Pain Hustlers

Starred review from November 22, 2021
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.