Thursday, April 9, 2020

Another Addition to The Opioid Crisis? Insys Theraputics Bribes Doctors to Increase Their Profit (2012-2015)

Insys Theraputics Inc. is a pharmaceutical company that focuses on giving patients cannabis and
Sybsus Drug
novel drug delivery systems. Novel drug delivery systems are systems that improve drug potency control drugs to give patients a therapeutic effect, provide greater safety and target a drug that helps a specific area. Insys’ vision is “To improve the quality of patient care by building a specialty pharmaceutical company focused on cannabinoids and novel drug delivery systems that address unmet patient needs”(Insys). John Kapoor, founder and former CEO of Insys, created a highly addictive opioid, Subsys. Subsys is a liquid form of fentanyl and is much stronger than morphine. Mr. Kapoor originally created Subsys to help those with cancer control their pain. Originally, patients had to be 18 years of age or older and had to be currently or previously using opioid therapy for their cancer pain. Patients were told to spray the liquid under their tongue. Kapoor claims he created this company after he witnessed his wife die of cancer. He said “ I wanted to believe in Subsys perhaps too much. I never wanted Subsys to be prescribed to patients who did not need it” (Thomas). 

Starting in May of 2012 and ending in December of 2015, Kapoor and other top executives bribed practitioners to prescribe the spray outside the usual course of the professional practice. Kapoor was helped by Babich, Burlakoff, Simon, Lee, Rowan, Gurry and other supporters. They used bribes and kickbacks, such as covering fees for speakers and marketing events, food and entertainment, administrative support, and paid fees to other pharmacies to make this all happen. In March 2012, the company planned and funded a marketing program called the “Speaker Program ''. The Speaker Program was created to increase the awareness of the spray and its use. They held peer-to-peer educational lunches and dinners.  Later in 2012, Insys, misled insurance companies into agreeing to pay for the drug. They falsified the identity and location of the employer of the fentanyl, misrepresented the patient's diagnosis, the pain being treated, and the patient's prior medication taken (United States District Court District of Massachusetts).  More than 8,000 people died from overdosing after using this drug. There are many stories that illustrate the tragic outcomes of all of this.  Sarah Fuller was one patient that was prescribed Sybsus when she shouldn't have been. Recently, a federal judge sentenced John Kapoor and six other Insys executives to prison for “racketeering conspiracy.” Racketeering is a criminal activity in which a person or organization engages in a ‘racket.’  John Kapoor, CEO, and founder, was sentenced to five and a half years in prison, three years of supervised release and ordered to pay restitution and forfeiture that is due at a later date.  The other six employees were also sentenced to prison for a time ranging from 26 to 33 months. Insys agreed to pay $225 million to settle fraud charges which led them to bankruptcy. The company said they would continue to operate while they come up with a plan to pay back their creditors. 

Patient Sarah Fuller who was prescribed wrong drug
Stakeholders are anyone affected by the decision or actions made by the business. In my opinion, the stakeholders affected the most are the doctors and insurance companies. The doctors and insurance companies are the ones who are receiving the bribes and being lied to by upper management. Upper management, patients, the community and the business itself are also stakeholders of this case. Upper management includes John Kappor, CEO and founder as well as the six other members that joined him in bribing and lying to doctors to increase their sales.

Individualism has two points of views by Milton Friedman and Tibor Machan. Both philosophers agree that the only goal of business is to make a profit within the law. Machan adds in that "“The primary obligation of the business is to maximize profit but the direct goal of profiting may need to be met by indirect goals not aimed at profiting and business people may have other goals and those goals may at times be prioritized over the goals of profit-maximizing” (Salazar). Insys' goal was to make more profit by bribing doctors to write false prescriptions and lying to insurance companies to cover the cost of the prescription. Insys’s CEO and six other employees were helping out with these bribes. After being caught bribing doctors and lying to insurance companies, Insys was in trouble with the law, which resulted in several charges against the company. Insys owes $225 million to cover all the charges against them which, in turn, led them to file for bankruptcy. Bankruptcy is not a way to maximize profit as it destroys the company. An Individualist would not agree with the way Insys tried to maximize profit. 

A Utilitarian would deem this case as unethical. Utilitarians use the stakeholders' approach that maximizes happiness for all. Happiness is the only value of measure and can be defined as pleasure and absence of pain and is sometimes interpreted as the satisfaction of desires. This makes this case unethical because Insys Therapeutics was not maximizing happiness for anyone except for themselves. Doctors were being bribed to write false prescriptions that hurt their patients. Patients were killed from overdosing on this drug. Insurance companies were also lied to which in the end does not make them happy that they covered the cost for false prescriptions. The only happiness that came out of this case was for Insys during the period of time their sales increased. 

