths, 12.5 percent instead of 10, an extra carrot for the sales force. In late 2012, if a doctor put pen to paper for one Subsys script at the highest strength, the rep would collect $1,830.
> In the last couple of decades, a number of major drugmakers have made an important change to their call-note systems. Now, reps don’t type anything at all. They just select from a series of drop-down menus, answering queries in multiple choice: How much time did you spend with the doctor? Which of the following product benefits were discussed? There is no place for the rep to engage in free writing, no opportunity to accidentally leave evidence of off-label promotion or spell out warning signs about the physician. The genius of the drop-down menu, in other words, is that every possible answer a rep can give is legally clean. — Insys failed to practice such self-protective measures.
> nothing that Insys did was truly new. Its leadership didn’t invent targeting decile 10 opioid prescribers and pushing higher doses. They weren’t the first to promote off label, nor to insert themselves into insurance decisions and fudge the facts to get to yes. And they didn’t come up with using speaker programs as a pretext to set up a quid pro quo.
> Data analysis had revealed that the patients on the lowest strengths of Subsys were the most likely to stop taking it. Clearly, Kapoor concluded, doctors needed to titrate up—move patients up to higher-strength prescriptions.
> The higher strengths of Subsys were more expensive, so reps naturally earned more on those scripts because their commissions were tied to the dollar amount. On top of that, Kapoor authorized an incentive structure where the bonus percentage was higher on the top two strengths, 12.5 percent instead of 10, an extra carrot for the sales force. In late 2012, if a doctor put pen to paper for one Subsys script at the highest strength, the rep would collect $1,830.
> In the last couple of decades, a number of major drugmakers have made an important change to their call-note systems. Now, reps don’t type anything at all. They just select from a series of drop-down menus, answering queries in multiple choice: How much time did you spend with the doctor? Which of the following product benefits were discussed? There is no place for the rep to engage in free writing, no opportunity to accidentally leave evidence of off-label promotion or spell out warning signs about the physician. The genius of the drop-down menu, in other words, is that every possible answer a rep can give is legally clean. — Insys failed to practice such self-protective measures.
> nothing that Insys did was truly new. Its leadership didn’t invent targeting decile 10 opioid prescribers and pushing higher doses. They weren’t the first to promote off label, nor to insert themselves into insurance decisions and fudge the facts to get to yes. And they didn’t come up with using speaker programs as a pretext to set up a quid pro quo.
April 15, 2022
Beautifully researched and reported. This is an infuriating and all too common narrative.
I loved the part at the end stating that the company could have avoided this if they had effective legal council. It points out that if there were lawyers involved the company could have done the same things but in a less egregious way. The problem would be EXACTLY THE SAME! but they would be able to CYA. Infuriating and important to understand.
"It takes a certain fortitude to be responsible. Insys found people that were weak"
I loved the part at the end stating that the company could have avoided this if they had effective legal council. It points out that if there were lawyers involved the company could have done the same things but in a less egregious way. The problem would be EXACTLY THE SAME! but they would be able to CYA. Infuriating and important to understand.
"It takes a certain fortitude to be responsible. Insys found people that were weak"
November 26, 2023
Mind boggling how the opioid crisis happened
June 16, 2024
Non-fiction but with the pace of a true crime docuseries
July 2, 2022
Non-fiction authors of the world PLEASE keep writing books exposing the problems with the pharmaceutical industry.
We will NEVER receive safe and appropriate treatment from doctors until pharma is properly regulated and conflicts of interest are kept in check.
Just one of the chilling stories from the Insys saga: Women went to doctor with depression-was given a potent high dose of an opioid and became incredibly addicted and sick.
Others died following the advice their doctors gave them.
We live in a country where going to your doctor can make you sicker. Your doctor will sell your health for a profit.
That isn't right.
"Go to therapy" "Go to the doctor"-NO. Doctors fucking kill people.
They obviously don't do it intentionally. It isn't a conspiracy. It's just humans justifying terrible behavior when there's a monetary incentive. These doctors convinced themselves that prescribing an opioid off-label was the right thing to do. Funny how the "right thing" doesn't usually involve losing money.
It isn't only opioids. It is all drugs. We can never trust the motivations of a doctor prescribing a drug until pharma is regulated and we remove the financial incentive to get as many people on a drug as possible. It has to be done. This is a human rights violation.
READ THIS BOOK. Then read Sicking by John Abramson. Then read Toxic Psychiatry by Dr. Peter Breggins.
I want to live in a world where I can feel safe going to the doctor. This incredibly well-researched book proves that we aren't in that world yet.
We will NEVER receive safe and appropriate treatment from doctors until pharma is properly regulated and conflicts of interest are kept in check.
Just one of the chilling stories from the Insys saga: Women went to doctor with depression-was given a potent high dose of an opioid and became incredibly addicted and sick.
Others died following the advice their doctors gave them.
We live in a country where going to your doctor can make you sicker. Your doctor will sell your health for a profit.
That isn't right.
"Go to therapy" "Go to the doctor"-NO. Doctors fucking kill people.
