[HN Gopher] New SF public health chief was part of McKinsey opio...
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New SF public health chief was part of McKinsey opioid-marketing
operation
Author : iancmceachern
Score : 136 points
Date : 2025-02-15 19:32 UTC (3 hours ago)
(HTM) web link (sfstandard.com)
(TXT) w3m dump (sfstandard.com)
| AlexandrB wrote:
| Say something spicy on Facebook: lose your job. Make a living
| pushing prescription painkillers triggering an opioid epidemic:
| awww shucks guys, he deserves another chance.
|
| This quote at the end is particularly funny cope:
|
| > "Just like [Tsai] distributed the drugs, maybe he can
| distribute the solution to the drugs," Beal said. "Hopefully, he
| can use the knowledge he has from helping to create the monster
| to figure out how to solve it."
|
| Yeah, ok. I guess this is also why we usually hire people
| arrested for carjacking to head police task forces on auto theft.
| /s
| ketzo wrote:
| I mean -- the best cybersecurity experts _are_ often former
| black- or gray-hat hackers.
|
| Hiring people with intimate knowledge of Bad Thing to try to
| fix Bad Thing is not necessarily a bad strategy.
|
| Just need them to have very legible incentives. That's less
| clear to me in this case.
| daeken wrote:
| The reason we hire established hackers for pentesting/red
| teaming is because the work is the same no matter which side
| you're on. This isn't the case with drug distribution or
| whatnot; like doesn't cure like when it comes to most
| problems. To me, this is akin to hiring a mass shooter to
| solve gun violence.
| DevKoala wrote:
| I have never seen an SF news publication being truly critical
| of the politicians that lord over the city and state. These
| publications will criticize the situation and blame factors,
| but never individuals and their actions. Never expect
| accountability from them.
| mmooss wrote:
| Isn't this article highly critical and in a news publication?
| Swizec wrote:
| This looks bad of course, but isn't he also someone who knows
| about how this stuff works and has lots of relevant experience
| building messaging strategies to achieve a goal? Sounds like the
| guy you'd want handling the opioid epidemic.
| mszyndel wrote:
| I know this type of comment is frowned upon here, but you
| should consider quitting opioids mate.
| jazzyjackson wrote:
| Maybe as a part of a work release program from prison, sure
| anigbrowl wrote:
| Do you seriously think that marketing opioids to doctors means
| he's going to be a good communicator with opioid addicts and
| their street dealers?
| Swizec wrote:
| No idea but at least he knows where to find the doctors who
| are overprescribing and knows how to talk to them right?
| mszyndel wrote:
| United States is a banana republic, per the original meaning, a
| country so weak that a group of millionaires can swoop in and do
| whatever they want with it.
| stouset wrote:
| I hate regulatory capture as much as anyone, but this makes for a
| more damning-sounding headline than it actually is. To steal a
| comment from Reddit[1] user NewInThe1AC:
|
| > It's a lot less concerning if you actually think about what he
| specifically did, and what information he would've had access to
| at the time
|
| > He was 23 and working on an early career project. Given how
| consulting teams are structured, he was not an architect of any
| grand scheme or plan, and was just executing the work ahead of
| him. Based on the evidence cited in the article, this was run of
| the mill business research -- interviewing experts about how
| pharma sales works and how to segment doctors, summarizing and
| framing to get to recommendations, and editing PowerPoints
|
| > It's only bad when you consider that the product was opioids,
| but keep in mind that the scientific literature he would've had
| access to at the time would not have suggested they were
| especially harmful. If anything, there were compelling reasons
| for a 3rd party at the time to actually believe that more
| widespread use of these products would improve wellbeing. If it
| was so obvious to everyone how bad these things were, we wouldn't
| have ended up with the crisis we did
|
| [1]
| https://old.reddit.com/r/sanfrancisco/comments/1ipgwcm/sfs_n...
| anigbrowl wrote:
| It's been widely understood since the 1970s, if not longer,
| that opioids have a high potential for addiction and that long
| term use tends to be harmful. Sure, he seems to have been quite
| a junior employee, but I knew opioids were a high risk category
| of drugs when I was in high school. I don't think he's the
| worst guy in the world, but I do think McKinsey style
| consulting and this experience in particular is a net negative.
