Challenge those critical assumptions early and hard

Patrick Radden Keefe’s Empire of Pain is a compelling read for anyone, but especially those involved in marketing. Extensively researched it explores the history of the Sackler family, their private company Purdue Pharma and the introduction of OxyContin. It highlights greed, corruption, failures in regulation and unrestrained, ruthless marketing among the contributors to the opioid crisis in the USA and Canada.

Prescribed opioids have caused 600,000 deaths in Canada and USA alone

The innovation behind OxyContin was a mechanism that ‘promised’ a steady opioid dose over 12 hours. For the Sackler family business it presented an opportunity to stretch opioid use beyond cancer care to the much bigger ‘mass’ market of regular pain relief. Using the 12 hour release, Purdue Pharma claimed a huge dose could be taken safely without disrupting sleep. They also boldly asserted a low risk of addiction (less than 1%) based only on observations of hospitalised patients who in some cases received one opioid dose.

These claims were pushed by an aggressive sales and marketing machine. A heavily incentivised salesforce targeted doctors and advertising presented the opioid as the “next step in pain therapy” with testimonials for “getting your life back”.

Purdue Pharma has proved a frightening case study for the failure to question critical assumptions. The Sackler business assumed they had cracked the code for a wider use of opioids to benefit pain sufferers. OxyContin, however, proved addictive, could be crushed to create one huge dose and with ongoing use the effects diminished. Doctors effectively became dealers introducing the opioid to patients with free 30-day taster courses. How patients could get off the drug was completely ignored and having created a cash cow (benefiting the Sacklers by around $10 billion) the emerging evidence of harm or societal impact was hidden and aggressively refuted.

Empire of Pain is a remarkable example of investigative research and a thought-provoking drama. It is also a reminder of the imperative of exploring critical assumptions early and hard for any innovation. Finding validation, answers, alternatives and failure quickly removes later bigger and more costly mistakes. Family run Purdue Pharma may have been an outlier in culture and practices, but it is not alone in relying on assumptions in consumer behaviour, building a top-down ‘consensus’ and pushing for a roll-out of a solution with some unanswered questions. Innovations will continue to have unintended consequences – Facebook/Meta’s action on protecting mental health is increasingly being questioned and AI vulnerability to bias is an emerging concern. Also, as the absence of successful whistle-blowers from the Sackler story suggests, challenging an organisational stance is difficult.

Do read the book if you can. Also listen appreciatively to those curious colleagues that raise new questions to explore – even if it may challenge everyone’s assumptions or road map.

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