The Hard Sell

Evan Hughes has managed to combine two works into one. The first is a true story that reads like a novel, full of vivid and colorful, very human characters working in a small but innovative pharmaceutical company based in Phoenix. The second is a substantive, in-depth analysis of how one rogue pharmaceutical company allowed greed to take over its marketing efforts with disastrous effects for drug addiction, as patients became hooked on fentanyl and doctors put profits over safety regulations. Hughes tells how key figures of this particular company were brought to a dramatic trial in Boston and convicted, even though, sadly, some of their tactics are still clearly in evidence in other pharmaceutical companies who have thus far escaped the same punishment.

The American health care system is touted, at least by many Americans, as the best in the world. This true story exposes the underside of how it works at some companies, at least for the pharmaceutical industry. It should be required readingfor anyone taking prescription drugs, to understand that they have to be educated, skeptical, and questioning when taking prescription drugs of any type, not just opioids. Wait, not just prescription drugs, but also all the non prescription drugs, remedies, supplements and treatments offered to the public. It was great to read about how at least the top execs of one pharmaceutical company were caught illegally gaming the regulatory system to enrich themselves. Great read, and very illuminating.

The Hard Sell reads like a mob novel, a story of colorful characters doing terrible things whom you can't help but sympathize with at times. It's a work of journalism but also something of a page turner. But this real-life Breaking Bad doesn't quite end, because while the characters of the book each find their fates, the author takes care to remind us of a continuing industry, populated by characters smart enough to live a bit less colorfully, a bit more respectably, while performing in substance the same bad acts. The protagonists live large and it is diverting to be placed in their heads. But much of this book's punch comes when you set it down, think of the patients whom these protagonists never much thought about, about how odd it is that the "miraculous innovations" for which we tolerate extortionate prices by drug companies require little armies of peddlers to flog them, and we act as if that's necessary and normal and okay.

This is a fast-paced, thrilling book that is difficult to put down. The characters are beautifully developed and the storyline moves apace. It’s unsettling and tragic to know it’s all true. Evan has accomplished the triple lindy of engrossing, enriching and enjoyable. Highly recommend!

This story rings so true!I wasn't even a minnow myself, through more than three decades of medical practice. I'm female and was educated in the era of great caution about prescribing narcotics, and then practiced in large groups with strict ethical guidelines restricting access of drug reps to physicians. Only in the first decade of the 21st century, when working in a practice group with looser rules and mostly male partners, did I see this dynamic in real life. (I had heard complaints from my husband about drug reps with a combination of tenacity and sliminess that earned them the name "barnacles," but they rarely crossed my path.)What I experienced was far from working in a pill mill, but the success of persuasive strategies on my partners' prescribing practices was unmistakable, even in a practice group that did have guardrails.Evan Hughes points out the need for guidance and guardrails in medical clinics, in insurer interactions, in regulatory agencies and law enforcement, and especially in the pharmaceutical industry. His conclusions about how the Big Pharma can continue to misbehave with just a little better cover-up schemes and better layering are chilling.