Kantianism focused on the four basic principles of the theory as well as their right motivation. The principles say to act ethically one must act rational and make rational decisions while respecting others and being motivated by goodwill. To determine if one was motivated by goodwill, Kantians use three formulas; The Formula of humanity, autonomy and the universal law. Under the formula of humanity, it states “ Act in such a way you treat humanity, whether in your own person or in the person of another, always at the same time as an end and never simply as a means” (Kantian Business Ethics). Insys Therapeutics bribed doctors and lied to insurance companies as a means to increase their sales which shows they were not motivated by goodwill.   Additionally, Kant says the only right motivation comes from the duty or moral law, meaning you will do something because that's the right thing to do. The motivation for Insys did not come from doing the right thing. Insys knew that using bribes and lying to other companies was not an ethical or legal way to increase their sales. Overall, a Kantian theorist would see Insys’s actions as unethical because of the way they tried to increase their sales. 

Virtue Theory 

Virtue Theory has a different take on a business's actions compared to other theories mentioned before. Virtue Theory is based on Aristotle's functions. Aristotle is an ANcient Greek Philosopher who developed the virtue theory. Aristotle focused more on the character traits of one. The character traits must promote wellness or flourish of the individual in society( Salazar, 22). One should act in good character and avoid any vicious or bad character traits. The first trait Insts did not obey is courage which is defined as “risk-taking and the willingness to take a stand for the right ideas and actions" (Business Ethics and Virtues). Insys did not stand up against the wrong idea and action of using bribes to increase their sales. Along with using these bribes, they were not honest with the insurance companies which violates the honesty virtue. Insys lied to insurance companies to get them to cover the cost of these prescriptions.  The next virtue is temperance. Temperance is defined as “reasonable expectations and desires” (Business Ethics and Virtues). Again, using bribes and lying is not a reasonable desire to increase profit. I also don't think Insys also should have ever expected these doctors to agree to accept these bribes. Lastly, the virtue trait justice is not followed due to the fact they were not following fair practices. They were working hard to increase their sales but not doing it in a way that is legal or ethical. Insys did not follow any of the virtues in business. 

In my opinion, Insys Therapeutics acts were unprofessional and did not follow proper business ethics. Every day we hear and read about the opioid crisis that our world is facing.  The CDC states that in 2017, more than 70,000 people died from drug overdoses (CDC). These overdoses start with patients becoming overly addicted to their drug they were given. I don't understand why Insys would want to contribute to this crisis but they did and they hurt many people. John Kapoor hurt his own company, doctors, other companies, patients and many other people. More than 8,000 people overdosed from Sybsus. They knew that they were doing it and not following proper business ethics. Every person knows that you should not lie or use bribes to make more money. They put so much effort behind these bribes and programs they created to increase their profit just to get caught and file for bankruptcy. I believe they could have put that effort into following proper business ethics to increase their profit. It may have taken longer but the business would still be in good hands and have the same reputation before any of this. I think it goes to show that Insys does not care about others besides themselves and their profit after this case.
CEO and Founder John Kapoor

Action Plan
Insys Therapeutics has a long road ahead of them till their company is back to “normal” business, if it ever even gets back to that point. There are many steps that need to be taken to get back to that way of business. Their first step is to apologize to those they hurt like the doctors, insurance companies, families and the general public. Insys needs to write a personal apology to all the patients that were affected by this drug. They also need to apologize to the families that lost loved ones from overdosing on the drug. Doctors and insurance companies deserve an apology for putting them in the awkward position of using bribes and being lied to. Lastly, the public deserves an apology for contributing to the opioid crisis and assuring them that they won't do it again. Insys may also want to change their mission statement to one that is focused on the needs of their customers. A new mission statement that could work is “We are focused on caring for our patients by offering them cannabinoids and novel drug delivery systems that address their unmet needs.” This mission statement shows customers that they are focused on helping them. Along with a mission statement, they should lay out the core values that they will now follow. Some new core values might include honesty, commitment, innovation, and trust. Insys needs to be committed to their patients' needs by creating new products. They need to be honest with those who they work with and create trust with them.

Another option Insys has is to rebrand the whole company which includes changing the name of the company and their logo. Currently, when we hear Insys, this is the only thing we think of. A new name will blur out this case for the company and so will the logo. Hopefully, a new name and logo will bring a new set of business to them. They may also want to hire new or fire former employees as a new start to ensure no unethical practices will be done again by the same people. This may also bring back trust in the company. Lastly, I believe Insys should create a system that locks up the drug so patients aren't able to use the drug whenever they want. This lock could be on the spray bottle or just kept in a lockbox that only authorized people know the password to. If Insys Therapeutics carries out this action plan or some aspects of it, they may no longer have a negative reputation. Some may forgive them and give them a new start and try to do business with them again.

S. Bartlett

“Better Patient Care Through Innovation.” INSYS Therapeutics,
Thomas, Katie. “Insys Founder Gets 5½ Years in Prison in Opioid Kickback Scheme.” The New  York Times, The New York Times, 23 Jan. 2020,
Carlson, Rosemary. “What Is Racketeering?” The Balance, The Balance, 25 Sept. 2019,
Salazar, Heather. The Case Manual
Salazar, Heather. Business Ethics and Virtues
Salazar, Heather. Kantian Business Ethics
“Understanding the Epidemic.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 19 Mar. 2020,

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