| asdff wrote:
| Potential for addiction yes but we are looking at it from the
| lens of a post Purdue media bias. People abuse plenty of
| drugs that aren't opioids and we aren't say seeing a big push
| against Xanax for example because that wasn't in any
| crosshairs of media spectacle. People die on Xanax but it
| doesn't seem to matter because people write them off as
| combining with alcohol or that they were addicts. And indeed
| most drugs of this sort are not particularly harmful if they
| are used within recommendations. At a certain point a doctor
| can't control what you chose to do at home with your
| prescription and that doesn't mean you shouldn't have people
| who would use it responsibly not receive it even if it means
| some will abuse it.
| sepositus wrote:
| > At a certain point a doctor can't control what you chose
| to do at home with your prescription and that doesn't mean
| you shouldn't have people who would use it responsibly not
| receive it even if it means some will abuse it
|
| I'd like to think that most of those decisions are coming
| from datasets that suggest, on average, certain medications
| tend to lead to abuse, including from people with no prior
| history of abuse.
|
| I'm quite libertarian in a lot of my views, but this
| particular one on lax drug controls I've never really been
| able to buy into.
| skippyboxedhero wrote:
| I can't remember the exact stats but something like 5% of
| doctors were writing 75% of the sales for these products.
|
| It isn't that they lead to abuse, it is that people who
| are using heroin will abuse them, and will go to doctors
| who facilitate that.
| wlesieutre wrote:
| Dentists were handing opioid prescriptions out like candy
| to teenagers getting their wisdom teeth out. How many of
| those kids were previously on heroin and were picking
| dentists who would hook them up?
|
| It's a massively common procedure and defaulting to
| "here's some addictive painkillers just in case you want
| them" was an insane thing to do, even if only 1% of cases
| turn out badly.
| SmellTheGlove wrote:
| When I was in my mid to late 20s I was at a consulting firm
| and later in government directly. I wasn't assigned to
| anything particularly objectionable or anything, but I've
| looked back on it a lot and it's heavily influenced how I
| operate in the tech industry now, 20 years later. In
| government and in consulting I saw a lot of misaligned
| incentives that led to empire building, duplicative efforts,
| and treatment of individuals that I didn't really find to be
| effective. And today, I'm really good at spotting that and
| stopping it quickly, because I think much of that was not the
| best way to operate. But I didn't immediately get into it and
| realize it wasn't how I would run things - and experiencing
| being part of the machine for a bit first taught me lessons
| that I would not have learned as an outside observer.
|
| If you made the same assumptions about me based on what I did
| in my 20s, you'd actually be assuming the direct opposite of
| what I believe in and how I work today. We're all shaped by
| our experiences, but that shaping doesn't always mean we grow
| into the behaviors that we experienced during our formative
| early career. Maybe this guy looks on that experience and
| knows exactly what he doesn't want to see happen.
| rgrieselhuber wrote:
| Yeah he was just an innocent marketing consultant:
|
| " In a March 2008 PowerPoint presentation, Tsai outlined a
| marketing strategy for the drug that included guidance on
| targeting "specific physician segments to grow high-prescriber
| group (i.e., physicians more sensitive to patient needs)" and
| an idea to introduce "coupons" for the drug as part of a pilot
| program."
| asdff wrote:
| Are you trying to say this quote is painting him as not
| innocent? That really doesn't seem so sinister. Sinister
| would be buying billboard space in west virginia like
| something out of newport cigarettes playbook.
| skippyboxedhero wrote:
| Yes, it is fairly obvious that he wasn't innocent based on
| that quote.
|
| The high-prescribers were people operating out of strip
| malls, often with unclear credentials, and whose main
| clientele were opioid addicts. Many of these people (I am
| choosing not to use the word doctors) ended up in
| prison...consultants who were advising them, not so much.
|
| There are a large number of people who could do this job,
| it is reasonable to ask whether the person you want doing
| this job is someone who, at best, was unaware that these
| people were breaking the law. And, to be clear, he was
| Partner of their Healthcare practice whilst this was going
| on...he wasn't just making Powerpoints.
