Sales incentives killed 450,000 Americans. The molecule was the weapon. The comp plan was the trigger.
Purdue paid representatives bonuses tied to high-dose prescriptions. The bonus structure made the epidemic inevitable. Internal documents show the company modeled exactly this.
Beyond opioids, the same playbook runs every quarter — evergreened patents extend monopoly, pay-for-delay deals block generics, and DTC advertising creates demand for the most-profitable molecule, not the most-effective one.
Every one of these is a designed incentive operating exactly as intended. Naming the design is the first redesign.
The Structural Flip
Cap the upside on harmful prescribing. Tie pharma bonuses to outcome data, not script volume.