McKinsey, Purdue and the Opioid Crisis: A Strategy Case

A growth question needs boundaries before an answer

A commercial engagement often begins with a legitimate analytical toolkit: segment customers, identify high-value accounts, allocate sales effort and measure conversion. Those methods do not determine whether the objective is acceptable. The product, the conduct being encouraged and the people exposed to the consequences change the decision.

In this case, treating prescription volume as an isolated business outcome would omit essential context. Medicines have clinical indications, risks and promotion rules. A strategy team needs qualified medical, legal and compliance judgment about those constraints. It cannot infer acceptability merely because a tactic resembles something used successfully in another industry.

That does not mean an article should make unsupported health-impact estimates. The public-health consequences of opioids span many actors and years. Neither a consulting fee nor an industry death total supplies a causal estimate of one project’s impact. The stronger analytical claim is narrower: a project designed to amplify sales must examine foreseeable risks and lawful boundaries before it optimises the commercial target.

Build the risk assessment into the engagement decision

Client acceptance should assess the specific work, not only the client’s name. Advising on an administrative process, a distribution model and a sales campaign can create different exposures. The review needs the real objective, the likely interventions, the data required and the people whose decisions the project seeks to change.

The engagement should then have constraints that survive commercial pressure. If a proposed lever depends on questionable promotion, unsafe targeting or a conflict that cannot be controlled, the team needs an authority capable of rejecting it. A committee that receives a summary after the strategy has been sold has less room to change course than a reviewer involved before the commitment.

This is a proposed professional-services framework, not a description of the controls operating in the historical engagement. A business-case presentation should state the constraints beside the financial model so that approval cannot be mistaken for permission to use every commercially effective tactic.

Conflicts must be examined at the level of people and work

The House committee’s FDA investigation raised a separate question from the sales advice itself: what happens when a consultancy works with a regulator and firms in the regulated industry? The committee’s findings and McKinsey’s response should be read together. The firm said its FDA work concerned administrative and operational topics rather than regulatory decisions.

For a risk review, those descriptions are a starting point. The reviewer should establish which people worked on which topics, what information they could access and whether one engagement could influence another. An industry-wide policy does not answer every project-level question. Nor does the mere existence of two clients establish that confidential information crossed a boundary.

The practical control is an evidence-based map of overlap. Identify personnel, timing, deliverables and access rights. Record what must be disclosed to each client and who can approve an exception. If a conflict cannot be explained in a way that both clients could understand, the firm should reconsider whether it can perform the work responsibly.

Do not turn the financial comparison into an impact estimate

The story contains consulting fees, manufacturer revenue, settlement payments and public-health statistics. They refer to different entities, periods and outcomes. Adding them together would produce a dramatic number with no coherent definition. A useful exhibit labels each measure and explains what comparison, if any, is valid.

Likewise, a ratio of settlement payments to consulting revenue is not a complete measure of either social harm or project profitability. It can illustrate the scale of later consequences relative to historical fees. It does not include all costs, establish causation or assign responsibility for the entire opioid crisis.

For an executive presentation, put the period and scope directly under each number. Distinguish an agreed payment from an amount alleged in a complaint and from a public-health estimate. Where a total combines several resolutions, show the components and ensure the agreements do not overlap before displaying the sum.

A practical review exercise for strategy teams

Consider a fictional product with high revenue per repeat user and a known risk of serious harm if used inappropriately. A sales model recommends concentrating effort on the highest-volume purchasers. Before accepting that recommendation, the team should ask what high volume represents: legitimate need, customer concentration, inappropriate use, or some mixture of those factors.

The model alone cannot answer the question. The team needs the relevant specialists, appropriate data and a clear standard for acceptable promotion. A better brief would specify the customer need being served and prohibit growth routes that depend on unsafe or unlawful behaviour. That may change the recommended segment, channel or even the decision to proceed.

The exercise is illustrative. It is not an allegation about a specific prescriber or a clinical recommendation. Its purpose is to show how a seemingly neutral segmentation rule can encode a value judgment. The ICE cost case asks the corresponding question for efficiency: which standards remain binding when a model recommends a cheaper option?

Records are part of the work product

The former partner’s obstruction proceeding illustrates why records retention is a professional obligation in its own right. The individual case should not be merged with the firm’s deferred prosecution agreement. Both belong in the narrative, but they answer different legal questions.

For a working team, the practical lesson is to preserve the evidence supporting advice, including assumptions and objections. A final polished deck can omit the uncertainty that mattered during development. Version histories, source material and approval records allow later readers to understand what the team knew and why it recommended a course of action.

Retention rules should be supported by actual systems and clear ownership. Staff should know when normal disposal must stop and whom to contact. A presentation workflow that improves charts while losing the underlying decision record creates a different kind of quality failure. The Gupta case explores another boundary around information: the difference between authorised access and personal disclosure.

The question a responsible recommendation should answer

The consulting lesson is not that growth strategy is inherently suspect. It is that a professional recommendation must explain what outcome is being optimised, under which constraints, and with what foreseeable effects. A client’s commercial request does not remove the adviser’s need to assess the work.

An effective decision page therefore contains the proposed action, supporting evidence, product-specific constraints, unresolved risks and the person accountable for approval. The strategy recommendation workflow can organise that argument, but the underlying constraints must be established by the team. If the intervention cannot be defended in those terms, producing a more persuasive chart is not progress. The strategy has not yet met the standard required for a decision.