|
| The revolving door between consultancies and government
| must continue. No-one is more skilled than running
| government than lawyers and consultants who have lots of
| experience in...advising other people how to run things.
| noah_buddy wrote:
| To be frank, the issue is that our society is not _more_
| damning of people involved in the low-level actioning of great
| injustices.
| lolinder wrote:
| A far bigger issue with our society is our willingness to
| brand someone forever based on what they did decades prior--
| we (as a society) pay lip service to the idea that people
| change, but we don't truly believe it.
|
| It's the same punitive impulse that causes the permanent
| second-class citizenship bestowed upon anyone who finishes a
| prison term.
| noah_buddy wrote:
| Generally, that problem is separate. The impact of little
| Eichmanns everywhere is greater than the loss of
| productivity from people convicted of crimes who can't get
| a job later imo.
|
| Our society is very forgiving if you propagate "faceless"
| evil. It's unforgiving if there's a human face to it. Part
| of this ties into the power of monetary capital over social
| capital.
| lolinder wrote:
| > Our society is very forgiving if you propagate
| "faceless" evil. It's unforgiving if there's a human face
| to it.
|
| How does this track with your assertion that "the issue
| is that our society is not more damning of people
| involved in the low-level actioning of great injustices"?
|
| Isn't your impulse to damn now that there's a low-level
| face to the faceless evil the exact same impulse as the
| one people have to condemn a low-level drug runner for
| the rest of their life?
| noah_buddy wrote:
| > Isn't your impulse to damn now that there's a low-level
| face to the faceless evil the exact same impulse as the
| one people have to condemn a low-level drug runner for
| the rest of their life?
|
| First, there's a disconnect here in my opinion: the low
| level drug offender deals with headwinds entering
| professional society writ large, not specific industry.
| This is much more consequential and, in my opinion,
| unfair. Being a drug runner doesn't imply you would be a
| bad sales rep, but that's how our society operates. If we
| were considering that low-level drug dealers face a
| specific impediment to becoming public health officials,
| I would argue that's at least more sensible.
|
| Both the drug dealer and this guy have probably caused
| outsized social health impacts (and, don't forget,
| deaths) through their actions. That invites scrutiny.
|
| Second, I have no delusions. Yes, I think this guy should
| be heavily scrutinized. Perhaps it's not exactly fair
| that your actions follow you for your life, but if you
| have a hand in one of the worst public health crises of
| recent years, that's damning if you want to run a public
| health office. Civil servants necessarily should be held
| to a higher standard. All that said, I doubt he will be
| disqualified from the office.
|
| There's a wider question: what are we prioritizing?
| Individual fairness or public health (more generally,
| public good)? I think from that frame (and a similar
| framing in many industries) more people should be made an
| example of if they have worked against the interests of
| an office they seek. Airline lobbyists should not be
| heads of transportation (and heads should be legally
| disallowed from entering lobbying for a period after
| office), food magnates who seek to dilute and adulterate
| their products as much as legally allowable should not
| run the USDA, the parallels are numerous. These people
| hold the wrong incentive (making money) highest. By
| making examples of these people and disqualifying them,
| you right the scale to some degree and influence the
| actions of others.
|
| I don't have the time at the moment to make a wider
| argument of systems, but if you look at China vs. the
| US...
| ricksunny wrote:
| I feel the gap to be crossed here is whether the low-level
| employee demonstrably took pro-active steps in their
| subsequent career to either 1. steer far
| clear of, (incl. steering clear of *the fruits of*),
| or 2. mitigate/neutralize/counter the effects
| of...
|
| ...the gestalt whose function they were supporting prior.
| ricksunny wrote:
| But I do feel we as society participants should not be
| bkinkered from recognizing social-scale pathologies in
| the atomic units that form our society. Those atomic
| units are individuals - their decisions, actions, and yes
| their career-paths.
| theossuary wrote:
| No it's not. The issue with our society is allowing the
| people who built the system and created the incentives that
| caused it to get off without jail time.