They obviously don't do it intentionally. It isn't a conspiracy. It's just humans justifying terrible behavior when there's a monetary incentive. These doctors convinced themselves that prescribing an opioid off-label was the right thing to do. Funny how the "right thing" doesn't usually involve losing money.
It isn't only opioids. It is all drugs. We can never trust the motivations of a doctor prescribing a drug until pharma is regulated and we remove the financial incentive to get as many people on a drug as possible. It has to be done. This is a human rights violation.
READ THIS BOOK. Then read Sicking by John Abramson. Then read Toxic Psychiatry by Dr. Peter Breggins.
I want to live in a world where I can feel safe going to the doctor. This incredibly well-researched book proves that we aren't in that world yet.
January 11, 2024
Caught this title off a bookshelf in Chiang Mai International Airport. I have been following some investigative journalism on American drug decriminalisation and its unravelling of a system that took a real pricy toll on cities. Easy access to drugs coupled with poor rehabilitation infrastructure funding meant that existing issues spiralled out of control like increased crime and violence for drugs/ territories, unemployment from poor mental and physical state, growing homelessness hotspots, degrading urban life & vanishing communities, etc... Heartwrenching.
So, bite me curious on America's pharmaceutical industry and the idea of accountability. What part do they play in all of this? The book details how an early startup made it big and what it took to gain significant success (evading regulatory frameworks by FDA/ insurance companies or frameworks that favour companies, aggressive marking tactics that blur designed product use, how doctors choose profit over patient, etc). It is a good intentions turned to greed harrowing account. An exploitation of people's pain for market gain.
4 stars because I cannot say for sure whether this book is an accurate reflection of the larger big Pharma terrors (surely there has to be some good, right?) but do recommend it as an engaging entry read that made non-fiction a such a thriller. Finished it in a day.
So, bite me curious on America's pharmaceutical industry and the idea of accountability. What part do they play in all of this? The book details how an early startup made it big and what it took to gain significant success (evading regulatory frameworks by FDA/ insurance companies or frameworks that favour companies, aggressive marking tactics that blur designed product use, how doctors choose profit over patient, etc). It is a good intentions turned to greed harrowing account. An exploitation of people's pain for market gain.
4 stars because I cannot say for sure whether this book is an accurate reflection of the larger big Pharma terrors (surely there has to be some good, right?) but do recommend it as an engaging entry read that made non-fiction a such a thriller. Finished it in a day.
May 18, 2023
This was interesting but also familiar as the names change but the crimes are pretty much the same. John Kapoor a brilliant scientist and pharmaceutical entrepreneur looses his beloved wife to a painful battle with cancer, out of that grief he then goes on to develop a novel fentanyl spray meant to help end-stage cancer patients with breakthrough pain, all sounds great so far, right?. What does he do then, not retire with his millions instead he sets up a new company and sends his sales force to bribe doctors to give his new medication to any and all patients regardless of cancer status, and of course we all know what happens next.
Kapoor is not the only bad guy here, there are many including doctors and other medical professionals. If there is any bright spot at all with this story, is some of the executives, including Kapoor went to trial and got some time in prison, although not nearly enough in my estimation.
Kapoor is not the only bad guy here, there are many including doctors and other medical professionals. If there is any bright spot at all with this story, is some of the executives, including Kapoor went to trial and got some time in prison, although not nearly enough in my estimation.
June 4, 2023
A great example of the Icarus ‘flew too close to the sun’ story, if Icarus (Insys) brought down hundreds of thousands of people along with him. Also if he built his wings with greed, willful ignorance, weak leadership, and nonexistent values. AND also if there’s hundreds more Icaruses (pharmaceutical companies) flying out there that the sun can’t touch because they coated their wings in secret sauce (legal loopholes and $$$ settlements).
Evan Hughes clearly left no stone unturned in this story, but is also a talented writer. I was super engaged through the whole thing and will gladly read his next book if he chooses to report through this format again.
Evan Hughes clearly left no stone unturned in this story, but is also a talented writer. I was super engaged through the whole thing and will gladly read his next book if he chooses to report through this format again.
September 5, 2023
This book is a nice complement to Empire of Pain but shorter. If you have to read one of them, I still recommend Empire of Pain. But this book dives into the prosecution of Insys and its corporate hierarchy for rampant abuse and misconduct in pumping the market with its drug, which was just a novel way to administer fentanyl. Ethics, morals, compunction, etc. were thrown out the window, all led by a tyrannical founder who didn't care about anything but winning -- an attitude that nearly got him through all of life until the end, when he ended up in federal prison for 5.5 years. Four stars.
June 20, 2022
This was very captivating. I hadn’t heard a thing about this story. I love that unlike the Sackler family (the biggest pieces of shit in the pharmaceutical industry), these assholes actually went to jail.
July 18, 2022
I thought this book was super interesting! It reminded me of Bad Blood but also taught me a lot about the opioid epidemic which was insightful. I think this is a great option for anyone looking to read more nonfiction that finds a lot of other non fiction to be a bit slow paced.
March 1, 2023
4.5/5
May 9, 2023
yikes! alarming that stuff like this still happening in the 21st century
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