Hard Sell

Hard Sell tells the story of Insys, a startup that made millions selling opioids until its aggressive tactics came to light and its executives went to prison. It begins with John Kapoor, an immigrant and billionaire founder of Insys who had already built a fortune in pharmaceuticals. In the 2000s, with opioids a booming business, he saw an opening: a new way to deliver the highly potent drug fentanyl, which he could patent and sell at a steep price.

There was one obstacle. Kapoor's drug, Subsys, was approved only for breakthrough cancer pain, and too few patients needed it to make the company profitable. Insys therefore had to convince doctors to prescribe it off-label for lesser kinds of pain. Led by its executives, sales reps courted doctors with charm, money and sex. Administrators told health care providers that patients had cancer when they did not, and the drug was pushed onto people who would have done better with safer options or none at all.

The approach paid off, and Insys's public offering was the biggest IPO of its year. Then several employees reached their limit and quietly blew the whistle, drawing the full force of the justice system down on the company.

Evan Hughes, a National Magazine Award finalist, uses the Insys case to lay out how drug makers turn deception into profit when driven by greed and the hunger for market share. He presents the outcome as both a vindication and a warning, since Insys did nothing its competitors were not also doing and was simply worse at hiding it.