| sweeter wrote:
| The people doing the bulk of the corruption here in the US just
| decided to stop even trying to hide it. Why would they hide it at
| this point? They aren't even worried about the optics anymore,
| they are sending a clear message imo. There's like a handful of
| people in high positions who aren't corrupt, and all of the ire
| is aimed at low level employees. I wish I could say that I didn't
| know why, but it is pretty clear.
|
| Even then, it seems like this headline is a little
| sensationalist. But optically, not good. Even then, this is
| something that everyone should be aware of. It is easy to jump to
| conclusions, but we should also do our due diligence here to
| verify these connections. This can end similar to how Bernie
| Sanders was painted as a health industry "shill" when in reality
| it was just the way political donations are categorized.
|
| Nurses and such had donated X amount of dollars to his campaign
| and that was twisted as him taking money from "the healthcare
| lobby" when in reality he is basically one of the 3 people in
| government who don't accept super pac and lobbying money, proving
| that you can indeed survive off of grassroots donations. So we
| have to be careful here. Optics is not enough to make a
| conclusion, and people will try to use that against you.
| xyst wrote:
| What I am concerned about is the increasing number of bean
| counters and MBA-flunkies filling positions where technical or
| medical expertise should be required.
|
| Just based on his resume he shouldn't be managing state/federal
| medical resources. He should be managing a franchise of fast
| food chains. He has no medical background. LinkedIn only
| mentions graduating from Harvard. Out of college he joins the
| parasites at McKinsey. Then fails upward from there.
|
| Current administration is doing this across all departments.
| xyst wrote:
| This guy is a classic example of failing upward. Goes from
| parasitic consultant at McKinsey. Consulting/devising strategy to
| market opioids to masses. Then to _medical_ director at
| MassHealth. Then to director of Medicaid and CHIP. And now a
| public health chief.
|
| No medical degree or scientific background. Background reads like
| an accountant from McDougal & McDouglass (w/e firm that took over
| Boeing).
|
| It's no wonder people have no confidence in our health system.
| It's filled with nepo babies and neoclassical economic types that
| min/max cost.
| ricksunny wrote:
| (I believe the firm you're referring to is the aerospace
| company McDonnell Douglass which in hindsight may be being seen
| as having brought a more financial accounting orientation to
| Boeing)
|
| ..and o/w your point is well-taken, thank you for the
| instructive comment.
| btilly wrote:
| Things may be seen in many ways.
|
| I see it as, "Destroyed an engineering safety culture."
| GIVEDADDYABYTE wrote:
| I'm reading a book on McKinsey now titled "When McKinsey Comes To
| Town". Given the firms track record finally coming to light it's
| amazing that working at McKinsey is a career booster instead of a
| black mark. Hopefully more people start to realize that putting
| the most ruthless business minds in charge of public healthcare
| leads to poor outcomes.
|
| I'd recommend reading the book, it is a bit of a downer though
| mmooss wrote:
| The interesting question is why the mayor is sticking with him.
| That seems like a major change in the embrace of corruption
| recently. What does the mayor gain politically by sticking with
| this guy?
| SoleilAbsolu wrote:
| SFDPH in general has been moving in a more corporate/consulting-
| BS direction in last several years, guessing that will accelerate
| with this individual. Their transition to Epic EHR across the
| system has heralded a new era of squeaky-clean product/project
| managers who sling massive Agile jargon but don't actually
| understand the technical/compliance processes involved that
| affect orgs like mine who have to integrate with their systems
| (basics like not understanding the limitations of numerical
| precision in Excel data types affecting .CSVs, Unix vs. Windows
| line endings, BOMs, leading zero truncation, demanding tons of
| excess PHI in billing records for de-duplication).
|
| Their response to our issues is kindly, gently strong-arming us
| to ditch our EHR to join the Epic monopoly if we want to keep our
| contracts. And this when last time I went to SFDPH in person I
| literally had to step over junkies shooting up on the street a
| couple blocks away.
|
| On the bright side, Epic seems more functional than the Avatar
| system it replaced (made national headlines for its botched
| implementation, SFDPH made it even worse when they completely
| borked their internal Avatar server migration around 2019 because
| they didn't know how to properly load-balance using NGINX, maybe
| 1 in 200 access attempts would succeed).
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